Monthly Archives: May 2009

It’s Not The End Of The Road For Lymphoma Vaccine

Sometime patience pays off.  And sometimes patience means you think you have come to the end of the road, only to find that someone has built an extension for the highway.


 


That’s the outcome from the next study, which reported that the use of a tumor vaccine in patients with a non-Hodgkin lymphoma called follicular lymphoma were found to have longer remissions after chemotherapy if they received the vaccine when compared to patients who received the same treatment but did not get the vaccine.


 


This research was no flash in the pan.  The basic research which led to this study was first reported in a well-known medical journal back in 1999.  Ten years later, we have a report that the use of the vaccine in a select group of patients who were able to have their disease successfully treated and remain in remission for at least six months increased the time to progression of 44.2 months, compared to 30.6 months for the patients who also achieved a complete remission for at least six months but did not receive the vaccine.  That is over a 14 month improvement.


 


But this was a very select … Continue reading →

Ovarian Cancer: Early Therapy Of Relapse No Better

It is day two of the annual meeting of the American Society of Clinical Oncology in Orlando.  Over the next three hours, we will hear the four papers which have been selected for the plenary session of the meeting for presentation to thousands of researchers, doctors, and other cancer professionals.  These are, in one sense, the best of the best—the ones which will likely get the most media coverage and be of interest to largest number of meeting attendees.


 


The first paper that is being presented in an interesting one, if for no reason other than for its seeming simplicity (I promise you, nothing in cancer medicine is simple).  The bottom line: trying to seek out evidence of ovarian cancer recurrence after successful treatment for  metastatic disease and starting immediate treatment made no difference in survival when compared to waiting until a woman had symptoms related to that recurrence and starting treatment at that time.


 


Talking to patients and getting an idea of how they are doing is becoming a lost art in this age of medical technology.  The history and physical is becoming a lost art.  Yet surgeons knew a … Continue reading →

The Complex Web Of Advancing Cancer Treatment

This morning I am in Orlando at the annual meeting of the American Society of Clinical Oncology (ASCO) in Orlando, listening to an address by the outgoing President of ASCO, Dr. Richard Schilsky from the University of Chicago.


 


Although these types of talks are generally perfunctory and organizationally oriented, this one actually made some interesting points that show how far cancer care has come, how far it has to go, and how many obstacles stand in the way of progress.


 


For example, do you know that there are currently over 700 drugs currently in the testing pipeline for cancer care? 


 


Dr. Schilsky pointed out that we simply do not have the resources to test all these drugs.  On top of this despairing thought, the fact remains that only 5-8% of those drugs will actually go through the clinical trial gauntlet and get to the clinic and help cancer patients in their quest to survive their disease.


 


There are a lot of reasons for this dilemma, but one of the most serious is the amount of work it takes before a clinical trial cooperative group such as the CALGB, a large national research … Continue reading →

Circle Of Sharing™: Help In A Complex World

When it comes to communicating, the world has certainly changed a great deal.  Instant access, instant information, immediate worldwide coverage of events—these are just a few of the things that we now take for granted.


 


Today, cancer patients, their families, friends and colleagues can take one step forward in that information world as the American Cancer Society in partnership with Microsoft’s HealthVault unveils a new internet tool on our website called “Circle Of Sharing™” that will help cancer patients take charge of their care, and communicate information more effectively to those friends, families and others who support them through the difficulties of their illness.


 


The Circle of Sharing™ will help cancer patients, their families, care partners, friends, colleagues and medical team put the information they need in one place.  It is designed to organize the information, control the communication flow, and avoid the need to repeatedly answer the same questions or give the same information.  It is designed to help catalogue important medical information, get support when you need it and want it, get reliable answers to important questions all while keeping you as the patient in control of everything.


 


(You can access Circle of … Continue reading →

The Measure of Progress: 650,000 Lives Saved

Every year the American Cancer Society publishes a detailed analysis on the incidence and deaths from cancer in the United States. This year’s report—released today—is no exception.  It shows in clear and graphic detail the impact of cancer in terms of the number of times each cancer is diagnosed, and how many deaths we can expect. 


The statistic in this year’s “Cancer Statistics 2009” that I find so compelling is the number of lives that have been saved as a result of improvements in the prevention, early detection and treatment of a number of cancers. My colleagues who prepare this report now say that from the early 1990s until 2005 (which is the latest year for which accurate information is available), about 650,000 cancer deaths have been avoided (481,300 in men and 169,100 in women).  And, in more recent years, as the gap between expected and actual deaths has been increasing, about 100,000 people each year have not died from cancer.


 


Once again, I keep coming back to that figure as a clear and convincing demonstration that we have made real progress against these terrible diseases we collectively refer to as “cancer.”


 


What has happened?


 Continue reading →

Celebrating “Don’t Fry Day”: Stay Safe In The Sun!

It is hard to reconcile the raindrops falling outside my office window this morning with the fact that this weekend marks the beginning of the summer vacation season.  But that is what it is, and I know that somewhere someone(s) will be trekking off to a beach, a lake, a mountain, or an outdoor activity for a couple of days of fun and relaxation. 


 


So today is still a good day (the rain notwithstanding) to remind all of you that sun safety should be at the top of your mind as you head off to your well deserved and well earned weekend of fun.


 


Today is also a good day to introduce you to something new, which hopefully will remind you throughout the summer that sun safety is an important part of your outdoor lifestyle.  That “something new” is the first annual “Don’t Fry Day” sponsored by the National Council on Skin Cancer Prevention, and its 45 member organizations who are dedicated to the cause of doing just what the organization’s name implies: preventing skin cancer.


 


“Don’t Fry Day” may be formally acknowledged on the Friday before Memorial Day weekend, but every day you … Continue reading →

The Preacher and the Boy:Lessons of Life and Death

Events of the past three weeks have left me thinking once again about what we do as oncologists and the impact of our decisions on our patients and their families for better or worse.


 


The primary driver of these thoughts was something that happened in my own family.  But the recent news about the boy in Minnesota with Hodgkin disease and his mother’s decision to forgo additional chemotherapy serves as a stark contrast to the circumstances that my own family has had to deal with around the very same question.


 


The person in question was my wife’s uncle.  He lived in a rural part of Georgia, and was a farmer, an educator and a counselor.  His greatest professional pride, however, was his work as a minister and evangelist.  He was in the ministry for 60 years, travelling across this part of the country, preaching his gospel.  He was indeed a man of faith, committed to his family, his community, his church and his religion.


 


Uncle Chester appeared to be a taciturn man, but his friends and colleagues were aware of an impish sense of humor that he apparently used often.  Continue reading →

CT Colonography: Medicare Failed to Meet Challenge

We now have the “final answer” from Centers for Medicare and Medicaid Services as to whether or not they will provide coverage for colorectal cancer screening with CT colonography under the Medicare program.  And the answer is: no.

To say the least, I am personally very disappointed.  Not that my opinion should be the driving force on a decision that may affect the lives of thousands of people.  But this is something that became a bit of a “cause” for me, in no small part because I felt it represented an opportunity to advance our medical science and knowledge at a time when lives could be saved.  It was an opportunity in my view to start setting the stage on how we can do things the right way in health care going forward, which will be a critical part of any reform effort.

In my opinion, we have failed to meet the challenge.

For me, the issue was reasonably straight forward.  We lose close to 50,000 people every year in this country from colorectal cancer.  We could save thousands of lives if we were able to get people screened for this disease.  The Continue reading →

Pain Medicines And The FDA: Changes Are Coming

I participated in a meeting convened by the Food and Drug Administration this past Monday that addressed a new program the FDA has to put in place to address problems with certain pain medicines. 


 


The purpose of the program—called Risk Evaluation and Mitigation Strategy, or REMS—is to deal with the two conflicting goals of adequately and effectively treating pain with powerful medicines while making certain these medicines are used as intended and don’t end up in the wrong hands causing harm. 


 


Depending on how this program is designed and implemented—and those decisions are a long way off—we could either enhance pain control or significantly reduce access to these medications for patients who truly need them, frequently at the end of life.


 


On one hand, there is the need to be certain that patients in pain have access to adequate and appropriate pain control using effective medications as safely as possible.  On the other hand, there are the legitimate concerns of the FDA, the DEA (Drug Enforcement Administration) and many, many interested organizations and others concerned about the diversion and abuse of these medicines throughout the country.


 


How to balance those concerns and … Continue reading →