Tag Archives: Cancer

Common Drugs That Can Change Cancer Survival NOW

Image   A recent New York Magazine front page headline, “The Cancer Drug Racket,” highlighted an investigative report (1) about the increasing costs of cancer drugs in America. This article describes the anger felt by Leonard Saltz, director of G.I. Oncology at Memorial Sloan-Kettering Cancer Center when he was asked to approved an exorbitantly priced a new cancer drug, Zaltrap, very similar to several medications already on the Memorial formulary. This article highlights what I consider to be the tip of an iceberg, the dramatically escalating cost of new cancer drugs that are quickly outstripping the ability of the nation to pay. In this new era of personalized medicine, a few of these drugs may someday markedly improve the survival of some cancer patients. However, the majority of these “promising” drugs often gain approval after “eeking” out a small, though “statistically significant” increase in survival or response in clinical trials but at what cost? A huge price tag that is often associated with significant toxicity. As noted by Light and Kantarjian in a commentary in the journal Cancer this month (2), twelve of the 13 new cancer drugs approved in 2013 carry an average annual price of ~$100,000 while only one has demonstrated improved survival greater than 2 months. Because of the enormous financial benefit to the drug manufacturer, there’s a premium on developing such targeted drugs. Because of the significant shift in the financial incentives as well as the attraction of being at the frontline in cancer drug development, many of my colleagues have left the practice of medicine for more lucrative positions in the pharmaceutical world. Very few medical oncologists who continue to treat cancer patients on a daily basis can afford to practice in an outpatient private practice setting. Why? Because of the lack of affordability and the financial risk to provide these medicines. In my final year in private practice, my monthly pharmaceutical costs exceeded half a million dollars. With reimbursement by insurance companies close to or below cost, as well as delays and denial of payment, it simply became financially unsustainable.

As a result of this new reality, there is the increasing consolidation of cancer therapies into large institutional settings such as hospital-based clinics and specialized cancer centers. Many medical oncologists are leaving private practice for hospital-based positions or are choosing to retire early. In this setting cancer care is BIG BUSINESS. One disturbing trend is the recent announcement of the opening of outpatient cancer treatment centers by non-medical organizations, including a large grocery chain in the Midwest! (3). Yes it’s hard to believe and let me tell you about some of the ramifications. Continue reading

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On the Origins of Cancer in the Paradox of Good Health

ImageA recent New York Times article, In Sickness and in Health: a Wedding in the Shadows of Cancer, struck a particularly sensitive chord. It profiled the courageous journey of two of my patients, a husband with advanced pancreatic cancer and his wife with metastatic breast cancer and their preparation for the wedding of their daughter in the face of their battle with cancer. Among the responses of readers, an interesting and common concern stood out, why we continue to have an epidemic of cancer and why have we not dealt with the toxic mix of chemicals in our environment that they assume are a major cause of these cancers.

This perception is widespread. While there is little doubt that there are adverse health effects from these exposures, their role in the origin of the typical “western cancers” (breast, colorectal, prostate, etc.) remains uncertain. Certainly the central role of tobacco in lung cancer and several other cancers is undisputed.

What is most striking is the lack of awareness among the public and health care providers alike about the growing evidence that many non-smoking related cancers may actually be, in part, a direct effect of modern good health.  The marked improvement in maternal and early childhood nutrition has played an important role in the health and well being of modern populations.

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SOY. Is It Bad for Me?

Soy Beans and TofuI get this question almost daily from my breast cancer patients. People are understandably confused. As is the case with other foods, as research evolves, there are changing messages disseminated about their impact on health matters.

So, what information compels you to make decisions in life? The story about soy is the story about the evolution of knowledge about diet and cancer in general, as they say, and here is the rest of the story.

The earliest studies in the 70’s and 80’s indicated that Asian women had lower breast cancer risk than European and American women.  It turns out that many things about the life and culture of Asian women are different beyond their diets. The early thinking about possible connections to lower cancer risk focused on low fat intake and soy. Many in the research community advocated lowering dietary fat and increasing soy intake to reduce breast cancer risk and improve survival. Thus was born a wave of enthusiasm for all things soy.

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