Change Happens: The Incredibly Rapid Pace of Change In Cancer Care

Change is a good thing, a necessary thing. At the same time, I have to ask how many realize how much change is happening so quickly in oncology and cancer care? And I wonder even more how we are going to separate change that is valuable from change that is simply, well, for the sake of change.

What brought about this moment of reflection was my attendance at a conference this past week sponsored by the American Cancer Society Cancer Action Network focused on the future of health care. The specific topic was “The Role of Technology in America’s Shifting Health Care Landscape.”

 After spending a day listening to discussions of change in cancer care—led primarily by emerging data analytics and health information technology—I was struck how the cancer landscape might be shifting quickly in ways that many of us don’t understand, and in fact can’t fathom. Putting the pieces of this puzzle together in a rational way in my opinion is beyond the capabilities of many of us, even those who have devoted our lives to understanding cancer.Continue reading →

Need To Balance Innovation, Benefits and Restraint When It Comes To The Rising The Costs Of Cancer Drugs

Cancer drugs—especially the new targeted and immunotherapies—are very, very expensive.

No doubt about that, and there is also no lack of effort trying to cast blame on who bears responsibility for those costs. There is even a recent article in the British Medical Journal that analyzes the size of the vials those drugs come in and suggests for some companies at least that may be a strategy to increase costs even further. What most experts can agree on is that this is a complicated problem for which there are no easy solutions.

I recently wrote a short commentary on the issue which appeared in Healio’s “HemOnc Today.” Although not exhaustive in terms of analyzing the issue, it does point out that we need to find a balance that continues to provide the incentive to innovate and bring new treatments to the care of cancer patients, while maintaining some degree of restraint given the reality that these costs simply cannot continue to increase without limit.… Continue reading →

Making A Difference: The Melanoma Research Alliance

A full waiting room. To most of us, it’s a bad sign, as we anticipate the excruciatingly dull minutes ahead. But at a meeting I attended this past week, it was a sign of hope, of progress; of making a difference.

I was in Washington DC to attend the annual scientific session of the Melanoma Research Alliance (MRA) in Washington DC, an organization that is only eight years old. When this group first met, it was made up of a relative handful of melanoma researchers and clinicians who came together to figure out what they could do to discover and promote more research and better treatment options for patients with melanoma.

The people behind the effort were Michael Milken and Debra and Leon Black. For them the mission was personal: Mr. Milken was a prostate cancer survivor who wanted to devote his energies to accelerating discoveries in cancer care. The Blacks are also well known in financial circles, and Ms. Black was (and remains) a melanoma survivor. 

At the time, the landscape for patients with advanced melanoma was bleak. There were a couple of available treatments, but they really didn’t have much of an impact on improving or extending Continue reading →

Keeping A Cool Head On Cold Cap news

The Food and Drug Administration this week approved a device to reduce hair loss in women receiving chemotherapy for the treatment of breast cancer. The media attention has been extensive and highly favorable. But taking a closer look at this, there are a couple things, as yet unreported, that have me more than a little concerned.

The machine is a form of a cold cap, and is designed to reduce the blood circulation to the scalp while a woman receives treatment to either reduce the risk of breast cancer returning, or to treat recurrent disease. The theory—which has been around for decades—is that if one reduces the circulation of blood to the scalp you also reduce the circulation of the drugs that can cause hair loss to the hair follicles. The result is that the hair doesn’t fall out, a common and very sad side effect of some chemotherapy drugs.

It is that same phenomenon, reducing chemo’s attack on the hair follicles that has always been the concern, as well: by preventing the chemotherapy from reaching the scalp, are we creating a “safe haven” for tumor cells that may cause a problem years or even decades later?

But that’s only … Continue reading →

The Updated Breast Cancer Screening Guideline From The American Cancer Society

The American Cancer Society has now released its newly updated Breast Cancer Screening guideline in the Journal of the American Medical Association

This guideline—which was last updated in 2003—reflects the American Cancer Society’s best thinking on breast cancer screening for women at average risk of breast cancer. They are not intended for women at high risk, such as those with genetic abnormalities (BRCA as an example), a personal history of breast cancer or a history of radiation therapy prior to age 30.  That guideline is available on our website at www.cancer.org.

So let’s get right to the heart of the matter: what are the new recommendations?

  1. Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 (Strong recommendation*)

          1a) Women aged 45 to 54 years should be screened annually (Qualified       recommendation*)

          1b) Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually. (*Qualified recommendation)

          1c) Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (Qualified recommendation*)

2) Continue reading →

10 Years And Half A Million Words…

I just noticed this blog celebrated its 10th anniversary this September. So I hope you won’t mind me taking this opportunity to share some observations and reminiscences of what it’s been like to document by blog a decade of the changing landscape of cancer.

The first blog was published on September 9, 2005 when I introduced the blog and my vision for what i hoped it would represent.

The blog originated with a concept developed by our media relations team. Social media was just coming into prominence, and the Society was looking at ways to get into this space. Bob Lutz, a senior executive at General Motors at the time, was the model: he wrote a regular blog himself, and was pretty open in sharing his thoughts. It was clearly not one of those ghost written, pre-packaged types of things. How he found the time to do a blog was an interesting question, but the concept was intriguing: if we could have one of our senior folks write something similar, perhaps it would get some recognition in this rapidly expanding means of communicating.

So we ventured into the space and I started writing “Dr. Len’s Blog”. One of … Continue reading →

The Commission on Cancer: An “Unsung Hero” Of Cancer Care

Sometimes we take for granted what goes on behind the scenes to improve the care offered to patients with cancer.

Having spent two days in Chicago attending meetings of the Commission on Cancer recently, I think it is worth highlighting and commending the work done by this very special organization and the volunteers and staff who make it possible—and successful as well.

Cancer is a complex disease. And it is no secret that not every person with cancer either can or even wants to be treated at a major research center when diagnosed with cancer. That means many of us with cancer are treated locally, some in large “megasystem” hospitals that are popping up across the country to much smaller institutions like the one that serves my hometown community in South Georgia.

But when you walk in the door, do you ever wonder who does the check-up to be certain that the hospital meets acceptable standards of cancer care? Is there anyone watching the store?

For more than 1500 hospitals across the country, that organization is the Commission on Cancer (CoC).  Established by the American College of Surgeons in 1922, the Commission on Cancer develops standards to ensure high quality, … Continue reading →

Is It Appropriate To Offer The Public “Liquid Biopsies” For the Early Detection Of Cancer?

The recent announcement by a California company offering DNA blood tests (also known as “liquid biopsies”) for the early detection of cancer takes us to a place most of us expected we would get to, but much earlier than we are prepared for. Simply stated, our technology and rush to get new tests to market-even before we have a basic understanding of how to use those tests to improve the health of consumers–has outstripped our scientific understanding, and we ignore the implications at our own peril. [more]

First, some history:

The concept of having a blood test to diagnose cancer early is not new. In fact, I recall an international meeting about a decade ago where a lecturer predicted the diagnosis of cancer through a simple finger stick that would be sent to a lab for analysis.

Fast forward to June of 2009 when I was a guest on the Today Show and was asked to offer a closing thought telling viewers something they didn’t know about cancer. My comment was to the effect that one day in the not too distant future we would be able to find cancer cells circulating in the blood in people who didn’t … Continue reading →

New Research On Ductal Carcinoma In Situ (DCIS) Brings Knowledge–Now We Need Understanding

It has been said that with knowledge comes understanding.

A research paper and editorial published in this week’s issue of JAMA Oncology may have brought knowledge, but if you read various media reports I am not so certain it has clarified understanding. And the distinction is important, because when a woman is confronted with the diagnosis of a “Stage O” breast cancer (aka ductal carcinoma in situ or DCIS), the decisions she makes about treatment can have far-reaching and long lasting impact for her and those who care about her. [more]

First, some brief background: DCIS was rarely diagnosed before the advent of mammographic screening for breast cancer. Perhaps it was found incidentally when a breast biopsy was done for another reason, or perhaps a woman or her physician felt a mass that turned out to be DCIS. Once mammography became more widespread in the 1970’s, we began to see a marked increase in the number of women diagnosed with DCIS. Today, the American Cancer Society estimates that in 2015 slightly more than 60,000 women in the United States will be diagnosed with this lesion (compared to 234,190 women who will have a more typical invasive breast cancer).

The situation … Continue reading →