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...
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...
May 24, 2013
Today is the beginning of Memorial Day weekend and the summer holiday season. It's a day to remember to enjoy your fried chicken, while not frying your skin. (OK, fried chicken isn't exactly healthy for you, but it is fun once in a while. Frying your skin is never healthy nor fun).
It is also Don't Fry Day, an annual reminder of the need to be sun safe while we enjoy the outdoors during the summer months. More...
May 14, 2013
So May is skin cancer awareness month. No time like the present to come out with the news: I have been diagnosed with skin cancer.
There really isn't much special about that, since it is a distinction I share with over 2 million Americans who have a skin cancer removed every year. Fortunately, for most, it is a cancer that is not of particular concern since most can be removed. But even those "simple" surgeries--as I have learned from my own experience--can be a bit problematic.
Occasionally it helps to find some humor in difficult situations, and this is one of those times. And since I am generally pretty open about what goes on in my aging body--in an effort to help others understand that they are not alone on some of these issues--I have to hold myself out as an example of what NOT to do when it comes to taking care of yourself.
You see, I am supposed to know this stuff about skin cancer. I know the risks, I know how to prevent it, I know what it looks like, and I know what we are supposed to do when we see a suspicious lesion. Not only do I know these things, I talk and write about them frequently. I am supposed to have a certain level of expertise about skin cancer. In fact, this very month if you happen to be in a doctor's office and they have a closed circuit program from CNN's Accent Health, you will see my smiling face telling you what you need to know about skin cancer.
And if you look closely at my chin in that segment, you will see the little nodule on the left hand side that I chose to ignore--until some friends of mine would not let me ignore it any longer. More...
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...
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...
June 04, 2012
Yesterday I wrote a blog discussing how meetings like the current annual gathering of the American Society of Clinical Oncology (ASCO) gives me a chance to think about big picture questions.
Well, there is another side to the experience that is also interesting and important, such as getting information that helps put together pieces of a larger puzzle, and perhaps even gives closure to a nagging question. When you have one of those "Aha!!!" moments, it can truly solidify your thoughts and maybe even save a few lives in the process. In this case, the same presentation that led to yesterday's comments about the emerging complexities of the diagnosis of cancer also produced another enlightening moment.
Dr. Levi Garraway is a highly regarded genomics researcher from Dana Farber Cancer Institute in Boston who presented a lecture on the topic of how genome sequencing is bringing new insights to the biology and treatment of cancer. As part of his presentation, Dr. Garraway offered information on areas where genomics has already offered us definitive information that has direct implications in understanding cancer.
The #1 item on Dr. Garraway's list was a topic of intense interest to me and several of my skin cancer colleagues.
According to Dr. Garraway, genetic analysis of cancers from patients with melanoma show an overwhelming number (my words) have a signature genetic marker proving their melanomas were caused by ultraviolet (UV) radiation. He elaborated that there have been questions in the scientific literature as to whether or not this was the case, and acknowledged that we have had to rely on relatively indirect research to prove the case that melanoma is caused by UV light. However, he continued, because of genomics it is now essentially "case closed" and essentially proven: melanoma is caused by exposure to UV light. More...
June 03, 2012
One of the things I enjoy about coming to meetings like the current annual session of the American Society of Clinical Oncology (ASCO) is that it gives me a chance to give thought to some larger questions that face cancer care. A presentation I attended Friday afternoon on the impact of genomics on cancer diagnosis and treatment in the future has offered just such an opportunity.
Most of you I suspect give little thought to the actual processes that we use to diagnose cancer. One has a tumor somewhere in the body, the doctors take a specimen, send it to the pathologist and the pathologist makes the diagnosis. Simple and straightforward. Get it done and get on with treatment.
But in fact it isn't so simple and straightforward. And in the world we live in, it is getting more and more complex.
Looking at cancer tissue under the microscope is something that has been done for over a century. More recently, we have seen the advent of special additional tests that tell us for example whether or not a cancer such as breast cancer is hormone sensitive or whether it has other markers such as HER2. We can send specimens of the cancer to a lab to find out whether or not it is more or less aggressive and we can even do tests to find out whether or not--for example--a woman with a breast cancer really needs to take traditional cancer chemotherapy. There are even special stains that can be applied to tumor tissue through a variety of techniques that can further refine the characteristics of a particular tumor and help us determine what kind of cancer it may be, or what subgroup of a family of cancers, such as lymphoma, a particular cancer fits in to.
All of that is well and good, but unfortunately that simple explanation does neither justice to how doctors diagnose cancer, nor does it say much about the problems that can occur in making cancer diagnoses, especially with all of the new tests that are available. I suspect that many physicians will agree that simply looking at the tissue under the microscope just doesn't tell us anymore all the things we should know about a particular individual's cancer. More...
June 02, 2012
Every year at this time cancer specialists and researchers from around the world descend on Chicago for the annual meeting of the American Society of Clinical Oncology (ASCO) to hear the latest breakthroughs in cancer research and treatment.
Through all the fog of all the information--which is impossible for any one individual to evaluate much less comprehend--there is always the search for the "buzz," or the next "big thing" that will make a huge impact on cancer treatment and the lives of the patients we care for and the people we love who are affected by cancer.
This year, it is apparent already that one of this year's "big things" are the reports of new success in an old and ongoing effort to harness the body's own defense mechanisms to fight cancer. And--being the skeptic that I can be at times--I will throw my hat in the ring that maybe this is going to be one of those events that truly will impact cancer care. But despite the enthusiasm, we must always temper our expectations with reality and lessons we have learned from the past that early success doesn't always tell us the whole story.
Without going into great detail here, the reality is that in early stage trials an antibody drug now called "BMS-936558" produced significant responses in a number of patients who had certain advanced cancers and had failed multiple prior treatments. In these studies, patients with melanoma, kidney cancer and non-small cell lung cancer showed responses to this new drug and some of those responses lasted for over a year.
When you see these kinds of results in cancers that are ordinarily difficult to treat, and in patients who have failed multiple other therapies, that becomes news. More...
March 29, 2012
I have a confession to make:
As soon as I finished reading the Annual Report to the Nation yesterday as I was preparing to write my blog, I got up from my desk and took a walk for 20 minutes.
What, might you ask, compelled me to do this?
The answer is what made me take a walk is the same reason I am writing this follow-up commentary to yesterday's blog: Sitting at my desk all day may kill me. It may be doing the same for you. More...