Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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In An Era Of Bold New Cancer Treatments An Older Drug Shows Real Promise For Advanced Prostate Cancer

by Dr. Len June 02, 2014

The annual meeting of the American Society of Clinical Oncology here in Chicago is a place where many commercial interests jostle for attention to make their latest promising therapy the star of the show. But this weekend, a standard widely available generic drug stole the show by producing incredible results in improving survival for men with advanced prostate cancer. And that has some of us asking, "Why did it take so long to find out? More...

From The ASCO Meeting In Chicago: A Focus On Cost, Value, And Financial Toxicity Of Cancer Care

by Dr. Len May 31, 2014

At the annual meeting of the American Society of Clinical Oncology (ASCO) here in Chicago, something vitally important is happening: there is an increasing recognition of something no one really wanted to talk about in polite company until now. It is the fact that the costs of many of the new treatments being developed are extraordinary.

The headlines about cost and value of cancer care greeted me when I walked into the McCormick Center in Chicago for the opening sessions of the meeting. This is the leading cancer meeting in the world, and what happens here makes news worldwide, significantly impacting the lives of patients with cancer wherever they may be.

Now there is an increasing recognition of the elephant in the room: the costs of these new treatments are extraordinary. No matter how one chooses to slice and dice the arguments, these drugs are expensive with costs per month of $8000 and upwards getting a lot of attention and increasing concerns, especially at this meeting. More...

We Need A Sense Of Urgency To Assure The Safety Of Health Information Technology

by Dr. Len May 16, 2014

This was the dream: we would use technology to create a seamless healthcare system, one where people, computers and machines would work together to improve patient care in many different ways. Health care would be more efficient, it would be safer, it would be less expensive, we would be able to transfer health-related information quickly and accurately.

After spending three days at a meeting this past week with some of the top experts in the field, I am not so certain that the dream is going to come true anytime soon. Perhaps more concerning, the problems--including patient safety issues--that are cropping up in so many areas are very troubling. More...

Relay For Life Is All About People Making A Difference In The Fight Against Cancer Every Day In So Many Ways

by Dr. Len May 11, 2014

My wife and I did something special this past Friday evening. We attended a Relay for Life in our hometown of Thomasville GA. And the memories of the event will not be soon forgotten, for so many reasons. More...

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...

It Helps To Know What Watchful Waiting Really Means In Prostate Cancer Treatment

by Dr. Len March 06, 2014

News reports covering a prostate cancer study this week in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who were assigned to "watchful waiting" after they were diagnosed.

But guess what? There's a critical fact that seemed to be missing in much of the coverage I saw. And that fact is this: the men who were given the "watchful waiting" as described in the study never received any curative treatment. Let me repeat: No curative treatment. That is a much different approach to watchful waiting than we currently recommend in the United States, where watchful waiting after a diagnosis of prostate cancer usually means offering curative treatment when the prostate cancer changes its behavior. More...

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...

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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