I attended the National Press Foundation's (NPF) Cancer Issues 2010 meeting this week in Washington, DC. The meeting was wonderful and had excellent speakers including professors of medicine & oncology, directors of departments (including from Georgetown University Medical Center, and other places also), chief medical officers, senior science writers, deputy director of the NCI, senior investigators, a survivor/advocate, and a reporter from the Washington Post. I will list the weblink below so you can read more about this excellent meeting and speakers. You can download some of the speakers powerpoints also.
Copy/Paste this web link into your web browser:
http://nationalpress.org/programs-and-resources/program/cancer-issues-2010/
Some highlights of the meeting include the following:
Minetta, Liu, Assistant Professor, Medicine and Oncology, Lombardi Comprehensive Cancer Center spoke about the need for an individual approach to cancer treatment to maximize benefit and minimize the cost. She pointed out that the U.S. gives more chemo than other countries; if there is an individualized approach it would help cut down on overtreatment.
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Carol Taylor, Ph.D., MSN, RN, Director, Center for Clinical Bioethics, Georgetown University Medical Center spoke on the topic of 'End of Life Issues in Cancer Care'. She pointed out the current hot topic of the 'death panel' (as Sarah Palin called it). The case of Terri Schiavo was discussed, which was a big case in end of life issues. Dr. Taylor suggested reading 'Letting Go', which is about what should medicine do when it can't save your life. It was published in August of 2010. Another suggestion was watching 'The Lady and The Reaper' on youtube.
Dr. Taylor talked about three universal needs, which are:
1. Meaning and purpose
2. Forgiveness (or forgive others)
3. Love and belonging, to love and be loved.
Dr. Taylor talked about paradigms on death and dying including
1. Death as a natural part of life
2. The medicalization of dying....70% of Americans die in a hospital.
Other issues talked about were 1/2 of conscious patients had moderate to severe pain at least 1/2 the time before death. 21% complained the dying person was not receiving enough respect.
Dr. Taylor mentioned the TENO study in 2004 which said 1 in 4 people did not receive enough pain medication.
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Otis Brawley, Chief Medical Officer, American Cancer Society (remotely), Professor, Emory University School of Medicine and Emory Rollins School of Public Health spoke about the facts and numbers of cancer including the following:
Cancer kills more than TB, AIDS and Malaria combined.
In 2009 the U.S. spent 2.53 trillion on health care.
The growth in cancer incidence and mortality is due to increasing of aging population and western habits (such as smoking).
Brawley also pointed out that obesity from high calorie intake and lack of physical excercise will cause more cancer than tobacco by 2030.
Brawley also pointed out the following numbers of obesity:
Breast, prostate, colon, uterine, and pancreas cancer risk is increased with obesity.
1/3 of adults are couch potatos.
35% are obese
60% are overweight
20% of kids ages 6-11 are obese.
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Aziza Shad, M.D., Amey Distinguished Professor of Neuro-Oncology and Childhood Cancer Director, Lombardi Cancer Center, Georgetown University Hospital talked on the issue of Pediatric Palliative Care.
Some facts presented by Dr. Shad are the following:
1. 50,000+ children die every year in the U.S. from cancer, AIDS and other chronic illness.
2. More than 500,000 children live with life threatening, complex medical conditions.
3. Wolfe found 89% of children who die of cancer suffer in the last month with fatigue, pain and dyspnea.
4. 80% of cancer patients have pain.
Dr. Shad pointed out that no child should die in pain. More funding is needed for palliative care (preparing to die) and allow natural death.
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Claudine Isaacs, M.D., FRCPC, Director, Clinical Breast Cancer Program Lombardi Comprehensive Cancer Center had the topic of New Treatment Options for Breast Cancer (Risk Management, BRCA mutation). Her information is the following:
Metastatic Breast Cancer spread beyond the breast and local lymph node area to distant sites (lungs, liver, bones, skin). It is incurable with current treatment. The median survival is 2 to 3 years. There is survival improvement. Some option treatments were presented:
1. PARP Inhibitors (blocks mechanisms)
2. Bevcizumab (targeting angiogenesis in MBC; blocks growth factor, ECOG did a trial
3. Endocrine Therapy Resistance
4. CYP2D6 (San Antonio may be doing a study on this)
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(This session below was at the National Cancer Institute)
Mark Schiffman, M.D., Chief Interdisciplinary Studies, Environmental Epidemiology Branch; Natural History of HPV, including co-factors, chronic inflammation and hormones.
* 1 in 14 cancers in the world are due to the HPV virus.
* HPV 16 causes 1/2 cervical cancer.
* HPV 18 is another bad cancer causing virus.
* HPV infection is common; persistence and precancer are uncommon
* Infections usually go away in months to 2-3 years.
* It is persistence that leads to precancer, it can then invade to cancer.
* Screening too often is bad. Suggested screening is 3 years, starting at age 30, many of the viruses go away on their own so should not be screened earlier. Europe suggests 5-7 years for screening.
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(This session below was at the National Cancer Institute)
Diane Solomaon, M.D., Senior Investigator, Breast and Gynecologic Cancer Research Group: Screening pap smears, and HPV testing.
Failures in Cervical cancer screening are due to:
1. Lack of screening.
2. Lack of appropriate follow-up
3. False negative test results (perhaps the machines or slide doesn't read it).
To reduce cervical cancer mortality, we need to reach women underscreened including the elderly, minorities, those in rural communities and the poor.
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(This session below was at the National Cancer Institute)
Allan Hildensheim, Ph. D., Chief, Infections and Immunoepidemiology Branch: Global Impact of HPV-related cancers: Studies in Oregon, Costa Rica and beyond.
Dr. Hildensheim spoke of the two HPV vaccines:
A study of GSK (GlaxoSmithKline) showed HPV 16 and GSK HPV 18 caused 70% of cervical cancer.
A study of Merck showed HPV 16, HPV 18, HPV 6 and HPV 11 caused 90% of genital warts.
For vaccines, both are given in three doses over six months. The FDA licensed Gardasil for young women and girls in 2006. In 2009 the FDA licensed Gardasil to prevent warts in males. Both vaccines are highly effective at preventing cervical precancers.
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(This session below was at the National Cancer Institute)
John Schiller, Ph.D., Head Neoplastic Disease Section; Prevention, microbicides and future directions.
Dr. Schiller spoke on microbicides, topically applied that prevent infections.
He spoke of two trials being planned to see if carrageenan was effective as a APV microbicide.
There is a leading trial by Mark Einstein at the Albert Einstein University to test the microbicide Carraguard® against the human papillomavirus (HPV), which causes cervical cancer. The research will evaluate the efficacy of Carraguard® – a clear gel made from the seaweed derivative carrageenan – in preventing new HPV infections in women.
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Nilofer Azad, M.D., Assistant Professor, Gastrointestinal Oncology, Sidney Kimmel Comprehensive Cancer Center at John Hopkins spoke on the topic of epigenetics.
Dr. Azad was a member of a 'Dream Team' for Stand Up To Cancer. The following information on lung cancer was presented:
With lung cancer, if all things are exhausted, life expectancy is three months. Some trials have helped extend to 8.6 months.
In one trial there were 28 patients, two had very good responses to treatment (but the hope was to have 10% have good responses to treatment).
With colon cancer, stage 4 life expectancy is two years.
With leukemia, one mutation drives the disease.
In epigenetics (the study of changes in gene), DNA sequence is not changed or mutated, but just turned on or off.
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Norma Kanarek, Ph.D., Associate Professor, Johns Hopkins Executive Director, MD Cigarette Restitution Fund at JHMI spoke on the topic of cancer and minorities.
Dr. Kanarek said cancer and minority reports could be found at The Office of Minority Health (HHS). For charts she recommended the website statecancerprofiles.cancer.gov . She also recommended the SEER Cancer Statistics Review for a good source of information.
Dr. Kanarek pointed out that cancer is declining since the early 1990's.
Some facts are:
* 1 in 2 will be diagnosed with cancer.
* 1 in 3 will die from cancer.
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Suzanne Lindley, survivor, advocate, spoke on the topic of living with cancer. Suzanne's session was incredibly moving. Her courage to help others living with cancer is admirable. I will put a paragraph about her below that can be found on the canceradvocacy.org so you can read more about her:
"When I was 31 years old, I was diagnosed with stage IV colon cancer and told I had six months to live. I didn't accept that verdict: instead I sought out other opinions and began taking the only chemotherapy drug for colon cancer that was available at the time. That was 10 years ago.
Since I was diagnosed in 1998, several new treatments for colon cancer have been discovered, and I have had them all, including five new chemotherapies, the gamma knife, Sir-spheres, cyberknife, external beam radiation and intrathecal chemo for spinal metastases. Those are foreign words to most readers, as they were for me when I researched them all myself. If I had had a written care plan, with all the options outlined before undergoing treatments, it would have helped me make decisions and give me an idea of what to expect going forward. Instead, I've had to navigate the complex path of treatment possibilities on my own.
I have had numerous surgeries and side effects, and over the last decade my care has been conducted by several facilities and at least a dozen different physicians. There is no written summary of all the treatment I have received over the last ten years, so I've compiled copies of my medical records from several different facilities and physicians in four 3-inch binders. These are important because many cancer treatments produce late effects - conditions that show up long after treatment has been administered and can include damage to vital organs such as the heart, lung, bones, joints, bone marrow, nervous system and more. Some cancer survivors are at higher risk for serious infection, infertility, thyroid dysfunction, hearing loss, premature osteoporosis, anxiety, depression, and second cancers - conditions they and the other members of their healthcare team can monitor if they have a written treatment summary and follow-up care plan.
In the spring of 2008, I was again told my journey was coming to an end, but I have already outlived that prognosis. I still receive treatment, but I still have no written plan for my care going forward. It's scary –for instance, I once almost lost a leg due to a drug interaction that could have been avoided with a written care plan.
Hearing that you have cancer is enough to comprehend. No one should have to concern themselves with the amounts or types of chemo, procedures, or radiation they have received but should instead be provided with clearly delineated plans for moving forward."
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Jeremy Moore, Senior Manager, Science Communications, American Association for Cancer Research. Mr. Moore spoke on the topic of reporting on scientific journal articles. He spoke on the following issues:
* In 2010 cancer surpassed heart disease as the leading cause of death.
* Cancer affects 1 in 3 women and 1 in 2 men.
* The NCI (National Cancer Institute's budget in 2009 was 4.96 billion, in 2010 the NCI budget was 5.1 billion. In 2011 the ask for the budget was 5.26 billion.
* Everyday 75 clinical trials and 11 systematic reviews are being published.
Mr. Moore mentioned the following publishers:
* New England Journal of Medicine
* Journal of the American Medical Association
* Cancer (from American Cancer Society)
* Journal of Clinical Oncology (ASCO)
* Cancer Research (AACR)
* Clinical Cancer Research
* Cancer Epidemiology, Biomarkers and Prevention
* Cancer Prevention and Research (AACR)
* Molecular Cancer Research
* Cancer Discovery (AACR)
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John Marshall, M.D., Chief Division of Hematology/Oncology, Georgetown University Hospital spoke on the topic of developing drugs to treat cancer and clinical trials, and what journalists need to know.
Dr. Marshall suggested reading the article 'Fighting A Smarter War Against Cancer'. He talked about how the larger the clinical trial was, the smaller the difference. Gleevic was discussed (Imatinib) Imatinib is used to treat certain types of leukemia and other cancers of the blood cells. It is also used to treat gastrointestinal stromal tumors.
Dr. Marshall also pointed out that the #1 way to keep cancer from coming back is exercise.
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Nurith Celina Aizeman, reporter, Washington Times, spoke on the topic of health care reform and cancer.
Ms. Aizeman suggested the book on health 'Landmark', a collection of essays written by Washington Post reporters that gives the history of the work and a summery of the legislation put into the passing of the health care bill in 2010.
Ms. Aizeman also talked about the controversial no more life limits (limiting how much insurance one can receive) with individual health care plans.
Other issues discussed were the HHS preventive care measure, and provision for long term care, and the issue that individual mark plans annual limits may be phased out by 2014.
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