The New England Journal of Medicine is celebrating its 200th anniversary this year. Kind of amazing -- almost as old as the country itself, and its been providing cutting edge medical research for all that time.
As part of the celebration, the NEJM has been including lots of articles the history of medicine, including this one by Dr. Vincent T. DeVita, and Dr. Steven A. Rosenberg called "Two Hundred Years of Cancer Research."
It's a fairly quick summary of a lot of history. I like the opening line: "In the 200 years since the New England Journal of Medicine was founded, cancer has gone from a black box to a blueprint." Indeed, for many, many years we really had little understanding of what makes cancer cells begin, grow, and survive. We have so much more knowledge now, enough to understand a lot of the genetic makeup of cancer, and to attempt to use that knowledge to create treatments. Pretty amazing how far we've come.
I also like this line: "Until recently, cancer treatment was a three-legged stool sitting on a
base of surgery, radiation therapy, and chemotherapy. In the past 25
years, immunotherapy has been added as an important component of cancer
treatment." This begins a discussion of the importance of immunotherapy in recent cancer treatment approaches. Hello, Rituxan, my little friend....
Mostly, though, I found this fascinating to compare to Dr. Siddartha Mikharjee's incredible book The Emperor of All Maladies: A Biography of Cancer. Mikharjee doesn't claim to write a history of cancer, though there's quite a bit of history in it. But as with all historical subjects, it's interesting to see how two historians pick and choose the details that they think are important. DeVita and Rosenberg are writing a 7page article aimed at physicians; Mikharjee is writing a 300 page book aimed at the general public, and is much more interested in telling a good story.
That said, I learned something from this article, and it was nice to see that two prominent cancer researchers see the development of monoclonal antibodies and the development of kinase inhibitors as two of the three most important events in cancer treatment to have occurred in the last 15 years.
Thursday, June 14, 2012
Monday, June 11, 2012
Robin Roberts
Robin Roberts announced on Good Morning America today that she has been diagnosed with MDS, Myelodysplastic Syndrome. This link shows the GMA segment and gives a little more information about what's going on.
MDA was once known as "pre-leukemia," though it now seems better understood as a collection of several different diseases. What they all have in common is that they affect the body's ability to create blood cells; production grows slower over time. Sometimes (but not always), MDS does develop into leukemia.
Roberts mentions a recent Good Housekeeping article about her fight against breast cancer five years ago. I read that article when it came out last month, and I have to say, she's pretty impressive. I don't watch GMA, but I remember her as an anchor on ESPN's SportsCenter years ago. When she says she's going to beat this, I am inclined to believe her. (And it seems that she has some advantages that will certainly help in her fight.)
She's going to have a bone marrow transplant, with her sister being the donor. If we're looking for a silver lining in all of this, maybe it's that people will become more aware of the need for bone marrow donors, something especially important to blood cancer patients.
And, as a nice follow up to what I wrote yesterday, we can use her words as a rallying cry:
"Fight, not fright."
Good luck, Robin. We're pulling for you.
MDA was once known as "pre-leukemia," though it now seems better understood as a collection of several different diseases. What they all have in common is that they affect the body's ability to create blood cells; production grows slower over time. Sometimes (but not always), MDS does develop into leukemia.
Roberts mentions a recent Good Housekeeping article about her fight against breast cancer five years ago. I read that article when it came out last month, and I have to say, she's pretty impressive. I don't watch GMA, but I remember her as an anchor on ESPN's SportsCenter years ago. When she says she's going to beat this, I am inclined to believe her. (And it seems that she has some advantages that will certainly help in her fight.)
She's going to have a bone marrow transplant, with her sister being the donor. If we're looking for a silver lining in all of this, maybe it's that people will become more aware of the need for bone marrow donors, something especially important to blood cancer patients.
And, as a nice follow up to what I wrote yesterday, we can use her words as a rallying cry:
"Fight, not fright."
Good luck, Robin. We're pulling for you.
Sunday, June 10, 2012
Coping (Magazine): Fear
Sometimes I go days without having anything to write about, and sometimes I have a pile of drafts for posts waiting to be shared. With all of the ASCO news over the last month, I'm in one of those "pile of drafts" phases. I have a whole bunch of articles that I've saved that I haven't yet had a chance to share and comment on.
One of them came from someone's Facebook post about a month ago, an article from Coping magazine. I've linked to Coping articles before, and they're usually very good. They provide information about different types of cancer (including lymphoma), but there are lots of other sources that give more detailed information, so that's not usually why I check out Coping. Instead, I think they're a great source for inspiration. Their articles are just as likely to be written by a survivor as by a doctor or other health professional. On down days, it's worth just checking out what's there, just to see if something speaks to you -- an interview with a celebrity, perhaps, or another first-person story from a survivor. They even have an excellent section caregivers, who have their own special coping needs.
The article that I have had sitting on my list for a while is from the March/April issue; it's called "Facing the Fear of Recurrence." For someone with Follicular Lymphoma, that fear is kind of constant -- or, at least, present in some form. But, really, it's there for any survivor (or, at least, all the cancer survivors I know).
The article talks about fear, and how the mind and body have evolved over time to use fear. Fear can be positive -- short term, it warns us to get out of the way of something bad. Long term, it teaches us to avoid things that can harm us.
But, of course, fear can be bad, too -- especially long term. We can avoid things that might harm us, but to such an extent that we are paralyzed by that fear, and stop living our lives. And what's the point, then? We fear that cancer will take things away from us, and then we're so worried, that we end up not doing those things we were afraid to we were going to lose.
I'll give you the last few lines of the article (but you should read all of it yourself):
We are born with a full range of emotions. Joy, anxiety, love, sadness, guilt, happiness, peace, and even fear all have purpose in our lives. When any emotion, especially fear, begins to overwhelm you, remember two things:
We can't let fear paralyze us. We can't let Fear win, any more than we can let Cancer win, when we have some weapon to use against it. We have to live our lives.
One of them came from someone's Facebook post about a month ago, an article from Coping magazine. I've linked to Coping articles before, and they're usually very good. They provide information about different types of cancer (including lymphoma), but there are lots of other sources that give more detailed information, so that's not usually why I check out Coping. Instead, I think they're a great source for inspiration. Their articles are just as likely to be written by a survivor as by a doctor or other health professional. On down days, it's worth just checking out what's there, just to see if something speaks to you -- an interview with a celebrity, perhaps, or another first-person story from a survivor. They even have an excellent section caregivers, who have their own special coping needs.
The article that I have had sitting on my list for a while is from the March/April issue; it's called "Facing the Fear of Recurrence." For someone with Follicular Lymphoma, that fear is kind of constant -- or, at least, present in some form. But, really, it's there for any survivor (or, at least, all the cancer survivors I know).
The article talks about fear, and how the mind and body have evolved over time to use fear. Fear can be positive -- short term, it warns us to get out of the way of something bad. Long term, it teaches us to avoid things that can harm us.
But, of course, fear can be bad, too -- especially long term. We can avoid things that might harm us, but to such an extent that we are paralyzed by that fear, and stop living our lives. And what's the point, then? We fear that cancer will take things away from us, and then we're so worried, that we end up not doing those things we were afraid to we were going to lose.
I'll give you the last few lines of the article (but you should read all of it yourself):
We are born with a full range of emotions. Joy, anxiety, love, sadness, guilt, happiness, peace, and even fear all have purpose in our lives. When any emotion, especially fear, begins to overwhelm you, remember two things:
- As a survivor, you have come through fearful times before and can do it again.
- Fear can actually empower you to be more active in your ongoing well-being.
We can't let fear paralyze us. We can't let Fear win, any more than we can let Cancer win, when we have some weapon to use against it. We have to live our lives.
Thursday, June 7, 2012
Mr. Rogers
It's been a long time since I wrote about Mr. Rogers, but I saw a video today that brought back nice memories of him.
PBS commissioned the video -- one of several that they have planned -- as a tribute to Mr. Rogers, highlighting his message to kids.
(And, by sheer coincidence, I very recently heard a song by the alt rock dance band Pencilgrass that included a Mr. Rogers reference in the middle.)
As I wrote so long ago, I don't really have great memories of Mr. Rogers when he was on TV. My brother and sister were the ones who watched him. But I remember seeing several of his albums in the stack on the shelf under the stereo, including this one, with a built-in mirror so you can see your special self:
So I wasn't a fan until much later in life, when I heard a story that helped me shed my cynical attitude toward him.
It was on a radio show, and Mr. Rogers was readings letters from fans, which he collected into a book. One letter broke my heart. It was from the mother of a young girl with cancer. As part of her treatment, she had to have scans, which she absolutely hated. She had to stay very, very still for 2 full minutes, or the scan would be ruined. [I've been there.] Like all scanning machines, this one had a communication system, so the tech could talk to the girl, who could talk to the tech. To help keep her daughter still, the girl's mom would go into the booth with the tech, get on the mic, and sing the Mr. Rogers' theme song with the girl. The song took exactly 2 minutes, enough to distract the girl and keep her still.
I was an adult when I heard that, and it made me completely re-evaluate my feelings toward Mr. Rogers. And now, as a father (of children who were very fond of him) and a cancer patient, it makes me love him even more.
PBS commissioned the video -- one of several that they have planned -- as a tribute to Mr. Rogers, highlighting his message to kids.
(And, by sheer coincidence, I very recently heard a song by the alt rock dance band Pencilgrass that included a Mr. Rogers reference in the middle.)
As I wrote so long ago, I don't really have great memories of Mr. Rogers when he was on TV. My brother and sister were the ones who watched him. But I remember seeing several of his albums in the stack on the shelf under the stereo, including this one, with a built-in mirror so you can see your special self:
So I wasn't a fan until much later in life, when I heard a story that helped me shed my cynical attitude toward him.
It was on a radio show, and Mr. Rogers was readings letters from fans, which he collected into a book. One letter broke my heart. It was from the mother of a young girl with cancer. As part of her treatment, she had to have scans, which she absolutely hated. She had to stay very, very still for 2 full minutes, or the scan would be ruined. [I've been there.] Like all scanning machines, this one had a communication system, so the tech could talk to the girl, who could talk to the tech. To help keep her daughter still, the girl's mom would go into the booth with the tech, get on the mic, and sing the Mr. Rogers' theme song with the girl. The song took exactly 2 minutes, enough to distract the girl and keep her still.
I was an adult when I heard that, and it made me completely re-evaluate my feelings toward Mr. Rogers. And now, as a father (of children who were very fond of him) and a cancer patient, it makes me love him even more.
Monday, June 4, 2012
Bendamustine, Baby
Every year at ASCO, it seems that each cancer has one big bit of news -- more than one, if we're lucky. This year, it seems like the updated results for the study of Bendamustine vs. CHOP are the big story for indolent lymphomas like Follicular NHL.
And boy is it big. You can read about it here, here, here, here, and here. And probably a bunch more other places, but I stopped looking.
The study's author, Dr. Rummel, added to what we already knew from previous updates from this study: that Bendamustine (also known as Treanda) plus Rituxin is just as effective as CHOP-R, but with less toxicity and fewer side effects. (He points out again that none of the 500 or so people in the study lost their hair -- hair loss being a sign of toxicity.)
But the big news, now that there's been more time to follow patients, is just how much better the Progression Free Survival seems to be: 31.2 months for CHOP, and 69.5 months for Bendamustine. In other words, the median for people on CHOP was that they went less than three years before the disease came back or got worse. For people on Bendamustine, it was almost 6 years.
Pretty dang impressive. All of the data from this study has been presented at conferences, so it has not gone through peer-review (that is, other lymphoma experts have not reviewed the data yet and approved it for publication in a medical journal -- more reliable than just a conference presentation). I think there will be some louder calls for the study director to make that to happen now.
I also think this will push Bendamustine over the edge, in terms of it being a preferred first-line treatment over CHOP. I'm sure there will still be some old school oncologists who will continue with CHOP or even CVP, but I can see Rituxan (on its own) and B-R being increasingly the go-to choice very soon.
This is excellent news.
And boy is it big. You can read about it here, here, here, here, and here. And probably a bunch more other places, but I stopped looking.
The study's author, Dr. Rummel, added to what we already knew from previous updates from this study: that Bendamustine (also known as Treanda) plus Rituxin is just as effective as CHOP-R, but with less toxicity and fewer side effects. (He points out again that none of the 500 or so people in the study lost their hair -- hair loss being a sign of toxicity.)
But the big news, now that there's been more time to follow patients, is just how much better the Progression Free Survival seems to be: 31.2 months for CHOP, and 69.5 months for Bendamustine. In other words, the median for people on CHOP was that they went less than three years before the disease came back or got worse. For people on Bendamustine, it was almost 6 years.
Pretty dang impressive. All of the data from this study has been presented at conferences, so it has not gone through peer-review (that is, other lymphoma experts have not reviewed the data yet and approved it for publication in a medical journal -- more reliable than just a conference presentation). I think there will be some louder calls for the study director to make that to happen now.
I also think this will push Bendamustine over the edge, in terms of it being a preferred first-line treatment over CHOP. I'm sure there will still be some old school oncologists who will continue with CHOP or even CVP, but I can see Rituxan (on its own) and B-R being increasingly the go-to choice very soon.
This is excellent news.
Sunday, June 3, 2012
National Cancer Survivors Day
Today is the 25th annual National Cancer Survivors Day.
To all you survivors -- congratulations!
And remember just what a Survivor is, according to the folks who organize this day:
"The National Cancer Survivors Day Foundation defines a "survivor" as anyone living with a history of cancer – from the moment of diagnosis through the remainder of life."
That's important. None of this "I have to wait 5 years before I can call myself a survivor" nonsense.
Because for most of us, getting out of bed is evidence enough of our survival.
So do something fun and life affirming today. My schedule includes seeing my daughter sing at church; watching one son's soccer game; listening to another son trying to sneak in playing some sax when he should be focusing on studying for his English final exam; grading a stack of papers (and being thankful that I can work); and working to find 10 minutes to talk to my wife.
A full day.
A very good day.
A Survivor's day.
Enjoy your own -- or make someone else's better.
Friday, June 1, 2012
ASCO Highlights
The ASCO conference starts today, and while I've been writing about it for a few weeks, I think we need one more post to really get pumped up for it.
This one is a brief video from Dr. Andre Goy, another Lymphoma Rock Star. He very briefly discusses some of the ASCO research that he thinks will be exciting.
On his list: The Bendamustine-Rituxan vs. CHOP-R update for indolent lymphomas. I'm looking forward to this, too. It has caused quite a stir every time the study directors report updated results, and I suspect this won't be any different.
Like many Follicular Lymphoma patients, I have a vested interest: Dr. R and I have discussed Bendamustine-R as a potential treatment for me, should it seem appropriate. It's one more arrow in the quiver [I noticed I've been going back to this comparison more since I read The Hunger Games], and one more way to save CHOP for if/when it's needed most.
This one is a brief video from Dr. Andre Goy, another Lymphoma Rock Star. He very briefly discusses some of the ASCO research that he thinks will be exciting.
On his list: The Bendamustine-Rituxan vs. CHOP-R update for indolent lymphomas. I'm looking forward to this, too. It has caused quite a stir every time the study directors report updated results, and I suspect this won't be any different.
Like many Follicular Lymphoma patients, I have a vested interest: Dr. R and I have discussed Bendamustine-R as a potential treatment for me, should it seem appropriate. It's one more arrow in the quiver [I noticed I've been going back to this comparison more since I read The Hunger Games], and one more way to save CHOP for if/when it's needed most.
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