I was very lucky. When I was diagnosed with lung cancer nearly three years ago I was symptomatic (I had a persistent cough) but thankfully I did not have any complicating issues or disease.
I did not know at the time that the medical world uses a scoring system to quantify a patient’s general well-being. I had a “performance status” of one when I was diagnosed (symptomatic but completely ambulatory.). A performance status indicating generally good health allowed my doctors to treat me without needing to account for how treatments would affect some other disease. Today I would be scored a zero (asymptomatic, fully active and able to carry on all activities without restriction.) If I have a cancer recurrence, my general good health should help me fight the disease. These days I work hard at trying to stay healthy.
I say I was lucky, because people with cancer frequently have other medical issues, such as diabetes, high blood pressure, kidney disease, COPD, and so on. These patients are understandably more challenging for an oncologist to treat effectively.
I was surprised to learn that diabetics, despite seeing a doctor more often than most other people, appear to be less likely to be screened for cancer. That is disturbing on a number of fronts, not the least of which is the suspicion that there exists some link between cancer and diabetes. In fact, one estimate I found is that cancer rates among diabetics may be as high as 18%. The link between these two diseases is as yet unproven. Nevertheless, you would think that, given the high rate of cancer among diabetics, screening rates would be higher, not lower.
One Canadian study showed that the mammography rates for women with diabetes were more than 30% below their non-diabetic counterparts. The low screening rates in that study were attributed to “time constraints during office visits for complex disease care.” The upshot is that if you are diabetic, you may want to ask your physician about cancer screening and prevention.
Diabetic patients present treatment challenges for oncologists. For example, may diabetic patients may have pre-existing issues with their kidney or heart or suffer from neuropathy. All of theses conditions may be exacerbated by chemotherapy, depending on the agent being used. Cisplatin, which is what I was given, is known to impair the kidneys and cause peripheral neuropathy. But successful treatment typically requires that 85% of the chemo-therapeutic dose be given. Reducing the treatment dosage or timing to temper side effects may also impact the treatment’s efficacy. It is a difficult choice to have to make.
Diabetics face other challenges in being treated for cancer, with the largest being control of blood sugar levels. Treatment induced nausea and vomiting, for example, can be controlled with drugs, but steroid based anti-nausea drugs may in turn wreak havoc on controlling blood sugar levels and the amount of insulin a patient is required to take. Being able to maintain proper nutrition during cancer treatment is a challenge for a diabetic.
While the link between diabetes and cancer is not yet definitive, there are many common risk factors, including age, obesity, poor diet and lack of exercise. Prevention of diabetes is an important factor in fighting all cancers. People with diabetes double the risk of developing liver and pancreatic cancer. It is known to increase the risk for colorectal, breast and bladder cancer by 20% to 50%. In contrast, for some unknown reason, prostate cancer is less prevalent in men with diabetes. Go figure.
Research presented at ASCO this year showed that metformin, a drug commonly used in the treatment of type-2 diabetes, helped guard against tobacco-induced lung cancer in mice. More research is needed to see if this commonly used drug to treat diabetes is a potential lung cancer preventative in humans. Let’s hope research progresses soon.
Thursday, August 19, 2010
Tuesday, August 10, 2010
American Food Culture
I have never been heavy, but since I was diagnosed with cancer, I have put on a few pounds. Actually, I’ve gained more than a few. I am 5 foot 10 inches tall and for most of my adult life, while living in Japan, I weighed less than 140 pounds. That’s pretty skinny.
I started gaining weight when we moved back from Japan in 1998. When I was diagnosed with cancer in 2007 I weighed about 150 lbs. During chemo and radiation treatment I lost a few pounds but since then I have continually gained weight. As of this writing I weigh 165 pounds and rising.
So why am I gaining weight? Well, one reason is my metabolism has slowed. It used to be that I could eat like a horse, drink like a fish, and not gain an ounce. Lately I have to watch what I eat and drink.
The main reason for my weight gain is what I put in my mouth. We eat and drink a lot of sweet things in this country and, as Yoko will tell you, I love sweet things, like pies, cookies, ice cream, and candy. When I lived in Japan I did not consume as much sweets as I do here. At work in Japan we would drink unsweetened hot green tea. Here I drink coffee with sugar and cream throughout the day. There is no question that hot green tea is better for you and less fattening.
A third reason for my weight gain has to do with the amount of exercise I get. I get in my car and drive to and from work. In fact, I drive everywhere. I’m walking the dog or riding my bike in the morning before work as a way to purposely get some exercise, but, obviously it is not enough. Fattening foods and the convenience of living a middle-class American lifestyle lends itself to weight gain.
In contrast, my daily routine in Japan was embedded with good eating and exercise. I typically walked 15 minutes to the train station in the morning and home again in the evening. During the day I would walk to and from the subway station and up and down stairs and then walk to appointments.
I easily walked two or three miles a day as well as up and down 10 to 15 stories of stairs. In short, I lead a pretty healthy lifestyle that allowed me to stay trim.
Of course, I ate a lot of fish and rice in Japan as well as steamed vegetables. The Japanese don’t use much butter or oil in their cooking and bread is not served with a Japanese meal. The only really bad thing the Japanese use regularly as an ingredient is soy sauce, which is high in sodium. Generally the Japanese don’t fry a lot of food in oil or eat a lot of meat. They boil things in water, steam-cook foods, grill, or prepare foods raw (like sushi or sashimi). Japanese cuisine is often described as “delicate.” Some might say “bland.” Meals are generally light and prepared in numerous small dishes. Steamed white rice is the staple. Japanese food culture offers a wide variety in tastes and textures.
Both Yoko and I bemoan America’s food culture and our unhealthy eating habits. We both think Americans generally lack education about good food and healthy eating. We find it hard to believe, for example, that children are allowed to choose what they eat at school. Do we really expect kids to make healthy food choices? It is little wonder that there is a growing obesity crisis in this country.
School lunch in Japan is determined by a committee of parents who collectively decide on what their kids will eat each day. Maybe that’s what we should do too. Are you listening school board?
I started gaining weight when we moved back from Japan in 1998. When I was diagnosed with cancer in 2007 I weighed about 150 lbs. During chemo and radiation treatment I lost a few pounds but since then I have continually gained weight. As of this writing I weigh 165 pounds and rising.
So why am I gaining weight? Well, one reason is my metabolism has slowed. It used to be that I could eat like a horse, drink like a fish, and not gain an ounce. Lately I have to watch what I eat and drink.
The main reason for my weight gain is what I put in my mouth. We eat and drink a lot of sweet things in this country and, as Yoko will tell you, I love sweet things, like pies, cookies, ice cream, and candy. When I lived in Japan I did not consume as much sweets as I do here. At work in Japan we would drink unsweetened hot green tea. Here I drink coffee with sugar and cream throughout the day. There is no question that hot green tea is better for you and less fattening.
A third reason for my weight gain has to do with the amount of exercise I get. I get in my car and drive to and from work. In fact, I drive everywhere. I’m walking the dog or riding my bike in the morning before work as a way to purposely get some exercise, but, obviously it is not enough. Fattening foods and the convenience of living a middle-class American lifestyle lends itself to weight gain.
In contrast, my daily routine in Japan was embedded with good eating and exercise. I typically walked 15 minutes to the train station in the morning and home again in the evening. During the day I would walk to and from the subway station and up and down stairs and then walk to appointments.
I easily walked two or three miles a day as well as up and down 10 to 15 stories of stairs. In short, I lead a pretty healthy lifestyle that allowed me to stay trim.
Of course, I ate a lot of fish and rice in Japan as well as steamed vegetables. The Japanese don’t use much butter or oil in their cooking and bread is not served with a Japanese meal. The only really bad thing the Japanese use regularly as an ingredient is soy sauce, which is high in sodium. Generally the Japanese don’t fry a lot of food in oil or eat a lot of meat. They boil things in water, steam-cook foods, grill, or prepare foods raw (like sushi or sashimi). Japanese cuisine is often described as “delicate.” Some might say “bland.” Meals are generally light and prepared in numerous small dishes. Steamed white rice is the staple. Japanese food culture offers a wide variety in tastes and textures.
Both Yoko and I bemoan America’s food culture and our unhealthy eating habits. We both think Americans generally lack education about good food and healthy eating. We find it hard to believe, for example, that children are allowed to choose what they eat at school. Do we really expect kids to make healthy food choices? It is little wonder that there is a growing obesity crisis in this country.
School lunch in Japan is determined by a committee of parents who collectively decide on what their kids will eat each day. Maybe that’s what we should do too. Are you listening school board?
Tuesday, August 3, 2010
Clincial Trial Bottleneck
I always thought that clinical trials were something you considered doing as a patient when there were no other treatment options available. It made sense to me that you would try all the conventional treatment options first and then, if all else failed, resort to trial drugs. It’s a fair assumption, but it’s wrong. In many cases, using a trial drug first may be the better option.
A newly diagnosed cancer patient does not typically think to ask their physician what trials are available to them before beginning “standard of care” treatments. Most physicians are themselves are not familiar with all of the trials available and the eligibility criteria for participation. A quick search for lung cancer trials currently recruiting patients at the National Institute of Health’s website (www.clincialtrial.gov) reveals that there are over 1000 open trials related to lung cancer alone. There is no way to easily find a trial other than to do a search and narrow down or refine the criteria to meets your needs, condition and location. In many cases it will be up to the patient to find a clinical trial and then consult with their physician about the benefits of participating.
Clinical trials are an important part of cancer research and medical research in general. Unfortunately, the patients “accrual rates” for many studies are so low that trials are frequently closed for lack of participation. It’s estimated that only 3% of newly diagnosed cancer patients enroll in clinical trials – an exceedingly low number. I saw one study that declared that more than 40% of all oncology trials “don’t meet the minimum target for patient accruals.”
Clinical trials are the bottleneck to faster advancement in cancer research. We all have a stake in seeing cancer research advance more rapidly. A recent report from the National Cancer Institute estimates that 41 percent of Americans living today will develop cancer in their lifetime; one in four will eventually die from the disease.
One study that looked into the reasons for low accrual rates for cancer patients in clinical trials reveals that of the 276 patients studied only 14 percent ultimately participated in a trial. The most common reasons for patients not participating were elimination by their physician due to perceived availability or poor performance status; the desire for other treatment and distance from the available trial sites.
The Phase III Stimuvax trial I am enrolled in requires 1200 patients be recruited. There are 259 sites around the world participating in this particular trial with four here in Florida. It may take five years or more before 1200 patients are accrued and the study completed.
Before joining a trial, a participant must qualify for the study. Some research studies seek participants with illnesses or conditions to be studied, while others need healthy participants. Clinical trials require that patient sign a document that explains the risks and benefits of the trial, called an “Informed Consent.”
All clinical trials have guidelines about who can participate. The factors that allow someone to participate are called "inclusion criteria" and those that disallow someone from participating are called "exclusion criteria". These criteria are based on such factors as age, gender, the type and stage of a disease, previous treatment history, and other medical conditions.
In my case the inclusion criteria for enrolling in the Stimuvax trial was having been diagnosed with nonresectable Stage IIIA adenocarcinoma. Exclusion criteria included having any sign of metastatic disease. I also had to meet a strict time window from the end of conventional treatment to enrollment.
The internet makes it fairly easy to research available clinical trials. One day electronic medical records may automate matching patients with trials and improve recruitment. In the meantime, patients need to be their own advocate. Being proactive may get you access to state of the art medicine and the chance for a better future.
A newly diagnosed cancer patient does not typically think to ask their physician what trials are available to them before beginning “standard of care” treatments. Most physicians are themselves are not familiar with all of the trials available and the eligibility criteria for participation. A quick search for lung cancer trials currently recruiting patients at the National Institute of Health’s website (www.clincialtrial.gov) reveals that there are over 1000 open trials related to lung cancer alone. There is no way to easily find a trial other than to do a search and narrow down or refine the criteria to meets your needs, condition and location. In many cases it will be up to the patient to find a clinical trial and then consult with their physician about the benefits of participating.
Clinical trials are an important part of cancer research and medical research in general. Unfortunately, the patients “accrual rates” for many studies are so low that trials are frequently closed for lack of participation. It’s estimated that only 3% of newly diagnosed cancer patients enroll in clinical trials – an exceedingly low number. I saw one study that declared that more than 40% of all oncology trials “don’t meet the minimum target for patient accruals.”
Clinical trials are the bottleneck to faster advancement in cancer research. We all have a stake in seeing cancer research advance more rapidly. A recent report from the National Cancer Institute estimates that 41 percent of Americans living today will develop cancer in their lifetime; one in four will eventually die from the disease.
One study that looked into the reasons for low accrual rates for cancer patients in clinical trials reveals that of the 276 patients studied only 14 percent ultimately participated in a trial. The most common reasons for patients not participating were elimination by their physician due to perceived availability or poor performance status; the desire for other treatment and distance from the available trial sites.
The Phase III Stimuvax trial I am enrolled in requires 1200 patients be recruited. There are 259 sites around the world participating in this particular trial with four here in Florida. It may take five years or more before 1200 patients are accrued and the study completed.
Before joining a trial, a participant must qualify for the study. Some research studies seek participants with illnesses or conditions to be studied, while others need healthy participants. Clinical trials require that patient sign a document that explains the risks and benefits of the trial, called an “Informed Consent.”
All clinical trials have guidelines about who can participate. The factors that allow someone to participate are called "inclusion criteria" and those that disallow someone from participating are called "exclusion criteria". These criteria are based on such factors as age, gender, the type and stage of a disease, previous treatment history, and other medical conditions.
In my case the inclusion criteria for enrolling in the Stimuvax trial was having been diagnosed with nonresectable Stage IIIA adenocarcinoma. Exclusion criteria included having any sign of metastatic disease. I also had to meet a strict time window from the end of conventional treatment to enrollment.
The internet makes it fairly easy to research available clinical trials. One day electronic medical records may automate matching patients with trials and improve recruitment. In the meantime, patients need to be their own advocate. Being proactive may get you access to state of the art medicine and the chance for a better future.
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