Monthly Archives: April 2009

Have We Learned The Lessons Of The ESAs?

Two articles published this afternoon in the Lancet and the Canadian Medical Association Journal once again remind us that just because something looks good in cancer treatment doesn’t mean it is good, and may actually cause harm.


 


You may remember the controversy that surfaced a couple of years ago about medications called ESAs which were (and continue to be) used to boost the red blood cell counts of patients with cancer.


 


What did today’s studies report that has me so concerned?  Basically that there was no situation—whether or not patients were on active chemotherapy or whether they were simply being treated for anemia associated with their cancer—where these drugs did not increase the risk of death. 


 


As the story unfolded at the time, it appeared that these medicines not only improved anemia in cancer patients, but also increased the risk of death.  There was a considerable outcry, guidelines from respected medical organizations were quickly changed, Medicare put definitive treatment guidelines in place, and the Food and Drug Administration eventually changed their guidance on how the drugs could be used.


 


Now, two years later, we have these new reports that take the story … Continue reading →

Provenge A Winner, Questions Remain

The results are as predicted: the prostate cancer vaccine Provenge (sipuleucel-T) prolonged survival in men with hormone –resistant prostate cancer, but didn’t do anything to delay progression of the disease.


 


The results of a clinical trial studying this controversial vaccine were released this afternoon at the annual meeting of the American Urological Association in Chicago, and the news wires are already humming with the news.


 


Unfortunately, I still don’t have access to the actual abstract and have to rely on a news release from the company that ran the trial, which is not always the most satisfactory way for me to get information.  Once I receive the abstract, I may update my comments if there is any significant new information.


 


According to the press release, 512 men participated in the trial.  They were men who had prostate cancer that had progressed and was no longer responding to hormonal manipulation or medications.  They were asymptomatic, which does put them in a better risk profile for long term survival, but this was true both for the men who received the vaccine and received a placebo.  The study measured the overall survival of the … Continue reading →

Progress In Cancer: Glass Half Full Or Half Empty?

The article in today’s New York Times by reporter Gina Kolata has a lot of truth, and perhaps a bit of misdirection.


 


It seems that we are hearing more and more about the lack of progress in treating cancer, or the failures of prevention and early detection.  I’m not certain what is driving this sudden spate of articles in several highly regarded media venues, but it must be acknowledged as an obvious topic of interest.  Otherwise, reporters wouldn’t be reporting it. At the same time, I also believe that we must put these discussions into balance and context. 


 


It is undeniable that we have made progress in the prevention, diagnosis, and treatment of cancer.  At the same time, we need to acknowledge the harms of our treatments and the limitations of our capabilities.


 


First, the concern: the article suggests that we have made little if any progress in reducing cancer deaths in this country since 1950, in contrast to dramatic declines in deaths from heart disease, flu and pneumonia. 


 


A true statement, but maybe a bit misleading.  It suggests no progress in reducing cancer deaths. Our top epidemiologist at … Continue reading →

Praise The Volunteers!

Praise the volunteers!!! 


 


That certainly is a thought that is very important to the American Cancer Society during this annual celebration of National Volunteer Week.  After all, we have millions of volunteers in thousands of communities nationwide, and even some throughout the world.


 


Without our volunteers, the Society—as well as thousands of other schools, churches and other organizations—could not support our core mission, let alone survive.  We are fortunate to have many wonderful people throughout this nation who are devoted to our cause.  They are what makes the American Cancer Society such a special place for so many of us, volunteers and employees alike.


 


Volunteers often labor for hours with little recognition.  They do what they do from the goodness of their hearts and their belief in a cause.   They offer their time and their skills because they want to make a difference, help someone who needs help, offer comfort to others in their time of need.


 


It so happens that this year’s National Volunteer Week coincides with another anniversary that that the American Cancer Society is celebrating: our 25th anniversary of Relay for Life. 


 


Within that celebration is perhaps … Continue reading →

The Special Meaning Of “Happy Birthday!”

“Happy birthday to you, happy birthday to you…”


 


How many times a year do you sing the birthday song or wish a loved-one, a friend, a colleague or anyone you know happy birthday?   Although sometimes done casually and without much thought (except for those of us over the mystical age of 39), there actually is a lot of meaning in that greeting, more than we frequently acknowledge.


 


For many of us, especially cancer survivors, that greeting is more than a casual gesture to wish us well.  It marks survival, progress and the hope of birthdays to come. 


 


To acknowledge and celebrate those birthdays, the American Cancer Society announced today the launch of a nationwide campaign as “The Official Sponsor of Birthdays”. (You can get more information at www.morebirthdays.com).


 


We know that hundreds of thousands of lives that would have been lost to cancer and its consequences have been saved over the past two decades.  We know that those lives have influenced many other lives, and as a result there are an untold number of people in this country and throughout the world who are indeed celebrating birthdays that otherwise would not … Continue reading →

Is Comparative Effectiveness The Answer?

There are two new buzz words that could have significant implications for our health care going forward.  Those words are “comparative effectiveness.”


 


Why is comparative effectiveness so important?  Because depending on your interpretation and definition of the concept, this could be anything from a very much needed way to address some nagging questions about how we treat different diseases or the forerunner of a more aggressive effort to control medical costs.


 


It is no secret that many of us think we spend too much money on health care.  We have a difficult time in this country demonstrating that we get true value for the money we spend.  Our technology in health care is state-of-the-art, unlike any place else on earth.  However, our outcomes are far down the list when we compare ourselves to other countries when we look at some measures of health, such as our average life expectancy.


 


One of the things we have learned over the past couple of decades is that we don’t know as much about the effectiveness of our treatments as we should. 


 


For example, are newer medicines for the treatment of common … Continue reading →

Vaccine To Treat Prostate Cancer:Are We There Yet?

Another day, another announcement of a potentially promising new cancer treatment, and another day of caution. Dendreon is the name of the company that issued the press release and has worked for years to develop the vaccine to treat advanced, hormone-refractory prostate cancer. 


 


In today’s announcement, the company said that the vaccine—called Provenge–“met its primary endpoint of improving overall survival compared to a placebo control.  The magnitude of the survival difference observed in the intent to treat population resulted in the study successfully achieving the pre-specified level of statistical significance defined in the study’s design.  The safety profile of Provenge appeared to be consistent with prior trials.”


 


But not everyone is ready—just yet—to say the battle is won.  And the advocacy community is poised and ready to fight back if anyone suggests we not accept today’s announcement as the final word as to whether or not this vaccine is effective.


 


Take for example the comments from the American Cancer Society’s chief medical officer, Dr. Otis Brawley, posted on-line today at Forbes.com:


 


“It certainly sounds good, but we really need to see the details…I will be watching with interest and some … Continue reading →

The MRI Dilemma: Is It A Better Screening Tool?

We are voracious consumers of technology in this country when it comes to our health care.  A recent discussion with a physician I know well about breast cancer screening using MRI highlights how sometimes our love-affair with technology can lead to personal dilemmas that are not easy to resolve.


 


The situation confronting this doctor and her patient was a fairly straightforward one: a woman in her 40’s who had dense breasts on a routine screening mammogram with no suspicious lesions, no family history and no other risk factors for breast cancer was advised in a report from a radiologist that she needed an MRI scan of her breasts.  The woman had a high deductible health insurance policy, which meant that she would have to pay several thousand dollars out of pocket to have the test done.  Simply put, she didn’t have the money readily available, but would figure out a way to get the scan if she needed to have it.


 


Worried that she would be forgoing recommended care, the patient had a discussion with her physician.  Given the fact that a formal recommendation had been made by the radiologist in a written report, the doctor … Continue reading →