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...

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...

One Doctor's Confession: Basal And Squamous Cell Skin Cancers Are NOT Benign

by Dr. Len January 07, 2014

I have made a resolution for 2014: I will never, never, never again call basal and squamous skin cancers "benign" cancers.

Why would I make such a strange commitment? The explanation is simple:  I spent 4 hours on New Year's Eve sitting in the surgeon's chair getting a skin cancer taken off my nose. Nothing about the experience fits the "benign" label so many professionals, including yours truly, have used:  routine; easy to treat; nothing to worry about.  Friends, after this experience, which left me looking like a tall, white-haired Rudolph the Reindeer, I am here to tell you these cancers are not to be trifled with, and are worth every effort you can make at preventing them by reducing exposure to UV radiation. 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...

If PSA Tests Don't Impact Survival, Why Do Insurance Companies Do The Test Without Your Knowledge?

by Dr. Len August 21, 2013

A discussion on Twitter caught the eyes of my colleagues yesterday, and raised a very interesting question: should insurance companies be allowed to do PSA testing to detect prostate cancer on men as a condition of getting insurance?

What started the discussion was a blog post by a well-known and respected medical blogger who goes by the name "Skeptical Scalpel." In his blog he detailed the saga of a 56 year old man who had a pre-employment physical in order to be covered by his new company's health insurance plan. He was not informed that he was going to have a PSA test. It was just done as part of the process. No informed consent, no nothing, just stick out your arm, have blood drawn, and register your surprise that the test was done once the results come back.

The United States Preventive Services Task Force recommends against any man having the test to detect prostate cancer. Even among those who say the test is an option, -including the American Cancer Society-recommend that a man have a full, informed understanding of the pros and cons of PSA testing before getting the test, given the uncertainties of whether it really saves lives and the known frequency of side effects associated with treatment for prostate cancer. None of those recommendations were part of the consideration for this man when he was examined for his insurance plan.

You can imagine what happened: his PSA was slightly elevated at 5.9. He was "rated" by the insurer, charged an extra $200 a month for his health insurance, and may well have to have a number of additional studies. Not to mention that he may have prostate cancer, and may undergo more treatments-as a result of a test that is of uncertain value for most men. And, by the way, the odds are overwhelming that the gentleman in question does not have prostate cancer, but will have to go to considerable lengths (and some risk) to find out. Because he had not discussed the test, he did not have the opportunity to prepare for it correctly, so his reading may have been falsely high; we'll never know. And, if he does have prostate cancer, as reflected in the USPSTF recommendations, he has a significant chance of having long term side effects from the treatment, but little proven benefit in terms of saving his life. 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...

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...

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...

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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