Blog

Different Financial Paths and ChoicesCancer changes the lives of millions of people. While those affected by cancer understand its impact, most people do not understand how significantly a cancer diagnosis can disrupt and, ultimately, take a person’s life. Cancer is “a group of diseases characterized by uncontrolled growth and spread of abnormal cells.”1 Cancer strikes across the population; it afflicts people of all ages, gender, race, ethnicity, religion, residence and socioeconomic status. It is estimated over 1.6 million new cancer cases were diagnosed in the United States 2012.2 Regardless of the specific type of cancer one has, a cancer diagnosis can be devastating to the patient, as well as their family and friends.

In addition to the obvious physical and emotional hardships, a cancer diagnosis can cause many to suffer financial hardship. Typically, those with more deadly forms of and late‐stage3 cancer suffer more substantially from the financial challenges that accompany a cancer diagnosis. In one study, researchers found 7.7% of those diagnosed with lung cancer (the deadliest form of cancer) filed for bankruptcy within five years of being diagnosed.4 These financial challenges arise from a number of different sources. First, the cost of treating the cancer5 can be overwhelming, notwithstanding the patient’s access to health insurance. A recent study from Duke University Medical Center and Dana‐Farber Cancer Institute found out‐of‐pocket cancer‐related costs averaged $712 per month, despite all but one survey participant having health insurance and 83% of survey participants having prescription drug coverage.6 Such costs can include insurance co‐pays and non‐covered treatments and medications.

Second, and perhaps more financially impactful, is the loss of income associated with the patient’s and potentially the caregiver’s inability to continue working full time. The physical strains on late‐stage cancer patients often prevent a patient from remaining employed and can even require the caregiver (often a spouse, sibling or adult child) to forego or limit employment, compounding the higher cost of living with cancer with a significant reduction in household income. Finally, late‐stage cancer patients often seek palliative care, whether in‐home or in a hospice, which can be costly if not covered by Medicare or other insurance carriers.

While there is an incredible amount of data, information and resources devoted to informing and assisting cancer patients, very little of it is designed to help late‐stage cancer patients meet their overwhelming financial needs. Instead, a great deal of what is available attempts to reduce the incidence of cancer by focusing on research, awareness, prevention and early detection of cancer. In
addition, resources for helping those diagnosed with cancer offer assistance with topics such as navigating the health care system, transportation, education and support groups. There are very few resources available to assist late‐stage cancer patients in meeting their growing financial needs and their options are not generally well known or understood.

The most likely place for late‐stage cancer patients to turn to meet financial needs is current assets. Obviously, patients have the most control and easiest access to their own assets. Unfortunately, given the American economy over the past four years, fewer people have meaningful “rainy day” funds to allow them to use current savings to fund cancer treatment and other daily living expenses. To the extent patients have savings available, often their savings is quickly depleted and is often difficult to replenish. Another asset that may be helpful can be a cancer patient’s home. For many homeowners, it can be a source of significant cash, but accessing this value can be time consuming and more difficult when a family’s income is reduced by the inability to continue earning at the same level as prior to the cancer diagnosis. Equity levels have dropped so precipitously with falling real estate prices and lending criteria have tightened so much, a home equity line or even a reverse mortgage7 is less viable as a source of funds for late‐stage cancer patients.

Government assistance for cancer patients is limited. While there do not appear to be government assistance programs specifically for cancer patients, there are a number of federal and state programs that provide financial benefits that cancer patients may access, including Social Security, Medicare and Medicaid, the Department of Health & Human Servicers and the U.S. Administration on Aging.8 These benefits are typically entitlements and, therefore, do not require patients to use up current assets or take on future obligations. These programs, however, are typically set up for low income households, the elderly and the disabled and many cancer patients may not qualify. Other government and nonprofit benefit programs have eligibility requirements that can limit a cancer patient’s access to potential benefits. Navigating the application and eligibility process for such assistance programs can be difficult, time consuming and frustrating, especially for those suffering physically from cancer. In addition, some individuals are unable to access these programs.

In addition, sources of financial aid such as non‐profit grants and charitable grants generally provide assistance for specific expenditures (e.g., patient care, co‐pay off‐sets and prescription costs). Other programs limit the aid to defray the costs of transportation or the costs of treatment outside the home. These resources and the government assistance programs generally do not provide discretionary funds to help with day‐to‐day living expenses, such as mortgage payments, child care and other necessary expenses not tied directly to the cost of treating cancer. Therefore, other financial solutions are necessary.

For those late‐stage cancer patients with a life insurance policy, there are a number of other potential options to help meet financial needs. Policy owners with built up cash value9 may take a loan or a withdrawal against that cash value from the insurer that issued the policy. Unfortunately, the vast majority of life insurance policy owners do not have significant, if any, cash value accumulated in their policies. Some insurance policies offer an Accelerated Death Benefit Rider (ADBR). The ADBR provides a benefit to the policy owner if the insured is diagnosed with a terminal illness resulting in a life expectancy of less than 24 months and sometimes as short as only 6 months. If available, the benefit is typically up to 50 percent of the policy’s death benefit and may only be available in monthly installments, as opposed to a lump‐sum payment. Of course, there is a cost to purchase this rider and few policy owners have policies with such a rider. Even those who do, however, cannot take advantage of the rider until their medical condition has become terminal. Therefore, the ADBR is rarely an option for late‐stage cancer patients.

Two other options exist for policy owners who cannot take advantage of the more traditional options discussed above. The first is to sell the life insurance policy for cash proceeds. Generally, this transaction is known as a life settlement,10 and involves the policy owner receiving a lump sum cash payment and forever giving up any rights to the policy, including receiving the payment of the death benefit upon the insured’s death. Policy owners submit their policy and medical information to a licensed provider,11 who solicits offers from multiple bidders to buy the life insurance policy. The life settlement buyer will keep the policy in force by making all the future premiums and receive 100 percent of the death benefit from the insurance company. Life settlements can be fairly complicated transactions and many insureds are uncomfortable with the notion that a third‐party investor will potentially profit from their death. Also, the life settlement market is relatively immature and no sizable market currently exists, making it uncertain a policy owner will actually qualify for a life settlement and receive fair value for selling their policy.

A second less traditional option for a policy owner to access value in their life insurance policy is a non‐recourse loan secured solely by the policy’s death benefit. Under this relatively new option12 for late‐stage cancer patients, qualifying insureds can obtain a loan for up to as much as 70 percent of the policy’s death benefit. As a non‐recourse loan, the borrower has no obligation to make any loan payments or premium payments during the insured’s lifetime and the loan is repaid by the insurance company out of the policy’s death benefit at the time of the insured’s death. Unlike other options discussed above, this product has been specifically designed to address the financial needs of late‐stage cancer patients. There are certain advantages to this product over other options discussed above, including (1) there is no need to exhaust current assets, (2) there is no restriction of the use of loan proceeds, (3) there are no credit‐based, needs‐based or age qualifications, (4) the loans are available for most insurance policies, (5) the policy beneficiary still receives the residual death benefit after the loan is repaid and (6) the transaction process is generally simpler and quicker. Yet, qualifying for such a loan and the amount of proceeds available will depend greatly on the insured’s medical condition and the size of the insurance policy. In addition, not every type of cancer will qualify.

To many, the financial challenges that accompany a late‐stage cancer diagnosis can be as crippling as the disease itself. Unfortunately, there is little focus in the cancer community on addressing these needs and there are few adequate solutions. The cancer community can be instrumental in helping cancer patients become better acquainted with and help identify solutions for the very real and debilitating financial challenges that often accompany a cancer diagnosis. This article discusses a number of options that do exist today, but they are generally limited and often inaccessible to the patients. For those who own a home or a life insurance policy, more options become available. The best solution may be different for each individual and will be a function of a number of factors, including an individual’s access to liquid assets, homeownership, ownership of a life insurance policy and medical condition. Cancer patients need access to and a better understanding of the financial options at their disposal to fund the fight of their life.

1 American Cancer Society, Cancer Facts & Figures 2012. Atlanta: American Cancer Society; 2012.

2 Id.

3 Staging describes the extent or spread of the cancer, ranging from State I (least) to Stage IV (most). For purposes of this article, we use the term “late‐stage” to refer to Stage III and Stage IV.

4 The Wall Street Journal, Health Blog, Study Illuminates Link Between Cancer, Bankruptcy, available at http://blogs.wsj.com/bankruptcy/2011/06/07/study‐illuminates‐link‐between‐cancerbankruptcy/?mod=google_news_blog (last visited December 4, 2012).

5 The National Institutes of Health estimates direct medical costs of cancer in 2007 were $103.8 billion and will reach $158 billion in 2020.

6 The Wall Street Journal, Health Blog, Out‐of‐Pocket Costs for Some Cancer Patients Top $700 Monthly, available at http://blogs.wsj.com/health/2011/06/06/out‐of‐pocket‐costs‐for‐some‐cancer‐patients‐top‐700‐monthly (last
visited December 4, 2012).

7 A reverse mortgage is a loan for a senior homeowner secured by the home’s equity. Unlike a home equity line, the reverse mortgage does not get repaid until the homeowner moves or passes away.

8 CancerCare, Sources of Financial Assistance, available at http://www.cancercare.org/publications/62‐sources_of_financial_assistance (last visited December 6, 2012).

9 The most common type of life insurance policy, a term insurance policy, has no cash value. Permanent insurance policies (such as whole life or universal life) may have cash value built up, but only if the policy owner has overfunded the policy.

10 Life settlement transactions are generally regulated transactions and, when involving an insured with a life expectancy of less than 24 months, are referred to as viaticals and subject to even further regulation. For more information about life settlements, see http://www.lisa.org.

11 There are many providers, subject to different regulations in each State in which a provider operates. The largest and most well‐known provider is Coventry (see http://www.coventry.com).

12 Currently, Fifth Season Financial Assistance LLC is a company offering this non‐recourse loan product. For more information about Fifth Season, see http://www.fifthseasonfinancial.com.

Author: Scott B. Rose

Annual Cost of Cancer

Note: All estimates adjusted for patient deductibles and coinsurance expenses

1. Phases of care: Initial year after diagnosis, Last year of life, and the period between (Continuing). Months of survival are first applied to last year of life, any
remaining to initial phase, then to continuing.

Source: http://costprojections.cancer.gov/annual.costs.html

Tagged: cancerlate-stage cancerfinancial alternativesfinanceloanscostbudget

|

Timothy Wilson, MDIf you’re up for a prostatectomy or have questions about prostate health, you’ll want to hear from today’s expert. Measured by volume, Timothy Wilson, MD, ranks among the top six surgeons worldwide of robotic-assisted laparoscopic prostatectomy.  Since 1992 he’s served as the chief of the division of urology and urologic oncology at City of Hope, a comprehensive cancer center in Duarte, California.  He’s also the director of the center’s prostate cancer program.  Ask your questions about prostatectomy, as well as prostate and bladder cancer, here and in a few days you can view his answers on his profile page.

Tagged: prostate cancercancerprostatectomyCity of HopeTimothy Wilson MDUrology

|

Nicholas Vogelzang, MDIf you’ve been exposed to asbestos dust—or even think you’ve might’ve been—you owe it to yourself to get checked out.  You might have mesothelioma, a carcinoma of the lungs, heart or abdomen.  Today’s expert is Nicholas J. Vogelzang, a medical oncologist with Comprehensive Cancer Centers of Nevada.  He serves as the chair, site research leader and medical director of the Developmental Therapeutics Committee and is a member of the Genitourinary Committee for US Oncology Research.  His research interests include clinical trials for mesothelioma. Ask your questions to Dr. Vogelzang about mesothelioma here and in a few days we’ll notify everyone of his answers.

Tagged: mesotheliomacancersurvivorsciencebiology

|

Jonathan Kolitz, MDClinical trials help to increase our understanding of diseases and discover new treatments, but what’s in them for you, the patient?  That might sound selfish, but people in life-or-death struggles have every right to ask how their participation in tests help them.  Sure, studies broaden knowledge and help future generations, but what about the test subjects’ immediate interests?  Do you really want to spend the very limited time you have to get well as a guinea pig?  Today’s expert is Jonathan Kolitz, M.D., Associate Chief, Hematologic Oncology at the Division of Medical Oncology and Hematology at North Shore University Hospital/LIJ Medical Center.  His main interest is protocol development for anti-cancer agent clinical trials.  Ask your questions to Dr. Kolitz about clinical trials and leukemia here and in a few days we’ll notify everyone of his answers.

Tagged: leukemiaclinical trialscancerhematologycancer patientpatientsurvivorscienceresearch

|

Eduardo Bruera, MDWhen fighting cancer, as with many diseases, there may be a balance struck between feeling better and getting better.  There are also challenges to treat symptoms on two different planes, body and mind.  Of course, those realms aren’t easily divided and influence each other.  Similarly, there’s a relationship between palliative and curative cares.  Today’s expert is Eduardo Bruera, M.D., chair of the Department of Palliative Care and Rehabilitation Medicine at The University of Texas M.D. Anderson Cancer Center.  Dr. Bruera serves on the Scientific Review Committee at the National Palliative Care Research Center in New York.  His focus is the treatment of physical and mental pain of advanced-cancer patients and those close to them.  He’s helped to start up palliative care programs around the world. 

Ask your questions to Dr. Bruera about palliative cancer-care from his profile page before 5PM EST and in a few days we’ll notify everyone of his answers.

Tagged: palliative carecancercurative carehealthhospice

|

Lidia Schapira, MDPatient-doctor communication might sound like a “touchy-feely” topic, but when you think about it, it’s essential to effective treatment.  How can there be any hope of success without a regular exchange of clear information?  

Today’s expert, Lidia Schapira, MD, researches ways to improve communication between patients and physicians.  A medical oncologist at the Gillette Center for Breast Oncology at the Massachusetts General Hospital, Dr. Schapira has studied the impediments to patient-physician dialogue.  She’s worked with professional societies and advocacy groups to improve awareness and overcome misperceptions that discourage patients from joining clinical trials.  Dr. Schapira is an Assistant Professor of Medicine at Harvard Medical School and an active member of the Empathy and Relational Science Program at the Massachusetts General Hospital in Boston.

Ask your questions before 5PM EST today and in the next week we will publish and notify everyone of Dr. Schapira’s answers here!

Tagged: communicationpatient communicationdoctor communicationdoctor patient communicationcanceroncologybreast cancerbreast cancer oncologydoctoroncologistbreast cancer oncologist

|

Kristen GembalaI am very excited about our featured BRCA+ previvor today, Kristin, who has been active in her local breast cancer community raising funds and educating.  She is now starting a company, braGGs, that creates bras specifically for women who have had breast reconstructions.  We heard from Kristin’s sister last week, Kara, who is a breast cancer survivor and partner in starting braGGs. 

Kristin and Kara have traced cancer in their family back 5 generations. After learning that her sister had the BRCA1 genetic mutation, Kristin discovered she too was carrying the mutation.  Although, only 5-10 % of breast cancers are genetically linked, if one has the BRCA1 mutation there are astronomical rates, up to an 87% chance of developing breast cancer and 48% chance of developing ovarian cancer.  Kristin decided to have a prophylactic double mastectomy, breast reconstruction, and prophylactic hysterectomy.  Based on her experiences of wearing bras after having breast reconstruction, Kristin felt that there had to be a better solution that would help her feel more normal throughout the day.  She collaborated with her sister, and they took the leap and started braGGs.

Ask Kristin questions now from her profile page.  Below are a couple of pictures of the new designs for braGGs, very exciting!

braGGs designbraGGs design

Tagged: brca+brcabreast cancersurvivorprevivorbreast reconstructionbrareconstruction bra

|

Overview of follow-up guidelines for melanoma patients. Once a patient has had melanoma, appropriate medical follow-up is necessary, combined with lifelong awareness of the consequences of a melanoma diagnosis. Because most melanomas arise due to ultraviolet (UV) exposure, and because such exposure doesn’t just happen to one specific place on the skin, melanoma patients are at high risk of developing other skin cancers – including another melanoma as well as non-melanoma skin cancers like basal and squamous cell carcinomas. Therefore, all patients with a melanoma diagnosis should have a dermatologist or other doctor examine their skin on an ongoing basis (usually at least yearly and often more frequently than that). All patients with a melanoma diagnosis should also be aware of the consequences of UV exposure and take proper precautions when they are out in the sun. When it comes to the details of follow-up aimed at detecting recurrence or spread of a patient’s melanoma, however, things need to be much more individualized. The risk of recurrence and spread after complete surgical removal can vary from very low (for stage 0 or IA melanomas) to quite high (for patients with stage IIIC or IV melanoma), and of course the patient’s age and overall state of health also need to be taken into consideration. Because so many individual variables must be considered, there is no ‘one size fits all’ approach to melanoma patient follow-up. Blood tests, CT scans and PET scans are sometimes helpful, but in many cases unnecessary – and sometimes even misleading or harmful. But melanoma can be very unpredictable, and sometimes even patients with very low risk melanomas have recurrences of their disease. So every patient should be vigilant, and if there are any unexplained or persistent symptoms or problems, these should be reported to a doctor for evaluation. Which doctor should provide follow-up to a melanoma patient is also highly variable, depending on the doctor’s expertise and experience as well as the patient’s condition. For example, surgical oncologists such as myself often provide primary follow-up for patients with some stages of melanoma after surgery without the involvement of a medical oncologist – but usually in combination with a dermatologist to provide annual or more frequent whole-body skin exams. If a general surgeon, plastic surgeon or dermatologist did the initial surgery, even if the melanoma was in a very early stage, they may refer the patient to a medical oncologist for subsequent follow-up. Many medical oncologists are more experienced with advanced stages of melanoma than with early stages, however, and we sometimes see patients getting scans and tests that are more appropriate for late-stage patient because of that. So whatever your stage and whoever your doctors are, be sure to have a conversation with them about your risk of recurrence and exactly what kind of follow-up is being recommended and why. There is no “right answer” here, the goal is to set up a follow-up program that is right for you. Top priority is always the detection of new cancers or local and lymph node recurrences of the original melanoma, as these are the situations that are most readily treated – and where earlier discovery can be helpful in improving the outcome. What follows are some suggestions for how we might follow an “average” melanoma patient after surgery, based on their stage.

Stage 0 (melanoma in situ): Since melanoma in situ has not yet become invasive, it theoretically has virtually zero chance of spread. If the melanoma in situ was completely removed, the chance of a local recurrence should be extremely low as well. For us at the Moffitt Cancer Center Cutaneous Oncology Clinic, once the initial surgery site has healed and we’ve seen the patient a few months later to verify a good outcome of the surgery in terms of appearance and function, the focus shifts to detecting new skin cancers of all types. Accordingly, we usually turn the follow-up responsibilities over to a dermatologist. Depending on the patient’s age, skin cancer history and the number and type of moles they have, the dermatologist may see them two to four times per year for the first few years after surgery and annually thereafter. We do not recommend any blood tests, x-rays or scans for patients with melanoma in situ.

Stage I-IIA (thin or intermediate-thickness melanoma, negative lymph nodes): For these patients, the risk of recurrence and spread is low, but not quite as low as for melanoma in situ. Still, the main focus in follow-up is on detecting new melanomas and other skin cancers, so the dermatologist often plays a leading role in the follow-up plan. However, there is a small risk of recurrence, particularly in the lymph nodes nearest the primary site (such as the armpit for arm melanomas and the groin for leg melanomas, etc). Because of this, patients should be aware of where those lymph nodes are and should examine their own lymph nodes once a month (in the shower is often a good opportunity to do so). There are many causes of enlarged lymph nodes, but any melanoma patient who notices a persistent or enlarging lump or bump anywhere in the region of their melanoma should have it checked out promptly, ideally by the surgeon who performed the original melanoma surgery if available. Overall, follow-up schedules are similar to that outlined above for stage 0 melanoma, and in most cases we do not recommend any blood tests, x-rays or scans for patients with stage I-IIA melanoma.

Stage IIB-IIC (intermediate-thickness or thick melanoma, negative lymph nodes): These patients have at least some high risk features, and the risk of recurrence and spread can be enough to justify treatment after surgery – such as with interferon. Generally, all these patients should be seen at least annually by a surgical or medical oncologist with expertise in melanoma for five years or more after surgery, in addition to close follow-up by a dermatologist or other physician to provide several whole-body skin examinations each year. While in most cases we do not recommend any blood tests, x-rays or scans for patients with stage II melanoma, there are situations in which we may consider them. So this is a group of patients where individualized attention to the screening plan is particularly important.

Stage III (positive lymph nodes and/or localized recurrence):  These patients are all at some risk of recurrence and spread, but the exact risk can vary dramatically depending on the details. Many stage III patients are considered for adjuvant therapy with interferon or for entry onto clinical trials, and so most patients in this category should see an oncologist of some type. Radical surgery on the lymph nodes also can have long-term effects, so follow-up by the surgeon who performed the operation is often advisable. Most patients in stage III are followed with some combination of blood tests, x-rays or scans, but again the details of the case are very important in deciding the actual follow-up plan.

Stage IV (metastatic beyond the lymph nodes):  Increasingly these days, surgery is being used for patients with stage IV melanoma if it is confined to only one or a few sites in the body. But these patients are at extremely high risk of further recurrence, which may or may not be amenable to additional surgery for treatment. Virtually all such patients should be treated by melanoma specialists, usually both a surgical oncologist and a medical oncologist. Adjuvant therapy or clinical trial participation is frequently encouraged, and most patients will need blood tests, x-rays or scans for follow-up.

Vernon Sondak, MDAuthor:  Vernon Sondak, M.D., chair of the Department of Cutaneous Oncology and director of Surgical Education at Moffitt Cancer Center. He is also a professor in the departments of Surgery and Oncologic Sciences at the University of South Florida College of Medicine.




Tagged: melanomamelanoma guidelinesmelanoma follow upcancercancer guidelinesmelanoma surveillancecancer surveillancecancer follow up

|

Judd Moul, MDWe have an amazing Q&A workshop today on prostate cancer with Dr. Judd Moul, who is the Director of the Duke Prostate Center and a Professor of Surgery at Duke University School of Medicine.

Dr. Moul is an international authority on prostate cancer and an expert on minimally invasive surgery, elevated PSA and screening, active surveillance, and outcomes research.  He serves on the editorial boards of several leading publications and has published over 500 medical manuscripts and book chapters.

Here is a list of Dr. Moul’s publications in PubMed to ask specific questions about his research: http://www.ncbi.nlm.nih.gov/pubmed?term=moul%20jw

Ask Dr. Moul questions now!

Tagged: prostate cancercancerpsa levelspsaminimally invasive surgeryurologyprostate cancer screeningcancer screening

|

Kara GorskiA big welcome to our featured survivor today, Kara Gorski, who has an amazing story to share about both her breast cancer experience, and her new adventure of starting a company to make bras for women who have had breast reconstruction. 

Kara is a stage 1, BRCA+ breast cancer survivor, diagnosed when she was 35, 4 years younger than when her mother died from the same disease.  Kara had a double mastectomy, breast reconstruction, prophylactic hysterectomy, and a year of chemotherapy.  She has also been an activist in the breast cancer community by raising funds, engaging the local community, and participating in several clinical trials. 

Kara needs our help now.  She is starting a company called braGGs, whose purpose is to help women who have had breast reconstructions be more comfortable as they go through their daily activities.  braGGs is currently taking discounted pre-orders as well as raising funds to finish the design and begin production of the bras, scheduled for this Fall.  Check out their MedStartr page and watch their video to learn more and consider donating.

Ask her questions now!

Tagged: cancersurvivorbreast cancerbreast cancer survivorcancer survivorbreast reconstructionbrca+brca

|

Erik Castle, MDWe are excited to welcome Dr. Erik Castle for today’s Q&A workshop about bladder cancer treatment and genomics. 

Erik Castle, MD, Associate Professor of Urology at College of Medicine, Mayo Clinic, is an expert in prostate cancer, bladder cancer, and kidney cancer.  His research focuses on the basic science and genomics of prostate and bladder cancer, outcomes of robotic and laparoscopic surgery, and building a urologic oncology biorepository.  His goals include developing new treatment options, evaluating treatment options, and discovering new biomarkers.

Here is a list of Dr. Castle’s publications in PubMed to ask specific questions about his research:
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=PureSearch&db=pubmed&term=Castle%20EP%5BAuthor%5D

Ask questions now to Dr. Castle and in a few days, all of his answers will be viewable at the bottom of his profile page.

Tagged: bladder cancercancergenomicsprostate cancersciencebiologybiomarkersmayo clinic

|

Kanti Rai, MDToday’s Q&A workshop is with Dr. Kanti Rai, who is answering questions about chronic lymphocytic leukemia (CLL), including treatment options, molecular biology, and using biomarkers to stage, choose treatments, and predict the clinical course of patients. 

Dr. Kanti Rai is known around the world for establishing the Rai clinical staging system for chronic lymphocytic leukemia (CLL) that helps predict how the disease will behave as well as plan treatments.  Dr. Rai is currently a Professor at Einstein College of Medicine and Chief of the Division of Hematology/Oncology at Long Island Jewish Medical Center. 

Here is a list of Dr. Rai’s publications in PubMed to ask specific questions about his research: http://www.ncbi.nlm.nih.gov/pubmed?term=rai%20kr

And here is a wonderful story on Dr. Rai and why he became a cancer researcher - “Dr. Kanti Rai, researcher and ‘doctor’s doctor’”

Ask questions now to Dr. Rai and in a few days you will be able to view his answers at the bottom of his profile page.

Tagged: leukemiacancerchronic lymphocytic leukemiaeinstein college of medicinecancer researchresearch

|
Christopher Recklitis, PhD, MPHWe have a very interesting Q&A workshop today on health psychology and behavioral outcomes in cancer survivors with Dr. Chris Recklitis from Harvard Medical School.  Dr. Recklitis is doing amazing research on the psychological effects of cancer, how to screen for psychological distress, and how to encourage health behaviors in cancer survivors.

A few of his current studies are how to measure depression and anxiety in young adult cancer survivors, physical and emotional health after prostate cancer, and sun protection in young adult cancer survivors.  

Here is a list of Dr. Recklitis’ publications in PubMed to ask specific questions about his research: http://www.ncbi.nlm.nih.gov/pubmed?term=Recklitis%20C

And here are links to a few abstracts from his publications that we recommend:
- Posttraumatic stress disorder (PTSD) in survivors of Hodgkin’s lymphoma
- Sun exposure in young adult cancer survivors on and off the beach
- Addressing psychological challenges after cancer: a guide for clinical practice.

Ask questions now to Dr. Recklitis and in a few days, all of his answers will be viewable at the bottom of his profile page.

Tagged: psychologyhealth psychologybehaviorcancersurvivorcancer survivorbehavioral psychologypsychological distressanxietydistressPTSDdepression

|

David Sidransky, MDToday’s Q&A workshop is about tumorgrafts, a technology that may help predict which treatment will be most effective in shrinking and controlling a tumor.  Our expert today answering questions about Tumorgrafting is David Sidransky, MD, Chairman of Champions Oncology, a company he founded to offer tumorgrafting services to patients.  Dr. Sidransky has been extensively involved in tumorgraft research and is one of the top scientists in America, being profiled by Time magazine in the past for his cancer research.

Tumorgrafting works by testing drug regimens on mice that have been implanted with a patient’s tumor.  Some of the potential benefits of this technology are to increase the chances of finding the most effective chemotherapy, save time by identifying ineffective medications, and test novel treatments that may otherwise not have been considered.

Of course, we have many questions about Tumorgrafting, such as how extensive is the research, does this technique work for all cancers, and in what situations is it helpful and not helpful in predicting a tumor’s response to drugs.

Ask questions to Dr. Sidransky about tumorgrafts and in a few days, check out all of his answers here..

See the Champions Oncology web site for more information on tumorgrafts.

Champions Oncology

Tagged: oncologycancertumortumorgraftingcancer treatmentspersonalized medicinemedicinehealth

|

Update From The American Society of Breast Surgeons Annual Meeting, 2012.


In the ASBrS study, 50 patients treated with brachytherapy (3.5%) developed an ipsilateral breast tumor recurrence (IBTR), 14 (1.1%) at the initial tumor site and 36 (2.6%) elsewhere in the breast.  For invasive cancers, IBTR was associated with estrogen receptor (ER) negative disease.  For DCIS, IBTR was associated with age <50 or close/positive surgical margins.

“Prior studies have demonstrated that the risk of cancer recurrence in the conserved breast is similar for WBI or APBI. Following WBI, most breast recurrences are at the initial tumor site, and relatively few are elsewhere in the breast,” says Dr. Peter Beitsch, Director of the Dallas Breast Center, Co-Principal Investigator for the ASBrS MammoSite Registry and lead author on the ASBrS study. “This study demonstrated that for patients treated with APBI, this ratio was reversed: most breast recurrences were elsewhere in the breast and only a minority were at the initial tumor site. These data suggest that although tumor control in the breast appears to be similar for APBI and WBI, disease control at the initial tumor site may be better with APBI.”

The findings of the ASBrS study contrast with the MD Anderson Cancer Center JAMA study, which also compared APBI to WBI.  That study compared the results of breast brachytherapy to WBI in 92,735 women 67 or older, 7% treated with brachytherapy and 93% with WBI. At 5 years of follow-up, compared to WBI, survival was the same (87.6% vs. 87%) but the brachytherapy patients had higher rates of subsequent mastectomy (4% vs. 2%), infectious complications (16% vs. 10%), non-infectious complications (16% vs. 9%), pain (15% vs. 12%), fat necrosis (8% vs. 4%) and rib fracture (4.5% vs. 3.6%).

Dr. Beitsch notes that the limitations of the MD Anderson study are that 1) it is based on Medicare claims data, which often does not provide an accurate clinical picture,  2) many endpoints are “soft”, poorly defined and difficult to quantify,  3) reported  complication rates after breast surgery and radiotherapy vary widely, and depending on study design are subject to under- or over-reporting, and 4) the authors’ inferences of harm to patients from breast brachytherapy are at best speculative.

An extensive body of literature, drawing on the ASBrS Registry and other sources, suggests that for APBI 1) local control is comparable to WBI, 2) local control is similar for women younger vs. older than age 70, 3) infectious complications are similar, 4) non-infectious complications including fat necrosis are similar, 5) pain is comparable, 6) cosmesis is excellent, and 7) survival, including overall, disease-free, and disease-specific survival, is similar to WBI.

Standard treatment for early stage breast cancer often involves breast conserving surgery (lumpectomy) and WBI.  Clinical trial data clearly demonstrate the need for some form of radiation therapy following lumpectomy to reduce the rate of tumor recurrence. APBI  may offer advantages such as reduced treatment time, reduced radiation dose to normal tissue such as lungs, ribs and heart, increased utilization of postoperative radiation therapy leading to lower recurrence rates, and an increased rate of lumpectomy compared to mastectomy in areas with limited patient access to WBI centers.

Dr. Beitsch also notes: “We radiate the breast to control undetectable cancer cells left behind around the lumpectomy cavity. Common sense would say internally targeted radiation would be the best method to kill these cells. We now have strong data to support that, and that the complication rate is very low from this form of therapy.”

“APBI appears to be safe and effective treatment for properly selected breast conservation patients,” says Dr. Hiram S. Cody III, Attending Surgeon, Breast Service Department of Surgery, Memorial Sloan-Kettering Cancer Center and Professor of Clinical Surgery, Weil Cornell Medical College. Dr. Cody, who is also a member of the Executive Committee and Board of Directors for ASBrS, notes that the ASBrS continues to support its Consensus Statement on APBI and guidelines for patient selection (August 15, 2011 revision): (http://www.breastsurgeons.org/statements/PDF_Statements/APBI.pdf).

However, Dr. Cody also states, “We wish to emphasize that although the six year results of APBI are encouraging, they do not conclusively establish equivalence with WBI, for which the supporting data include multiple randomized trials with follow-up exceeding 20 years, and meta-analyses that conclusively link local control and survival. APBI must ultimately be held to the same standard, and a randomized trial, NSABP B-39, directly compares partial breast irradiation (by interstitial catheters, balloon devices, strut-based devices, or external beam) with WBI and promises to better define the ultimate role of APBI.”

Author:  Dr. Peter Beitsch. Fellow of the Society of Surgical Oncology and American College of Surgeons. Previously on Board of Directors for American Society of Breast Surgeons.
Peter Beitsch, MD

Tagged: breast surgerybreast cancercancersurgerybrachytherapyradiationradiation therapyinternal radiation therapy

|