Dr. Len's Cancer Blog

Last night was a special moment for me: I was one of those 164 people representing the “face of America” that was in the East Room of the White House as Charlie Gibson and Dianne Sawyer from ABC News interviewed the President as he answered questions about health care reform.

My bottom line conclusion?  This guy knows his stuff. 

I have been in Washington the past several days primarily to participate in a congressional staff briefing on the importance of funding for research and to attend the discussion with the President on ABC’s “Prescription for America” which will air this evening at 10PM EDT. 

But something I saw yesterday really bothered me, and brought me back to reality when it comes to understanding the barriers our country faces in achieving true personal health reform. 

The issue?  The extent of overweight and obesity in this country and its impact on our health and our health care costs.

I had the opportunity last week to participate in a conference sponsored by the American Cancer Society and others that brought together companies to talk about changing the course of cancer through innovative corporate programs and policies.

The take home message for me was that if we are going to solve the health care crisis in this country, we are going to have to learn about the unique and successful corporate health focused initiatives that are happening all around us.

A recent article in the New England Journal of Medicine praising the decision by the Centers for Medicare and Medicaid Services to not cover CT colonography for the prevention and early detection of colon cancer for Medicare patients left me with a great deal of concern—especially since it was written by some of the same people who made the decision in the first place.

I consider myself a fairly reasonable, experienced and tolerant person when it comes to the legislative and regulatory decision-making processes.  You win some, you lose some, you reevaluate and generally you move on to the next issue.  But this time, for me at least, it’s different.

Ok, Ok. I must admit that sitting about 40 or 50 feet from President Obama as he delivered his talk this morning at the annual meeting of the American Medical Association House of Delegates was pretty special (I even have the pictures to prove it).

The talk, surprisingly, included a number of comments about cancer and the importance of health care reform as it related to the treatment of cancer and the impact of cancer on the lives of ordinary people.  The difference here, perhaps, is that this President knew and loved one of those “ordinary people.” That person was his mother.  He used the opportunity of this address to once again remind us of his family’s personal travail trying to pay for her medical care and the impact that had on their lives at a very difficult time.

I realized last night while reflecting on the annual meeting of the American Society of Clinical Oncology that concluded yesterday in Orlando that my luggage on the trip home was much lighter than in years past. 

The reason?  New pharmaceutical regulations prohibited the drug companies from giving me “anything of value,” namely pens, bags, calendars or whatever they could come up with to give to me and other attendees at the conference to gain attention for their products.

I must admit that I now feel much more pure than I have in years past, and much less conflicted since I haven’t been able to gather my supply of pens for the coming year.

But there is another side to this story; a story of unintended consequences that has not been told and that may have far reaching implications for clinical practice and even for groups like ours that work to defeat cancer.

Sometimes research reports are as interesting to me for the story behind the story as much as the actual story itself.  Such is the case with two abstracts presented at the annual meeting of the American Society of Clinical Oncology here in Orlando, which closes today.

The two reports deal with the impact of anti-depressants on the effectiveness of tamoxifen, a drug that has been used for decades in the adjuvant (preventive) treatment of breast cancer after surgery and radiation, as well as for the treatment of breast cancer that has spread to other parts of the body.

But the “story behind the story” is that the research was done through the analysis of large medical data banks, one of which is owned by a public company which happens to be a major prescription benefit manager here in the United States.

One of the papers presented during yesterday afternoon’s plenary session at the annual meeting of the American Society of Clinical Oncology (ASCO) captured my attention for a couple of reasons.

The study reported on a new drug code named BSI-201 in a trial where the researchers treated women with a form of breast cancer called “triple negative.”  Triple negative breast cancers (or TNBC) are called that because they don’t have estrogen or progesterone hormone receptors and are negative for a genetic marker called HER2. As a result, they can’t be treated with some of the more successful breast cancer treatments such as hormonal therapy or targeted drugs such as trastuzumab (Herceptin ™),  They tend to occur in younger women and especially in African American women.  Unfortunately, they tend to be more aggressive than other forms of breast cancer.

Sometime patience pays off.  And sometimes patience means you think you have come to the end of the road, only to find that someone has built an extension for the highway.

That’s the outcome from the next study, which reported that the use of a tumor vaccine in patients with a non-Hodgkin lymphoma called follicular lymphoma were found to have longer remissions after chemotherapy if they received the vaccine when compared to patients who received the same treatment but did not get the vaccine.

It is day two of the annual meeting of the American Society of Clinical Oncology in Orlando.  Over the next three hours, we will hear the four papers which have been selected for the plenary session of the meeting for presentation to thousands of researchers, doctors, and other cancer professionals.  These are, in one sense, the best of the best—the ones which will likely get the most media coverage and be of interest to largest number of meeting attendees.

The first paper that is being presented in an interesting one, if for no reason other than for its seeming simplicity (I promise you, nothing in cancer medicine is simple).  The bottom line: trying to seek out evidence of ovarian cancer recurrence after successful treatment for  metastatic disease and starting immediate treatment made no difference in survival when compared to waiting until a woman had symptoms related to that recurrence and starting treatment at that time.