cancer treatment – Page 4 – Medical Lessons

Crizotinib, An Experimental Drug for Some Lung Cancers and Other Tumors With Alk Mutations

October 28, 2010March 17, 2011 Elaine Schattner, MD

Why am I blogging about this drug, a pill, that works imperfectly in perhaps most of 5% of non-small-cell lung cancer patients and, maybe, in some other rare tumors? Because this is the future of oncology and, ultimately I think, will provide cost-effective medicine that’s based in evidence and science. The key is that the investigators tried the experimental drug in lung cancer patients with a specific genetic profile, one that predicts a response to this agent…
How drugs like crizotinib could save money: 1. This drug is a pill; slash the costs of IVs, pumps, bags of saline, nurses to administer…2. Don’t give it to patients without a relevant genetic mutation; 3. Monitor patients for resistance and stop giving drugs when they no longer help the individuals for whom their prescribed.

Posted in cancer treatment, health care costs, Oncology (cancer), Under the RadarTagged ALK mutations, chemo pills, crizotinib, drug resistance, IMT, lung cancer, non-small-cell lung cancer, targeted therapy2 Comments

Stem Cells, Breast Reconstruction and a Magazine Cover

October 26, 2010May 25, 2012 Elaine Schattner, MD

The cover of the November print edition of Wired features large, unnatural-appearing cleavage. Inside and toward the back of the issue, a curious article ties together stem cells and the future of breast reconstruction. It got my attention. The detailed and admittedly interesting piece, by Sharon Begley, describes what’s science or science fiction: first humans, […]

Posted in Breast Cancer, cancer treatment, Future of Medicine, Magazine, Plastic and Reconstructive Surgery, ScienceTagged beauty, biotechnology, Breast Cancer, Cytori, reconstructive surgery, stem cells, Wired Magazine1 Comment

New NY State Law on Information for Women Undergoing Mastectomy

August 18, 2010March 5, 2011 Elaine Schattner M.D.

The reality is that many women, particularly poor women without newspapers or internet access in their homes, don’t know about any of this. They don’t know their insurance covers pretty much all of these options, by law. Now they will, or should as of Jan 1, 2011. Good. The other curiosity is that …

Posted in Breast Cancer, cancer treatment, Communication, Medical News, Patient Autonomy, Plastic and Reconstructive SurgeryTagged Breast Cancer, empowered patient, informed decisions, mastectomy, New York State law, reconstructive surgery, right to know, Women's Health2 Comments

Why Blog on OncotypeDx and BC Pathology?

May 21, 2010May 26, 2011 Elaine Schattner M.D.

I can’t even begin to think of how much money this might save, besides sparing so many women from the messy business of infusions, temporary or semi-permanent IV catheters, prophylactic or sometimes urgent antibiotics, Neulasta injections, anti-nausea drugs, cardiac tests and then some occasional deaths in treatment from infection, bleeding or, later on, from late effects on the heart or not-so-rare secondary malignancies like leukemia. And hairpieces; we could see a dramatic decline in women with scarves and wigs.

Posted in Breast Cancer, cancer treatment, Communication, Diagnosis, Empowered Patient, health care costs, Informed Consent, Pathology, Patient AutonomyTagged adjuvant chemotherapy, Breast Cancer, early-stage breast cancer, empowered patient, health care costs, medical tests, oncology, Oncotype Dx, Pathology2 Comments

More News, and Considerations, on OncotypeDx

May 16, 2010December 4, 2010 Elaine Schattner M.D.

This week I’ve been reading about new developments in breast cancer (BC) pathology. At one level, progress is remarkable. In the 20 years since I began my oncology fellowship, BC science has advanced to the point that doctors can distinguish among cancer subtypes and, in principle, stratify cases according to patterns of genes expressed within […]

Posted in Breast Cancer, cancer treatment, clinical trials, Diagnosis, Informed Consent, Oncology (cancer), Pathology, Patient AutonomyTagged Breast Cancer, ER+, estrogen receptors, evidence-based medicine, gene profiling, node-negative, Oncotype Dx, Pathology, risk of recurrence, Women's HealthLeave a Comment

Considering Targeted Therapies For Cancer

March 5, 2010October 31, 2021 Elaine Schattner M.D.

I first heard about STI-571 (Gleevec, a targeted cancer therapy) from a cab driver in New Orleans in 1999. “Some of the doctors told me there’s a new cure for leukemia,” he mentioned.

We were stuck in traffic somewhere between the airport and the now-unforgettable convention center. His prior fare, a group of physicians in town for the American Society of Hematology’s annual meeting, spoke highly of a promising new treatment. It seemed as if he wanted my opinion, to know if it were true. Indeed, Dr. Brian Druker gave a landmark plenary presentation on the effectiveness of STI-571 in patients with chronic myelogenous leukemia (CML) at the conference. I was aware of the study findings.

“Yes,” I said. “There is a new drug for leukemia.”

Since then, oncologists’ enthusiasm for targeted therapies – medications designed to fight cancer directly and specifically – has largely held. But the public’s enthusiasm is less apparent. Perhaps that’s because many people are unaware of these new drugs’ potential, or they’re put off by their hefty price tags.

Posted in cancer treatment, Oncology (cancer), Selected TopicsTagged cancer medicine, cancer treatment, Gleevec, health, health care costs, monoclonal antibodies, Oncology (cancer), Sutent, targeted therapy1 Comment

Today’s Press on Targeted Therapy for Cancer

February 24, 2010February 28, 2010 Elaine Schattner M.D.

Today the NY Times printed the third part of Amy Harmon’s excellent feature on the ups and downs and promise of some clinical trials for cancer. The focus is on a new drug, PLX4032, some people with melanoma who chose to try this experimental agent, and the oncologists who prescribed it to them.

What I like about this story is that, besides offering some insight on the drug itself, it balances the patients’ and doctors’ perspectives; it explains why some people might elect to take a new medication in an early-stage clinical trial and why some physicians push for these protocols because they think it’s best for their patients.

And it provides a window into the world of academic medicine, where doctors’ collaborate among themselves and sometimes with corporations.

Here’s some of what I learned:

Posted in cancer treatment, clinical trials, Communication, Medical News, Oncology (cancer), ScienceTagged cancer medicine, clinical trials, communicating in medicine, decisions, health, medical news, melanoma, Oncology (cancer), patient-doctor relationship, PLX40321 Comment

News on Aspirin After Breast Cancer

February 18, 2010September 13, 2021 Elaine Schattner M.D.

There’s promising news on the breast cancer front.

A study published on-line this week in The Journal of Clinical Oncology (JCO) suggests that regular, low-dose aspirin use reduces the risk of recurrence and death from breast cancer among women who’ve had stage I, II or III (non-metastatic) disease.

This is a phenomenal report in three respects:

1. The dramatic results: among women who’ve had breast cancer, regular aspirin use was associated with a reduced risk of recurrence and of death from cancer by more than half;

2. The relevance; these findings might affect millions of women living after breast cancer, today;

3. The cost: aspirin is widely available without patent restriction. Aspirin costs around $5 for 100 tablets, several months’ supply.

Posted in Breast Cancer, cancer survival, cancer treatment, Medical News, Oncology (cancer), Women's HealthTagged aspirin, Breast Cancer, cancer medicine, cancer treatment, medical news, Women's Health2 Comments

Health Care Costs, Communication and Informed Choices

February 12, 2010August 30, 2011 Elaine Schattner M.D.

For those of you who’ve been asleep for the past year: the health care costs conundrum remains unsolved. Our annual medical bills run in the neighborhood of $2.4 trillion and that number’s heading up. Reform, even in its watered-down, reddened form, has stalled.

Despite so much unending review of medical expenses – attributed variously to an unfit, aging population, expensive new cancer drugs, innovative procedures, insurance companies and big Pharma – there’s been surprisingly little consideration for patients’ preferences. What’s missing is a solid discussion of the type and extent of treatments people would want if they were sufficiently informed of their medical options and circumstances.

Maybe, if doctors would ask their adult patients how much care they really want, the price of health care would go down. That’s because many patients would choose less, at least in the way of technology, than their doctors prescribe. And more care.

What I’m talking about is the opposite of rationing. It’s about choosing.

Posted in cancer treatment, Communication, Empowered Patient, health care costs, Informed Consent, Medical Ethics, Patient AutonomyTagged cancer medicine, chemotherapy, communicating in medicine, decisions, doctor-patient relationship, empowered patient, end-of-life, life as a patient, palliative care1 Comment

A Visit With My Oncologist

January 28, 2010February 28, 2010 Elaine Schattner M.D.

After a while my oncologist stepped out into the waiting area and guided me to the hall by her office. “The cells are low,” she said. “We’ll have to wait another week, that’s all.”

I knew she was right. But a week seemed like a lifetime to me then….

Posted in Breast Cancer, cancer survival, cancer treatment, Life as a Patient, Women's HealthTagged blood cells, Breast Cancer, cancer screening, cancer treatment, chemotherapy, health, life as a patient, mammography, Women's Health2 Comments

How to Avoid Death in the ICU

January 25, 2010September 13, 2021 Elaine Schattner M.D.

It was sometime in April, 1988. I was putting a line in an old man with end-stage kidney disease, cancer (maybe), heart failure, bacteria in his blood and no consciousness. Prince was on the radio, loud, by his bedside. If you could call it that – the uncomfortable, curtained compartment didn’t seem like a good place for resting.

Posted in cancer treatment, Communication, Empowered Patient, Essential Lessons, health care costs, Life as a Doctor, Medical Ethics, Palliative Care, Patient Autonomy, Patient-Doctor RelationshipTagged being in the hospital, communicating in medicine, community awareness, DNR order, DNR orders, doctor-patient relationship, doctors' lives, empowered patient, end-of-life, health, hospice care, intensive care, life as a patient, palliative care, patient-doctor relationship, Women's Health4 Comments

How Well Do You Really Want to Know the “Red Devil?”

December 11, 2009September 13, 2021 Elaine Schattner M.D.

I know what it’s like to get the “red devil” in the veins.

You can learn about Adriamycin, a name brand chemotherapy, on WebMD. Or, if you prefer, you can check on doxorubicin, the generic term, using MedlinePlus, a comprehensive and relatively reliable public venture put forth by the National Library of Medicine and National Institutes of Health. If you’re into organic chemistry, you might want to review the structure of 14-hydroxydaunomycin, an antibiotic and cancer therapy first described 40 years ago…

Posted in Breast Cancer, cancer treatment, Essential Lessons, Life as a Doctor, Life as a Patient, Medical Education, Oncology (cancer), Women's HealthTagged Breast Cancer, cancer medicine, cancer treatment, chemotherapy, communicating in medicine, decisions, health, life as a patient, medical education, Women's Health2 Comments

Getting the Math on Mammograms

November 20, 2009July 20, 2011 Elaine Schattner M.D.

But consider – if the expert panel’s numbers are off just a bit, by as little as one or two more lives saved per 1904 women screened, the insurers could make a profit!

By my calculation, if one additional woman at a cost of, say, $1 million, is saved among the screening group, the provider might break even. And if three women in the group are saved by the procedure, the decision gets easier…

Now, imagine the technology has advanced, ever so slightly, that another four or five women are saved among the screening lot.

How could anyone, even with a profit motive, elect not to screen those 2000 women?

Posted in Breast Cancer, cancer screening, cancer treatment, Diagnosis, health care costs, Medical Ethics, Medical News, Policy, Women's HealthTagged Breast Cancer, breast cancer screening, cancer screening, health care costs, mammography, mammography math, screening controversy1 Comment

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