Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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Progress In Colorectal Cancer Not Shared By Everyone

by Dr. Len March 19, 2014

An article published this week in the American Cancer Society journal CA: A Journal for Clinicians received a lot of media attention. The report showed dramatic declines in the rate of people being diagnosed with colorectal cancer, as well as decreases in the rates of colorectal cancer deaths over the past number of years.

But the press didn't say much about the fact that not everyone has benefitted from the progress we have made in the prevention, early detection, and improved treatment for colorectal cancer. It is a sad but very real commentary on how we approach health care in this country that African Americans have not benefitted equally from this progress in treating a cancer that for many people can be prevented or effectively treated when found before it spreads to other parts of the body.

As a nation, I believe it is incumbent that we address this glaring health disparity. To do less is unacceptable. More...

Personalized Medicine Revolution Will Require Revolutionary Changes In How We Care For Cancer Patients

by Dr. Len October 18, 2013

I attended a meeting in Washington this past Wednesday that got me to thinking about the fact that as we revolutionize cancer research and treatment, we are also going to have to revolutionize cancer care. And that  may prove to be an even more daunting task than finding new treatments for the disease itself.

The meeting was sponsored by a collaboration called "Turning The Tide Against Cancer". The organizers brought together experts from a variety of disciplines ranging from insurance companies and economists to advocacy groups and highly regarded cancer specialists to discuss policy solutions to support innovation in cancer research and care. Walking in, I anticipated this was going to be another one of those sessions where we talked about funding for research, bringing research into clinical trials, and having patients get access to new drugs. But I was wrong. The discussions quickly steered into a different direction: what do we need to do to make the cancer care system work for patients?

Of course there were the continuing themes of "big data" and the impact of genomics on drug development and patient care, but a surprising amount of the discussion centered around new payment models, quality of care, and fundamental redesign of medical care to become more patient centric. And although we talked a lot about data gathering and analysis, what stuck with me was the redesign piece. I thought the discussion around redesign would focus on personalized medicine, but we spent a lot of time on changing the fundamental structure of cancer care and payment.

How are those two linked? Did we miss our focus?

The answer? If we don't change the way the system is working, we won't realize the promise of personalized medicine. Seems pretty simple and straight forward until you start thinking about the implications. More...

Palliative Care Is About Quality Of Life Throughout The Cancer Journey

by Dr. Len August 09, 2013

A newspaper story last week caught my eye when it headlined: "Senators Revive Push for End-of-Life-Care Planning." It reported on new legislation making the rounds in Washington to address care planning for those with advanced illnesses.

You remember "end of life care planning," don't you? It was part of the Affordable Care Act debate several years ago, and quickly became translated into "death panels" where opponents made the argument that the government wanted to help people decide not to receive needed treatment. That was a moment that will live in my memory forever, and it's not a pleasant memory.

So here we are with this new bill, and a headline that suggests we may be headed down the same path once again. This time, however, I hope we can have a more rational and appropriate discussion about an issue that is rapidly evolving in cancer care, supported by medical evidence and medical professionals, not to mention organizations like the American Cancer Society who believe the time has come to engage our patients, their families and caregivers, and the nation at large in understanding the need for compassion as we care for patients with serious illness, including cancer. More...

Big Data And The Transformation Of Health Care: Promise Or Peril?

by Dr. Len August 06, 2013

There was a memorable scene in the movie "The Graduate" from 1967. You may know it or have heard of it, when the older man turns to the college graduate and says the future is all about one word: "plastics."

Well, plastics may have been then, but this is now. And the core themes I keep hearing these days there are two central ones that our becoming our new "plastics" in medicine: genomics and big data. Words that didn't mean much to most people a year or so ago now occupy front and center discussions at every level, not to mention are the topics of a number of meetings I have attended recently.

This past week I went to one of those meetings (sponsored by e Health Initiative) where over 450 people spent two days hearing from experts about the meaning, uses, and precautions that come along with "big data" in medical care. (Interestingly, there were also several presentations on the intersection of genomics and big data. So the two are definitely not mutually exclusive.)

Not that medicine is unique: big data is transforming much of the way we live and the way we experience life. What is different about medical care is that we are so far behind everyone else when it comes to adopting and effectively using information technology and data analysis to improve healthcare. But that is quickly changing. The power of technology is just beginning to impact health care as hospitals and doctors' offices increasingly adopt (and adapt to) health information technology, but it takes lots of resources and commitment--both human and financial--to make that happen. More...

They Are YOUR Medical Records. Will The Blue Button Help You Get Them?

by Dr. Len June 07, 2013

 

It is a disarmingly simple idea: create a blue button logo with a download moniker on it and let it loose so people can actually download, review, and keep their own medical records. But simple on the surface masks complexity below a revolutionary concept: that patients are not only the subject of the records, but that they own those records, and through that ownership can actually be partners in their care or even improve their own health.

That was the topic of a meeting I attended yesterday at the White House, where representatives of government, health technology vendors, consumer groups, and others interested in advancing the role and usefulness of health information technology came together to give updates on the progress of the "Blue Button" program, review the current state of affairs, and pledge to advance the concept going forward. And I was honored to be invited to join this knowledgeable and committed group on behalf of the American Cancer Society.

When you think about it, patients with cancer and other serious illnesses should be clamoring for this to become the routine and not the exception. As I have written before, it is difficult enough to hear that you have cancer and are going to need complicated treatment. But that is just the beginning of what can be a very tortuous journey for patients and their caregivers through the cancer treatment maze. Complex diagnoses, loads of records, and no way to have the health information communicated easily from one place to another is just one more way that the quality of life of cancer patients is impacted by their illness.

Why do we tolerate this? I don't know, that's for sure. As patients we should be our own advocates. We should be expecting--no, demanding--a more transparent and efficient system of care. And getting our information in our hands is just one way to make that happen. The people in that room yesterday are committed to the concept that you own your medical information and should have access to it,, and that we are obligated to make to find a simple and straight forward way to get your medical information to you and to anyone you choose to share it with, whether that be a doctor, a family member, or a company or organization you want to help you organize and understand that information. More...

It's Guns vs. Butter (Again): How Do We Reconcile Expensive Cancer Treatments With The Need To Improve The Basics Of Cancer Care?

by Dr. Len June 03, 2013

As we walk the halls and sit in the lectures at the annual meeting of the American Society of Clinical Oncology, there's an elephant in the room. It is right there in front of us, but not many of us seem willing to talk about it. Fewer still are making any commitments to do something about it.

So what is this ubiquitous juxtaposition that is right in front of us but we can't seem to see?

It is the contrast between incredibly sophisticated science and computer data that will help us understand cancer and its treatment vs. the reality that we can't have medical records that really work. It is the fact that we have million dollar machines to treat cancer but we have tens of thousands of lives lost to cervical cancer in underdeveloped and underserved countries that could be saved with saved using vinegar. It is cancer care's version of the "guns vs. butter" debate of the 1960s. More...

American Cancer Society Celebrates Its 100 Year Anniversary Today With A Vision Of Making This Century Cancer's Last

by Dr. Len May 22, 2013

One hundred years.

That is a long time. And although thriving, remaining relevant and engaged for 100 years is a remarkable accomplishment for any organization, the American Cancer Society today takes pride not only in reflecting on the accomplishments of the last 100 years but also in our commitment to continue the fight, and make this century cancer's last.

A lot will be written about the remarkable accomplishments of the Society over the past century. The American Cancer Society takes pride in the fact that it has been able to serve millions of people during that time. It has put its mark on numerous improvements in the science and treatment of cancer. We have made incredible strides in understanding cancer, what causes it and what influences it, including the role of tobacco and overweight/obesity. We have funded 46 Nobel Prize winners at some time during their careers, frequently when they needed a start to develop their theory which led to great discoveries. And we have funded numerous investigators who have made other important and lifesaving contributions to understanding cancer and reducing its burden.

But the list is not complete. There is still too much we don't understand about cancer, its causes, and its impacts on patients, their families, their communities. We have come to a "tipping point" in the cycle where we have unlocked the genetic code of cancer and are just beginning to transform that information into lifesaving treatments. We wrestle with the early detection and prevention of some cancers, at a time when we thought--incorrectly, as it turns out--that simply finding cancer early was enough. We struggle with finding a way to get access to lifesaving or life comforting treatments to those who are diagnosed with cancer but don't have the resources to follow their journey in the best way possible. We have millions of survivors, yet understand too little about the problems they face long term, let alone being able to provide them with a system of care to respond to their needs. We have made remarkable progress in keeping children with cancer alive, free of disease into adulthood, but we haven't acknowledged the terrible price some of them have to pay from the side effects of their treatments. More...

National Minority Health Month Is A Call To Action

by Dr. Len April 18, 2013

April is National Minority Health Month.

That's the "dry" statement. The impact statement is that-unfortunately-for many in this country, this is more than a phrase. It's a reality that their health and their health care are in crisis. And the sooner more of us understand this, the sooner we can make a genuine effort to implement effective strategies that will address the sad state of affairs many people find themselves in when it comes to their health, and preventing and appropriately treating their diseases.

This is about more than high blood pressure and diabetes. It's about heart disease and stroke and cancer and the list goes on. This is about neighborhoods were residents don't have a place to walk or may even have fear of walking outside their homes. This is about people living in communities where they can't find affordable, fresh vegetables and healthier foods. This is about not having access to a regular source of medical care, or getting timely treatment for conditions such as breast cancer which many of us take for granted. It is about assuring equitable and quality treatment once diagnosed. This is about the lack of trained health professionals from these communities who have roots and understanding of their cities, towns and neighborhoods where they might be able to make a real difference in the lives of so many people. More...

Two New Reports From eHealth Initiative Provide Valuable Information On eHealth Tools For Cancer Patients

by Dr. Len March 08, 2013

Since we have started the conversation about eHealth tools in my previous blog this week, I thought it might be worthwhile to explore some of the other applications and internet based programs that may be useful to cancer patients.

As I wrote in early February, I have become (and remain) infatuated with apps that have helped me track my activity and my diet. They have made a big difference for me and others I know, and continue to keep me motivated and on target. The larger question, however, is whether we can harness electronic media to help us live healthier lives, get better control of our health, or if we have an illness or disease, become more informed and more empowered.

For some diseases-like heart disease and diabetes-there appear to be no shortage of such efforts either to prevent illness or help manage illness once it occurs. However cancer is a different animal: it is not one disease but over 200. And it is far from uniform, even within particular cancer diagnoses. We have a lot to learn about cancer, its treatment, helping care givers and improving quality of life for cancer patients among many other topics. But actually harnessing social media and the internet to help our patients remains in very early stages of development for cancer compared to some other more common and perhaps more straightforward situations such as heart disease and diabetes.

So imagine a world where a patient has access to immediate information about their disease, its treatment, the side effects of the drugs, and how they can better manage the inevitable problems that arise during the diagnosis, treatment and recovery from cancer treatment. And further imagine harnessing that information to learn more about the disease and the treatments, the patients' reactions to the drug and the illness, how to connect caregivers, and then uploading that information in a useful digest so health care professionals can spot progress or problems, and help their patients in a more effective manner than is available through a short visit to the office.

That is the type of future we should all hope for. But we are not there yet, and we have a long way to go. The American Cancer Society is proud of its electronic health media offerings, which include our web information at www.cancer.org, our Cancer Survivors Network which links survivors from across the country to help guide each other with information and support, our "WhatNext" service which matches patients with other patients who have similar situations and demographics to learn more about their illness and treatment, and validate their own experiences with their cancer, and finally (and not least) our Circle of Sharing where patients can enter their information about their illness, let friends know how they are doing, and otherwise participate in their process of care.

All of those are good and worthy efforts. But what else is available and where can you get information? And more important, what is the current status of eHealth in cancer care, especially compared to other diseases?

Some answers to both questions were recently provided by an organization called e Health Initiative, or more fondly eHI. eHI is a collaboration among committed stakeholders from industry and non-profit sectors which brings together hundreds of organizations who are interested in promoting eHealth and making it a feasible and effective part of our health care in this country. (I have a special place in my heart for eHI, since the American Cancer Society has been involved with them for a number of years and I currently serve on their Leadership Council and board of directors).

The reports I referred to above are available on their website, and include one review of currently available eHealth programs from a variety of sources around the country. The second report was commissioned by the California HealthCare Foundation to address the availability and utilization of mobile health applications by underserved populations being treated for cancer, but in fact serves as a guide to the current status of mobile health in the larger context of cancer care. More...

Annual Report to the Nation on Cancer Trends: Cancer Deaths Continue to Fall, But We Can Do Better

by Dr. Len January 07, 2013

The positive news continues: cancer death rates have continued to fall in the United States, for men and women, maintaining a trend that began in the early 1990's. That's the essence of a report released today by the American Cancer Society, the National Cancer Institute, the Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries in the Journal of the National Cancer Institute.

The report, titled in part "Annual Report to the Nation on the Status of Cancer, 1975-2009" also features a special section on the burden and trends in Human Papilloma virus (HPV) associated cancers and HPV vaccination coverage levels. Unlike the continuing decline in cancer deaths in the United States, we could be doing a much better job of getting young folks vaccinated against HPV and reducing the incidence and death rates from several HPV-associated cancers, according to the authors of the report and an editorial that accompanied the report.

This report comes out every year. It is a summation of what we know about the trends in incidence rates for the most common cancers in the United States among both men and women as well as the trends in death rates from those cancers that lead to the highest mortality in the general population as well as specific ethnic groups. It is in a real sense a report card on our progress, which in large part is good but in a number of cancers, not so good.

The good news is what we have come to expect: since the year 2000, the overall cancer death rates have continued to decline 1.8% per year in men, 1.4% in women and 0.6% per year in children. That may not sound like much, but when you consider the fact that this is an average change seen every year, those numbers begin to add up. More...

About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.

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