Uncategorized

Do Fitness Trackers Help Us Lose Weight? The New York Times Says “No”; I Say “Not So Fast”

I am devoted to my fitness tracker, having used it for several years to remind me to be active, monitor my diet and improve my sleep. Now the New York Times tells me it doesn’t make a difference, at least when it comes to the weight loss part of the program. And I might agree, if only the evidence they relied on told the whole story. In my opinion, it did not.

Unfortunately, some of the science on which the Times’ reporter based his comments had a possible flaw that may influence the conclusion that fitness trackers not only don’t encourage weight loss, but improbably may lead to less weight loss when using the device.

That, my friends, would be a real bummer. However, if you had evaluated that research closely you may have been aware of the problem. From where I sit, I don’t think many folks have made that effort. And I remain unconvinced that the research supports the conclusion that fitness trackers–when used in typical real-life situations–don’t make a difference in keeping us engaged in our health including as an adjunct in weight loss programs.… Continue reading →

We Can Find Lung Cancer Early And Save Lives, So Why Aren’t More Smokers And Former Smokers Getting Screened?

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 →

Mammograms At The Shopping Mall Raise Interesting Questions About How We Get Our Health Care

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 →

We Order Anything From Anywhere In A Flash But Still Fill Out Paper Forms At The Doctor’s Office. Why?

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 →

Cold Caps May Prevent Hair Loss From Chemotherapy: What We Know–And What We Don’t

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 →

Twenty Years Later, And We Still Don’t Routinely Offer BRCA Test To Women At High Risk For Breast Cancer

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 →

The Minnesota Vikings Show Their Heart To Breast Cancer Survivors And Their Communities

The Minnesota Vikings have won their first four games this year. At a local event in Minneapolis the day following that fourth win this week, they also won a lot of hearts including mine. A comment from their coach Mike Zimmer suggests that “heart” plays a big role for this team in their games, and from what I witnessed they show that heart off the field as well.

The event was a luncheon hosted by the Vikings to honor breast cancer survivors, and highlight the team’s efforts to bring more awareness about breast cancer and access to care to their Minnesota community. I was privileged to attend and participate along with other American Cancer Society colleagues from our Midwest Division (with a special “shout out” and thanks to my table partners Chantel SinGs and Larry Fitzgerald).… Continue reading →

Sometimes Bold Predictions Do Come True: The Lesson Of Chronic Myeloid Leukemia

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 →

The Cancer Moonshot Summit: A Day For Our Nation To Reflect And Commit To What We Can Accomplish To Make This Cancer’s Last Century

Cancer Moonshot Summit.

Who would have imagined five short months ago that on this special day, almost 300 cancer centers and programs in every state attended by over 6000 leaders in cancer care and research, patients, advocates, and many others would have come together to commit themselves to doing what needs to be done—by everyone—to make this cancer’s last century?

Yet that is exactly what happened. President Obama made the declaration in his recent State of the Union address, put Vice President Biden in charge, and there has been no looking back. It is truly an amazing day in the annals of cancer care.

I was honored to be part of the program at the MD Anderson Cancer Center, hosted by the Center’s President Ronald DePinho MD. We were joined by hundreds of participants for two and one half hours of discussions focused on what all of us can do to move this effort forward. And among the speakers was Houston Texans’ defensive end, Devon Still, who shared with a hushed audience about his young daughter’s journey with neuroblastoma—and challenged all of us to reach out to communities to increase awareness about prevention, early detection and … Continue reading →

Aromatase Inhibitors To Prevent Breast Cancer Recurrence: How Much Treatment Is Enough Treatment?

Here at the annual meeting of the American Society of Clinical Oncology in Chicago, we see results of eagerly awaited clinical trials that have involved hundreds or even thousands of patients, millions of dollars, and years of hard work and analysis. The results can be a success; they may fail; but quite often fall somewhere in between. And even when successful, the results may not be as clear cut as one would like.

Such is the case with an important trial whose results came were reported at this meeting and simultaneously published in the New England Journal of Medicine about the use of aromatase inhibitors (AI) in post-menopausal women with breast cancer. As is so often the case, the researchers are highly regarded, the study well designed—but even with all the best efforts possible, left open are some extremely difficult questions.… Continue reading →