William Hudson, a producer for the CNN medical team, recently donated bone marrow, and wrote a really nice article on why he did it.
Bone marrow transplants, as Hudson points out, can be life savers for people with blood cancers. They are typically accompanied by aggressive, high dose chemotherapy, which wipes out the patient's bone marrow (the source of blood cells, including cancerous ones -- and including white blood cells which are essential to the immune system). The donated bone marrow helps the patient's immune system recover more quickly.
Hudson describes the procedure he went through for getting on the bone marrow donation registry; for being chosen (only about 1 in 500 people on the registry are ever actually matched up with a cancer patient); and donating the bone marrow. He also describes an alternative procedure, a Stem Cell Transplant. Both of them help, though he chose to donate bone marrow and not just stem cells.
I think Hudson does a great job of not only describing the procedures, but of also answering the question, "Why do it?" As he puts it, "Joining the registry is a statement -- that when cancer affects one of us, it affects all of us."
If you're reading this, you're likely a blood cancer patient, or someone who is very close to one. If you're a patient, encourage your family and friends to add this to their New Year's Resolutions. If you're a loved one, then do it yourself.
There might even be a steak in it for you.....
Monday, December 31, 2012
Saturday, December 29, 2012
Oncologists' Income
The Journal of Clinical Oncology just released the results of a study that shows that some oncologists could potentially increase their income by over-treating their patients.
The article stated the results of a survey of oncologists, and found that while most oncologists are paid a salary, about 27% of them are paid through fee-for-service; that is, they get paid depending on what they do for a patient. So while some oncologists could send a patient to a hospital for treatment, others will have patients receive treatment in their office; for the latter doctor, he or she, and not the hospital, would get paid for administering the treatment.
As an article from Reuters points out, this has the potential for a lot of abuse. It would be easy to give a patient a treatment that isn't quite needed, or one that's a little more expensive, if there was some kind of cash incentive to do so.
For example: I spend two years watching and waiting, with regular doctor visits, but no treatment. Many oncologists recommend that their patients go through treatment immediately. Current research suggests that there is no harm in watching and waiting, and that there are some benefits to it. But a doctor might look at all of the choices available, and consider: W & W? No income from that. Straight Rituxan? A cheaper option for the patient, but less income for me. CHOP? Maybe we can stretch it out to 6 rounds instead of four -- hope he's got a strong heart. We'll make it R-CHOP, and throw in 6 rounds of Rituxan, too. And let's not forget Rituxan maintenance.....
Now, all of that is a little alarming, but the Reuters article is maybe a little bit alarmist. The study didn't find that there was abuse going on. It did what a good scientific study should do: it raised some questions. So while it's probably not a bad idea to find out of a doctor is benefiting financially from the treatments being prescribed, it's probably not the best idea to assume that your doctor is putting her own pocketbook ahead of your health. If you're thinking that way, you probably need a new oncologist anyway.
Still, it would be nice to see if this was being done by lots of doctors. No one wants over-treatment; it hurts everyone when the cost of health has to go up unnecessarily. But no one wants under-treatment either. There has to be some way of determining the best options, so a patient's health is ultimately the priority. Unfortunately, that's not always easy to do. What "the best" way to treat Follicular NHL? We're still trying to figure that one out.
So I guess the solution is to find a doctor you trust. Always your best bet anyway....
The article stated the results of a survey of oncologists, and found that while most oncologists are paid a salary, about 27% of them are paid through fee-for-service; that is, they get paid depending on what they do for a patient. So while some oncologists could send a patient to a hospital for treatment, others will have patients receive treatment in their office; for the latter doctor, he or she, and not the hospital, would get paid for administering the treatment.
As an article from Reuters points out, this has the potential for a lot of abuse. It would be easy to give a patient a treatment that isn't quite needed, or one that's a little more expensive, if there was some kind of cash incentive to do so.
For example: I spend two years watching and waiting, with regular doctor visits, but no treatment. Many oncologists recommend that their patients go through treatment immediately. Current research suggests that there is no harm in watching and waiting, and that there are some benefits to it. But a doctor might look at all of the choices available, and consider: W & W? No income from that. Straight Rituxan? A cheaper option for the patient, but less income for me. CHOP? Maybe we can stretch it out to 6 rounds instead of four -- hope he's got a strong heart. We'll make it R-CHOP, and throw in 6 rounds of Rituxan, too. And let's not forget Rituxan maintenance.....
Now, all of that is a little alarming, but the Reuters article is maybe a little bit alarmist. The study didn't find that there was abuse going on. It did what a good scientific study should do: it raised some questions. So while it's probably not a bad idea to find out of a doctor is benefiting financially from the treatments being prescribed, it's probably not the best idea to assume that your doctor is putting her own pocketbook ahead of your health. If you're thinking that way, you probably need a new oncologist anyway.
Still, it would be nice to see if this was being done by lots of doctors. No one wants over-treatment; it hurts everyone when the cost of health has to go up unnecessarily. But no one wants under-treatment either. There has to be some way of determining the best options, so a patient's health is ultimately the priority. Unfortunately, that's not always easy to do. What "the best" way to treat Follicular NHL? We're still trying to figure that one out.
So I guess the solution is to find a doctor you trust. Always your best bet anyway....
Thursday, December 27, 2012
PITS Video
OK, this was just too weird to pass up: a video from almost two years ago, created by the British Lymphoma Association. It's meant to alert people to the typical symptoms of lymphoma, with the acronym PITS: Persistent lumps, Itching, Tiredness, and Sweating. They make excellent use of the whole "pits" visual pun.
The video is aimed at people under 30, who are most susceptible to lymphoma. (I think they are referring to Hodgkin's, specifically, though they lump it (ha!) all under "lymphoma."
Still, it's a nice way to make people aware of the symptoms. Of course, with the prevalence of WebMD and other medical sites, the problem might also be people who know about some symptoms and suspect they have lymphoma, when those very general symptoms could be many other things, too. We get a lot of those folks visiting the support group: "I have a lump/itchiness/fatigue -- could I have lymphoma." And the gentle response is always, "We don't know -- go see a doctor."
And that's ultimately the message. No one wants to be a hypocondriac, but no one wants undiagnosed cancer, either. So this video does a nice job of getting people's attention and encouraging them to do just that -- go see a doctor.
Enjoy.
The video is aimed at people under 30, who are most susceptible to lymphoma. (I think they are referring to Hodgkin's, specifically, though they lump it (ha!) all under "lymphoma."
Still, it's a nice way to make people aware of the symptoms. Of course, with the prevalence of WebMD and other medical sites, the problem might also be people who know about some symptoms and suspect they have lymphoma, when those very general symptoms could be many other things, too. We get a lot of those folks visiting the support group: "I have a lump/itchiness/fatigue -- could I have lymphoma." And the gentle response is always, "We don't know -- go see a doctor."
And that's ultimately the message. No one wants to be a hypocondriac, but no one wants undiagnosed cancer, either. So this video does a nice job of getting people's attention and encouraging them to do just that -- go see a doctor.
Enjoy.
Tuesday, December 25, 2012
Merry Christmas
A Merry Christmas to all who are celebrating. I hope Santa brings everyone good health this year.
Saturday, December 22, 2012
New Immunology Technique
The blog that Sloan-Kettering Cancer Center runs reports on a new Immunotherapy technique that could be a boon for treating all types of cancers, including blood cancers.
The technique is called Adoptive Cell Transfer (ACT), and is an improvement on previous attempts at this kind of Immunpotherapy.
Immunotherapy approaches try to find ways train the body's natural defenses to recognize and attack cancer cells the way they would any other invader. This is hard, because 1) cancer cells aren't really "invaders," as such, since they come from the patient's own body, and 2) cancers are smart as hell and develop additonal ways to protect themselves from the immune system.
Some immunotherapies target a single antigen on a cancer cell. Rituxan, for example, targets the CD20 protein on the surface of B cells. The problem, as successful as Rituxan has been, is that both cancer cells and healthy B cells have CD20. So you get a little bot of collateral damage. There's no antigen that exists only on cancer cells, so that kind of damage to at least some healthy cells is unavoidable with most immunotherapies.
ACT is different because it is able to target two antigens on the surface of cancer cells, something much more likely to be unique to cancer cells. That is, few healthy cells have combinations of antigens that cancer cells have. Follicular NHL cells often have, for example, CD20 and CD22. A therapy that targeted both could help keep some healthy cells safe.
It works by removing some T cells from the patient's body (these are white blood cells that naturally attack invaders), and training them to recognize the antigens. The cells are then reintroduced into the patient and get to work.
The article discusses work done with prostate cancer cells, and it looks promising.
The problem, if I can extend the lymphoma example, is that not all Follicular NHL patients have the CD20 or the CD22, let alone both of them. So these therapies will need to be matched to individual patients. this isn't necessarily a big deal; it's not like every patient has his or her own set of antigens that no one else has. But it will be an extra step. On the other hand, that kind of individualized approach is gaining steam anyway.
More advances. Always nice to see.
The technique is called Adoptive Cell Transfer (ACT), and is an improvement on previous attempts at this kind of Immunpotherapy.
Immunotherapy approaches try to find ways train the body's natural defenses to recognize and attack cancer cells the way they would any other invader. This is hard, because 1) cancer cells aren't really "invaders," as such, since they come from the patient's own body, and 2) cancers are smart as hell and develop additonal ways to protect themselves from the immune system.
Some immunotherapies target a single antigen on a cancer cell. Rituxan, for example, targets the CD20 protein on the surface of B cells. The problem, as successful as Rituxan has been, is that both cancer cells and healthy B cells have CD20. So you get a little bot of collateral damage. There's no antigen that exists only on cancer cells, so that kind of damage to at least some healthy cells is unavoidable with most immunotherapies.
ACT is different because it is able to target two antigens on the surface of cancer cells, something much more likely to be unique to cancer cells. That is, few healthy cells have combinations of antigens that cancer cells have. Follicular NHL cells often have, for example, CD20 and CD22. A therapy that targeted both could help keep some healthy cells safe.
It works by removing some T cells from the patient's body (these are white blood cells that naturally attack invaders), and training them to recognize the antigens. The cells are then reintroduced into the patient and get to work.
The article discusses work done with prostate cancer cells, and it looks promising.
The problem, if I can extend the lymphoma example, is that not all Follicular NHL patients have the CD20 or the CD22, let alone both of them. So these therapies will need to be matched to individual patients. this isn't necessarily a big deal; it's not like every patient has his or her own set of antigens that no one else has. But it will be an extra step. On the other hand, that kind of individualized approach is gaining steam anyway.
More advances. Always nice to see.
Thursday, December 20, 2012
Watch and Wait? A Case Study
The Watch-and-Wait question never really goes away.
The question is usually asked in some variation of: "Now that Rituxan is so common, do we really need watch-and-wait?"
You'll get as many different answers as there are oncologists to answer it (not to mention know-it-all patients like me).
Earlier this month, the ASH Education Book featured a case study designed to respond to that question. The case study and response were written by Dr. Brad Kahl of the University of Wisconsin's Carbone Cancer Center. It's a pretty thorough treatment of the question, I think -- as would be expected, given that it was written to educate other oncologists (not to mention know-it-all patients like me).
Dr. Kahl's focus is on low tumor-burden Follicular NHL patients. Interestingly, as he points out, there is very little hard data on such patients (me included); most research focuses on fNHL patients with high tumor burden. And what little exists was mostly done before Rituxan was common, so we really can't rely on that data.
Dr. Kahl offers a case of a 47 year old male with low tumor burden and some anxiety about it all. It's pretty interesting to read, actually; there are a bunch of parallels between this patient's case and my own. Except this guy is an accountant, and Lord knows I am not. Also, the patient in the case is not a know-it-all, but his wife seems to be.
Dr. Kahl offers three possibilities for this patient, and provides pros and cons for all three, including quality of life considerations. the options are 1) watch-and-wait; 2) Rituxan plus chemo (CVP, CHOP, or MCP, and maybe something else, but I can't tell what from the title of the citation); or 3) Rituxan alone.
So which one does Dr. Kahl choose for this 47 year old accountant?
You'll need to read that for yourself. But it's all certainly educational.
The question is usually asked in some variation of: "Now that Rituxan is so common, do we really need watch-and-wait?"
You'll get as many different answers as there are oncologists to answer it (not to mention know-it-all patients like me).
Earlier this month, the ASH Education Book featured a case study designed to respond to that question. The case study and response were written by Dr. Brad Kahl of the University of Wisconsin's Carbone Cancer Center. It's a pretty thorough treatment of the question, I think -- as would be expected, given that it was written to educate other oncologists (not to mention know-it-all patients like me).
Dr. Kahl's focus is on low tumor-burden Follicular NHL patients. Interestingly, as he points out, there is very little hard data on such patients (me included); most research focuses on fNHL patients with high tumor burden. And what little exists was mostly done before Rituxan was common, so we really can't rely on that data.
Dr. Kahl offers a case of a 47 year old male with low tumor burden and some anxiety about it all. It's pretty interesting to read, actually; there are a bunch of parallels between this patient's case and my own. Except this guy is an accountant, and Lord knows I am not. Also, the patient in the case is not a know-it-all, but his wife seems to be.
Dr. Kahl offers three possibilities for this patient, and provides pros and cons for all three, including quality of life considerations. the options are 1) watch-and-wait; 2) Rituxan plus chemo (CVP, CHOP, or MCP, and maybe something else, but I can't tell what from the title of the citation); or 3) Rituxan alone.
So which one does Dr. Kahl choose for this 47 year old accountant?
You'll need to read that for yourself. But it's all certainly educational.
Monday, December 17, 2012
Stand Up Immunology
A quick video from Stand Up to Cancer:
SU2C and the cancer Research Institute have created a "Dream Team" too look into ways immunology can tackle cancer. Immunology, in general, involves treatments that allow the body's own immune system to do it's job and recognize cancer as an invader.
This is exactly the kid of work that Stand Up 2 Cancer was designed to do: rather than approaching cancer in traditional ways, SU2C funds projects that bring in different perspectives, to look at cancer in new ways.
This looks like a great team. Can't wait to see what they come up with.
SU2C and the cancer Research Institute have created a "Dream Team" too look into ways immunology can tackle cancer. Immunology, in general, involves treatments that allow the body's own immune system to do it's job and recognize cancer as an invader.
This is exactly the kid of work that Stand Up 2 Cancer was designed to do: rather than approaching cancer in traditional ways, SU2C funds projects that bring in different perspectives, to look at cancer in new ways.
This looks like a great team. Can't wait to see what they come up with.
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