Category Archives: General Articles

Coping with Cancer’s Financial Aftermath Summarization

Installment # 3 of:   Coping with Cancer's financial aftermath article  highlights summarized:

1.  Predicting problems, strategizing solutions - patients worried about financial strain when initially diagnosed,  should raise their
concern early in their treatment.  Asking the doctor if someone on the clinical team to walk them through what bills they should
anticipate, as well as an availability of financial resource entities is beneficial.
2.  Patients do better and regain some sense of control if they are able to harness  a proactive problem-solving approach and be
able to generate solutions to address financial concerns.
3.  Several aspects of the Affordable Care Act (ACA) may affect the cost of cancer care in the long run, as the law did not go far
enough, as the true costs of actual care delivery were never specifically addressed;  many feel that insurance companies needed to provide more coverage for cancer surveillance.  Cancer care data were not included in a recently released report by Medicare and Medicaid Services on what different hospitals charge for certain services.  Therefore, a cost comparison for cancer care is difficult to establish.
4.  The financial ripple effects can linger long after treatment ends.  A 2012 study found that of the 23% of patients with medical
debt, the average accrued debt for cancer care was $25,860.  The vast majority of patients reporting debt - 81% - were still carrying some of it more than a year after diagnosis.
5.  Financial strain cannot only erode patients' well-being, but also their ability to fight cancer, according to a study published in The Oncologist in 2013. 57% of patients who did discuss costs with their medical care team said the conversation led to a decrease
 in expenses.
On a different note ...
6.  Going back to work: A different topic but one that sometimes can cause angst for a patient returning to work:  A licensed clinical
psychologist practicing near Denver suggests the following when patients are worried about how much to reveal to co-workers,
how much information to keep private,  and how many times can the same questions be responded to . . . the advice:   to
develop a short script before that first day back to work-  one that is courteous, but does not invite further questioning. If a
conversation starts turning awkward,  perhaps it may be possible to turn it into a more pleasant discussion about common
work/project goals and expressing  "All of the support I have received has meant so much to me . . . and I'm glad I to be back."
Again, if you have questions that you would like to have answered from any of the highlights shared in these three installments,  please send them to me via email.
Thank you -
Annie

Advances in LeioMyoSarcoma Surgery

Heidi Bright, M.Div.

http://www.heidibright.com
Author, Thriver Soup: A Feast for Living Consciously During the Cancer Journey http://thriversoup.com/

Hidden Voices: Biblical Women and Our Christian Heritage http://www.helwys.com/sh-books/hidden-voices/

Advances in LeioMyoSarcoma surgery was addressed briefly Oct. 8 at the National Leiomyosarcoma Foundation patient symposium in St. Louis, Mo.  This was one of several cancer treatment topics that I am reporting about during the coming weeks.

Jeffrey Moley, associate director of the Siteman Cancer Center, said LMS can occur anywhere in the body and has a 50 percent mortality rate. It most commonly is found in the extremities of the body. Nineteen percent of sarcomas are LMS. High-grade LMS has a greater than 50 percent chance of metastasizing; low-grade has a less than 15 percent chance.

Sarcomas are the only cancers that are graded.

During surgery, the doctors always try to get a negative margin. To avoid amputation, one good option is to do limb-sparing surgery followed by radiation. This decreases the chance of a local recurrence by 30 percent.

MRIs and CT scans give pretty much the same information to the doctors.

The definitive treatment is complete surgical resection.

For abdominal and retroperitoneal tumors, sometimes repeat operations can be very effective, especially for low-grade sarcomas.

 

Surgical Management of Uterine Smooth-Muscle Tumors

Author: Heidi Bright, M.Div.
http://www.heidibright.com
Author, Thriver Soup: A Feast for Living Consciously During the Cancer Journey http://thriversoup.com/Hidden Voices: Biblical Women and Our Christian Heritage http://www.helwys.com/sh-books/hidden-voices/

Surgical management of uterine smooth-muscle tumors was addressed briefly Oct. 8 at the National Leiomyosarcoma Foundation patient symposium in St. Louis, Mo.  This was one of several cancer treatment topics that I am reporting about during the coming weeks.

Matthew Anderson, associate professor and director of research (gynecology) at Baylor University, said “Uterine leiomyosarcoma is a unique disease.” As many as 80 percent of women are impacted by a uterine smooth muscle tumor. About 200,000 hysterectomies are performed every year, which costs $3 to $5 billion.

“The only way to know if it’s malignant is to surgically remove it,” he said, because there are no diagnostic markers and no blood tests that can be used to determine malignancy.

Leiomyomas can arise in unusual locations. If they are morcellated, they can create other problems down the road. These myomas tend to respond to hormonal therapy.

They generally don’t tend to respond to chemotherapy or radiation.

About 70 percent of uterine LMS are discovered as isolated uterine masses. Recurrence rates are 40 to 70 percent.

With surgical debulking, doctors can increase progression-free survival from 6.8 months to 14.2 months.

Resection of pulmonary metastases can improve disease-free survival by as long as 24 months. This can include extensive resections while preserving good functional lung status.

Surgery by itself is not the answer. Unseen cells can come back. Ultimately patients have to rely on chemotherapy.

On April 17, 2014, the US FDA issued a safety communication regarding the use of power morcellation for performing hysterectomies or myomectomies. This led manufacturers to withdraw the devices and hospitals generally are not using this method.

Impact: 99 percent of the time, the uterine tumor is not cancer. Yet demand from patients for minimally invasive hysterectomies continues.

There is one case of ULMS in every 1,960 cases.

Short-term, the risk of ULMS should be discussed thoroughly with each patient.

The long-term goal is to develop a diagnostic test that can be used to determine malignancy.

Chemotherapy Clinical Trials

Heidi Bright, M.Div.
http://www.heidibright.com
Author, Thriver Soup: A Feast for Living Consciously During the Cancer Journey http://thriversoup.com/

Hidden Voices: Biblical Women and Our Christian Heritage http://www.helwys.com/sh-books/hidden-voices/

Chemotherapy clinical trials for leiomyosarcoma (LMS) were discussed briefly Oct. 8 at the National Leiomyosarcoma Foundation patient symposium in St. Louis, Mo.  This was one of several cancer treatment topics that I am reporting about during the coming weeks.

There are 70 different types of sarcoma, and treatment is moving toward individual types of sarcoma using genetically specific molecular therapy, said Dr. Scott Okuno, Chief Medical Officer in Sarcoma Alliance for Research Through Collaboration, a non-profit research cooperative,  and professor of oncology at Mayo Clinic.

“As we get deeper into LMS, we find molecular subtypes of LMS,” he said.

He explained that adjuvant treatment is preventative. Typically a tumor is removed and the patient is given additional treatment to eradicate microscopic metastatic cells.

Neoadjuvant treatment is given prior to removal/ablation of a tumor, and is used to shrink the tumor and eradicate any microscopic metastatic cells.

In determining which path to follow, the physician will look at outcomes. For neoadjuvant treatment, for example, perhaps 33 percent (about three of 10 patients) will have a recurrence.

With adjuvant treatment, there might be another 33 percent reduction in recurrence—which means instead of three out of 10 patients with recurrence, there will be two out of ten patients with recurrence.

Chemotherapy is given when a tumor cannot be surgically removed.

In clinical trials, a tumor has to decrease in size by 30 percent to be considered a partial response.

Progression has to be a greater than a 20 percent increase for the treatment to be considered no longer working.

Sometimes the lump might get bigger but the tumor is dying, so the percent increase in size is allowed. One needs a sarcoma specialist to determine if the growth is from dying cells or from a growing tumor.

Dr. Mohammed Milhelm, director of the Melanoma Program at the University of Iowa, added, “We really don’t know what’s going on inside the tumor.”

Dr. Okuno said Gemzar and Taxotere together aren’t showing much difference beyond just what Gemzar can do. Dacarbazine alone doesn’t make much difference. Yet when Gemzar and dacarbazine are combined, patients tend to have better outcomes. A difference in outcomes also was found in the rate of infusion—for example, infusing the same amount of chemotherapy over a longer period of time can result in better outcomes.

Immunotherapy as a cancer treatment

Heidi Bright, M.Div.
http://www.heidibright.com
Author, Thriver Soup: A Feast for Living Consciously During the Cancer Journey http://thriversoup.com/

Hidden Voices: Biblical Women and Our Christian Heritage http://www.helwys.com/sh-books/hidden-voices/

Immunotherapy as a cancer treatment was addressed briefly Oct. 8 at the National Leiomyosarcoma Foundation patient symposium in St. Louis, Mo.  This was one of several cancer treatment topics that I am reporting about during the coming weeks.

Dr. Mohammed Milhelm, Holden Chair of Experimental Therapeutics at the University of Iowa, said “Sarcoma doctors aren’t happy with the current treatments available. I’m trying to move immunotherapy into sarcoma treatment.”

Historically, immunotherapy is used to stimulate the immune system, yet if our immune systems are always accelerated, we would not live. “We have a good brake system in our bodies,” he said.

Immunotherapy is using the body to target the tumors. “A lot of people are thinking about immunotherapy in combination with other treatments,” he said. “We are still trying to understand how the immune system works. It’s tricky and complicated.”

A lot of questions are coming up about how to do immunotherapy. Sometimes imaging months after treatment ends might show significant improvements. Combining immunotherapy with radiation might help the immune drug work better.

Newer, more powerful drugs are on the horizon. “We’re learning a lot from the melanoma world and trying to transfer it to other cancers. There haven’t been enough immunotherapy treatments with LMS to know if it is effective.”

Swelling can be a big problem, especially in the bones and the brain, and is a concern researchers still don’t know how to address.

There is a lot of promise right now, but researchers don’t yet know how to translate it into treatments for LMS.

Clinical Trials and Leiomyosarcoma

Heidi Bright, M.Div.
http://www.heidibright.com
Author, Thriver Soup: A Feast for Living Consciously During the Cancer Journey http://thriversoup.com/

Hidden Voices: Biblical Women and Our Christian Heritage http://www.helwys.com/sh-books/hidden-voices/


Clinical trials for leiomyosarcoma (LMS) were discussed briefly Oct. 8 at the National Leiomyosarcoma Foundation patient symposium in St. Louis, Mo.  This was one of several cancer treatment topics that I will be reporting about during the coming weeks.

Dr. Peter Oppeli, assistant professor of medicine at the Washington University School of Medicine, said LMS is one of the more common types of soft-tissue sarcoma. It is found in smooth muscle cells that naturally occur in the intestines, blood vessels, and the uterus, all of which are in charge of involuntary action in the body. For pregnant women, these muscles play a key role in labor and delivery.

LMS can originate anywhere smooth muscles are found. In almost half of all new LMS diagnoses, it is found in the uterus. It also occurs in the body’s extremities and in the abdominal cavity, especially in the back part of the abdomen.

There are about 2,000 new diagnoses each year. Compare that to another type of cancer, such as colon, which has about 135,000 new diagnoses each year.

Because LMS is rare, it is more challenging to come up with treatments. Any new drug for a rare disease is cause for a lot of excitement. Trabectadine, for example, was approved by the FDA in October 2015.

New drugs are approved when they show proven benefit from a clinical trial.

Clinical trials are research studies for understanding cancer and how to treat it. Trials can look at new drugs, combinations of drugs, ways to ease side effects, new forms of radiation, and new surgical methods.

A Phase 1 clinical trial is for finding the right dose and finding out the treatment’s side effects.

A Phase 2 trial involves larger groups of patients. In a Phase 3 trial, large number of patients are treated to confirm effectiveness.

The vast majority of clinical trials do not have a placebo-only option. Placebos usually are combined with standard effective treatment, so every patient gets what is determined to be the best treatment.

What is research protocol? It is the rule book for each clinical trial. Each trial will have a unique/specific protocol that describes inclusion and exclusion criteria for potential treatment.

Is a clinical trial going to help a particular patient? “We hope so, but cannot say with certainty that enrolling is going to be beneficial,” Dr. Oppeli said.

Almost every standard treatment has first been proven effective in clinical trials.

After his talk there was a 10-minute time period for questions.

A lot of clinical trials have interim times to see if a trial is helpful or not. Then if not shown effective, the trial is stopped. If the results look promising, the trial continues.

Thriver Soup Ingredient:

For more information on clinical trials, go to www.cancer.net for a large video library.