Tuesday, February 12, 2019

Bills can be as bad for patients as side effects

Lack of money may adversely impact health of cancer patients, says AARP article

Surviving cancer may depend on what's in your savings account.

At least that's the conclusion of an article by Peter Moore in an edition of "AARP: The Magazine" a while back.

The piece suggests that average costs for the disease "run in the $150,000 range."

Why so much?

Moore postulates that "containing the cancer and killing [the] abnormal cells without damaging nearby healthy cells often requires a range of treatments, over an extended period of time — lengthy radiation, complicated surgeries, costly chemotherapy, plus other strong medications to supercharge your immunity."

Although new treatments emerge with regularity, he writes, "with new hope comes even more cost: 11 or the 12 cancer drugs that the Food and Drug Administration approved in [a recent year] were priced at more than $100,000 [annually.]"

Even with a good insurance policy, "a patient is probably looking at a bill of more than $4,000 in deductibles and co-pays."

Patients, of course, must often cope as well with "loss of income during months of treatment and recovery," not to mention travel and lodging expenses "at a cancer-centric health facility."

Plus the costs of myriad follow-up tests.

Moore notes that "not only are cancer patients two and a half times as likely to declare bankruptcy as healthy people, but those patients who go bankrupt are 80 percent more likely to die from the disease than other cancer patients, according to studies from the Fred Hutchinson Cancer Research Center in Seattle."

Dr. Gary Lyman
The AARP story also quotes Dr. Gary Lyman of that center: "For many patients, when they get the bills, it can be as bad as some of the side effects of the disease or the treatment."

Moore entertains the idea that many patients don't discuss their financial fears with their doctors, fearing such action could "compromise their treatment."

The result of that silence and fears, or from a patient lying because he or she couldn't afford to follow a prescribed regimen?

"Doctors [don't] know that their patients might take their pills less often than prescribed [and/or] avoid follow-up therapies or tests."

More details about what else impacts cancer patients psychologically can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Tuesday, February 5, 2019

600 old medical tests, treatments still used

Physicians have big trouble unlearning outmoded practices, New York Times writer claims

The public is paying more because it's hard for physicians to unlearn what they were taught long ago.

That — along with the notion that "procedures live on even after they've been proved ineffective," which "can lead to harms and wasted resources" — is the contention of a recent story in The New York Times by Dr. Aaron E. Carroll, a pediatrician.

The article leans on a review in JAMA Pediatrics magazine of "medical literature related to overuse in pediatric care" — finding "that we still recommend that children consume commercial rehydration drinks [that] cost more, when their drink of choice would do," that we "give antidepressants to children too often," that "we induce deliveries too early, instead of waiting for labor to kick in naturally," and that "we get X-rays of ankles looking for injuries we almost never find."

Overuse, the article maintains succinctly, "is rampant. And it can harm patients."

The Times specifically cites an initiative of the American Board of Internal Medicine Foundation, "Choosing Wisely," which it says is "entirely focused on the identification of care that physicians routinely recommend but shouldn't."

Almost 600 tests, procedures or treatments collected over six years, it claims, "are currently listed on their website. Almost all the recommendations basically say 'don't do' them."

But the public "shares some culpability," Carroll's story says: "Americans often seem to prefer more care than less."

Professional organizations are also to blame, the piece contends, because they "seem better at telling physicians about new practices than about abandoning old ones."
David Niven
Carroll asks David Niven, lead author of an earlier study, why it's so tough for docs to "discontinue certain practices. The researcher says "physicians have a hard time unlearning what they have learned, even when there's newer and better science available [in part] because they work within a system that doesn't adapt well to changing evidence."

More details on medical community attitudes toward treatments and tests can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Saturday, January 26, 2019

'Precision medicine' altering treatment focus

FDA clears pricey oncology therapy drug for multiple cancers with a shared mutation

The federal Food and Drug Administration has approved a drug, Vitrakvi, for a wide range of cancers based on a shared mutation.

According to a recent Washington Post story by Laurie Mcginley that was reprinted in newspapers across the country, the decision shifts treatment focus away from tumor location, apparently "an advance for the sometimes controversial field of 'precision medicine.'"

The FDA action on Vitrakvi (aka larotrectinib) marks the second treatment to receive the agency's "clearance based on a common biomarker found in an array of cancers."

The approval was given simultaneously for adults and children, contrary to the more typical FDA action regarding oncology drugs whereby kids are not considered until much later than adults.

Vitrakvi is intended, Mcginley's story says, "for patients with advanced solid tumors containing what's called an NTRK gene fusion, a hybrid of two genes that can promote uncontrolled cell growth. Cancers of the thyroid, lung and head and neck, among others, can be caused by the defect."

Dr. Scott Gottlieb
According to a story in the online magazine Healio, Dr. Scott Gottlieb, a FDA commissioner, notes that approval of the new site-agnostic oncology therapy "marks another step in an important shift toward treating cancers based on their tumor genetics rather than their site of origin in the body."

The breakthrough drug (that was tested in three clinical trials), the Washington Post piece adds, "is for patients whose cancer has spread or who would experience severe complications by undergoing surgery and have no satisfactory alternatives."

Precision medicine has spawned both enthusiasm and skepticism, partially because both the drugs and the tests can be quite expensive.

The drug's manufacturer, Loxo Oncology, Inc., and its partner, Bayer, announced that "the wholesale acquisition cost will be $32,800 for a 30-day supply of capsules for adults. The cost for the liquid formulation for children…will start at $11,000 per month."

Patient affordability "is one of the big barriers to precision medicine right now," McKinley quotes Carolyn Presley, a geriatric oncologist at Ohio State University Comprehensive Cancer Center, as saying. "Show me the money — how are you going to pay for it?"

Elizabeth Jaffee, Johns Hopkins oncologist, nevertheless predicted that precision medicine "is going to be the way to treat cancer in the future," the Washington Post story reports.

More information on research into cancer can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Sunday, January 13, 2019

Dubious ties to cancer industry undercut docs

Sloan Kettering pulls rug out from under its execs after apparent conflicts of interest

Memorial Sloan Kettering Cancer Center, under siege for potential conflicts of interest, has severely tightened the reins on its top executives.

No longer will they be able to serve on corporate boards of drug and health care companies, according to a story by Katie Thomas and Charles Ornstein in The New York Times this week.

The sanctions were imposed following a series of stories by The Times and ProPublica, a nonprofit journalism organization, that exposed questionable exec ties to the industry. 

In some cases, the article indicates, the companies "had paid them hundreds of thousands of dollars a year."

Officials at the facility, one of the world's most prominent, apparently also were informed by officials of their parent hospital that "a series of reforms designed to limit the ways in which its top executives and leading researchers could profit from work developed at Memorial Sloan Kettering, a nonprofit with a broad social mission that admits about 23,500 cancer patients each year," were being made permanent.

The conflicts at the center, the story continues, "have had a rippling effect on other leading cancer institutions across the country."

Dana-Farber Center Institute in Boston and Fred Hutchinson Cancer Center in Seattle, for example, are said to be reconsidering their policies on financial ties.

Dr. Craig B. Thompson
After muck-raking reports were published last fall that included information that Dr. Craig B. Thompson, Sloan Kettering's chief exec, was paid about $300,000 for his services in 2017, Thompson resigned from the board of Merck.

Earlier, The Times and ProPublica had alleged that Dr. José Baselga, Sloan Kettering's chief medical officer, "had failed to disclose millions of dollars in payments from drug and health companies in dozens of articles in medical journals."

Baselga resigned within days of the stories going public — and "stepped down from the boards of the drugmaker Bristol-Myers Squibb and Varian Medical Systems, a radiation equipment manufacturer."

Sloan Kettering employees who represent the hospital on corporate boards now will be barred from "accepting personal compensation, like equity stakes or stock options, from the companies."

The Times story quotes Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, as calling the policy changes a "watershed moment."

More information about research facilities can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Saturday, January 5, 2019

Link possible between obesity and cancer

Fat cells can fuel the growth and spread of skin cancer, new Sloan Kettering study finds

Is being fat a potential cause for a surge in cancer?


At least if you believe a story by Matthew Tontonoz a while back on the Memorial Sloan Kettering Cancer Center website.

It says, in short, that cancer cells eat fat to grow and spread.

It cites discoveries at the Sloan Kettering Institute that "melanoma cells in zebrafish use fat from nearby fat cells to fuel their growth and spread," and indicates that a new study finds fat cells, or adipocytes, are filled with fats called lipids that can fuel cancer's aggressiveness.

In humans as well as fish.

Dr. Richard White
The story, sent me by my high school classmate Philip Greenhut, focuses on the words of Richard White, a doctor-scientist in SKI's Cancer Biology and Genetics Program:

"This is the seed-and-soil hypothesis. Tumor cells like to go to places where there is fertile soil. Based on the results of our study, we think that adipose tissue can be very fertile soil for melanoma."

The story notes that "knowing that adipose tissue enables some cancer cells to grow and spread suggests that cutting off their fat supply could be a way to fight the disease."

The findings, it contends, "also add to the growing understanding of the link between obesity and cancer."

White and his colleagues "stumbled onto the connection," Tontonoz's article claims, after using "zebrafish as a model system for studying skin cancer" because those "small freshwater fish get melanomas that are very similar to human melanomas" and because it's easy to see where the fish's cancer cells go as tumors progress since the creatures are transparent.

Ultimately, of course, the researchers examined the connection in human beings by looking at tumor samples from people with melanoma who were treated at Memorial Sloan Kettering.

Details of the findings were published in the journal "Cancer Discovery."

Details about other research can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Tuesday, December 25, 2018

FDA approves 31 new therapies in one year

New screenings and treatments are helping to boost the number of cancer survivors in the U.S.

By 2026, some 20.3 million cancer survivors will be living in the United States — up from 15.5 million a decade earlier.

That, according to a recent article in Parade magazine by Sheryl Kraft, is because innovations in screening and treatment are helping patients beat the odds.

"In just one year," the piece reports, "31 new therapies to treat more than 16 types of cancers were approved by the U.S. Food and Drug Administration."

Dr. Otis Brawley, chief medical and scientific officer for the American Cancer Society, believes that screening can save lives. "Some estimates say that we can decrease the number of colorectal deaths by 12,000 to 20,000 if screening guidelines were followed."
Dr. Jame Abraham
And Dr. Jame Abraham, director of Cleveland Clinic's Breast Oncology Program, notes that hormone therapy might be all that's necessary to treat 70 percent of women with the most common form of breast cancer. 

"That means a large number of patients can safely avoid chemotherapy," the Parade story quotes her as saying. "We can individualize treatment and make sure we are prescribing the right treatment for the right purpose."

It was tough previously to identify which women with early-stage breast cancer were at risk for recurrence, so many had received unnecessary chemo, radiation and hormonal therapy. But a groundbreaking study known as the TAILORx trial found that many women could be saved from "unnecessary side effects like fatigue, hair loss, nausea, vomiting and anemia," the quote continues.

Another new treatment, immunotherapy, which "works by reprogramming a patient's own immune cells to find and attack those cancer cells through the body," also is being held out as innovative — and the American Society of Clinical Oncology's "advance of the year."

Immunotherapy now is being heralded as "extremely promising for treating triple-negative breast cancer, one of the most difficult-to-treat breast cancers," after having already been shown to have "significant results in young patients with a form of leukemia and adults with multiple myeloma (a type of blood cancer) and lymphoma (a type of cancer involving cells of the immune system)."

Yet another new testing method, CancerSEEK — according to the Parade piece, "a simple blood test, which in its research phase was performed on people already diagnosed with cancer," can identify markers for for tumors containing mutated DNA in the bloodstream. 

These markers are associated with eight common cancer types: breast, lung, colorectal, ovarian, liver, stomach, pancreatic and esophageal.

Lastly, the story cites a less invasive and faster lung-cancer technique called microcoil localization, "which can pinpoint and remove small bits of affected tissue using a needle inserted through the chest wall to remove the cancer at its earliest stage."

Minimally invasive surgery — instead of the currently popular "lobectomy, which removes a portion of the lung by opening up the chest, followed by radiation and chemotherapy."

More details on new techniques and treatments can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Tuesday, December 11, 2018

American Cancer Society vs. U.S. advisory group

Agency and task force disagree on when people should start screening for colon cancer 

Whether U.S. adults should start colon cancer screening at age 45 or 50 is still in doubt.

The most recent guidelines from the American Cancer Society advocate the former, but an influential government advisory group, the U.S. Preventive Services Task Force, still believes the latter age is perfectly okay.

According to an Associated Press story by Mike Stobbe a while back, the cancer society admits its recommendation of the earlier age "could cause confusion for doctors and patients." 

Both groups, however, apparently recommend six other kinds of screening exams, "from inexpensive take-home stool tests performed every year to colonoscopies done every 10."
Dr. Rich Wender
The best test, the cancer society's Dr. Rich Wender is quoted as saying, "is the test that gets done. All of these tests are good tests, and the choice should be offered to patients."

Most colon cancer occurs, according to the story, "in adults 55 and older, and the good news is rates of cases and deaths have been falling for decades."

Colon cancer, combined with rectal cancer, is the second leading cause of cancer deaths in the United States — the top cause being lung cancer.

Some 140,000 Americans were expected to be diagnosed with colon cancer this year, "and about 50,000 will die from it," Stobbe's piece reports.

Only "about two-thirds of people 50 and older have been following screening guidelines," the article notes, quoting Dr. Marcus Plescia of the Association of State and Territorial Health Officials as saying that "it's hard enough to get people to do it at all."

But Dr. Andrew Wolf, lead author of the American Cancer Society study, reportedly said his agency had considered and rejected that reasoning.

More information about conflicting research and findings can be found in "Rollercoaster: How a man can survive his partner's breast cancer,"  a VitalityPress book that I, Woody Weingarten, aimed at caregivers

Sunday, December 2, 2018

Can laparoscopic surgery spread cancer cells?

New data shows less invasive operation causes more deaths for women with cervical cancer

In news that may appear counter-intuitive, two studies have shown a higher death rate for a less invasive version of a cancer operation in women.

According to a recent Associate Press story by Carla K. Johnson, the new evidence challenges standard practice "and the 'less is more' approach to treating cervical cancer."

The article notes that the unexpected findings already "are prompting changes at some hospitals that perform radical hysterectomies for early-stage disease."
Dr. Pedro Ramirez
Dr. Pedro Ramirez of the University of Texas MD Anderson Cancer Center in Houston, who led the more rigorous study, says that after the results became known "we immediately as a department changed our practice and changed completely to the open approach."

Findings from his study, which was conducted at more than 30 sites in a dozen countries and were published in the New England Journal of Medicine, showed "women who had the less invasive surgery were four times more likely to see their cancer return compared to women who had traditional surgery."

Dr. Jason Wright of New York-Presbyterian Hospital, a co-author of the other study, says "we're rethinking how we approach patients. There's a lot of surprise around these findings."

And Dr. Amanda Fader of Johns Hopkins Kimmel Cancer Center, explaining that the Baltimore hospital "has stopped doing less invasive hysterectomies for cervical cancer until there is more data," is quoted as saying the new research "is 'a great blow' to the [newer] technique and the findings are 'alarming.'"

Surgeons, she adds, ""should proceed cautiously."

In both studies, Johnson's story says, "researchers compared two methods for radical hysterectomy, an operation to remove the uterus, cervix and part of the vagina. The surgery cost around $9,000 to $12,000 with the minimally invasive version at the higher end."

Traditional surgery involves a cut in the lower abdomen; in the newer method, laparoscopic surgery, from which patients recover more rapidly, small incisions are made for a camera and instruments.

Some experts believe the reason for the higher death rate is because "there may be something about the tools or technique that spreads the cancer cells from the tumor to the abdominal cavity," AP's article reports.

More information on research into cancer for both men and women can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.