Get Thee To A Screening

Recent news reports have called for changes in how frequently people should go for cancer screenings and that's raised all kinds of debate over what's truly appropriate and how the screenings affect health care costs, effectiveness, and life-expectancy.

Having a healthy debate over the issues is all well and good, but early detection is a major factor in getting good outcomes in any number of forms of cancer. That means regular screenings. You should absolutely talk with your doctors about screenings and how frequently you should go by looking at your family history, risk factors, and environmental factors.

Without a doubt, that means if you're a woman, that means going for regular mammograms.
For men, it means prostate and testicular cancer screenings (a federal panel of doctors found that regular screening for prostate cancer may not be worth the risks). It also means that if you find your body changing - are more fatigued or notice other physical changes that aren't easily explained to go see a doctor.

For everyone, that means regularly checking for skin cancer (which is the most common cancer there is with more than 2 million cases diagnosed annually but which has very high cure/remission rate). Skin cancer cases exceed the number of pretty much every other form of cancer combined.

Skin cancer screening is fairly simple - if you see something on your skin that doesn't look right (a mole that changes color, size, bleeds, etc.) you should go get it checked out.

It's a pain in the ass to go for regular screenings, but you know what's a bigger pain in the ass - waiting too long and finding out that you not only have a cancer, but that the docs have limited or no options. Early diagnoses can vastly increase chances of remission. The treatments might suck - and those are much improved from just a few years ago - but they're better than being dead (and leaving friends and families without their loved one).

Computerized Pathology May Lead To Cancer Diagnosis/Treatment Breakthroughs

Scientists have been working to create computer programs that can help identify and catalog cancers, which involve abnormalities in various kinds of cells in the human body. After researchers taught the program how to identify cancer cells among the slides, they found that the program not only correctly identified cancer cells, but that characteristics of the cancer cells and those of surrounding cells were important to identifying prognosis for recovery.

Once it was trained, Beck et al. used C-Path to evaluate tissues of cancer patients it had not examined before. Again, the researchers already knew the outcome, so they were able to check C-Path’s success rate. Its results were a statistically significant improvement over human-based examination, the authors say.

C-Path even figured out something pathologists haven’t — that the characteristics of the cancer cells and the surrounding cells were both important in determining a patient’s outcome. “Through machine learning, we are coming to think of cancer more holistically, as a complex system rather than as a bunch of bad cells in a tumor,” said Dr. Matt van de Rijn, a professor of pathology and co-author of the study, in a statement. “The computers are pointing us to what is significant, not the other way around.”

This is an impressive result, as Rimm explains it, because existing pathological analysis is a very subjective science. Experts make judgments about tissue metastasis and a patient’s overall chances of survival by simply looking at tissue, and their own diagnoses can vary widely, as a 2008 study showed. But a computer model using thousands of times more criteria could be much more consistent.

Despite this success, C-Path is still a long way from clinical use, the authors say.

Faster please.

Light The Night Kickoff

This weekend, I had the honor to attend the 2011 Light The Night Walk kickoff event for Red Bank, New Jersey. The Red Bank walk in the newest location in New Jersey to host a Light the Night Walk -- this is the third year for this location. As I explained in an earlier post, Light the Night is the oldest walk to raise money for cancer research.

At the kickoff event, we heard some additional information regarding the new treatment breakthrough for chronic lymphocytic leukemia, or CLL. Lawhawk posted about this last week. This new therapy essentially takes cancer T-Cells, infuses them with a new protein and reintroduces them into the body. The new infused cells begin to attack the cancer cells, and most excitedly, get the bodies existing cells to fight the cancer as well. Currently, two patients are more than 1 year cancer free, with a third approaching 1 year. When they get 12 patients cancer free for 1 year, the procedure will be considered for approval.

The reason for the discussion at the kickoff was that the Leukemia and Lymphoma Society has donated more than $50 million to this research over the years. Over that past several years, the FDA has approved 19 new drugs and therapies for blood cancer -- all with the assistance of the LLS. Of the 19, 12 have been approved or are being studied for the treatment of other forms of cancer as well. That is remarkable.

I was watching a baseball game the other day and a commercial for the MLB's involvement with Stand Up 2 Cancer came on (anyone who saw the All Star Game, the Stand up 2 cancer half inning display was chilling.) They splashed two stats on the screen that shook me. 1 in 3 women and 1 in 2 men will get cancer. The numbers are staggering. With respect to blood cancer:
• Every 5 Minutes: Someone in the United States learns that he or she has leukemia, lymphoma, Hodgkin’s disease or myeloma.
• Every 10 Minutes: Another child or adult is expected to die from a blood cancer.

This is why I renew my plea to all our readers and donations to the Light the Night Walk can be made through the link on the top left of the page, or by going to my team page . Any amount of support is greatly appreciated. By donating, you are not only helping to cure blood cancers, support caregivers, assist patients with purchasing drugs they could not otherwise afford, but you are indirectly supporting research that is going to treat and cure other cancers as well.

Cautious Optimism On Novel Gene Therapy Cure For Leukemia

A very small study involving three patients receiving a novel gene therapy treatment appeared to cure two patients completely of a common form of leukemia. The third patient showed significant improvement.

I'm stressing the small size of the study, because such results might not be found when applied to a larger group and that many additional studies will be needed to confirm the early findings.

"It worked great. We were surprised it worked as well as it did," said Dr. Carl June, a gene therapy expert at the University of Pennsylvania. "We're just a year out now. We need to find out how long these remissions last."

He led the study, published Wednesday by two journals, New England Journal of Medicine and Science Translational Medicine.

It involved three men with very advanced cases of chronic lymphocytic leukemia, or CLL. The only hope for a cure now is bone marrow or stem cell transplants, which don't always work and carry a high risk of death.

Scientists have been working for years to find ways to boost the immune system's ability to fight cancer. Earlier attempts at genetically modifying bloodstream soldiers called T-cells have had limited success; the modified cells didn't reproduce well and quickly disappeared.

June and his colleagues made changes to the technique, using a novel carrier to deliver the new genes into the T-cells and a signaling mechanism telling the cells to kill and multiply.

That resulted in armies of "serial killer" cells that targeted cancer cells, destroyed them, and went on to kill new cancer as it emerged. It was known that T-cells attack viruses that way, but this is the first time it's been done against cancer, June said.

For the experiment, blood was taken from each patient and T-cells removed. After they were altered in a lab, millions of the cells were returned to the patient in three infusions.

The researchers described the experience of one 64-year-old patient in detail. There was no change for two weeks, but then he became ill with chills, nausea and fever. He and the other two patients were hit with a condition that occurs when a large number of cancer cells die at the same time — a sign that the gene therapy is working.

"It was like the worse flu of their life," June said. "But after that, it's over. They're well."

The main complication seems to be that this technique also destroys some other infection-fighting blood cells; so far the patients have been getting monthly treatments for that.

Penn researchers want to test the gene therapy technique in leukemia-related cancers, as well as pancreatic and ovarian cancer, he said. Other institutions are looking at prostate and brain cancer.

This study should spur investment and research at utilizing similar treatments for other common cancers.

While the imminent side effect of a bad flu lasting a week or so would be a vast improvement over the kinds of side effects from current treatment options, that include everything from prolonged weakness, hair loss, organ failure, auto-immune disorders, among others, that other immune cells are affected might have long-term consequences that need to be studied as well.

These patients will need to be studied over the next couple of years to see if their cancer remains in remission or if there are thus-far undiscovered side-effects such as other forms of cancer or illnesses that result from the gene therapy.

Still, that this development is going to spur investment and research on this technique is a major breakthrough and here's hoping that the results hold up.

Astronomers' Discovery May Lead To Improved Cancer Treatments; Another Argument In Favor of Basic Science Research

For many people who suffer from any number of cancers, radiation treatments are a vital part of the regime along with chemotherapy.

A discovery by astronomers studying black holes may make that radiation treatment far more effective and safer.

Pradhan conducted computer simulations to calculate how individual atoms would react to every wavelength of energy -- no small feat. They logged many hours at the Ohio Supercomputer Center to complete the analysis.

But the effort was worth it. Pradhan found that some of the prior measurements of chemical abundances inside stars might be off by as much as 50 percent. They were also intrigued by how certain heavy metal atoms absorb radiation: they emit low-energy electrons when exposed to x-rays at specific energies. For example, bombarding iron, gold and platinum with a small dose of x-rays tuned to a narrow frequency range results in a burst of low-energy electrons.

Both x-rays and heavy metals like gold and platinum are routinely used in medical imaging and cancer treatment, hinting at more practical applications. It's the fine-tuning of the x-ray source that seems to be key.

The scientists are now examining how to take advantage of this observation and the assembly of a device that would take advantage of the fact that gold or platinum nanoparticles amass naturally in cancerous tumors in the body, and could then be zapped with the focused x-ray beam. The beam wouldn't require the levels of radiation utilized at present and could be even more focused than existing technologies. It would allow cancer cells to be killed without damaging nearby health tissue. The goal is to combine radiation therapy with chemotherapy, using platinum as the active agent.

It would also be able to target cancers that are previously considered to be inoperable or resistant to current medical treatment.

Once again, this is the result of basic science research and a multidisciplinary view on basic science. Projects like the follow-up to the Hubble Telescope are under fire for being over cost and may be cut by the current Congress. That would be a huge mistake considering the vast amount of knowledge gleaned about the universe from the Hubble and other similar technologies. Canceling the Webb telescope would hinder further discoveries that may have spinoff applications in other fields, including medicine.

It's yet another reason to donate to the Leukemia & Lymphoma Society's Light the Night campaign, which is fighting for a cure for a wide range of blood cancers, including the kind that Legalbgl wrote of that struck his wife, Non-Hodgkin’s disease called Primary Mediastinum B-Cell Lymphoma.

The 2011 Leukemia & Lymphoma Society’s Light the Night Walk

A few weeks ago I asked Lawhawk to place a widget on this page to donate to the Leukemia & Lymphoma Society’s Light the Night Walk. The Light the Night Walk is the oldest walk to raise money for cancer research and patient care. For those who have not attended one, the Light the Night Walk is an inspirational event, where thousands of people walk holding colored balloons with lights (red to honor someone, white for survivors and gold in memory of a loved one.)

Last year, I became personally involved with the LLS when my wife, while 29 weeks pregnant with our second child, was diagnosed with a rare form of Non-Hodgkin’s disease called Primary Mediastinum B-Cell Lymphoma. Essentially, a 10-centimeter mass had grown in her chest, above the lung, next to the heart and was effecting her breathing and blood flow. Because of the size of the mass, she required immediate treatment. She received two rounds of chemotherapy while pregnant, gave birth to our son at just shy of 36 weeks, and then continued for 4 additional rounds of chemo, followed by 17 rounds of radiation.

Since her diagnosis, both of us have become involved with the LLS. The LLS provides funding for research, support for patients who cannot afford medication, as well as patient and care-giver counseling and information. LLS is proud that over 72% of every dollar received goes directly toward the mission: To cure leukemia, lymphoma, Hodgkin’s disease and myeloma, and improve the quality of life of patients and their families. However, the statistics are startling:

• Every 5 Minutes: Someone in the United States learns that he or she has leukemia, lymphoma, Hodgkin’s disease or myeloma.
• Every 10 Minutes: Another child or adult is expected to die from a blood cancer.

Without support from the LLS, drugs like Rituxan (one of the main drugs in my wife’s regiment) and Gleevec (dubbed the “miracle drug” for Chronic Myeloid Leukemia) may never have hit the market. Thanks to the LLS, and support from its donors, people who cannot afford these drugs receive financial support. Patients, families and care-givers, have a place to turn for information, support or just someone to talk to.

Thankfully, for us the treatments worked. My wife is now in remission and our son, who just turned one, suffered no ill-effects from the chemo. She has also been honored by being selected as one of the 2011 Honored Heroes (http://www.lightthenight.org/nj/localchapter/patients). From what I was told by members of the selection committee, she was a unanimous, and virtually instantaneous, selection.

If any of you are so inclined, donations to the Light the Night Walk can be made through the link on the top left of the page, or by going to http://tinyurl.com/3v9w22m. Any amount of support is greatly appreciated.

For more information on the Leukemia & Lymphoma Society please go to www.LLS.org.

For more information on the Light the Night Walk, to join a walk in your area or to see a message from this year’s Ambassador, Michael C. Hall (himself a Hodgkin’s Lymphoma survivor), please go to http://www.lightthenight.org/.

Thank you for your support.

Chavez Admits To Cancer Surgery in Cuba; Venezuela Wonders What Comes Next

It's taken [T]hugo Chavez a couple of weeks, but he's finally come out and admitted that the reason he has been missing in action from the airwaves and media appearances for the past month has been the result of cancer surgery and recovery in Cuba.



It's rather telling just how serious the situation is that he has been silent for so long and that the military has had to come out and say that they will guarantee the ongoing safety and security.

General Henry Rangel Silva said on Friday the military would guarantee constitutional order during Chavez's absence for treatment in Cuba. The president, he said, would be home "soon" and was still in charge.

"We have seen our comandante thinner than usual but still standing. The truth is he is getting better, he's fine," Rangel told state television. "The country is calm."

The usually vivacious Chavez, 56, confirmed in a stern speech on Thursday he had surgery in Cuba to remove a cancerous tumor and was receiving more treatment. He said he needed time to recover before returning to Venezuela to run his self-styled revolution.

A fiery critic of the United States, Chavez will miss events marking Venezuela's 200th anniversary of independence from Spain. He had to cancel a regional summit planned for the momentous July 5 date.

Markets have generally reacted positively to news of Chavez's health problems, on the presumption they improve the chances of a more business-friendly government.

It's a sad day for democracy in Venezuela that everything has to hinge on Chavez's health; there's no line of succession and his underlings try to put on a veneer of calm when they have no idea what comes next.

It's also telling that Chavez had to go to Cuba for treatment; does Venezuela not have doctors and cancer care? Perhaps that was the result of Cuba being far more secretive about Chavez's condition and that he could get treatment without the prying eyes of media outlets. However, his prolonged absence spurred questions about his health condition.

I don't know, but this seems to be the position being taken by Chavez's apparatchik's and military:

Princeton Researches May Have Cracked Metastatic Cancer Code

A team of Princeton University researchers may have cracked the code to figuring out how cancer metastasizes.

A team of Princeton University biologists reported Thursday they may have finally figured out the cancer’s molecular point of attack.

“Everyone knows that metastasis — the spread of cancer — is the reason people die,” Yibin Kang said. “Everyone knows it’s the most important question — but it’s been almost impossible to tackle, it’s been too complicated. It’s only very recently that we have the tools to answer the question.”

Kang and his research team discovered breast cancer tumor cells use a well-known protein and molecular pathway to essentially hijack the bone repair process, according to a paper published in the online journal Cancer Cell.

The malignant cells, they wrote, use a protein called Jagged1 and its so-called “Notch pathway” to get a stronghold in bone tissue in 70 percent to 80 percent of patients with an advanced stage of the disease. From there, the cancer spreads throughout the body.

In healthy people, cells called “osteoclasts” and “osteoblasts” naturally repair the skeleton by breaking down and rebuilding bone, like microscopic repaving machines. But in cancer patients, Kang found tumor cells use Jagged1 to commandeer the process, using the osteoclasts to forge deep into the bone and even speed up the growth of tumors there.

The researcher and his lab have made previous discoveries about the spread of breast cancer to skeletal cells. In a 2009 study, Kang showed that TGF-beta, which controls cell proliferation, played a role in the growth of bone tumors.

Jagged1, it turns out, plays a similar role in that process.

The latest work by the Princeton researchers reveals TGF-beta is released in large amounts during the breakdown of bone and feeds the tumor cells, thereby stimulating increased production of Jagged1. Together, the two processes possess considerable destructive power.

“(It) establishes a vicious cycle, essentially driving the unstoppable expansion of tumor and the destruction of skeletal tissues,” said Nilay Sethi, a student who recently finished his doctorate in molecular biology at Princeton and worked with Kang on the discovery.

Blood Test May Revolutionize Cancer Treatment and Diagnosis

Scientists are looking at a blood test that could discover a single cancer cell floating amid billions of normal blood cells.

In 2007, researchers at Massachusetts General Hospital, developed a "microfluidic chip," called CellSearch, which could count the number of stray cancer cells, but that test didn't allow scientists to trap whole cells and analyze them.

But on Monday, Mass General announced an agreement with Veridex LLC, part of Johnson & Johnson, to study a newer version of the test. According to the Associated Press, the updated test requires only a couple of teaspoons of blood.

The microchip is dotted with tens of thousands of tiny posts covered with antibodies designed to stick to tumor cells. As blood passes over the chip, tumor cells separate from the pack and adhere to the posts.

Scientists are wagering that this type of test, if successful, might also detect cancer early in its course, predict the odds for a recurrence, and assess a patient's general prognosis.

"There has been speculation that these [stray] cells are the ones that are responsible for the spreading of the disease," noted one expert, Dr. Massimo Cristofanilli, professor and chairman of medical oncology at Fox Chase Cancer Center in Philadelphia. "Simple enumeration tells us that this patient has a worse prognosis . . . Now the question is, what other information we can gather, if we are able to capture these cells? For example, could we do gene analysis profiling and can we get information for the best treatment?"

As it stands today, biopsy -- an invasive and sometimes even hazardous procedure -- is one of the few ways doctors can get key information about a cancer's size and characteristics.

"Many people consider [the new blood test to be] a 'liquid biopsy,' so that eventually we can access cancer cells that are representative of the tumor without performing an invasive biopsy," said Cristofanilli, who is not involved in developing the test.

Experts stressed that the new type of test, if it ever arises, may still be years away, and researchers still aren't sure what these circulating tumor cells (CTCs) actually mean.

Identifying cancers at an early stage increases survivability and increases the range of treatment options.

Indeed, this has the potential to revolutionize pancreatic cancer and other difficult cancers. For now, the test is not being used in clinical situations, but several major cancer centers around the country are studying the test.

Major Breakthroughs In Cancer Research May Lead To Improved Life Expectancy and Prevention

Scientists have long tried to figure out how and why cancer develops and they may have come across a cell that helps the cancer to survive. It contains some kind of mechanism that enables cancer cells to avoid being targeted by the immune system.

Despite repeated attempts to create a cancer vaccine, none has proved fully effective.

Now scientists at Cambridge University have discovered why.

A successful vaccine works by priming the body’s immune system to attack disease.

But the researchers have pinpointed a cell type in cancer victims that prevents the body’s immune system from killing tumours.

Mice which were bred without this cell were able to fight off cancer with their immune system.

The team say they now need to identify what this cell does to block the immune system and then see if they can halt this process without causing any other damage to the body. After that it should be possible to create a working vaccine.

They've got a long way to go before they can develop a vaccine, but this is a step in the right direction. Other researchers are focusing on perforin, a protein that is critical to cell development and maintenance.

At the same time, another team of scientists has found that a combination of drugs has a tremendous effect on reducing secondary melanomas (skin cancers). Still another team of scientists has found that use of spiral CT scans can improve detection (and hence survivability) for lung cancers. Early detection is key to survival rates as the more advanced a cancer is, the more likely it has metastasized and spread to other parts of the body.

It's one of the reasons that pancreatic cancer is so deadly - usually by the time a patient is symptomatic, there's not much that can be done. If scientists can find a way to test patients for symptoms of the disease, they could intervene much sooner and improve the odds of survival.

Free the "Boobies" Bracelets From Overzealous School Administrators

Schools across the country have decided that a plastic bracelet sold to help raise funds for breast cancer research was inapporpriate for a school setting.

So, they've banned them.

A $4 rubber bracelet meant to raise breast cancer awareness has done that and more: Students nationwide are wearing the "I (heart) boobies" wristbands, and running afoul of school administrators.

Schools from California to Florida have banned the bracelets because they believe the "boobies" language is inappropriate.

The bracelets are marketed by a California-based nonprofit created to raise breast cancer awareness among youth. The Keep A Breast Foundation has sold 2 million of the bracelets so far, with the money going to breast cancer research and education programs.

The group believes a bracelet with a catchy, envelope-pushing slogan such as "I (heart) boobies" is a better way to teach kids about breast cancer than more traditional methods like pink ribbons.

Kollin West, a 14-year-old student at Laramie Junior High School, is one student who got in trouble over the bracelets.

Schools have demanded that students turn the rubber bracelets inside out so that the slogans aren't visible.

I think that the school administrators have more important things to do than patrol for bracelets that send a positive and uplifting message to breast cancer survivors. Inadvertently, these overzealous school administrators are highlighting the boobies campaign but their continued crackdowns send the wrong messages to students who are trying to do something positive.

The ACLU is considering getting involved over free speech implications, and I think that they'd be right to do so.

Faster Please! Cancer Treatments Improving And May Appear To Be Even More Impressive Than First Thought

The advances in cancer treatment continue to be encouraging for a wide range of cancers, but they can't come fast enough.

The key to the most recent advances, new drug regimes, combination therapies, and tailored treatments that benefit subsets of cancers based on specific subtypes.

But some of the victories reported this week against breast and prostate cancer, leukemia and the deadly skin cancer called melanoma may be larger than they appear. These trends offer reason for optimism:

• Newer drugs seem to be making a bigger difference for small, specific groups of patients, as companies develop treatments that more precisely target genes behind subtypes of cancer.

Pfizer Inc. rushed into late-stage testing one such drug: crizotinib, which is aimed at only 4 percent of lung cancer patients. More than 90 percent of them responded to the drug in initial tests. High response rates also have been reported for other novel drugs for melanoma and breast cancer driven by certain genes.

The hope: Develop enough of these specialized treatments that eventually every cancer patient will have something that works.

• Quicker answers from smaller, focused studies. Pfizer's test of crizotinib will need only 318 patients and will be finished early next year. It also will test the drug earlier in the course of illness rather than as a last-ditch option.

"You don't really need big trials if it works so well," and the group of patients who stand to benefit can be identified in advance, said Dr. Roy Herbst, lung cancer chief at the University of Texas M.D. Anderson Cancer Center in Houston.

• Big gains from novel combinations. All 66 patients testing a drug combo for the blood disease multiple myeloma saw a reduction in the amount of cancer they had by at least half. A 100 percent response rate is unheard of for any cancer and would not have occurred if two drugmakers had not teamed up to test their treatments together instead of against each other, said Dr. Paul Richardson of Boston's Dana-Farber Cancer Institute, who led the research.

The combo of Takeda Pharmaceutical Co.'s Velcade, Celgene Corp.'s Revlimid and the chemotherapy mainstay dexamethasone allowed more than half of patients to delay and perhaps avoid a bone marrow transplant — a harsh and risky treatment for the disease.

• Comparison tests of long-used treatments. For decades, men with cancer that has spread beyond the prostate have been given hormone treatments with or without radiation, yet only a few studies have tested these against each other or together. A Canadian study found that combo treatment extended survival an average of six months in high-risk cases, and the oncology society said it could become a new standard of care.

One thing that isn't improving is the cost.

These kinds of treatments remain expensive and aren't going to get any cheaper as treatments become even more tailored and specific.

Meanwhile, if you're interested in donating to cancer research, my choice is Memorial Sloan Kettering Cancer Center in New York City, which is one of the global leaders in cancer research.

Sen. Lautenberg Diagnosed With Stomach Cancer

New Jersey Senator Frank Lautenberg has been diagnosed with stomach cancer. He had fallen at his home and tests revealed a bleeding ulcer to be the cause. Further tests revealed a treatable stomach cancer.

“We expect a full and complete recovery for Senator Lautenberg. The senator will be treated with chemotherapy administered approximately every three weeks. We anticipate that he will receive between six and eight treatments, and in between treatments, the senator is expected to be back at work in the Senate.”

Lautenberg took ill Monday while at home in Cliffside Park. He fell down and phoned his doctor and an ambulance. The senator directed the ambulance to transport him to Manhattan for treatment at Mount Sinai Medical Center, where he has been hospitalized ever since. Lautenberg never lost consciousness, his aides said.

Doctors quickly determined that Lautenberg had fallen due to blood loss from a bleeding ulcer. The bleeding was stopped during an endoscopy. Additional pathology tests revealed the ulcer was caused by a b-cell lymphoma of the stomach.

Despite being the second oldest members of Congress (behind Richard Byrd), he has been quite active in recent months, including a trip to Haiti last week to tour the damage in Port au Prince.

I wish him and his family well. It doesn't sound like he's going to miss much time in Congress, or that this will somehow prevent him from completing his term in office. Still, his current term ends in 2014, so that if he were somehow forced to step down, it would mean that Republican Governor Chris Christie would have the power to appoint an interim senator.

The Depressingly High Costs Of Cancer Medications

The New York Times reports that a newly approved cancer medication that may be able to marginally improve the quality of life for those afflicted with a certain form of cancer costs $30,000 a month.

The price of the new drug, called Folotyn, is at least triple that of other drugs that critics have said are too expensive for the benefits they offer to patients. The colon cancer drug Erbitux, for instance, costs $10,000 a month and the drug Avastin about $8,800 when used to treat lung cancer. The price of Folotyn “seems way higher than I heard of before,” Robert L. Erwin, president of the Marti Nelson Cancer Foundation, a patient advocacy group. “I can’t imagine there not being a backlash against the pricing.”

Drug makers in general have been raising prices sharply in advance of the possible passage of health care overhaul legislation, according to various studies. But the price of cancer drugs has been an issue for several years.

Critics, including many oncologists, say that patients and the health system cannot afford to pay huge prices for drugs that, on average, provide only a few extra months of life at best.

And Folotyn has not even been shown to prolong lives — only to shrink tumors. The drug was approved by the Food and Drug Administration in late September as a treatment for peripheral T-cell lymphoma, a rare and usually aggressive blood cancer that strikes an estimated 5,600 Americans each year. It is available for sale, but its manufacturer, Allos Therapeutics, does not plan to start actively promoting it until January.

A company that seeks to produce a medicine has a limited time in which to recoup the costs for those drugs under existing patent law. If they can't recoup the costs, they can't turn around and engage in further research.

Doctors and patients have to decide whether a drug is cost-effective in their individual cases. That's regardless of the actual cost - whether it's a few hundred bucks or tens of thousands for the course of treatment. But, that's a decision to be made by the patient and doctor and whether they want to incur the costs when a drug is uncertain to make a long term difference.

There's no real way around the high cost of these kinds of drugs, unless the government is going to step in and demand the costs be dropped - and subsidize the costs, which will ultimately result in higher costs spread among many other people.

As it is, the drug manufacturer is providing co-payment assistance and giving the drug free to uninsured patients who cannot pay for it.

If the government steps in to purposefully reduce drug costs by limiting profits and/or the prices charged to patients, the result will likely be the slowdown in research and development of new and improved medications and drugs to fight rare diseases that have a limited target population. Drug companies aren't going to spend hundreds of millions of dollars if they can't recoup that investment.

Are Certain Cancer Screening Benefits Overstated?

The answer may be a qualified yes.

The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated.

It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”
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Prostate cancer screening has long been problematic. The cancer society, which with more than two million volunteers is one of the nation’s largest voluntary health agencies, does not advocate testing for all men. And many researchers point out that the PSA prostate cancer screening test has not been shown to prevent prostate cancer deaths.

There has been much less public debate about mammograms. Studies from the 1960s to the 1980s found that they reduced the death rate from breast cancer by up to 20 percent.

None of this addresses the fact that screenings are extremely useful for those in high risk groups, such as those women who are on hormone replacement therapy or those people with a family history of cancer.

Screenings are general guidelines and just one tool in improving personal health. In fact, screening for colon cancer and cervical cancers have resulted in significant improvement in detecting cancers at an early stage with a reduction in advanced cases.

What this suggests to me is that PSA screening for prostate cancer and mammograms for breast cancer detection need additional or different tests to better and more effectively screen and catch cancers at early stages. The complexity and multiple causations (particularly breast cancer) of those cancer types make screening alone more problematic. It also means that oncologists need to better tailor treatments to the cancers picked up by various screening methods.

Moreover, a message that suggests that screening isn't effective is going to reduce the number of people who should be getting screening, resulting in more people needlessly suffering from advanced cancers.

The study also seems to indicate that the incidence of cancers may be overstated because some of the cancers that have been detected are ones that will not fatal or are shown to become metastatic (spreading through the body to other organs). Also, it may actually point out that breast cancers are particularly aggressive and may spread faster than the current recommended mammogram cycle (cancer spread invasively between mammograms).

In other words, this study needs further analysis and study to determine just what lessons need to be learned. Media reports that don't reflect and highlight this are going to do a serious disservice to the public.

An End of Life Quandary

The New York Times posted a nurse's account of a terrifyingly and heartbreaking end of life situation where a young patient died after receiving all manner of advanced treatments.

We recently had a patient on my hospital floor who painfully brought to mind that suffering child and the story of Omelas. He was young, in his 20s, and had undergone an allogeneic stem cell transplant as the only chance of curing his cancer. He had many of the more severe complications that can occur with this treatment. A virus had turned his urine red with blood. His immune system waged a battle against the transplanted cells, leaving him temporarily blind and causing his skin to age unnaturally. His liver was slowly failing. He had almost constant diarrhea and for long periods got his only nutrition intravenously.

For months he stayed on our floor, slowly getting worse. In the end he couldn’t live without constant transfusions. Every time he stood up he leaked blood. Then his mind started to fail, too.

His doctors continued to throw one last-ditch treatment after another at him. Not one of them made a real difference in the patient’s condition, and each came with its own set of potentially dangerous side effects. Finally, and against the express wishes of at least one of his doctors, his parents decided to stop all medical care. Soon after they watched their son die.

Scenes like this are all too common in U.S. hospitals today. That is why proponents of health care reform call for provisions that would encourage patients to talk about end-of-life treatment long before they get there. For this patient, a lot of money was spent on care that made him worse when it could have been used to make someone else better. But more than that, we prolonged his suffering, racked his body with one toxic treatment after another, and held out false hope to him and his parents.

The nurse, and some of her coworkers, say that they don't think that this was a worthy expenditure of health care dollars.

I'm not sure I'd agree.

Scenes like this are all too common when it comes to cutting edge technologies and treatment options. Medicine is littered with millions of patients who benefit from improved treatment because of new technologies and treatment paths that weren't possible before.

I think to my own family's experiences with cancer. Two relatives died of cancer in the early 1980s - before the advent of MRI, CT, and other nuclear imaging. The doctors at Memorial Sloan Kettering, where both received treatment - were tops in their field (and in the world) and yet they could do nothing to keep either from wasting away and dying. They tried radical cutting edge chemotherapy treatments that we now take for granted, but in the end, radiation treatments and chemo didn't get it done.

Now, those same cancers are treated with completely different outcomes - long term remission and cures. Advances in nuclear imaging and radiology allow pinpoint treatment and customized chemotherapy, giving a much better outcome. Yet, there are some cancers are still stubborn (see Kennedy's glioma or pancreatic cancer) and are perceived as a death-sentence. Even with gliomas and pancreatic cancer, there is a better chance of short term survival now than only a few short years ago, and the more that researchers and doctors get to treat such conditions, the better options become available.

The only way doctors gain the knowledge and expertise in treating incurable cases (which later become treatable and curable) is to treat them. Pursuing other options means that the pace of knowledge and advances in medicine slow.

I think that is an incredibly short-sighted approach.

So, while it is imperative for the families and doctors to discuss end of life treatments, making sure that all are aware of the outcomes and to prepare for death, it should be their combined decision taking all those factors into account.

Unconscionable: Veterans Administration Hospital Botches 92 of 116 Prostate Cancer Treatments

Not only did the hospital botch the procedures, but regulators not only overlooked the errors, but made attempts to allow the doctor to revise his treatment plan for some of those patients to make the errors "go away".

Most of the seeds, 40 in all, landed in the patient’s healthy bladder, not the prostate.

It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear.

He simply rewrote his surgical plan to match the number of seeds in the prostate, investigators said.

The revision may have made Dr. Kao look better, but it did nothing for the patient, who had to undergo a second implant. It failed, too, resulting in an unintended dose to the rectum. Regulators knew nothing of this second mistake because no one reported it.

Two years later, in 2005, Dr. Kao rewrote another surgical plan after putting half the seeds in the wrong organ. Once again, regulators did not object.

Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years — and then kept quiet about it, according to interviews with investigators, government officials and public records.

This is medical malpractice coupled with government failures. Not only did the doctors work for the Veterans Administration, but the VA failed to provide proper oversight or notice anything wrong with the treatment being offered in the cancer unit.

How many men suffered needless complications from this one doctor's malpractice?

One of the men didn't realize it was medical malpractice until he went to another hospital outside the VA to treat his condition and they informed him of the errors made by the prior doctors at the VA.

The problem at the Philadelphia hospital isn't alone. Several other cancer units at VA hospitals in Jackson, Miss., and Cincinnati, Ohio, were also closed, although the problems weren't nearly as widespread as the Philadelphia case.

In fact, none of the errors at this hospital might have been uncovered but for a clerical error where seeds of lower dosage were reported. That resulted in closer scrutiny by the NRC, which governs radiation usage, and the discovery of dozens of cases of improper placement of the seeds used in brachytherapy.

So, while the doctors in this program were contractors operating at the behest of the hospital, the doctrine of respondeat superior is going to hold the hospital liable because of the failure to oversee the program.

Specter's Atrocious Assault on GOP Over Jack Kemp's Passing

Sen. Arlen Specter, who just switched political affiliations in the US Senate because he's reading the tea leaves showing that he'd lose badly in the GOP primaries, now makes the atrocious claim he switched parties because the GOP should have spent more on cancer research, which would have meant former Congressman and former VP candidate Jack Kemp would have continued living. Kemp died over the weekend after a prolonged battle with cancer.

"Well, I was sorry to disappoint many people. Frankly, I was disappointed that the Republican Party didn't want me as their candidate," Mr. Specter said on CBS's "Face the Nation." "But as a matter of principle, I'm becoming much more comfortable with the Democrats' approach. And one of the items that I'm working on, Bob, is funding for medical research."

Mr. Specter continued: "If we had pursued what President Nixon declared in 1970 as the war on cancer, we would have cured many strains. I think Jack Kemp would be alive today. And that research has saved or prolonged many lives, including mine."

Mr. Kemp passed away Saturday, after fighting with cancer. Mr. Kemp ran for the White House in 1996 with Republican presidential candidate Bob Dole.

Sorry to break it to Specter, but that's about as atrocious a claim as one can find. It doesn't even begin to bear any rational relationship to reality. It's a spurrious and bogus claim, particularly because federal funding for cancer research increased nearly 50% during the 1990s under GOP control of Congress. That's not exactly chump change.

There have been tremendous advances in cancer research, and yet there will always be people who die from cancer. It doesn't matter how much money is spent, as old age and disease will eventually catch up with every person on the planet. We can only forestall the inevitable for a little while longer, and unfortunately, Jack Kemp passed away over the weekend after succumbing to cancer.

Had Specter focused on his own battle with cancer, he might have had a point, but even there, it was tremendous amounts of spending on research and technological developments over the years that have enabled Specter to survive and thrive after his own battle with Hodgkin's disease starting in 2005. For all the tremendous medical advances, it still comes down to an individual case and the specific situations - whether the diseases were caught early, how the patient responds, and other factors that go beyond spending on research and development.

For Specter to make his comments is absurd and shows an abject lack of class. He should be ashamed of himself.

UPDATE:
Shouldn't Specter be slamming the Administration and Democrats in Congress for contemplating a budget cut to the National Cancer Institute? As one of Jammie's readers points out, After all, the FY 2009 budget was $4.83 billion, while FY 2010 shows a $4.81 billion budget - that's a net loss of $200 million. Specter moved to the party cutting the NCI budget? How can he live with himself? Then again, it was always about what was best for Specter's career, political affiliations be damned.

Don Imus Announces He Has Prostate Cancer

The curmudgeonly host of WABC radio's morning talk show program, Don Imus, announced on the air this morning that he has stage 2 prostate cancer.

Controversial radio host Don Imus announced on his radio show this morning that he is battling stage II prostate cancer.

Imus, 68, known for his outspoken opinions on everything from politics to sports, offered no details on his prognosis, but added that he had full confidence "his doctors will beat it."

I wish him and his family well. Dealing with cancer is always tough, and this page goes into the classification and prognosis.

Imus has graced the pages of this blog in the past for outrageous statements, including a 2007 dustup with the Rutgers University ladies basketball team (which later accepted an apology from Imus) that cost him his job on CBS radio. Imus is suing CBS and MSNBC for their firings related to that incident.

Sen. Kennedy Released From Hospital After Collapse Scare

Sen. Ted Kennedy was released from Washington Hospital Center after tests revealed that Kennedy suffered a seizure because of fatigue.

Dr. Edward F. Aulisi, the hospital’s chairman of neurosurgery, said Tuesday that the seizure had probably been brought on by “simple fatigue” after a long morning in the cold at the inaugural ceremony. Medical experts said a seizure in a brain cancer patient was not unusual and ordinarily had no serious consequences.

Dr. Aulisi said that Mr. Kennedy was “feeling well.” He was held overnight for observation before his release Wednesday.

Mr. Kennedy, who began serving in the Senate in 1962, disclosed last spring that he was suffering from a brain tumor, later identified as a glioblastoma, the deadliest form of brain cancer. Less than two weeks later, he flew to Duke University, where he underwent surgery.

Good news for the Kennedy clan.