A new TV commercial shows kids eating hot dogs in a school cafeteria and one little boy’s haunting lament: “I was dumbfounded when the doctor told me I have late-stage colon cancer.”Nice!
Thursday, August 28, 2008
Wednesday, August 27, 2008
In the last few weeks, I've spoken to a couple Kennedy aides who all told me the same thing: Health care. Kennedy has told them that this is his final crusade. Aides who work in other legislative areas have been told that their issue areas are going to almost dissolve, and they'll become something like support staff for the health team. Kennedy means to pass a bill. He means to muster the full force of his legislative talents, his sprawling staff, his longstanding relationships, and even the poignancy of his condition. It will be his legacy. It is his dream.
Friday, August 15, 2008
Other studies indicate that moderate exercise has additional benefits like strengthened immune function and lower rates of recurrence. Studies at Dana-Farber found that nonmetastatic colon cancer patients who routinely exercised had a 50 percent lower mortality rate during the study period than their inactive peers, regardless of how active they were before the diagnoses.I wondered how they figured that out, so I read a little more about the 2006 study. It made sense to me that having a more serious presentation of colon cancer would make you more likely to be sedentary after treatment and also more likely to die from a recurrence or other cause. I wanted to see how they adjusted for that. The study's authors say they can't completely eliminate that possibility, but they picked patients at the same stage of the disease who had similar surgery and chemotherapy, adjusted the data for other risk factors of death, and eliminated from the study population people who died within six months of having their physical activity assessed. That said, the study doesn't have much to say about causation or the mechanism by which exercise might lower recurrence risk.
Wednesday, August 13, 2008
Here are some notes about how the study works and the side effects of the drug that I gleaned from the documents:
Patients must have completed at least four cycles of chemotherapy without any worsening of the cancer; 1, 2 or 3 previous treatments (chemo completed 3-8 weeks before being randomized into the study)
Randomized in either placebo arm or treatment arm; double-blind
14 days of pre-study screening; includes review of scans (process may take up to 3 weeks, I think; little confused by this part)
Study involves bloods every month; scans every 8 weeks
Kicked out of study if disease progresses or toxicity becomes unacceptable
No crossover from placebo arm to treatment arm
Greater than 20 percent side effects:
weakness and fatigue
mouth sores or sore throat
low red blood cell counts
low white blood cell counts
increased blood fat levels
low platelet counts
Less frequent side effects:
tingling sensation in the hands or feet
high blood sugar levels
increased liver enzyme levels
low blood levels of sodium, potassium and phosphate
nail discoloration and brittleness
Tuesday, August 12, 2008
The idea that sugar feeds cancer, if it was true, would understandably terrify anyone. It is this belief, though, that has helped to feed fears of refined sugars and flours and other ‘bad’ carbohydrates.
Recent stories circulating the internet and media have led many people to think that concerns over sugars are real and that they come from upstanding doctors at prestigious institutions. No one can blame them for believing sugar is linked to cancer. There are more than one million websites (a stunning 1,080,000 by last count) capitalizing on this fear and virtually none offering the science.
But it is nothing more than an urban legend, the result of misunderstood and distorted science.
But there is no truth to the rumor that sugar causes cancer, or that people with cancer shouldn’t eat sugar because it causes cancer to grow faster, said Dr. Timothy Moynihan, M.D., a cancer specialist at Mayo Clinic, in Rochester, Minnesota. He debunked this popular misconception in a recent article, explaining:
Sugar doesn't make cancer grow faster. All cells, including cancer cells, depend on blood sugar (glucose) for energy. But giving more sugar to cancer cells doesn't speed their growth. Likewise, depriving cancer cells of sugar doesn't slow their growth.
This misconception may be based in part on a misunderstanding of positron emission tomography (PET) scans. Doctors use PET scans to help determine the location of a tumor and see if it has spread. During a PET scan, your doctor injects a small amount of radioactive tracer — typically a form of glucose — into your body. All tissues in your body absorb some of this tracer. But tissues that are using more energy — exhibiting increased metabolic activity — absorb greater amounts.
Tumors are often more metabolically active than healthy tissues. As a result, they may absorb greater amounts of the tracer. For this reason, some people have concluded that cancer cells grow faster on sugar. But this isn't true.
...I think doctors have a strange way of grieving their patients.It's about him! Those plans, those thoughts -- all for naught! And now he has to deal with another patient, some drone "with darker hair and different clothes," another faceless object of his doctorly care. He feels too much, his cup runneth over!
Probably no one cares about our feelings when a patient dies, and that’s as it should be. Our personal loss, after all, is trivial — most patients we know only as patients. But we do have feelings, a confusing mishmash that includes disappointment and embarrassment, but is mostly a sinking emptiness.
It’s like this: caring for very sick patients is exciting, probably because doctors, like everyone else, become swept away by human drama and possibilities. Managing a patient places us in the middle of hard decisions, bitter truths and sudden hallway conversations. We become futuristic acrobats of the high tech and the extreme, rather than yesterday’s stodgy pillars of the community, dispensing advice and lozenges, a silver-haired presence to steady any uncertainty.
But then the patient dies and bam! it’s over, just when we had so much to say, so many plans. We are left alone with our hectic thoughts ricocheting left and right and nowhere to point them.
Then, within hours after the death, a new patient is installed in the same room. You look in and see a stranger with darker hair and different clothes, reading a newspaper from somewhere else. And with the new patient comes a new set of visitors, in ones or twos or crowded at the door.
Monday, August 11, 2008
I had once said something fatuous to him about enjoying tonight’s sunset, whatever tomorrow would bring, and he had replied that when you know you are dying you cannot simply “live in the moment.” You loved a fine sunset because it slipped so easily into a history, yours and the world’s; part of the pleasure lay in knowing that it was one in a stream of sunsets you had loved, each good, some better, one or two perfect, moving forward in an open series. Once you knew that this one could be the last, it filled you with a sense of dread; what was the point of collecting paintings in a museum you knew was doomed to burn down?The essay interweaves many threads -- Varnedoe's coaching of the Metrozoids, Gopnik's recollections of befriending his teacher, Varnedoe's last, bravura art history lectures, the 1984 Boston College-Miami game.
But there were pleasures in life that were meaningful in themselves, that did not depend on their place in an ongoing story, now interrupted. These pleasures were not “aesthetic” thrills—not the hang gliding you had never done or the trip to Maui you had never taken—but things that existed outside the passage of time, things that were beyond comparison, or, rather, beside comparison, off to one side of it. He loved the Metrozoid practices, I came to see, because for him they weren’t really practicing. The game would never come, and the game didn’t matter. What mattered was doing it.
That Sunday, he did something that surprised me. It was the last lecture of the Mellons, and he talked about death. Until then, I had never heard him mention it in public. He had dealt with it by refusing to describe it—from Kirk the ultimate insult. Now, in this last lecture, he turned on the audience and quoted a line from a favorite movie, “Blade Runner,” in which the android leader says, “Time to die,” and at the very end he showed them one of his favorite works, a Richard Serra “Torqued Ellipse,” and he showed them how the work itself, in the physical experiences it offered—inside and outside, safe and precarious, cold and warm—made all the case that needed to be made for the complexity, the emotional urgency, of abstract art. Then he began to talk about his faith. “But what kind of faith?” he asked. “Not a faith in absolutes. Not a religious kind of faith. A faith only in possibility, a faith not that we will know something, finally, but a faith in not knowing, a faith in our ignorance, a faith in our being confounded and dumbfounded, as something fertile with possible meaning and growth."
Friday, August 8, 2008
My husband Steve was diagnosed with epitheliod sarcoma in November 2007 and presented with over 50 spots on his legs , sides and back. He was told initially by his doctor, Dr. Lei chen, that he had a less than 10% chance or survival rate for more than 30 months. We were devastated. He is 35 years old and we have 3 kids. He was experiencing a stomache ache and before they would start any treatment they made him have a full physical. They did a CT scan on his stomache and found that the cancer had created vascular invasion and he had to have a mesenteric bypass. It was a huge operation!! That prolonged any treatement for the cancer for 2 months while he recovered. He then started chemotherapy and we were asked if he would be willing to try an experimental cocktail, and we of course said yes after the diagnosis we got. He just finished his 6th round and he now has only 12 spots on the PET with nothing bigger than 2 mm. The doctors are amazed at his response!! The cocktail he recieved was temodar in pill form 325 mg. worth for seven days along with cisplatin through i.v. the first three days and then a week later one i.v. dose doxil. He has been told recently that he cannot have any more chemo for "a while." He is now waiting to see if he can go on study for a maintenance drug that would hold the cancer right where it is for now in hopes that it won't grow until he can have chemo again. The only problem is that he has a 50% chance of getting a placebo. He wants to continue with the chemo but his Dr. is insisting that he can't. Please let me know if anyone has any knowledge of anything else that is working for this type of cancer.I believe he is being treated at the University of Utah. If anyone has any insights on where they should go from here, I'm sure she'd appreciate thoughts in the original thread.
Is extending life by a few months worth $50,000? No, says the UK’s National Institute for Health and Clinical Excellence.
That high price isn’t worth the benefit conferred by the drugs, NICE concluded, and buying the drugs would force the National Health System to deny patients other treatments that are a better bang for the pound. The cost-effectiveness limit for NICE is £30,000 per good-quality year of life gained, the Times says.
The currency conversion is $57,638. A year of good-quality life for less than $60,000. I'd pay more than that, but I find the calculation chilling. (More chilling is that some of the cost-benefit calculations used in the United States -- say for airborne contaminants -- value lives at considerably less.) In most places, the price of high-quality, comprehensive health care is restrictions on treatments that haven't proved their worth over large populations. But what about for you, an individual? There's always the chance of being an outlier on the survival cure; of getting, say, eight extra months instead of the two or three these drugs usually provide. And, as these new agents are approved for more indications, the revenues may fuel additional trials to develop combination therapies that may more meaningfully extend life.
But take a drug like Erbitux, which can in some contexts provide six additional weeks of median survival, with uncertain quality of life, for $62,000. Is that a good deal? How about three weeks? I recall it being reported at the ASCO meetings that Erbitux, which happens to be the drug Martha Stewart got in trouble for insider trading on, was approved for a lung-cancer indication because it increased survival by a median of less than a month.
Wednesday, August 6, 2008
A research program designed to enhance spiritual awareness for persons with a cancer diagnosis is accepting volunteer participants at the Bayview Campus of the Johns Hopkins School of Medicine in Baltimore. The program consists of a brief counseling intervention, including medical screening, rapport-building appointments, two all-day sessions that include psilocybin administration, and appointments to facilitate initial integration and application of insights gained. More detailed information is available at cancer-insight.org
Conducted by Drs. Roland Griffiths, William Richards and colleagues, this program is designed to help cancer patients who are suffering with some degree of psychological distress to become less anxious and depressed, and to become more fully engaged with life again. Psilocybin, the psychoactive ingredient in the "sacred mushrooms" that have been used in religious ceremonies by indigenous people in Mesoamerica for approximately two thousand years, is employed to facilitate the resolution of personal conflicts and to occasion states of consciousness that for some may be indistinguishable from visions and mystical experiences recorded in the history of religions. Psilocybin has not been found to be toxic or addictive, and is considered reasonably safe for persons without a history of serious mental illness, when administered in accordance with the safety guidelines published by the Hopkins researchers.
This deserves more attention than a quick-hit link, so I plan on checking out the cancer-insight site. I'll report back. (No, I'm not going to try to sign on for some psilocybin. My grasp on reality is already tenuous enough.)
Tuesday, August 5, 2008
Dear SICK GUY,American Imaging Management, Inc. ("AIM") provides utilization management service on behalf of Blue Cross and Blue Shield...