Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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The Flu Is One Gift That We Don't Have To Keep On Giving For People With Cancer

by Dr. Len December 17, 2013

 

It's the holiday season, a time of reflection, celebration and for many, giving gifts. But there is at least one gift that no one wants to get, and certainly no one wants to give: the flu. And for people with cancer, and those they come in contact with, the flu can be a very serious event. For that reason and many more, people more than 6 months old-and especially those in contact with people who have serious illnesses like cancer-should get vaccinated against the flu.

Too many of us think the flu is a minor inconvenience. But that is almost certainly because we confuse the typical cold or upper respiratory infection, which usually means discomfort and maybe a day or two off work.  Influenza is a much different and much more dangerous animal, especially to people with chronic diseases.

Over time we have become somewhat immune to the messages about the dangers of the flu, now that we have vaccinations and medicines which can treat the illness. Few are alive who remember anything about the great influenza pandemic of 1918:

"The influenza of that season, however was far more than a cold...The flu was most deadly for people ages 20-40...It infected 28% of all Americans (Tice). An estimated 675,000 Americans died of influence during the pandemic, ten times as many as in the world war. Of the US soldiers who died in Europe, half of them fell to the influenza virus and not the enemy (Deseret News) An estimated 43,000 servicemen mobilized for WWI died of influenza (Crosby)."

We have been fortunate not to have a repeat of that pandemic. But for some of us, the flu remains a deadly possibility, one that we might be able to prevent if we take the precaution of getting a flu shot.

People with cancer are among the groups at especially high risk of getting the complications of flu. And also let's not ignore the "risk pool" of people who live with patients with cancer and those who care for people with cancer. We tend to forget that those healthier folks who help people with serious illnesses can be the transmitters of this potentially serious and life-threatening infection.

Because of those risks, people with cancer and those they come in contact with really need to understand their options about getting vaccinated against the flu, and-assuming they don't have specific contraindications to the vaccine-if at all possible get it done. It is still not too late to get this year's flu vaccination. No one can predict when the vaccine "season" will peak or how serious it will be in any given year. But waiting until the last minute, when the story is all over the news, is not a good idea and it's not good medicine. And worse, it doesn't work. 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...

New Update On Prostate Cancer Prevention With Finasteride Creates A Dilemma For Patients

by Dr. Len August 14, 2013

 

We've all heard the phrase, "When you come to a fork in the road, take it."  Well, that saying may hold particular relevance while reviewing a new research report published today in the New England Journal of Medicine.

The report is an important one. It is an 18 year follow-up of a study designed to show whether the use of the drug finasteride could reduce the incidence and deaths from prostate cancer. The study was called the Prostate Cancer Prevention Trial and when it was initially reported in 2003 it showed that the drug could reduce the incidence of prostate cancer by almost 25%.  However, there was a catch: there was actually an increase of almost 27% in the number of high grade-or more serious-prostate cancers in the group treated with finasteride compared to those men who did not get the drug. The men in this trial were followed very closely. Since this trial was done in an era when PSA testing to find prostate cancer "early" was part of routine care, these men were screened regularly with the PSA test.

The originally reported results of the trial meant two things to the researchers: first, finasteride was successful in reducing the frequency of prostate cancer, but most of that decrease was in the lower grade, less harmful forms of the disease, and second, it raised the question of whether the drug actually promoted more serious forms of prostate cancer. Some experts argued that in fact there weren't more numerous high grade tumors, only that finasteride made it easier to find them thanks to the fact that it shrinks the prostate.

The debate on the relative merits of using finasteride has continued since. Suffice to say, the use of the drug didn't get much traction. In 2011, the Food and Drug Administration added information to the drug label that finasteride and similar drugs could increase the frequency of more lethal forms of prostate cancer and that the drugs were not approved for prostate cancer prevention.

Meanwhile, organizations such as the American Cancer Society have suggested that men should make an informed decision as to whether or not they really want to be screened for prostate cancer with PSA testing, and the United States Preventive Services Task Force recommends that men should not be screened at all for the disease. But the impact of finasteride on reducing the incidence and deaths from prostate cancer and "the rest of the story" remained unanswered. At least until now. More...

Maybe It Really Is Different This Time For Patients With Advanced Melanoma

by Dr. Len June 03, 2013

Every convention and large meeting has a theme, and at the annual meeting of the American Society of Clinical Oncology in Chicago the theme is "Building Bridges To Conquer Cancer." But for me, the theme as articulated in my blog the other day is "Is it really different this time?" Some agree with me and some don't, but that's OK. I am wearing a badge that says I am a "35 year member of ASCO" (I actually have been attending these meetings longer than that) so I perhaps have a bit of a different perspective than those younger than me. And there is plenty of commentary to back up my well-meaning and hopefully thought provoking conservatism.

In one of the major "award" lectures yesterday, Dr. Charles Sawyers from Memorial Sloan Kettering Cancer Center in New York pointed out the disappointment we have had with many of our newer targeted therapies that once held the promise of truly making cancer a chronic disease. They are exciting in the beginning, but for many patients the responses are not long enough. As Dr. Sawyers noted, cancer cells eventually win the battle, and become resistant to the treatmentIn this context I was having another one of those ubiquitous hallway discussions with one of my friends and former colleagues who now runs a major advocacy/research organization focused on melanoma when she touted the new research and drugs available to treat advanced melanoma. And I said the words, "Is it really different this time?" to which she responded, "Yes, it is." And I said I wasn't so certain. So at her persistent urging, I went to the melanoma session yesterday to see for myself. And I sent my friend an email where I wrote, "You win" and to which she responded, "Told you so."

What changed? What made me eat the proverbial crow? Why is it different this time? More...

Genomics And Personalized Medicine: Is It Really Different This Time?

by Dr. Len June 01, 2013

Another year and another annual meeting for the American Society of Clinical Oncology in Chicago. This is a meeting that regularly attracts many thousands of doctors, researchers, pharmaceutical folks and others interested in the science and business of cancer from around the globe to learn, to discuss, to persuade, to educate on the progress being made in clinical cancer research and treatment.

And like every year, there are themes that emerge, that tend to dominate the discussions. And there are other themes that aren't so visible, that don't get as much attention yet in my mind are equally important as they reflect not only on the item of the moment but on how we deliver on the promises we have made in the past and the hopes we all have for the future.

Clearly, the dominant and visible theme at this year's gathering is personalized medicine.

What strikes me about this topic is that over the past year it has gone from a "niche" discussion to a dominant theme not only here at ASCO but everywhere I turn. I am even seeing routine television news shows and commentators talking about the promise of personalized medicine. A talk that I planned six months ago to deliver in a couple of weeks from now in Boston where I was going to discuss (once again) the promise of personalized medicine in cancer care is now passé. Everyone knows about it, thanks to the incredible coverage it has been receiving literally everywhere. Now anyone who has been paying attention to the evening news could give that talk. The topic is ubiquitous.

So what is personalized medicine? At heart, what this is all about is harnessing our exploding knowledge of the human genome and applying it to the treatment of severe disease for individuals based on genetic analysis. Our focus today is on cancer, but other diseases such as degenerative brain diseases also will be impacted by our knowledge of the human genome.

As I sat in a lecture yesterday afternoon on the topics of genomics and personalized medicine, I was amazed about how much knowledge we have garnered in what appears to be such a short period of time. We now are hearing about new approaches to analyze how cancer cells work to discover master regulatory cells. The promise, of course, now that we have insight into the pathways of how cancer cells work internally is that we can target our efforts to those master regulators and conquer them, thus converting the cancer cell back to normality. Sounds simple, but it's not. And it has taken a lot of research to get us to that point.

So one comes away from those discussions imbued with a new enthusiasm that the cure is around the corner. We are almost there. We will succeed--hopefully in the very near term.

But then I pinch myself and say, "Really?" More...

Is Cancer Research and Treatment Moving From Evolution To Revolution?

by Dr. Len April 09, 2013

Is our evolution becoming a revolution? Am I in danger of becoming a victim of the same "hope and hype" that I derided as a young oncologist in the 1970's and 80's and is currently the focus of some vocal critics of recent glowing media reports on the successes of cancer research and treatment?

Those are the questions I am asking myself as I reflect on the experiences I have had over the past two weeks. And although I may be proven wrong, I am becoming even more convinced that we are truly at the tipping point, the place where the sweat and tears of failure and slow progress give way to truly significant change in how we view, diagnose and treat cancer. More...

Maybe It's Time To Rethink Patient Safety When 1/3 Of The Cancer Professionals Would Have Prescribed The Wrong Treatment In Response To A Lecturer's Question

by Dr. Len March 20, 2013

I was sitting in a large lecture hall with about 1000 of my oncology colleagues this past week when I had one of "those moments." It wasn't a spectacular moment, and I doubt that anyone else in the room really paid much attention to the moment, but for me it was a significant moment--and frankly a bit chilling if not frightening.

In short, in answer to an audience response question--which admittedly is not a scientifically valid survey--over 1/3 of the oncology professionals sitting in the audience would have prescribed a treatment for advanced colon cancer that not only has been shown not to work, but also shorten lives. At that moment, I became very concerned about the implications of that response and what it may mean for patient care.

Maybe I am overdramatizing this a bit, but what happened pointed out to me that we may have a serious problem in cancer care, and it is imperative that we do something about it. More...

For Cancer Patients, It's Not Just About What's Now But Also What's Next--And We Can Help Answer That Question

by Dr. Len March 06, 2013

Here's an insightful comment from me: Social media has gripped our world, the way we live, the way we interact, what we know and influences what we do. (OK, stop laughing: I'm not a Luddite, but needed somewhere to start this conversation.)

At times, I wonder where all those folks (usually young folks) find all that interesting stuff they send to each other on a such a constant basis that it seems their smartphones are a direct extension of their fingertips. So much to say right now! I can't imagine there being that much that is so important that people walk down the street mesmerized by those things.

But maybe that is just my ignorance and my difficulty "engaging" in this new social sphere. For me, it has to be something useful to say, something useful to know, something that is going to impact my life. That's where I find all of the social media and instant access to information so helpful. Make me smarter, keep me in touch with what is important, broaden my horizon on topics of interest to me. Then you have me engaged as well.

For cancer patients-especially newly diagnosed cancer patients-and their families, loved ones and caregivers, the situation is more serious--a lot more serious. They need help,  understanding, explanation, and lots of care and compassion. The devastation of a new cancer diagnosis or a worsening cancer or the ravages of treatment can leave even the most informed person desperate to understand what is happening to them, what is happening to their lives, what they can expect to happen next. And filtering through all of the material now available with a click on the web can be overwhelming, especially when one considers that some of the information may be reliable and some of it not so reliable. Think of that recent ad which extols the virtues of the internet with the tagline, "If it's on the internet, it must be true." Right.

So where do you turn for help? Where do you reach out to people who are just like you: same age, same disease, same questions, same experiences?

The American Cancer Society has a web-based social network called "WhatNext". Developed in part with the help of the Society, WhatNext is designed to bring people together to share information about their experiences with cancer. Based on a number of factors including diagnosis and disease status, the site aims to link people and help them share insights that may be of mutual interest, such as the side effects of a treatment, what to expect from treatment, and experiences with a shared cancer diagnosis. (The proactive matching is what makes WhatNext different from our other online community, Cancer Survivors Network.) The information is all public except for the person's name, so others can learn as well. Through this community of learning and sharing, there is much we can learn about what to expect, what we need to know, and how we can build on common interests when it comes to understanding the cancer journey. More...

Breast Cancer Screening: The Search For Truth

by Dr. Len November 21, 2012

 We are on a search for truth, but will we ever find it? That summarizes how I feel after reading an article in today's New England Journal of Medicine, which once again raises the question of how much screening mammography contributes to the progress we have made in reducing deaths from breast cancer in the United States, and by inference, in other parts of the world.

The research paper-written by Dr. Gilbert Welch and Dr. Archie Bleyer, two highly regarded researchers-concludes that over the past 30+ years, screening mammography has contributed modestly, at best, in the progress we have made in decreasing death rates from breast cancer.  In contrast, based on their analyses, the doctors conclude that much of the gains we have seen are due to better treatment. An additional observation is that 31 percent of the women diagnosed and treated for breast cancer in 2008 - that's more than 70,000 women - were in fact treated unnecessarily, since if left alone or not diagnosed their cancers would never have caused them a problem during their lifetime. In contrast, they say, these women have endured surgery, perhaps radiation and chemotherapy, all of which have serious consequences and in fact did not contribute to their health or their longevity.

 This is not the first research that has been done on this very important-and very emotional--topic nor is this the first time that the question of "over diagnosis" and "over treatment" of breast cancer has become part of the national debate over the value of early detection of breast cancer.

 As the authors acknowledge, there has been a considerable body of research that has tried to answer the question regarding the value of mammography, and assess the "harms" of screening mammograms (which, for the patient may include repeat examinations such as additional mammograms, ultrasound and MRI, and for some women, breast biopsy in order to determine whether or not a suspicious lesion is in fact cancer). There have also been a number of studies-some of which are included in an online table which accompanies the Welch and Bleyer report-which try to determine how many women were treated for their breast cancer without health benefit.

 So let's acknowledge two basic principles:

 One: Many experts agree with the principles espoused in this current report. Yes, some women do have to undergo additional studies to determine if something seen on a screening mammogram is in fact a cancer.

 Two: many experts acknowledge that we do treat some women who would otherwise have done perfectly well had we not found their breast cancers in the first place. More...

Expert Opinion: A US Perspective On Beating Cancer

by Dr. Len September 06, 2012

(Author's note: The following blog was posted today on the "Science Update Blog" hosted by Cancer Research UK, where you can read it in its entirety. My thanks to Cancer Research UK and especially to Oliver Childs who made this opportunity available.)

 

Expert opinion: a US perspective on beating cancer

Posted on September 6, 2012 by Oliver Childs

 

 

Dr Len Lichtenfeld is deputy chief medical officer for the American Cancer Society. We invited Len to share his thoughts about our shared challenge of beating cancer.

As well as giving his unique perspective on the US's "war on cancer", Dr Len writes about the similarities and differences between the US and UK in our approaches to preventing, detecting and treating the disease:

 

It has been a long slog since we started our war on cancer here in the United States in 1971.

 

At times I am not certain that this has been so much of a war as opposed to a series of skirmishes that occasionally have produced incredible moments of optimism. But there have been a fair share of frustrations as well along the way. Our science and our care have made significant progress, but sometimes we find ourselves asking, "What have you done for me lately?"

 

I think it is important to reflect on the progress that we have made on several fronts in detecting cancer earlier, treating it more effectively and providing quality of care for those who find themselves caught in the jaws of illness, especially for those whose journey has not been successful. 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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