Posts Tagged ‘cancer’

The Case for Cancer Neurosis

Sunday, October 10th, 2010

The blessing and the curse of being a cancer patient is the very present knowledge that today may be one’s last on earth. The blessing is that God gives most of us some warning and we can plan the rest of our lives as we see fit. “Why me” makes no sense since we have not only lived the blessing of life, we are now given the privilege of enjoying what is a finite time left on earth. This is different than the person who’s sudden and untimely death occurs in an inopportune moment and there is no time to say good-bye, no time to make peace with the present and the past. It is the sense of knowing a recurrence of cancer can occur at any time just as it did the first time that gives us a sense of living in the present and the fear that we may have to leave.
This is the plight of the cancer patient. This is the cancer paranoia that each of us lives with in some degree of consciousness. A friend once said to me that only the paranoid Jews survived the Holocaust. The others blindly ignored their fate. So it is with the cancer patient. The subtle pain in the back, the indigestion following dinner, the recurrent cough – all may portend the recurrence that signal a resetting of priorities, a new allocation of time.
In 2002 I had pancreatic cancer and for reasons too ethereal for my understanding I survived. With due credit to my magnificent doctors there is some luck involved. The cancer was in the right spot to cause the jaundice to alarm my office manager who rushed me to the emergency room and on and on and the rest is my history. Several times in the past 8 years I have relived the fears and concerns as symptoms once considered inconsequential now become portents of my future. And so my indigestion and back pain led me to repeat my CAT scan 3 months ago with the disappointing news that there was a spot in my liver that could not be explained. What followed was the mandatory 3 month wait until I could repeat the scan to see if the lesion was real or ephemeral, was one that would realign my reality or would be followed by an all-clear signal. And so my wife and I waited and we waited and much of the time we put all of these thoughts out of our mind. But of a quiet moment, when we had time to reflect and to be thankful, the dark possibility always returned. Last week the repeat scan took place and to our relief and gratitude the “spot” was not present.
This is the fate of the cancer patient. This is our reality. We hope that groundless fears and neurotic pre-occupation will help protect us and at least serve as an early warning system. At worst it will give us time to share what is important and dispense with the rest. This hyperawareness is the domain of all who have brushed death and felt what might have been an imminent demise. This is the domain of all who are undergoing treatment or who support loved ones traversing the space of potential terminal illness.
I hope you will understand my sharing. I thought you might want to know.

If you are or will be a skin cancer patient: read this

Tuesday, March 2nd, 2010

Neoadjuvant Therapy. Adjuvant Therapy. Learn these words. One or the other may save your life if you get cancer. I am largely alive today because I was one of the first participants in a clinical trial using neoadjuvant therapy to treat my pancreatic cancer in 2002. I will write more about that later.
Neoadjuvant therapy can refer to treatments given to reduce tumor size or improve survival before definitive therapy such as surgery is performed. Adjuvant therapy is the use of drugs or other modalities after surgery to reduce the chance of surviving cancer cells from growing.
Skin cancer is the most prevalent cancer in the world. More than 1 million cases occur every year in the United States. It is the 7th leading cause of cancer death in the United States. It is the biggest single drain on the health care system of all cancers. It is promoted by sunlight and directly caused by suntan parlors. The odds of a patient who has had skin cancer developing another skin cancer is 30% over the next 3 years and 100% over a lifetime.
A patient came to see me today who told me about her husband who had skin cancer and a lot of sun exposure in his earlier life. He sees a dermatologist many times a year and at each visit the dermatologist “zaps” off lesions from his face. Yet no matter how many lesions are removed, at the next visit new ones have arisen. I think even a mule understands that when he is overheating in the sun and does not feel well, moving into shade gives relief. Yet here are millions of patients who go month after month, year after year, to get spots “zapped” with the “understanding” that this might prevent skin cancer. At best this is specious reasoning and between the doctor and the patient I am not sure who benefits most.
It was refreshing at the Orlando Dermatology Meeting last December to hear lectures on neoadjuvant and adjuvant therapy to prevent the onset of new lesions and ultimately to prevent new cancers. Remember these names- adjuvant and neoadjuvant. They are available for you now and will be the primary therapy for your children. The fact is patients have options on how to prevent cancer and what follows is a short list to consider:
• Topical vitamin A or tretinoin. Available as a gel or cream a little dab each night may prevent up to 90% of new cancers from arising. This has been known since 1980, yet few physicians recommend it to patients. Coincidentally it is used to treat wrinkles.
• 5-FU (5-fluorouracil): a known anticancer drug for breast and colon, it has been used for years as a cream to treat precancerous lesions. New evidence suggests using it for one week out of the year may prevent even these precancerous lesions from forming.
• PDT (photodynamic therapy): consists of applying a chemical, aminolevulinic acid, to the skin followed by intense light or laser therapy. With more than 20 years experience in Europe it is very successful in treating precancerous lesions and small cancers and is a very popular skin rejuvenation treatment. Like vitamin A you get two for the price of one: better health and better looks.
• Fractional Laser Resurfacing: While not yet successful as a preventive, this is another 1-2 punch making you look better and removing precancerous lesions.
In the 21st century it is archaic to get lesions “zapped” and do nothing to prevent skin cancer and its precancerous growths. In an age where we look to legislation to reduce health care expenditures it is incumbent upon each of us to utilize preventive measures to treat and prevent skin cancer. Well, the time is here and the methods are available. Are you?

Managing Cancer

Sunday, January 3rd, 2010

On or about August 27, 2002 I awoke in the morning and went to work as usual. I did not know that my world as I knew it was about to change irrevocably. On a subliminal basis I knew that I had cancer of the soul. My marriage was in name only, my family dissipated, my work was my passion. I did not understand that in a few hours, a Kafkaesque moment, I would turn yellow and the cancer in my soul would become the cancer in my pancreas. That was then and now I am a 7 year survivor of a cancer few get to tell about.
Back then, after a rapid work-up, I was presented a chance to become a patient in a phase III clinical trial. I enlisted before I knew what the trial entailed. Dr. Talamonti asked how I could volunteer with so little knowledge. “Look,” I said. “I have a minimal chance of survival regardless and the possibility of remission if I participate. At the least, someone else may benefit from my experience.” I was unaware of statistics which indicated that from 1980-1989 patients in clinical trials had up to a 400% greater chance of remission than patients who did not participate. So who wouldn’t participate?
75% of adults. That’s who. 75% of adults across all spectra of cancer do not participate in clinical trials. Yet the numbers get worse. My friend, Dr. Jane Petrow, showed me that today less than 5% of women with breast cancer participate in clinical trials. There must be an explanation. Antipathy? For God’s sake you are dying! Who the hell has antipathy at that point? Maybe false bravado, but certainly not antipathy. I judge there are 2 explanations.
Patients: Even today adults with cancer believe that clinical trials involve risk to them. They think they may receive a placebo. There are no placebos in a level III clinical trial. Flashback. The year is 1978 and I am asked to see a woman with Hodgkin’s lymphoma who has a skin rash. I enter her room to find that the lady is in a coma and she has disseminated varicella, chicken pox if not herpes zoster. Herpes Zoster. I erupted with anger. This was about me not the patient. Why had I been called in at all? I was helpless before this woman who had disseminated cancer, disseminated varicella, was clearly dying, and would soon leave 3 children and a husband at age 35. In anger I can be irrational so I began calling colleagues who might know of a clinical trial for this woman. I found one at the University of Chicago. Through a series of not so ethical subterfuges I got her transferred to the U of C Hospitals where she recovered and went on to remission from lymphoma. I later spoke with her attending doctor at the U of C Hospital and he told me the miracle of her cure was not in the drugs used in the trial but in the supportive care she received which was not available at most community hospitals. That’s the rub, the misconception. Patients in level III clinical trials receive the latest therapies, the best of old therapies, and very importantly a level of care that is often not available in a community setting.
Doctors: Doctors today are between a rock and a hard place. Their incomes depend on caring for sick people. Their egos are not satiated by referring every sick patient to a university type setting. They are not always privy to the inside advantages of medical institutions and pharmacopeia. And if the therapy they advise worked for Mrs. Jones why not for you.
But that’s not the point. The point is that cancer today gets far less government appropriations for research than bills filled with pork to advance the careers of politicians who are supposed to be serving us. The point is the system is not geared to give the majority of patients the optimal care that may be available. The point is that adult patients are fearful of the unknown and a known treatment that does not work may feel preferable to one that is being studied. The bottom line for me is that I survived, who knows how or why, and that it is painful to see cancer patients limit their chance of success for any of the above reasons.
So today I am free of the cancer in my pancreas, free of the cancer in my soul, and I am forever grateful for the wonderful care I received at Northwestern University Hospital and the opportunities they presented for me.