May 29, 2015
It was the title of an article in JAMA Oncology that captured my attention this past week: "Advancing a Quality-of-Life Agenda in Cancer Advocacy: Beyond the War Metaphor." That and, the fact that two of the authors (Rebecca Kirch and Otis Brawley) are my colleagues from the American Cancer Society.
As the American Society of Clinical Oncology (ASCO) convenes its annual scientific meeting in Chicago--where thousands of participants from around the world gather to learn about the latest advances in cancer research and treatment--we should not lose sight of the fact that the quality of life for patients during cancer treatment and survival is a critical part of what we must address as part of a holistic approach to the cancer care paradigm.
For decades cancer prevention and treatment has focused on the war metaphor: fight cancer, beat cancer, fight hard, whatever. The reality is that not infrequently people do everything right and they still die from this dread disease. Does that mean they didn't fight hard enough? I don't think so, and I suspect many of you agree.
But there is a yawning gap, and that is that we don't pay as much attention to the quality of life of cancer patients, their families and those who care for them. We can and must do better. That is the core of the message my colleagues delivered in their article. More...
May 29, 2015
(This blog was originally published on Medpage Today and is presented here with permission)
Disruptive innovation is a relatively new term that refers to dynamic changes in how we live our lives. Think of your smartphone and you have a good example of disruptive technology; one that replaces old tools. Who even takes pictures with a point and shoot camera any more, or uses a map to find their way? But the rise of disruptive technologies in medicine to me raises some difficult questions.
The recent announcement by a company called Color Genomics which will provide a 19 gene assay to help women assess their risk of breast and ovarian cancer could be called a disruptive innovation. For $249, a woman can have this panel of tests done at her request so long as she has a health professional order it.
And if she doesn't have a health professional readily available, the company will be glad to provide one.
Oh, and by the way: they don't accept insurance. They reason: the company says the cost is so low that insurance companies shouldn't come between women and the test. And if you want genetic counseling, they will provide that too but only after the test is done -- which clearly contravenes the recommendations of a number of professional and voluntary health organizations.
Another example of disruption in the laboratory world is the anticipated onslaught of direct consumer availability of laboratory studies based on minimal amounts of blood, possibly at a pharmacy near you. It is not clear for now whether a health professional will be an intermediary, but the end goal is pretty clear that patients will have the opportunity to order their own labs when they want to get them. More...
April 21, 2015
Years ago when I first started this blog I wrote about the democratization of information, and how people would come to an era where they had ready access to information yet reserved the right to determine whether that information was valid or not.
Fast forward to today, and a company called Color Genomics announced a new genomic based profile to measure breast cancer risk. They are clearly headed into the democratization of health care, since they are pricing the test at $249 and have tried to reduce the barriers for women and men to get the test.
Inevitably, this announcement is going to fan the flames of how far we should be going to allow people to get whatever laboratory tests they would like, whenever they want them. Although a health professional must order the test, in reality doctors will be available to meet your need if you decide to bypass your personal physician. And although most professional organizations active in this field recommend genetic counseling from a qualified professional be done before such tests are done, the company says they will provide such counseling-after the test results are known. More...
January 30, 2015
This blog was originally published on the Medpage Today website on January 22, 2015. It is reposted here with permission.
Are we prepared for the genomics revolution?
The President's proposed Precision Medicine Initiative as mentioned in his recent State of the Union address suggests it's probably time to get ready for some changes in our daily routines as health professionals.
I'm not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better match patients with genomic analyses of their cancers, for example.
And I am not talking about the advances in targeted therapies associated with diagnostic tests that can help guide the treatment of patients with a variety of cancers including but not limited to lung and breast cancers as examples.
No, I am asking whether we are prepared to usher in the new era of medical practice where genomic analyses in one form or another will be a part of our everyday medical practice. It's not just about cancer, my friends. It will be coming to a primary care practice near you probably sooner than you realize -- but it is coming. More...
November 12, 2014
(This blog was originally posted on Medpage Today and is reprinted here with permission)
A simple word with lots of meanings, all of which depend on the context of the moment. Value in healthcare -- especially in cancer care -- is certainly no exception. What is undeniable is that we are seeing an increasing clamor about value in cancer treatment. And one person's value is clearly another person's concern.
At the crux of the debate is the question of whether we will continue to see improvements in cancer care that are meaningful, and whether we will be able to support the very innovation that, in no small part, holds such great promise for the future of making cancer a chronic disease for many and even finding a cure for some.
A recent Washington conference sponsored by the Turning The Tide Against Cancercoalition is an excellent case in point.
Conference organizers brought together experts from around the country who are vitally concerned about the progress we are making, and must continue to make, in elevating personalized (or precision) medicine as a key part of advancing cancer research and cancer care. The agenda included a number of presentations about not only how to make personalized medicine more relevant to all of us, but also how to address the question of "value." More...
October 02, 2014
It's October and that means we are about to see a lot of pink for the next 31 days. And virtually all of the work comes down to one simple -some might say overly simple-message: get a mammogram.
But as National Breast Cancer Awareness Month (NBCAM), begins, I find myself one again asking some difficult questions: Are we really looking at the right side of the equation? Is it all about mammograms? Is there more to the story? The answer is absolutely unequivocal and without a moments hesitation: YES! More...
September 30, 2014
I had an interesting day this past week. Sadly, it left me wondering why the same "hope and hype" directed at cancer patients and their families decades ago when I started my oncology career was still alive and well today. But then, maybe I am the naïve one to think that anything should have really changed.
In the morning I found out that a story I had been interviewed for a story which appeared on the Kaiser Health News website. A discussion about proton beam therapy for cancer (PBT), it basically pointed out that insurers aren't necessarily paying for the treatment and that the information supporting its use is not as definitive as some would hope or claim.
Not long after, I was informed of an online discussion on Twitter (called a "tweet chat" at #protonbeam) being hosted by a major medical institution and a well-known weekly newsmagazine on the very topic of proton beam therapy, or PBT. What I watched unfold over the hour-long discussion was what I call a "scrum" of doctors and public relations people promoting proton beam therapy as the answer to many cancer treatment dilemmas with nary a word about the limitations of our knowledge or potential problems with the treatment. It was all about "we can do it, call us and we will tell you how good we are, and insurers won't pay us." Simply stated, the "conversation" seemed to be glancing by some of the inconvenient facts surrounding what has become another poster story for how we develop and promote new treatments in medicine, let alone cancer care. More...
July 24, 2014
I had the privilege this week to serve as the keynote speaker for the 4th Summit sponsored by Latinas Contra Cancer-an organization founded and led by Ysabel Duron, a formidable cancer survivor and news media presence in San Francisco.
Bringing together members of the Latino community, researchers, community health workers, promotores (more on that later) and advocates, the summit focused on the issues facing the Latino community in increasing awareness, access to care, improved treatment and research opportunities among other topics. But what was most impressive was the spirit, engagement and commitment that permeated the room for the two days of the meeting.
I would like to share with you some of what I learned during the preparation for that lecture, as well as some observations that tie together the impact and calls to action that are relevant to the Latino community and many other ethnic and socioeconomic groups in the United States. (You may wish to refer to the American Cancer Society's "Cancer Facts and Figures for Hispanics/Latinos 2012-2014" which contains a wealth of information relative to cancer for this community.) More...
June 17, 2014
This past week I had the privilege of participating in a meeting hosted by the President's Cancer Panel on the role of social media in improving cancer control and treatment. The goal was to give advice to the Panel on a planned series of meetings they will be convening to discuss the topic. It was the range and quality of the discussion that day that left me thinking about the broader topic of social media and how it could help improve cancer control going forward. More...
June 15, 2014
Today marks a major step forward in cancer clinical trials and drug development with the launch of the Lung-MAP protocol to evaluate new treatments for squamous cell lung cancer, a common cancer which has proven resistant to the standard drugs currently available. In response to this genuine unmet need, Lung-MAP has been designed to move new therapies more quickly from the laboratory to the bedside of patients afflicted with this serious disease and few options available.
Many--including present company--have written about the need to improve this process. We are in a new era of cancer drug development, spearheaded by our ever increasing knowledge of cancer genes and the targets within those genes that can be used to disrupt the cancer cell on its inexorable road to proliferation and destruction. Getting those drugs speedily through development and clinical testing has been a real challenge. And, going forward, finding the patients with the "right" genomic signature who are candidates to receive these therapies is going to be difficult. In simple terms, we need to find the patients where they live and match them to these new drugs as quickly as possible. And that hopefully will translate into more and better treatments for patients, and save lives. More...