By Deena BeasleyLOS ANGELES, May 15 (Reuters) - After decades of usingone-size-fits-all therapies to combat cancer, doctors are usingnew tools to help decide when their patients can skipchemotherapy
Richard Meyer's insight:
After decades of using one-size-fits-all therapies to combat cancer, doctors are using new tools to help decide when their patients can skip chemotherapy or other harsh treatments.
An approach to oncology that has been in place for decades is beginning to yield to an arsenal of long-term clinical studies, genetic tests and novel drugs that target cancer cells and their infrastructure.
"What is happening is a combination of new technology and more-targeted cancer drugs," said Dr Sandra Swain, medical director of the Cancer Institute at Washington Hospital Center and president of the American Society of Clinical Oncology (ASCO). "We've tried the approach of big, nonspecific treatments ... We have found that throwing chemo at patients has not (necessarily) cured them."
Traditional chemotherapy drugs work by interfering with the entire body's system of cell replication, causing harsh side effects like fatigue and hair loss.
Since the completion of the human genome project in 2003, scientists have made progress in unlocking the genetic basis of a range of diseases, including cancer. That has paved the way for genetic testing as well as drugs that block specific pathways that cancer cells use to grow and reproduce.
Such targeted cancer drugs, which sometimes preclude the need for chemotherapy, are being sold by companies ranging from Pfizer Inc, the world's largest drugmaker, to Ariad Pharmaceuticals Inc, which early this year launched its first drug, to treat leukemia.
The use of Apple iPads for certain tasks in an internal medicine residency program fell short of initial high expectations, although users reported overall satisfaction with the tools, according to study results published in an article in...
A study conducted by researchers at CVS Caremark and Brigham and Women's Hospital and published in the May issue of the American Heart Journal found that non-white patients had 50% greater odds of statin medication non-adherence compared to white patients, while women had 10% greater odds of statin non-adherence compared to men.
The researchers noted that there are a number of potential reasons for non-adherence among women and non-white patients. For example, active prevention of cardiovascular disease may not be a priority for women and their healthcare providers because of the common misconception that women are less at risk than men. In addition, women also frequently serve as informal caregivers for family members and may be further impacted by the fact that caregivers frequently have lower rates of medication adherence.
My agency was recently invited to participate in a pitch about which I was especially excited. The pitch was for a pharmaceutical product I’ve been taking for years – one that is critical to my health. Not only was I able to participate as an account planner helping to create the strategy and inspire our creative teams, but I could also draw on my personal experience and insight. After all, I’m an individual deeply passionate about an essential medication with which I’ve had more than 10 years of experience.
It was exciting to tackle the pitch process from both sides. I’ve always had lots of ideas about what the manufacturer could do to really help the people who prescribe and take their product. As a planner, I finally had a means for considering these ideas. And I could bring a little more compassion to the strategy. As an added personal benefit, it was cathartic to speak about my personal experiences, both with our internal teams and other people on this product.
But something began to bother me; a tendency that I, too, have been guilty of. Somewhere along the line, as a matter of convenience or shorthand, we begin to refer to people as patients. Or sufferers. Or caregivers. Or, worst of all, targets.
When we generalize to “patients,” we lose resolution. We lose the person inside that patient. And “sufferers?” No one is defined solely by his or her relationship with a disease.
Most polarizing of all is “target.” When we call our customers “targets,” do really we mean that? Do we mean to aim our forces at them and barrage them with messages? Do we expect this to be effective in a world where they can so easily ignore us – and form their own opinions of us?
How we define our customers defines our brand. If we treat them as “targets”, they become the opposition to us. And their responses will reflect that. For brands to succeed, we must treat our customers as partners, with common goals, seeking mutual value. The disease is our target, not our customers.
Let’s remember that those we are working to help are – first and foremost – people. They are individuals. Let’s move away from starting with a sole focus on the business objective, creating an idea, and then attempting to fit that idea to “patients.” Instead, let’s think and plan with empathy, starting with the problems at the center of people’s lives and working outward, finding areas of opportunity where these needs intersect with our business objectives.
In this way, people get help they need. Clients get better results. And agencies get to create more meaningful work. In the end, eliminating “sufferers” and “targets” from our vocabulary is good for us all.
Cuts to Medicare payments due to the budget sequester have hit reimbursements for cancer drugs, according to a non-profit group.
The Community Oncology Alliance released results Thursday of a survey of oncologists from around the country on the effects of the sequester cut to Medicare payments, finding that the 2% cut has "inordinately" affected community oncology practices because it is a cut to the underlying cost of cancer drugs, placing many of them "under water" — meaning that the reimbursement by Medicare is less than the drug's purchase price. The survey was based on a poll of 326, accounting for 1,650 oncologists who see a total of 728,721 Medicare patients per year.
Most cancer patients are treated in office-based practices, and 69% of those surveyed said patient treatment and operational changes had already been made due to the cut. These include 49% of practices that had to send Medicare patients elsewhere for treatment and 62% who said they would have to send them elsewhere if the cut stays in place through July 31. Meanwhile, 21% said they were laying off staff, and 38% would be forced to if the cuts stay in place this summer. More than 1,200 community cancer practices have closed, consolidated or reported financial problems since 2008.
Since putting together the database of NOV and Warning letters issued by FDA’s Office of Prescription Drug Promotion (OPDP), I have been looking to assess a number of patterns. Sometimes the meaning is obvious, in other’s I am left to speculate. This is one of the latter.
Every regular reader of Eye on FDA will note that they have frequently seen this chart evolve. Here is a profile of the combined pattern of Warning Letters and Notice of Violation letters issued by OPDP since 1997 and one will readily observe that the number of such letters experienced a steep decline after the 1990s. So that is the first point – there are fewer letters than there used to be.
The prescription drug cost curve is bending…for the time being. Spending on medicines fell by 3.5% in 2012 and will continue to fall below overall health spending over the next five years to 2017.
But different from general health spending, there’s a new game in town called specialty medicines, and they cost a whole lot more than the generics and the aging brands that bent the cost curve in 2012.
MY MOTHER fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.
We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer andovarian cancer.
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.
Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.
Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.
On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.
But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.
My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple.
Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.
Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.
I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.
It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.
I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.
For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.
I acknowledge that there are many wonderful holistic doctors working on alternatives to surgery. My own regimen will be posted in due course on the Web site of the Pink Lotus Breast Center. I hope that this will be helpful to other women.
Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.
I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.
Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.
Over the last three years, tablets have taken the world of healthcare by storm. Manhattan Research’s “Taking the Pulse” survey saw tablet adoption among physicians rising from 30 percent in 2010, to 62 percent in 2011, to 72 percent in 2012. Adoption will continue to ramp up as the opportunities to use tablets in the hospital increase, not just for doctors but for nurses, hospital administrators, and patients as well.