Monday, February 16, 2015

Good News On The Cancer Front


Some good news: last week I was back at City of Hope for tests after the interruption in my treatment caused by the broken ribs. Of course my oncologist is concerned about all the chemo side effects-- from the fainting that led to the broken ribs to the more mundane effects that plague patients in treatment, like constipation, weakness and fatigue, loss of appetite, neuropathy, etc. But her main task is the underlying disease-- the cancer. And that's where the good news comes in. Last night she e-mailed me-- I'm seeing her in person Tuesday-- that the tests last week showed continued improvement. I don't know how I'd have the strength to bear the side effects of the chemo if I didn't know it was working.

There's also some good news on the cancer front that isn't just about me personally. Over the weekend, writing for ThinkProgress Health, Sam Collins reported about Obama's ambitious plans to tackle cancer-- with Republican cooperation. Have you heard about precision medicine, an evolving type of medical research that tailors cancer treatment to the genetic makeup of a patient’s tumor? Obama referred to it in his State of the Union address, saying it will help "lead the United States into a new era of medicine” and he's announced a $215 million project that would help oncologists and researchers move away from the one-size-fits-all model of cancer treatment that all too often isn't the best we can do for patients.
Proponents of President Obama’s plan say that doctors can better predict a patient’s likelihood of developing cancer with a wealth of information at their disposal. Under the medical model of precision medicine, medical professionals conduct diagnostic testing on cancer patients and select therapy that’s closely tailored on their genetic content or a complex molecular analysis rather than the type of cancer. Tools used in precision medicine often include molecular diagnostics, imaging, and analytics software that deciphers the genetic sequence of ailments by drawing on a database of information from individuals with similar biomarkers.

So far, a handful of Republican lawmakers, including Sen. Lamar Alexander (TN) and Fred Upton (MI), have indicated their support for President Obama’s plan. Scholars at the conservative American Enterprise Institute have also expressed cautious optimism. The potential bipartisan initiative represents a rare example of collaboration across the political aisle-- a deviation from the gridlock Americans have seen when it comes to other issues like the federal budget, immigration, and abortion.

If approved by Congress, this multi-million dollar investment will be used to coordinate efforts between the National Institutes of Health, FDA, and the Office of the National Coordinator for Health Information Technology (ONC) to develop a voluntary national research group that will help researchers foster an understanding of cancers and ultimately create effective approaches to treatment. The funds will also help the ONC secure exchange of data across systems and allow the FDA to develop a regulatory structure that protects public health.

In addition to GOP politicians, the proposal also has some support among major players in the medical research industry.

“We commend the administration’s commitment to advancing the field of precision, or personalized, medicine,” John J. Catellani, president and CEO of Pharmaceutical Research and Manufacturers of America (PhRMA), wrote in a statement to ThinkProgress, in which he explained that between 12 to 50 percent of all compounds currently researched in the industry have the potential to be personalized medicines.

“The biopharmaceutical research sector is strongly committed to researching and developing personalized medicines, and ensuring patients can gain timely access to them. Recent advances in diseases such as cancer and cystic fibrosis are delivering on the promise of targeted treatments. These advances hold great promise in improving patient outcomes and controlling costs by targeting the right medicines to the right patients,” Catellani wrote.

The advancements that Castellani mentioned have ripened the opportunity for researchers across the country to collect the genetic sequences of cancerous cells and expand patients’ access to cutting edge technology that will help them get to the bottom of what’s causing their ailment. At Wake Forest Baptist Medical Center in Winston-Salem, N.C., for example, those who are covered by the state insurance plan MedCost can get their cancer diagnosed and undergo therapy that’s targeted to the genetic makeup of their tumor free of charge.

Dr. Boris Pasche, the director of the comprehensive cancer center at Wake Forest Baptist, told ThinkProgress that this type of research could increase the knowledge needed to effectively carry out the President Obama’s precision medicine initiative.

“Right now, we don’t have that centralized structure to put all that genetic data under one roof,” Pasche said. “First, we’ll use local storage facilities and cloud-based storage to put this together. For just one patient’s tumor, you’re talking about 650 gigabytes. We have to be thorough. If we have drugs that attack this Achilles heel effectively, we need to use them.”
Seems like common sense? Alas, common sense rarely comes into play around the healthcare systems and even personal healthcare decisions. A few days ago, the same Sam Collins did a piece on how preventable most cancers are. Perhaps as few as 20% of cancers are outside of human control and are all about genetics and family history.
Cancer-- which counts as the second leading cause of death worldwide-- often involves abnormal cell growth that spreads throughout the body, eventually crippling and killing the afflicted. While death rates have been on the decline in recent decades, it still poses a significant threat among smokers, the obese, and those with poor diets. Making matters worse, the number of Americans who know about the benefits of diets high in fruits and vegetables have declined by 10 percentage points since 2009. And more than half of Americans remain unaware about the link between alcohol and cancer.
On another level on the banishment of commonsense, let me end this with another personal travail. The doctor who was treating me for the broken ribs prescribed Oxy, which I hate. It clouds my mind, worsens the constipation, makes me feel like crap and doesn't even work that well in controlling the pain. A DWT reader suggested I try lidocaine patches, which she used when she broken her own ribs a few years ago. They are targeted just to the ribs and don't impact the mind at all. I asked my regular doctor to prescribe them for me and he did. As I've mentioned before, I'm a huge fan of Medicare, which is absolutely-- and quite literally-- life-saving. The one part of Medicare that sucks, though, is Republican healthcare: Medicare Part D, an anti-patient rip-off that is all about Big Pharma's profit margins. They turned down the lidocaine patches. Why? Who knows. Oxy is addictive and the lidocaine patches aren't so commonsense would indicate they would want to help patients keep away from the Hillbilly Heroin. But... helping patients doesn't usually go into the calculations around Republican healthcare.

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At 3:06 PM, Blogger Phil Perspective said...

Glad you're doing better. We need you around a lot longer!

At 3:10 PM, Blogger Alan Parker said...

Howie I'm Glad Your Tests Are Going In The Right Direction!! We All Need You o Fight The GD Republican Wing of the Democratic Party!!!!!

At 3:32 PM, Blogger RNK said...

This is really good news!! And, as always, you have interesting things to say about the broader picture.

At 1:37 AM, Anonymous ap215 said...

Good news stay strong Howie.

At 4:40 PM, Anonymous Anonymous said...

Thanks for the good news. And for the medical info too.


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