In #Boston, young adults do battle with #cancer metaphors

The  Dana-Farber young adult cancer program dealt with an important issue at its recent conference — battle metaphors and cancer.

The language used to talk about cancer often focuses on battle words – those who are cured “won” or “survived,” while those who die from cancer “lost” their “fight.” But is cancer really something to be won or lost?

…Loved ones and those without cancer often consider cancer patients “heroes,” but, as one young adult put it, “I don’t feel very heroic when I’m going through treatment; I just take my medications and do what I’m told to do.” Another young woman added: “The intention is, ‘you inspire me; it inspires me to watch you survive,’ but they don’t do a good job at expressing that.” Being labeled as a hero may put undue pressure on patients or make them feel like they aren’t allowed to look sick or express negative emotions about their experience.

More here on the topic from the NYTimes

Below, keynote talk from Carolyn Ridge, who offered advice for young adults coping with cancer.

Globe: BWH surgeon sues BWH over wife’s post-#hysterectomy #cancer diagnosis

The Globe’s play on this story should say something — Metro front rather than 1A.  Malpractice stories are tricky– serious charges and a response penned by a lawyer, not a doctor.  (At 8 a.m., a complete version of the story was lingering on White Coat Notes, outside the paywall.)

Note the Brigham’s carefully worded statement on the link between cancer and  morcellation, the procedure used during a minimally invasive hysterectomy.

The Brigham said in a statement that “while it’s not possible to know what impact the procedure will ultimately have on Dr. Reed’s health, we do know that literature suggests morcellation of malignant tumors increases the chances of mortality. 

Here’s the lead

A Boston surgeon and his wife, an anesthesiologist, are pushing to stop a widespread surgical technique used on thousands of women during hysterectomies, which they say caused her undetected cancer to dangerously spread.

The she said/she said suggest that

Dr. Barbara Goff  president of the Society of Gynecologic Oncology and director of the Division of Gynecologic Oncology at the University of Washington in Seattle says “Morcellation allows many women to have safer hysterectomies with better outcomes than full abdominal surgery, including less blood loss, smaller wounds, and a quicker overall recovery.”

“You try to balance cost and outcomes and doing the best you can for an entire population of women,” Goff said.

But Dr. Bobbie Gostout, chairwoman of obstetrics and gynecology at the Mayo Clinic, said more women should be given the option of a vaginal hysterectomy, where the uterus can often be taken out intact through the vagina, especially because morcellation “is a questionable practice.”

She said morcellating devices are not yet good at capturing tissue or protecting other sensitive organs from rotating blades.

“I don’t want to see [morcellation] go away, but I would like to see it kept in perspective and occupy its necessary place,” she said. “Morcellation is still so far off what it ought to be.”

Boston hospital CIO Halamka on his wife’s diagnosis: “We have cancer”

Beth Israel CIO John Halamka usually blogs about health information with posts like “The EHR/HIE Interoperability Workgroup,” and very occasionally, his life as a vegan or his plan to  retire to a small family farm to raise organic vegetables.

Today he reports the disturbing news of his wife’s breast cancer. They’ve decided to document her treatment in real time.

The headline “We have cancer.”

Last Thursday, my wife Kathy was diagnosed with poorly differentiated breast cancer. She is not facing this alone. We’re approaching this as a team, as if together we have cancer. She has been my best friend for 30 years. I will do whatever it takes to ensure we have another 30 years together.

She’s has agreed that I can chronicle the process, the diagnostic tests, the therapeutic decisions, the life events, and the emotions we experience with the hope it will help other patients and families on their cancer treatment journey.

Boston Globe editorial: Prostate screening limits “too sweeping”

A staff editorial in today’s Globe echoes comment made by prominent docs in town: The US Preventative Services Task Force went too far in calling for limits on prostate screening.

A better course would be for physicians to talk with their patients about both the uncertainties inherent in the PSA test and the relative innocuousness of most prostate cancers. Some patients may find the panel’s recommendation reason enough to forgo the test. Others patients might prefer to have it done, but to monitor their PSA levels rather than seek immediate treatment when the results are borderline.

Insurance companies often use the panel’s recommendations as their criterion for whether to cover a test. But until there’s a better test to detect prostate cancer or a broader consensus about skipping this one, insurers should continue to cover it.

Note that The New York Times editorial staff supports the limits and notes that the USPSTF guidelines allow for doctor patient conversations:

Critics, including urologists, who diagnose and treat prostate cancer, charge that the task force’s recommendations are misguided and will hurt patients. They have already been held up for two years lest they ignite charges of government rationing. That’s absurd. The recommendations are intended as guidance to help men and their doctors decide whether to use the test and how to react if it is positive. This is information patients need to know.       

 

Health reform and cancer: Mass can’t get either one right?

Fortune/CNN jumps all over Mass health reform

 …(T)he plans offer lavish subsidies that swell the demand for health care, they do nothing to increase the supply of medical services in a market suffering from shortages of everything from family doctors to nurses to hospital beds. Two years after enacting health-care reform to rein in costs, Massachusetts strengthened “certificate of need laws” that prevent hospitals and other providers from competing with high-cost, entrenched suppliers. The state now requires that ambulatory surgical centers and outpatient treatment facilities get permission from regulators before they can enter the market. Their rivals invariably lobby the regulators to block competition, and usually win.

 And, the NY Times holds up MGH research as an example of the limits of targeted cancer therapies.

 Enthusiasts for the targeted drug have been saying for years that tumors will eventually be characterized by their molecular profiles — which mutated genes they have — rather than where in the body they occur. Names like breast cancer and lung cancer will be supplanted by terms like B-RAF-positive or EGFR-positive tumors. And drugs will be chosen based on that profile, the way antibiotics are generally selected based on the pathogen that is causing the infection, not on where in the body the infection occurs.

 Massachusetts General Hospital, for instance, is running a clinical trial testing a drug from AstraZeneca on any type of cancer — providing it has a mutation in the gene B-RAF, the same gene that is the target of PLX4032.

 But the test of PLX4032 in colon cancer suggests that the location of the tumor still does matter, that it will not be just a case of looking at the target. There are other examples as well. Erbitux and Vectibix do not work in colon cancer patients with a mutation in a gene called K-RAS. But the relationship between the mutation and the effectiveness of Erbitux does not seem to hold in lung cancer.

 

Get ready for cancer research hope/hype fest

Malcolm Gladwell on Massachusetts cancer research

In this week’s New Yorker, Malcolm Gladwell uses the history of leukemia drugs to get into a tale of the ongoing search for effective cancer treatments. He followed compound know as elesclomol from a successful Phase 2 studies through several Phase 3 clinical trials.  His main character is emeritus Harvard researcher Lan Bo Chen, who co-founded Lexington’s Synta Pharmaceuticals and did much of the research on elesclomol.  

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