In 2011 with much fanfare the National Cancer Institute announced that lung cancer screening decreased deaths from lung cancer by 20%. In 2013, the American Cancer Society (among other organizations) published well-thought-out guidelines recommending high quality screening along with shared decision making so eligible patients could understand the risks and benefits of screening. In 2015 the Medicare program announced that lung cancer screening would be covered, along with the shared decision component.
With all of that evidence and support, one would think that lung cancer screening would see rapid uptake in the United States in an effort to reduce deaths from this all-too-frequent cause of cancer death.
If you thought that, you would be wrong. So the logical question is why? In the face of all this evidence, why are high risk current and smokers not being screened, and how do we make it right?
That question is the result of a spate of recent articles (links 1,2,3) in journals from the American Medical Association, along with a somewhat “direct” editorial that highlights the need to better understand how lung cancer screening works and the need to inform health professionals and their … Continue reading →
Is the future of cancer screening at your local shopping mall?
That’s the question sticking in my mind after reading a recent report about a local radiology practice opening a large mammography center in an upscale shopping mall in Long Island, New York.
Let’s face it: Medical care is changing. And with changes come new ideas. Some will work, some won’t. The thought of getting a mammogram while on a shopping trip may just be what the doctor ordered and the consumer needs, or it may not. I don’t know the answer, and only time will tell.
I grew up in a world—which is now fading away—where patients and doctors had relationships. You had your doctor, and your doctor knew the other doctors who would be best for your care, and that primary doctor followed you and cared for you for years. As you aged, someone knew you well—maybe even became a family friend or someone you interacted with in your community.
Today we have mega hospitals, mega practices, and failing long term primary care relationships in many parts of the country. Having those relationships was once thought to be a key to successful health strategies. Now we are handing … Continue reading →
In a world where in a moment I can order from thousands of items and have them delivered to my doorstep the same or next day at the press of a button without having to re-enter my name, address, and billing information each time, it would seem that filling out paper forms at the doctor’s office by hand to have someone else re-enter the information into a computer that doesn’t communicate with other computers in the same clinic system is craziness. And if someone doesn’t do it right, it can follow you everywhere forever–and you may never know.
After some recent personal medical visits, I can’t imagine what it is like for cancer patients and families dealing with serious illness trying to navigate the complex system we call healthcare. It’s time we get the technology working for the patients, not making their lives even more difficult.
In each of my encounters the setting was fairly typical for a large health system in a large metropolitan city. I needed to get care regarding two straightforward problems with two different clinics in the same system a couple of weeks apart. So far so good: the care was excellent, the support staff friendly … Continue reading →
Some information just released is creating a lot of enthusiasm about the use of cold caps to prevent hair loss from chemotherapy in women with breast cancer. But a deeper look into the data shows that this welcome news is not nearly as clear-cut as it might seem. And I’m afraid doctors explaining the potential limitations of these devices to patients hearing enthusiastic reports are going to be left holding the bag if this new treatment doesn’t work as intended.
Let’s face it: losing one’s hair is traumatic, to say the least. For some folks, the risk of hair loss may affect their decisions about which chemotherapy treatment they should receive for their cancer, or whether they should receive it at all. No question: this is important to many women (and men) when faced not only with the trauma of treatment but with the very diagnosis of cancer itself.
Two articles and commentaries in this week’s issues of the Journal of the American Medical Association (JAMA) and its companion JAMA Oncology present new information about an old approach to preventing hair loss, along with some new thoughts and suggestions as to what this may mean longer term. And along … Continue reading →
A report in this week’s Journal of the American Medical Association (JAMA) shows that too few women with recently diagnosed breast cancer and at high risk of a BRCA genetic mutation received appropriate genetic counseling and testing for the mutation—a missed opportunity not only to improve treatment for these patients, but also to prevent some breast, ovarian and other cancers in the first place.
This study makes the difficult point that when it comes to routine screening for genetic abnormalities in women (and men, for that matter) who may be at increased risk, we simply aren’t doing the job. The situation may well be worse than this report suggests, especially considering that in some areas of the country Medicare doesn’t even cover preventive testing for the BRCA mutation. And this is more than 20 years after the test was first discovered and placed into clinical practice.
I guess sometimes it takes a long time for the way we care for our patients to catch up with the science that we know works. But twenty years??? Uh, that seems like a long, long time.… Continue reading →
When it comes to our health and our health care, we love the numbers. Sometimes, we even fall in love with the numbers, assuming that the numbers tell us the whole story when in fact that may not be the case. Cholesterol numbers, blood pressure numbers, body mass index, whatever. As patients and consumers, we are frequently defined by our numbers.
But what happens when those numbers and other medical tests such as CT scans really don’t tell the story we think they do? The recent evolution of prostate specific antigen (PSA) is a case in point: for decades we believed the numbers saved many lives. Turns out PSA did save some lives, but not as many as we thought and at the considerable financial and human expense of treating many men who probably did not benefit.
So in that vein an article and editorial in a recent issue of the Journal of Clinical Oncology makes the point that just because we have numbers does not really mean they offer us the scientific certainty about the course of cancer we may think they do.… Continue reading →
Perhaps more than most, doctors struggle with memories that mark sad moments in their careers. For me, one of the most indelible was about a wonderful young man with chronic myeloid leukemia (CML).
When I started my oncology career in the early 1970’s, CML was almost always fatal. It would start with a chronic phase which was treated with pretty simple medications. But those medications didn’t cure the disease.
The “almost always” scenario with CML was that several years on, it would morph into an acute phase, or “blast crisis,” that almost always ended in an untimely and frequently very premature death.
I came into contact with this young man just as he was diagnosed with CML. A couple of years later, he entered that acute phase. Rather than face the rigors of intensive chemotherapy, a regimen that was almost always futile, he took his own life. Moments like that live with us forever.
Decades later, (2003 to be exact) a prominent oncologist—who at the time was the director of the National Cancer Institute—made an audacious promise. Andrew von Eschenbach said that by 2015 we would end the suffering and death from cancer and convert it to a chronic … Continue reading →
Right now, when we want to know everything we can about a tumor, we do surgery: a biopsy to take a sample of it and look at it under a microscope and determine as best we can how to treat it. But what if instead you could get a blood test, and learn even more. That’s the promise of the relatively new science of what is called cell free DNA (cfDNA). It holds the hope of helping us better understand cancer, its behavior in our bodies over time, and even offering clues on how to better treat cancer in ways we would never have imagined even a few short years ago.
It was an important area of discussion at the American Society of Clinical Oncology meeting this week. It’s a meeting where, every year, we get a sense of the future of cancer treatment before it becomes a reality. From genomics, to immunotherapy, to targeted therapies–you name it—promising areas appear on the scene, then either become part of our reality or lose luster as the process unfolds over the course of several ASCO annual meetings. This year, several studies presented on the topic of the so-called “liquid biopsy” illustrate how … Continue reading →
Here at the at annual meeting of the American Society of Clinical Oncology in Chicago, we are beginning to see the future of cancer therapy—and it raises a provocative question: will precision medicine become so precise, we risk turning off the much-needed investment of human, intellectual and financial capital that keeps progress flowing?
The sheer number of new drugs and new combinations of drugs being reported here at the world’s biggest, and most relevant cancer conference is staggering. Not all of them are ready for prime time, and some may never be successful in the clinic for large numbers of patients, but it is clear the era of old fashioned chemotherapy is diminishing and newer forms of therapies (targeted and immunotherapies among others) are on the rapid ascent.
But with progress, it’s becoming clear that a changing paradigm in cancer care that was predicted a number of years ago is now coming to life.… Continue reading →
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 →