Living With Cancer: Collateral Damage

“When I was invited to attend a prostate cancer group called ‘Us Too’ in my town, its members were meeting in a private room in our public library. About eight men, some accompanied by their wives, had great difficulty communicating their discomfort about urine leaks and diapers. They wanted to know what strategies my gynecological cancer group used to talk about sexual issues. To alleviate their daily problems, the participants needed professional help that I could not furnish.

“Sexual dysfunction and incontinence in prostate cancer survivors underscore a quandary that shadows oncology. As we all realize, procedures that prolong lives also impair them. Yet cancer patients who must forfeit quality of life to gain quantity of life rarely receive adequate warning before treatment or guidance afterward.”


The Truth behind Three Natural Cancer “Cures”

“The Internet is full of ‘miracle cures’ for cancer and alleged surefire ways to prevent it, and well-meaning people may urge cancer patients to just try them out in hopes of eliminating their disease. Some patients, worried that conventional treatments won’t work or pose significant side effects, seek a treatment whose effectiveness isn’t actually supported by scientific evidence or may even prove dangerous. During a time of uncertainty and anxiety, it’s understandable that any hope for a cure — even if it isn’t medically proven — is tempting.

“ ‘Patients want something “natural” to try to treat their cancer or prevent their cancer from coming back,’ says Memorial Sloan Kettering pharmacist and herbalist K. Simon Yeung. ‘But the people promoting these treatments might not necessarily have a medical or oncology background. In addition, patients who try these therapies may find, when they come back to seek mainstream treatment, that it’s too late and their cancer has already spread.’ “


High Use of Alternative Medicine in Senior Oncology Patients

“Alternative medicines are widely thought to be at least harmless and very often helpful for a wide range of discomforts and illnesses. However, although they’re marketed as ‘natural,’ they often contain active ingredients that can react chemically and biologically with other therapies. Researchers performed a comprehensive review of all of the medications taken by senior oncology patients and found that as 26 percent were using complementary or alternative medicines (CAM), in a report published August 12th, in the Journal of Geriatric Oncology.

“ ‘Currently, few oncologists are aware of the alternative medicines their patients take,’ said Ginah Nightingale, PharmD, an Assistant Professor in the Jefferson College of Pharmacy at Thomas Jefferson University. ‘Patients often fail to disclose the CAMs they take because they think they are safe, natural, nontoxic and not relevant to their cancer care, because they think their doctor will disapprove, or because the doctor doesn’t specifically ask.’ “


Pancreatic Neuroendocrine Tumors: A Lesser Threat than Adenocarcinomas, but Still Hard to Treat


Pancreatic neuroendocrine tumors (PNETs) constitute only about 3% to 5% of all pancreatic cancers. Compared to the most common pancreatic cancer—adenocarcinoma (aka exocrine tumors), PNETs have a longer disease course and better prognosis; the 5-year survival rate is 42% for PNETs, but only about 5% to 6% for adenocarcinomas. When PNETs are localized, they can usually be removed by surgery. However, PNETs tend to metastasize, most often to the liver, and present a formidable treatment challenge at this stage. Continue reading…


Rolapitant Reduced Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Moderately Emetogenic Chemotherapy or Anthracycline/Cyclophosphamide

“In a phase III study reported in The Lancet Oncology, Schwartzberg et al found that the addition of rolapitant to serotonin (5-HT3) receptor antagonist and dexamethasone treatment significantly improved complete response rates in prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy or anthracycline and cyclophosphamide regimens.

“In this double-blind trial, patients from 170 sites in 23 countries were randomly assigned between March 2012 and September 2013 to receive oral rolapitant 180 mg or placebo 1 to 2 hours before the administration of moderately emetogenic chemotherapy. All patients received oral granisetron 2 mg and oral dexamethasone 20 mg on day 1 (except for those receiving taxanes, who received dexamethasone according to the package insert) and granisetron 2 mg on days 2 and 3. Treatment was given for up to six cycles, with a minimum of 14 days…

“The investigators concluded: ‘Rolapitant in combination with a 5-HT3 receptor antagonist and dexamethasone is well tolerated and shows superiority over active control for the prevention of chemotherapy-induced nausea and vomiting during the 5-day (0–120 h) at-risk period after administration of moderately emetogenic chemotherapy or regimens containing an anthracycline and cyclophosphamide.’ “


ASCO Calls for Cancer Trials to Include More Seniors

“In a position statement published online July 20 in the Journal of Clinical Oncology, the American Society of Clinical Oncology has called on the U.S. government and the cancer research community to broaden clinical trials to include older adults.

” ‘Older people living with cancer often have different experiences and outcomes in their treatment than younger cancer patients,’ Julie Vose, M.D., M.B.A., society president, said in a news release from the group. ‘As we age, for example, the risk of adverse reactions from treatment significantly increases. Older adults must be involved in clinical trials so we can learn the best way to treat older cancer patients, resulting in improved outcomes and manageable toxicity,’ she explained.

“More than 60 percent of cancers in the United States occur in people aged 65 and older, the statement authors say, noting the number of seniors will increase in coming years. However, there is a lack of evidence about cancer treatments for the elderly because too few are included in clinical trials, and clinical trials designed specifically for seniors are rare.”


Emergency Department Febrile Neutropenia Pathway for Patients With Cancer Reduces Time to Antibiotic Administration

“In a study reported in the Journal of Oncology Practice, Keng et al at Cleveland Clinic found that institution of an emergency department febrile neutropenia pathway for patients with cancer reduced the time to antibiotic administration compared with historical and direct admission cohorts.

“The study included all adult patients with cancer who presented with fever to the Cleveland Clinic Emergency Department between June 2012 and June 2013. The febrile neutropenia pathway interventions included providing patients with febrile neutropenia alert cards, standardizing the definition of febrile neutropenia and recognizing it as a distinct chief complaint, revising the emergency department triage level for febrile neutropenia, creating electronic febrile neutropenia order sets, administering empiric antibiotics before neutrophil count result, and relocating febrile neutropenia antibiotics to the emergency department. The primary outcome was time to antibiotic administration, with a target of 90 minutes after emergency department presentation. (The study was initiated prior to release of ASCO and Surviving Sepsis Campaign recommendations of a target of 60 minutes.)

“Outcomes were compared with those in a historical cohort of patients presenting to the emergency department between February 2010 and May 2012 and a cohort of patients directly admitted to the inpatient oncology service with a presumptive diagnosis of febrile neutropenia between June 2012 and June 2013. Directly admitted patients are judged to be clinically stable, with sicker patients being sent directly to the emergency department.”


Benefit of End-Stage Chemotherapy Is Questioned

“It is an excruciating question for cancer patients with a prognosis of only months to live. Should they try another round of chemotherapy?

“Guidelines for oncologists say no for very sick patients, those who are often bedridden and cannot handle most daily needs themselves. But for patients who are more self-sufficient, chemotherapy is considered a reasonable option. Despite its well-known toxic side effects, many end-stage patients and their doctors have considered chemotherapy worth trying, believing it may ease discomfort or buy time.

“Now, a study suggests that even those stronger patients may not benefit from end-of-life chemotherapy — and that for many their quality of life may worsen in their final weeks compared with patients who forego last-ditch treatment.

“ ‘It worsened quality of life for those that are relatively healthy, and those are the ones that the guidelines support treating,’ said Dr. Charles Blanke, a medical oncologist at Oregon Health and Science University, who was not involved in the study. ‘Chemotherapy is supposed to either help people live better or help them live longer, and this study showed that chemotherapy did neither.’ “


Top Oncologists Push Back On ‘Outrageous’ Costs Of Cancer Drugs

“More than 110 doctors from cancer centers around the country called on drug makers to justify their soaring prices and for the government to put regulatory curbs in place. They noted that every new drug approved by the Food and Drug Administration in 2014 was priced at more than $120,000 per year.

The New York Times: Drug Companies Pushed From Far And Wide To Explain High Prices
As complaints grow about exorbitant drug prices, pharmaceutical companies are coming under pressure to disclose the development costs and profits of those medicines and the rationale for charging what they do. So-called pharmaceutical cost transparency bills have been introduced in at least six state legislatures in the last year, aiming to make drug companies justify their prices, which are often attributed to high research and development costs. (Pollack, 7/23)

The Wall Street Journal: Doctors Object To High Cancer-Drug Prices
More than 100 oncologists from top cancer hospitals around the U.S. have issued a harsh rebuke over soaring cancer-drug prices and called for new regulations to control them. The physicians are the latest in a growing roster of objectors to drug prices. Critics from doctors to insurers to state Medicaid officials have voiced alarm about prescription drug prices, which rose more than 12% last year in the U.S., the biggest annual increase in a decade, according to the nation’s largest pharmacy-benefit manager. (Whalen, 7/23)”