This article was published online by Huffington Post on April 7, 2015:
To hear the words "cancer" and "cure" in the same sentence from experienced cancer researchers is both breathtaking and unexpected. Researchers and top oncologists are usually cautious to a fault.
To hear that Congress is again trying to squeeze cancer research budgets is breathtaking but predictable. They've become frugal, also to a fault.
Such is the cruel irony facing cancer patients and researchers today.
Building on over 50 years of scientific progress, research leaders from cancer centers across the country are achieving stunning results that have led even the most guarded of them to use such formerly forbidden words as "breakthrough," "miracle," and "cure" in describing patient reactions and the potential outcomes of their virology and immunology cancer work. Much of this work has been supported by federal grants (National Institutes of Health, National Cancer Institute). Along the way, the continuance of many promising ventures has been jeopardized by Congressional refusal to sustain funding, even for breakthrough projects whose outcomes are already exceeding clinical expectations.
Virology and immunology research sounds mysterious but can be described in simple terms. Most cancers have mechanisms that make them invisible to the body's immune system. In other words, the immune system can't recognize them as dangerous and so doesn't attack them.
Researchers are now genetically modifying viruses that -- if left unchanged -- would have had the power to paralyze or kill their hosts. The genetic modifications turn formerly harmful and even lethal viruses (such as measles, polio, rabies, and HIV) into therapeutic agents. Rather than harming normal cells and spreading disease throughout the body, modified virus particles or virus-infected cells (in the case of HIV) are injected into solid tumors or delivered intravenously into the blood stream.
William C. Phelps, PhD, Director of Preclinical and Translational Cancer Research at the American Cancer Society, describes recent research developments as "one of those scientific situations where two fields (virology and immunology) collide to provide a breakthrough. Fifty years of studying viruses in excruciating detail has allowed us to understand how to engineer viruses in clever and useful ways to accomplish what immunotherapy needs to create cancer-fighting weapons."
Some of these therapies inject direct cancer-killing "oncolytic viruses" directly into tumors while others stimulate the immune system to recognize and attack the cancer cells. Dramatic clinical trials of such new combination therapies are underway at leading cancer centers nationwide with patients who have exhausted traditional therapies for recurrences of potentially lethal cancers. A sampling of these include:
Similar work is also underway at other cancer centers across the country but may have received less visible press coverage. Many of the resulting therapies could--if current outcome trends continue--be eligible for "fast track" or "breakthrough" designation by the Food and Drug Administration (FDA). Both of these FDA programs offer a framework for accelerating broad market approvals.
"So what?," you might ask. "Doesn't this show that we're winning this war?"
On the contrary, much of this breakthrough work is still in the research pipeline and not widely available. Statistics from the American Cancer Society show that the need for such treatments is still greatly outstripping theor availability.
In this country, over 1.7 million people are diagnosed with cancer and almost 600,000 will die each year. There are currently almost 15 million survivors, many of whom worry about whether their cancers will return. Millions more, both patients and family caregivers, are in the midst of prolonged treatments and unpredictable disruptions of their work and family lives. The costs to the economy in health care expenses and lost work time are massive.
You don't have to use the word "cure" to appreciate the possibilities. Evidence exists that the dramatic life-saving impact of the newest cancer care treatments can generate massive cost savings if the nation would commit to making "cancer-free" a more common outcome of cancer therapies that are available to an ever-increasing number of patients.
As a nation, we've proven our willingness to defend our homeland against external threats through military defense spending. Perhaps comparable medical defense spending could advance our internal war against cancer. By "piling on" and intensifying research funding now, through increased Congressional support of NIH cancer research budgets, we could finally break the cruel irony of under-funding potential cancer breakthroughs.
Jane Brody's March 23 New York Times article, "The Road to Cancer Treatment Through Clinical Trials," highlights the fact that a higher proportion of pediatric cancer patients than adults have the opportunity to participate in clinical trials. For adults, the proportion is only around 5%. The article highlights the potential dramatic impact of the right trial and details resources for finding appropriate clinical trials (most of which are listed on the Resources tab of this website). Brody also details several cases where new treatments have changed the course of the disease for trial participants.
Unfortunately the availability of trials is often a function of a medical center's size and location in a major metropolitan area, where larger numbers of trials are conducted. Nevertheless, it's important to know where appropriate trials might be available in case a patient from a rural area is able to travel to such a location for treatment. American Cancer Society Hope Lodges (31 nationwide) may be available to help with free lodging in these circumstances.
Brody's article also previews Ken Burns' eagerly awaiting six-hour series, "Cancer: The Emperor of All Maladies," which will be broadcast on PBS in two-hour chunks on March 30, 31, and April 1. Featured as a commentator throughout will be Dr. Siddhartha Mukherjee, author of the Pulitzer Prize winning book, The Emperor of All Maladies: A Biography of Cancer. Given the quality of Burns' and Mukherjee's past work, the series should be well worth watching for anyone facing the uncertainty or stress of a cancer diagnosis and anyone who is advocating on behalf of a cancer patient. Thanks to Jane Brody for calling attention to the issue of clinical trials and to this important piece of broadcast journalism.
Experts say that 95% of cancer pain is controllable, but you need to be dealing with pain management or palliative car experts as part of your care team. If you're looking for pain management resources, check the tab above labelled Resources and scroll down. Three good resources are now listed there to find information that will greatly improve the quality of life for those suffering pain during treatment.
The drive to protect our children ― to help prevent falls, ease cuts and scrapes, and deflect nasty experiences ― is at the core of parenthood. It’s baked in to the classic parental desire to “kiss it and make it better.” Yet if carried too far, to the point where we don’t level with children after a family member or the child himself is diagnosed with cancer, this drive can actually inflict lasting pain.
Today the Cancer Knowledge Network published my article on this topic, based on Things I Wish I'd Known: Cancer and Kids, my new book focused specifically on how to communicate about cancer with children affected by a personal or family cancer diagnosis and key lessons about how to manage a child's cancer. For more information, click on the CKN link or go to the "Cancer and Kids" tab of this website.
It's not just women who lament losing their hair when faced with chemotherapy treatments, most of which are hostile to hair. Even four-year-old Eric was upset to have to shave his head in advance of his aggressive treatment for a rare lymphoma.
Well, the New York Times (Tara Parker-Pope) wrote on March 9, 2015 of a new treatment that applies a cold cap to the scalp before, during, and for two hours after a chemotherapy infusion. Apparently the concept has been in practice for over 20 years, but new and improved technology has just gone through its first clinical trial and isn't yet available in most hospitals. It's a good sign of a new development that offers both the opportunity for those in treatments to boost their self-esteem during chemo and increased privacy for those who don't want to walk around virtually advertising, through their baldness, that they're in cancer treatment.
For more information about the concept, history, and alternative types of caps that are being introduced to medical centers for rental, you may want to visit The Rapunzel Project. This site also offers information about Cold Caps Assistance Projects, which helps patients to cover around half of the $600 per month rental expense, depending on need. For access to the supporting research, information about how to get a "starter kit," tips for hair care during chemotherapy using the caps, and a list of the hospitals currently either offering cold cap therapies or with the needed freezer equipment to do so, see the CCAPS site.
Also, you may want to see The Cancer Knowledge Network's blog (April 17, 2015) on this topic.
Cancer patients for whom standard treatments haven't worked often feel desperate to find a clinical trial that can extend their window of hope. Yet many either can't qualify for or can't get into an appropriate trial. Often this happens because the controlled-experiment nature of the trials poses such stringent requirements and precludes the sickest patients from participating.
The good news is that precision medicine (see my blog posts of December 31, 2014, and February 3, 2015, below) is now staging a new and unconventional type of clinical trial that may convince the Food and Drug Administration to accelerate approval of new, genetically targeted cancer treatments.
The concept, described in Gina Colata's February 25 The New York Times article, "A Faster Way to Try Many Drugs on Many Cancers," is based on genomic analysis of an individual patient's tumor for known mutations that may contribute to the growth of cancers that strike may different body parts. In the past, potential therapies were tested and then approved to address cancers of particular organs or body systems. The new "basket trial" approach uses drugs already approved for specific genetic mutations in cancer of a given organ or system to treat patients whose cancers (regardless of where they appear in the body) are characterized by the same genetic mutations. In other words, the treatment is governed by the genetic mutation that is causing the cancer, rather than by the particular kind of cancer or body part where it appears. This is why these trials are called "basket studies" (because they lump together different kinds of cancer).
This kind of trial isn't saving every patient who is enrolled, but when results for a number of patients with different kinds of cancer are dramatic enough, a new therapy may be approved far faster than in traditional clinical trials. Each trial will be smaller than traditional clinical trials and will be conducted without a traditional control group (a group of patients who don't receive the new medication that's being tested). As a result, the FDA's office that approves new cancer drugs will be looking not at the relative efficacy of the new treatment in comparison with standard treatments, as in the past, but rather at whether the population of cancer patients will benefit significantly from access to the drug.
The National Cancer Institute is coordinating such basket studies nationwide to amass data quickly enough to identify and accelerate apprpoval for those drugs that appear to change the treatment "game" for cancer patients. The potential impact of such trials is breathtaking.
On February 19, The New York Times ran an OpEd entitled "My Own Life: Oliver Sacks on Learning He Has Terminal Cancer." It's worth reading on its own, as a commentary on how life looks when it's lived under the shadow of knowing that cancer is winning.
In addition, one of the people who commented on his article, Elizabeth Fuller from Peterborough, New Hampshire, offers remarks that are at least as compelling as Dr. Sacks piece. She wrote, in response to Dr. Sacks editorial, that she attended a friend's funeral in recent months where she heard a moving quote about immortality, "that we do live forever, and not just as memories. What we have done, said, and written lives on in ways big and small, often subconsciously, in those whose lives we have touched."
Both Dr. Sacks OpEd and Ms. Fuller's commentary offer words of solace to anyone who has lost a loved one to cancer, to think about how that person touched others in a lasting way. Second, they offer a reminder to all of us who care about cancer and are committed to ending its rampage that every time we reach out to touch someone else through our caregiving, advocacy, or active support of cancer research, we're doing lasting good that matters long after we're gone.
If we could all touch others' lives as she suggests, wouldn't the world be a better place?
The time has come to recognize that just because two people may carry the same diagnosis for a seemingly similar medical condition, the most appropriate treatment may well differ for each, based on individual patients' unique genetic make-up. The President announced this week that his proposed budget will not only seek to restore some of the cuts in health research funding that sequestration inflicted in the budgets of the National Institutes of Health and the National Cancer Institute, but will alaso propose a new "precision medicine" initiative.
This terminology may be new to the layman reader. Two resources that may help explain the term "precision medicine" are:
While the total budget for the new initiative is small ($215 million) in relation to the opportunity, it's a beginning. Hopefully public pressure will move this initiative forward and make it more robust over time, regardless of what happens to other budget line items. One or both of these articles is worth a read if the topic is new to you.
While cancer and diabetes are cited in the articles as potential targets for precision medicine, this combination of technologies (genomics, immunomics, proteomics, and "big data") has potential to help the thousands of people who are afflicted by less known conditions like dysautonomia that are both hard to diagnose and harder to treat. The future is before us. The only question is whether we, as a nation, will have the will to realize its potential.
The National Cancer Institute (NCI) of the National Institutes of Health has reorganized its National Clinical Trials Network (NCTN) to consolidate nine cooperative networks of medical and research centers that conduct multi-site cancer clinical trials into four groups. According to Cancer Today Magazine's Winter 2014 issue [published by the American Association for Cancer Research (AACR) in December 2014], this action will centralize the ethical and scientific review of trial protocols for multi-site trials and impose stricter timelines for their execution. The intent is to accelerate participant enrollment, shorten trial timeframes, and improve patients' access.
In addition, the community-based health program, the network of community hospitals which enrolls around 40% of trial participants, is being wrapped into a new NCI Community Oncology Research Program (NCORP) with 46 sites nationwide. Twelve of these sites have been designated to draw least 30% of their trial participants from racial or ethnic minorities or from rural areas. NCORP will also study which treatments offer the best return for their investment, generating important resource allocation insights for use by the government, organizations, health systems, and practitioners.
Total cancer research and clinical trials funding is still meager, but these initiatives offer the potential for existing spending to have greater efficiency faster than in the past and to broaden patients' access to appropriate trials.
My new book, Things I Wish I'd Known: Cancer and Kids, is now available on Amazon.com and BarnesandNoble.com in e-book form. The print book is now from both and will be available from this website www.thingsiwishidknown.com by January 28.
This short book was written for cancer caregivers who are responsible for helping children understand what a cancer diagnosis means for a loved one or for themselves. The cancer experience shakes most caregivers to their core. It is even more compelling and poignant when it involves children.
Thousands of families each year face this shocking reality. Based on interviews with caregivers who have first-hand knowledge, this book is intended to help anyone facing a cancer diagnosis affecting a child, either as the patient or as a member of a family. It offers advice and cites resources to help discuss cancer with children of different ages, manage the impact of the disease on their daily lives, navigate treatment for kids with cancer, and deal with children's grief in the event of a death in the family.
In short and direct language, tthis book offers guidance and resources (both references and internet links) for communicating and taking action in five areas:
If you're pressed for time and need to know what to do on these topics, you can't go wrong with this book. The references provided are comprehensive and will save you time and energy as you navigate through a challenging situation. The e-book contains live links to most of those resources; the print book offers those links in footnote form. Early reader comments are offered as testimonials on the website thingsiwishidknown.com.
Charlotte is 40 years old. Three years ago, diagnosed with ovarian cancer, this single mother of two survived the agonies of traditional chemo, which brutalized her body. She thought she had beaten the cancer, until it came back four months ago.
New newly remarried, it was hard to for Charlotte to feel hopeful, even though she was being treated at a world-renowned cancer center. Looking forward, she anticipated yet another round of nausea and pain without knowing whether long-term survival was in the cards.
Medical science has put a bright light on Charlotte's horizon because of huge strides made since her earlier treatment experience. Charlotte's medical team took a sample of her cancer, grew it in a lab, and learned, through genetic testing, that a specific genetic mutation had made her cancer more likely. With that finding in hand, her team learned that she was eligible for a Phase I clinical trial that was just starting. She is among the first 40 human patients (following animal testing) to take an experimental drug, together with two other drugs (one of which is in Phase III trials).
She participated in that trial for eight weeks, taking three pills each morning and one each night. Weekly she had blood draws that were subjected to rigorous testing to modulate medication dosage and track progress.
Interim results now look good: All of the key blood markers have been trending positively week after week. Her January 2 CT scan (as of this January 6 update) revealed that her tennis-ball-sized tumor had shrunk 6%, an amount that may seem small, except that it had continued to grow while she was taking standard chemo; right now, any measurable shrinkage is enough to induce celebrations in her household. Even more important has been her positive quality of life during treatment: Charlotte feels great and looks great, and now she has factual reasons to be hopeful. Her medical team has now reducced the frequency of her visits and monitoring to monthly, instead of weekly.
"I'm just 40, and I'm not ready to give up. I'm not only going to beat this," she told me, "but I'm also helping make history. " She's got ovarian cancer, and she's grinning for all she's worth.
Charlotte is living proof of my latest Huffington Post article on precision therapies as the future of cancer treatments. She is both meeting and making history, and in the process she's demonstrating remarkable courage and giving us all more hope.
Smoking is a proven way to kill yourself. On average, smokers die 11 years earlier than non-smokers.
So if someone you love is still smoking and you want that person to be in your life for the rest of your own life, try asking them the following question:
Would you knowingly ingest rat poison (arsenic), embalming fluid (formaldehyde), lighter fluid (butane), tar (blacktop paving material), or insecticide (nicotine)? These are only some of the poisons built into cigarettes. Smoking is responsible for one of every three cancer cases and one in five US deaths each year. For every smoking death, 30 more people are suffering from cancer, chronic bronchitis, emphysema, and other life-threatening diseases.
By continuing to smoke, your loved one is exposing you to these risks. Help your loved one help you. Spread the word!
Most of us are used to getting up in the morning and facing the day without health limitations . . . until a serious illness hits us or someone we care about. Many of us haven’t given a moment’s thought to the what-ifs — especially the what-ifs associated with a potentially life-threatening condition.
My 20+ years of volunteering with the American Cancer Society, and my experience interviewing nearly 100 cancer caregivers and writing a book about their learnings, have been a wake-up call for me. I have talked formally or informally with hundreds of people who have faced potentially life-threatening illnesses for themselves or their loved ones. Some of those people are thriving today, and others have died.
Regardless of their personal outcomes, all of them faced the need to think ahead about their health and to talk with loved ones about the most sensitive issues: What if I don’t get better? How can I avoid debilitating pain? How can I make things easier for myself and my loved ones? How can I ensure that my medical team carries out my wishes? Are there circumstances (like letting my children travel to my side) under which I would like them to override my wishes?
In general, these people said they wish they’d had those sensitive conversations earlier, rather than later, and they wished they’d had tools to help make those conversations easier and more complete.
These kinds of conversations are a little like the conversations saying "good-bye" to a loved one who is suffering from advanced cancer. As Deborah O's husband said, "consider saying good-bye before your loved one becomes too ill to do so, even if it turns out to be like the Rolling Stones Farewell Tour which, I think, has been underway since the early 1990s."
When you read about the costs of new cancer chemotherapy drugs, it can truly take your breath (if not your house) away. Recently Reuters and Bloomberg News reported that Amgen's newly approved drug, Blincyto (blinatumomab), for Philadelphia chromosome-negative precursor B-cell acute lymphoblastic leukemia (B-cell ALL) will cost an average of $178,000 for the average patient. Numbers at this level — one of the most costly of cancer treatments — are horrifying to anyone who is facing this form of ALL.
If this is a drug that will make a difference for you or your loved one, don't despair (yet): Check out Amgen's patient assistance website (http://www.amgenassist.com/support_programs/assistance_programs.jsp). This particular drug may not yet be showing as the date of this posting, but you can call their oncology assistance hotline at 1-888-427-7478 from 9 am to 8 pm eastern time. They can put you in touch with foundations that may be able to provide help in funding your treatments.
You may also be able to get help from three other organizations:
Your oncologist or cancer center's patient navigator or social work department may also be able to provide help finding support.
For those of us who work toward a cancer-free world, a world in which cancer is something you live with and not something you die from, "precision medicine" offers long-term hope. My Huffington Post article ("4 Rays of Hope for 'Precision' Cancer Therapies"), posted on December 16, provides an overview of emerging directions in cancer research.
Very simply, research is seeking treatments that target only the cancer cells and don't damage healthy ones. Such treatments, known as "precision medicine," offer hope to improve both survival and quality of life for cancer patients. The combination of developments in genomics (study of how each person's genetic make-up creates predilections toward or resistance to certain diseases), proteomics (study of the proteins and enzymes that our genes excrete), immunomics (study of ways that the immune system might be stimulated to fight certain cancers), and big data ("informatics") are potential game changers.
This article tries to present a layman's overview of some highly sophisticated scientific work that generates longer term hope for all of us. It will take lots of time, sustained cancer research funding, and extensive investment in data collection, storage, and analysis systems to realize the promise. That won't be quick or easy, but it's exciting to know that there's significant hope on the distant horizon.
Thanks to Dr. William Phelps, Ph.D. and Director of the American Cancer Society's Preclinical and Translational Cancer Research Program, for his contributions to the article, for making truly complex concepts accessible to all of us, and for investing his personal energies in a cause that will benefit us all.
I've been engaged in cancer advocacy for years. Advocacy is the process of trying to educate and influence legislators to shape public policy in a direction that can help a particular cause. (Legislators weren't born "smart" about every topic they encounter—they often need educating to understand why something we want them to do is so important)
For me, the cause is help to cancer patients, particularly the help that could come from increasing Federal cancer research funding. Yet our Congress is being penny-wise and pound foolish:
The American Cancer Socierty's Cancer Action Network (www.ACSCAN.org) and advocates from major cancer organizations and cancer centers are all pressing for increasing research funding. Other health organizations are pressing for increases in funding for their disease areas.
Sustaining and increasing research budgets for major life-threatening diseases just makes good sense. To some of us, it's as natural as motherhood and apple pie to put money where it can save lives in the long term.
Yet recently I had a wake-up call on this topic. I was volunteering at the Making Strides Against Breast Cancer event in Boston where we were circulating petitions to Congress to increase Federal cancer research funding. You can identify most breast cancer survivors who are in attendance because they register and wear a banner that says "Survivor." Curiously, several of those survivors refused to sign the petition. Each has experienced the terror and challenges of breast cancer on herself and her family. (On that day, all were women.) Many have lost other relatives and friends to the disease. All who were there were raising money for the American Cancer Society, some of which goes to research. And yet some survivors wouldn't add their voices to the chorus by simply adding their name and zip code to a petition to ask Congress for appropriate action.
Have we gotten to the point in our country where rampant politics or obsession with confidentiality are stopping us from speaking out for what's right? Or are we just not willing to speak out, lest it sound politicly incorrect or require us to go out of our way and do something out of the ordinary?
It's a certainty that we won't finish the fight against cancer in our lifetimes if we don't start funding research on a predictable enough basis to inspire young researchers to go into and stay in the field and to sustain the long-term projects needed to discover breakthroughs. It's also a certainty that there's power in numbers.
Those of us who have had cancer must speak up and tell our legislators that we expect them to sustain this important priority. That's not hard work. It's just good common sense.
Sammy is a professional advocate. She is a professional in the field of helping prevent and deal with the consequences of sexual assault. She works with people who have faced significant threats to their psychological and physical welfare, and she helps them to overcome both traumas. So it's no surprise that when her 45-year-old husband was diagnosed with bladder cancer, Sammy sprung into full action mode.
Initially he was treated at a community hospital where things just didn't seem to be going well. After his initial surgery, he not only didn't get the kind of patient focus that every cancer patient needs psychologically, but they left after his initial recovery without any information about what to expect or do moving forward. Convinced that he wasn't getting the best treatment, Sammy moved into the void.
She used what little information they had been given to seek out, on line, hospitals offering state-of-the-art treatment, and she found a cancer center in one of Boston's best hospitals only two hours from home that specialized in bladder-saving surgery. From the moment they consulted with the multi-disciplinary team that offered this specialized treatment, Sammy and her husband felt a sense of relief. The four physicians with whom they met, each representing a different specialty, were working together to plan her husband's course of treatment, a series of steps that would attend not only to his long-term survival but would also preserve his quality of life in the interim. The staff have been attentive; each doctor and nurse has followed up with him after every visit to ensure that each of them has done everything possible to answer their questions and to advance his well-being.
Now, three months after their first Boston consult, as I talked with them at Boston's Astra-Zeneca Hope Lodge Center, both are beaming. They've learned that he is already cancer-free, as a result of both surgery and initial rounds of radiation and chemotherapy. Even though the most aggressive chemo lies ahead, chemo that should sustain his cancer-free state, they are both wearing non-stop and contagious smiles. Not only has his life been saved, but his quality of life has been preserved so he can enjoy raising their young son.
There's a moral to this story: Sammy took charge. She did her research. She questioned what was being offered locally. She applied her professional skills to the problem her husband needed her to solve, and they both already see the benefits of having done so. Cancer caregiving isn't easy. In fact, as Sammy says, the stresses for the caregiver are sometimes challenging and unexpected. But for Sammy, her strong coping skills have generated early positive outcomes that will sustain them through his remaining treatment and beyond.
Take a lesson from Sammy. You have nothing to lose in taking charge of your loved one's care.
It would be easy to feel overwhelmed by negative news from all over the world, whether the issue is gun violence in this country, the border crisis and immigration issues, the tragedy unfolding in Ukraine, or the violence persisting in Israel / Gaza and other hot spots in the middle east. . . . So every once in a while, when people show their finest instincts, it's worth sharing the good news.
That's what happened at my golf club this past weekend. Golf tournaments are notoriously weak fund-raisers because the courses where they are held often charge so much for use of the course and the meal that inevitably accompanies the golfing event.
Back in March, I raised with the club's ladies' golf board the idea of a charity golf tournament to benefit The Cancer Support Community—Massachusetts South Shore (CSS-MSS), which provides free psychological and social support for adults at any stage of the cancer experience, whether they are the patients or the caregivers.
The idea had to move through various channels before being blessed in mid-June as a club-wide event scheduled for July 27. We had exactly five and a half weeks to get a committee organized and to mobilize both members and staff. It felt like we had Mount Everest in front of us, but a strong and motivated event chair and a carefully selected team of people got on the case with a vengeance.
The net result: Don't ever let anyone tell you that something amazing and important is impossible.
Once we knew the event would come off without a hitch, we started to worry about troublesome weather. It rained off and on all day during the event, but there was no thunder or lightening, so no one cared. Everyone had an amazingly fun time. The auctioneer was sensational. Spirits were high. In fact, several people came to check out after the event and wrote additional checks to the charity because they were so invested in the cause and the event's success.
An amazing amount of money was raised--$33,000 net, more than 10 times my original estimate, but more importantly, this group of people forged a sense of community and shared compassion for a cause that's bigger than any one of us. The cause mattered to all of us, and the results were memorable. The funds raised will all go directly to program support for those who are dealing with the life-changing impact of cancer and who are feeling truly alone.
Maybe sometimes we just need to be reminded what it really means to have a bad day, how lonely a cancer diagnosis may make you feel, and what positive impact each of us might be able to have if we reach out, beyond ourselves, and help even one person who is having a hard time dealing with cancer and its implications.
In the face of a disease that's cruel and defies a silver-bullet cure, we're making progress day by day, person by person, gene by gene, and support group by support group. That's worth remembering and smiling about.
I hear cancer stories every day, but this morning's was a dilly.
Sharon was diagnosed two years ago with ovarian cancer, at age 36. It was pretty serious then, as is any cancer at that age. She was treated at an affiliate of one of the world's best cancer hospitals, in the Boston area. Her treatment was so severe that she was close to death before the cancer was finally brought under control. Except for almost dying from cancer, she was strong as an ox, and that's fortunate since extensive surgery was needed to remove her ovaries, uterus, and some other organs and tissues that might have been reached by an errant cancer cell. After all, she was young, with a husband and two children. She had lots to live for. And she trusted her medical team.
Six months ago, 18 months after her treatment ended, a scan revealed a spot on her liver. Just a spot. Her physician, supposed to be one of the best, said "We can't do a biopsy, so let's just watch it. There's a chance it was just scar tissue from the earlier surgery." That was six months ago. She didn't ask for the next scan to be sooner. She knew she couldn't yet be declared "cancer-free" after only 18 months, but she trusted what she was told.
Last week (after six months of waiting), Sharon went in for another scan, and the spot that was "noticed" six months ago was in fact a sign of metastatic cancer. It's back with a vengeance. She now has a golf-ball-sized tumor in her abdomen, spots on her liver and lungs, and more. She's back in heavy chemo and doesn't yet know the prognosis. She trusted the doctor who said, "Let's just watch it." She didn't press or push back or say, "What else can we do to make sure? Why not do more frequent scans? Is there anything we could be doing now to prevent trouble down the line?" Now Sharon's fighting for her life again, and the odds aren't getting any better for her.
The moral of Sharon's story, at least for me, is that you must must must push back when something looks suspicious on a test or a scan. You must take charge of your own care and not trust everything that even the best doctor says about watching and waiting and "let's see what happens." That's because it's your body. Waiting too long in a questionable situation, with a potentially lethal cancer, may just give you a little trip to Hell, and only if you're lucky will it be a round trip ticket.
So . . . You must be your own advocate. You must ask every possible question. You must ensure that the watching of something questionable or suspicious or just not right is frequent enough that it won't lead you down an irretrievable bad road.
Sure, you need to trust your physicians, but you also need to remember that no one values your life as much as you do, and you've just gotta push back.
The New York Times, on May 9, carried an article entitled "Patient's Cells Deployed to Attack Aggressive Cancer." The title alone caught my attention and offered breathtaking hope for patients with advanced cancer.
The story summarizes a research experiment conducted at the National Cancer Institute (NCI). Researchers sequenced the genome of the potentially fatal cancer that whose cholangiocarcinoma (cancer of the bile-duct) had metastasized to her liver and lungs. Standard-of-care chemotherapy wasn't working, so she had nothing to lose in trying an experimental treatment.
Researchers at the NCI studied the genetic pattern of her cancer and discovered a particular mutation. Then they identified cells in her own immune system that could attack the cells that had the mutation. They cultivated those cells and injected billions of them back into her body. She's not cancer-free, but her cancer has receded enormously, and she has survived a nearly fatal prognosis almost one year later.
This kind of treatment is called "adoptive cell therapy" and has potential to treat several more common cancers. Such a treatment has, so far, only helped one patient, although a similar approach has been used with a couple of melanoma patients. It is now being studied at NCI and a small number of other labs for its potential to attack other types of cancer.
While this development isn't yet available in a nationwide clinical study, it offers more than a glimmer of hope on the horizon and illustrates the dramatic progress that could be made if:
Today I posted an article on Huffington Post on the urgency of advancing clinical trials for invisible cancers (http://www.huffingtonpost.com/deborah-j-cornwall/clinical-trials_b_5266765.html?utm_hp_ref=healthy-living). Many of these cancers — like mesothelioma, pancreatic, ovarian, and many types of mucinous (non-tumor) cancers — aren't discovered until they're too far advanced to cure.
After posting the article, I learned about another important place to find clinical trials for mesothelioma (http://www.mesotheliomaguide.com/treatment/clinical-trials/). Apparently there is also a recent development from a Stage 3 clinical trial that warrants the attention of current patients facing advanced mesothelioma diagnoses. An article describing it can be found at http://meso.gd/1fZmvk0. The treatment being developed is specifically for people with Stage III and IV diagnoses who are experiencing relapses and is based on the principle of angiogenesis (constraining the development of blood vessels within tumors) that has proven powerful in treating other cancers. It is still not a cure, but it prolongs life, which may be the first step toward a cure.
The statistics show that many patients diagnosed with these kinds of cancers at an advanced stage would be willing to consider participating in a clinical trial if they knew they existed and what impact the trial would have on the quality of the time they had left. I hope you'll take a look at the article and let me know what you think. The urgency of this issue can't be overstated, so if you or a loved one or friend is in this situation, ask your oncologist what kinds of trials might make your remaining days more comfortable while contributing to medical science so other lives might be saved in the future. That's a way to make sure that cancer won't win in the future.
Anyone who has been through the cancer space knows about support groups that involve meeting, chatting online, or engaging in telephone conference calls. Some people living with cancer reach out readily to embrace such resources. Many discover that dialogue with a social worker or a group of people facing similar concerns helps them overcome the isolation that accompanies a serious cancer diagnosis and may even offer some useful strategies for daily living. Others say they're uncomfortable sharing their deepest hopes and fears with folks they don't know, or they may say they're fine and don't need that kind of "warm, fuzzy stuff." Still others are in denial.
What many patients may not realize is that seeking emotional and psycho-social support for themselves can actually be a true gift to their caregivers, both during and after treatment. It's a powerful message, but it may be unspeakably hard to carry out when you're still in shock from the facts of a nasty diagnosis.
Take Paul. He's in his mid-40s and is dying of a particularly virulent esophogeal cancer that was diagnosed less than six months ago. His surgery and recovery were difficult, and he's miserable all the time. He had just changed jobs a couple of months before, and his new employer has just terminated him because Paul is too sick to go to work. His oncologist has told him that no further curative treatment is possible, and Paul now has nothing meaningful to do all day except feel miserable and worry about what's to come.
His wife had only been working part time and from the house, spending much of her time raising their pre-adolescent children. Now she's faced with having to find a full-time job fast that offers both a reliable income stream and full medical coverage so they can avoid paying huge amounts for his COBRA coverage.
Their children know that Dad's sick, but they don't know that he's dying. What they do know is that Dad's not himself—he's cranky, complaining, morose, and unable to spend any quality time with them. He's not good company for anyone. He won't even talk to them. He's feeling sorry for himself and feeling hopeless. In short, he's become so introspective and emotionally consumed by his cancer 24/7 that the Paul everyone knew and loved is gone, even though Paul himself is still alive.
If you raise the issue of support to either Paul or his wife, you get a quick brush-off. Paul won't think of it, saying it's his life and not anyone else's to share, and rejecting any efforts to convince him otherwise. His wife simply doesn't have time to seek support because she has to find a job fast, so they don't deplete all of their financial resources in his care. They're both feeling trapped, and both desperately need help they're not willing to seek out.
What no one is considering yet is the impact that Paul's current state of mind is having on the entire family unit and the way it will affect their ability to heal after he's gone. If he were in his right mind—if this were life as it used to be—he would never think of neglecting his wife and children. But Paull is not in his right mind. He's overwhelmed with his cancer experience. That's understandable, but it's hurting everyone in ways he would never have intended.
The best thing that Paul's oncologist, or his wife, or his minister, or his best friend could do for him is to wake him up to life beyond himself, that his family is facing the prospect of losing him and that the more positive and loving memories he can create today and tomorrow and next week, the easier it will be for them to heal. Whether help comes through a support group at his cancer center or through one-on-one counseling, or through hospice care, the most valuable gift he can give to his family and to himself is the choice to savor every day as it comes and to create new, positive memories for his wife and children to cherish after he's gone.
That won't be easy, but it may help him remember the joys of his earlier life and to feel that he's creating a comforting safety net for those he loves the most.
My latest Huffington Post article, http://www.huffingtonpost.com/deborah-j-cornwall/symptoms_b_4804631.html, deals not with cancer, but with what are called invisible diseases. These are diseases that present a bundle of symptoms that could be mistaken for other conditions and that are unrecognized by many traditional physicians. Often these are diseases of total-body systems (adrenal, autonomic nervous system, and so on) that may be recognized only recently by medical school programs. In that regard, they may share some things with rare cancers, in that it takes time, effort, and persistence to identify them. The major difference is that unlike cancer, some of these are debilitating but not life-threatening. I hadn't known about these until a relative, Val, shared her story. It's moving and provocative.
Any one who tracks news reports on a regular basis sees every day stories that are attention-grabbing, which can often mean horrifying, deviant, shocking, or tear-inducing. This week I had a tear-inducing experience on the good side--the side that shed light on those among us who represent all of our better instincts. I attended a "Gala" fund-raising event in Boston's TD Garden (down on the floor of the sports venue) to benefit the AstraZeneca American Cancer Society Hope Lodge in Boston.
Thanks to hundreds of attendees and sponsors, this event raised a net $1,000,000 to support the Lodge.
The generosity of donors, both before the event and on site, and the generosity of survivors and current patients in sharing their stories and their impressions of the hospitality and support they found at Hope Lodge, were almost overwhelming. The event honoree, Jim Foster (CEO of Charles River Laboratories), was masterful in the support he mobilized from his organization, the business community, and his family. Charles River's generosity in providing packages that enriched the live auction and generated a literal "feeding frenzy" among bidders helped bring the event over the top.
An event like this one and the widespread involvement and support that makes it work really reminds us about what really matters--what it really means to have a bad day and how our shared better instincts to support each other can spread powerful feelings of goodwill, mutual appreciation, and the fulfillment of giving back. In this season when we remember the Boston Marathon tragedies, and when every one of us knows someone who is touched by one health and survival challenge or another, let's give thanks for people who put their money where their mouths are and make the world a truly better place for the rest of us.
I met Debra Madden 9 months ago, at a conference sponsored by the Drug Information Association where I met a number of cancer and rare disease advocates. She is a remarkable person whose own journey through the world of cancer twice as a young adult has shaped her advocacy to help others understand the diagnostic challenges and lifelong implications of young adult cancers.
Debra maintains a blog where she interviewed me and placed our conversation in the context of her own experience. It's good reading. You can find Debra at Musings of a Cancer Research Advocate. She's also generous with her insights and helped influence my most recent Huffington Post Blog on the challenges that many people face in obtaining a diagnosis when the symptoms are uncommon. She's a champion for cancer research and a wonderful human being.