End-of-life patients need big picture

[flashl]

Patients with advanced cancer often don't know how long they have to live or how chemotherapy will affect their lives, a study shows.

In many cases, doctors don't give patients such information. Other times, patients misunderstand their doctors and perhaps hear what they want to hear, according to the study in today's Journal of the American Medical Association.

These patients may suffer from more than just the ravages of cancer, says co-author Sarah Harrington, an assistant professor at Virginia Commonwealth University School of Medicine in Richmond.

For example, patients may ask for aggressive, painful therapies that have no hope of helping them. More than 20% of Medicare patients who have advanced cancer start a new chemotherapy regimen two weeks before they die, she says. Such patients may miss the opportunity to mend relationships, seek spiritual counseling or create important documents such as advanced directives.

USA Today

Maybe, Cancer patients need to be educated about their government front for big pharma, the Food and Drug Administration, that recently approved the drug Avastin. The Drug company successfully used a widely debated measure of drug effectiveness that focuses on tumor growth, not patient survival.

So, we have a government approved drug for the tumor but not the patient.

[Lint Head]

1. If someone is dying they should have all information available as to

pain management. It should be the choice of the person that is dying. It is their death not someone else's death. It's a shame that not only have peoples rights been taken away while they are living but they are being robbed of their choices when they die.

[WildClarySage]

2. I guess I have a particular perspective on this precise topic

as my father is dying from lung cancer right now. He's just entered stage four, where cancer has entered his brain. His physician has discussed with us his prognosis, but he has not told my father yet that his cancer is terminal. There's no reason to: Dad needs to be able to believe he will recover- without that, he'd give up sooner, all treatments he's undergoing are intended to extend the quantity and quality of time he has left, he knows better than anyone how he feels and what that means, and one never knows, miracles do happen. But not having his doctor say it means that his expectations can chart his progress. Hope is what cancer patients need most. Honesty is what that patient's family needs.

I'm really not sure what the problem with Avastin is. I've not read anything about it. But trust me, anything that shrinks tumors is gonna benefit a patient even if it doesn't cure him/her. Tumors hurt. Smaller tumors hurt less, and help a patient feel better, and live longer, even if that isn't a cure, it helps them live longer and longer living means more opportunity for more effective cures to come down the pike.

[eilen]

4. My Dad died of lung cancer

and he suffered incredible pain. It was the pain that brought him to the Dr. After diagnosis, they never ever treated his pain appropriately and his financial burden in purchasing the pain medication added to his stress.

He was diagnosed at Stage 4. I feel the physician should have told him what the median life expectancy was for newly diagnosed Stage 4 non small cell lung cancer was -- it is 10 months. My Dad had a horrible reaction to Taxol. They ended up just treating him with Carboplatin-- 3 treatments, then when brought in with such uncontrolled pain, they admitted him and gave him Alimta.

While he was hospitalized, (over Thanksgiving). The "team" informed me that the chemo was having no effect on his cancer (no shit--otherwise his pain would have decreased). They recommended hospice. I took it. I was his proxy and his mental status rendered him unable to make decisions, luckily he had a Living Will and Health Care Proxy that he signed 3 years before.

He should have been on hospice to begin with. Once he was admitted to hospice, we finally received adequate pain treatment, but it took awhile. Since the drugs used for management of symptoms is 100% covered by hospice, it was easier to change therapies until we got to the one that worked.

Many doctors go immediately to fentanyl patches, they do not work for everyone and they are very expensive. Some people genetically just don't respond well to them. Also, for agitation, many Drs. like to use Haldol, another crappy drug. People with a history of alcoholism don't fare well with this drug and respond much better with Ativan. The concerns about liver enzymes and kidney notwithstanding, if a patient is St.4 lung cancer it doesn't matter, keep them comfortable and have a better quality life. What ultimately kept my Dad pain free in the end was not the oral morphine but was oxycontin and oxycodone administered per rectum and IM shots of ativan (the ativan potentiates the pain medicine). For some reason the oxycontin can absorb more effectively that way. We were able to decrease the total amount of pain medication that way with better result. Our hospice Dr. did lots of reading about methods used in Europe for pain relief and hospice. We had to move him from Long Island to upstate NY (my home) and that is when we met this Dr. (she came to our home and examined him) and her techinique. The other hospice Dr. never even managed to see my father.

My father died on Christmas morning. He was diagnosed in August. He would'v'e gone a little sooner (Dec. 4) but he rallied after I brought the priest in. However for some time his mental acuity was intermittent (a fact I only became aware of when he became hospitalized) but apparently his girlfriend knew but did not tell us.

I wish they had been more up front with him as to his best chances and the best choice for him. If his pain had been better managed and he had not had the chemo which depleted him and accelerated some organic brain changes, he might or might not have lived longer-- but he would have lived better. He could have also taken care of certain personal business before it was too late and his mental status declined. As it was, I had legal power of attorney but he had become so paranoid that it was difficult to manage things--the girlfriend was no help in that quarter.

[dropkickpa]

3. I wouldn't underestimate the value of shrinking tumors

There is no cure for cancer. Avastin shrinks tumors which can be and is a good thing. High tumor burden will suck the life out of a person like you wouldn't believe. Tumors take valuable energy and nutrients away from the rest of the body, they're pigs that way. I've seen tumors that have developed *insane* blood supplies, and one of the obvious outward signs of this type of tumor is cachexia, complete wasting away and comsumption of the bodys muscle, fat and resources.

Shrinking tumors (or just halting their growth) isn't a cure, but it most definitely does help quality of life. Avastin isn't intended to be used alone. It is intended to be used in conjunction with chemotherapy, and the results from the therapy are pretty exciting. Side effects are ALWAYS going to be a concern with chemo, but that is something that needs to be weighed by the patient and their physician. Is it perfect? Hell no, but NOTHING is, and it IS a step in the right direction.

Studies have also been showing that Avastin boosts the desired effect of many chemotherapeutics. This can be invaluable, if less of the drug can have the same (if not more) efficacy of much higher and more toxic doses. The main idea behind the use of chemotherapeutics is a race. They are toxic, this is a given, but they are MORE toxic to fast growing cells like cancer than normal cells, and it is that balancing act between killing the cancer 1. before it kills the patient and 2. without the chemo itself killing the patient that is so precariously performed. Anything that tips the balance in favor of survival is a step ahead.

[flashl]

5. Past DU Post ...

Cancer Drug Ruling Will Have Wide Impact

A decision expected Friday on federal approval for Genentech's Avastin cancer drug could have ramifications for all companies developing cancer medicines.

Genentech made its case for Food and Drug Administration approval of Avastin using a widely debated measure of drug effectiveness that focuses on tumor growth, not patient survival.

...

In December, a panel of outside FDA advisers voted 5 to 4 against Genentech's application, arguing the drug's benefits did not outweigh dangerous and toxic side effects.

Chicago Tribune

[trotsky]

6. We're talking about late-stage cancer patients.

You seem to be forgetting that. Speaking for myself personally, if I were in that position, I'd be a little more tolerant of possible side effects if it promised slowing of tumor growth. Sometimes it helps to take a step back and realize that it's not possible for EVERYONE in the FDA, entire government, "big pharma," and whoever else to be part of a worldwide conspiracy to kill everyone.

[flashl]

7. 47 million uninsured is not conspiracy nor disparity in healthcare delivery is not imagined. nt

[trotsky]

8. Lovely attempt to change the subject. n/t

[flashl]

9. No change. "worldwide conspiracy to kill everyone". nt

[trotsky]

10. Uh-huh. Got it. Kill everyone.

Enjoy your cornflakes. Try to take a moment today to enjoy life rather than fear everything.

[flashl]

11. Its not fear, its paying attention to business intersecting w/ medicine in this country.

Here we have the promotion of Avastin to attack tumors 'for the benefit of the patient' while in other end-of-life scenarios the same class of patients have difficulty obtaining pain relief medicine that is available.

The potential benefits of a new application of a drug means absolutely nothing to the patient if they not do have access to its 'benefits'.

Under this pay-to-live medical system, the investors are the winners not the patient.

[trotsky]

14. You're going about it entirely wrong, though.

That's the problem.

[flashl]

15. When the potential and promise of medicine is available and delivered to everyone

there will be no arguments from me.

[trotsky]

16. Yes because of course everyone else in the world opposes that.

:eyes:
Here in reality we need to recognize there are huge logistical and economic roadblocks to that goal. There isn't enough money in the world to give *everyone* access to every possible medical procedure and every drug. There are no easy solutions, and that's unfortunate.

[flashl]

17. Reality, SAME inflation model use in SubCrime loans or oil, drives medical costs, ie big pharma.

[dropkickpa]

12. Dead link again

Do a search on Avastin in the Chicago trib, you'll more recent articles that show a different picture. Avastin was approved in 2004, so while it is newer, it's not as new as you are implying. There are a lot more studies out since then, too, which show how this can be a good thing, and I see the people this helps everyday I come to work. In 1982, people were terrified of coming into contact with GRID patients, but we now know that casual physical contact with AIDS patients presents no danger. Get more up to date info instead of relying on an unreadable article from 4-5 years ago.

[flashl]

13. A quick search ....

Cancer Drug Ruling Will Have Wide Impact

FDA Decision on Genentech's Avastin Could Set New Standard for Cancer Drug Approvals

By MATTHEW PERRONE AP Business Writer
WASHINGTON February 21, 2008 (AP)

Avastin is already approved for advanced colon and lung cancer and was Genentech's best-selling drug last year, accounting for $2.3 billion in revenue. An additional use for advanced breast cancer patients who have not had chemotherapy would drive new revenue for the company.

In December, a panel of outside FDA advisers voted 5 to 4 against Genentech's application, arguing the drug's benefits did not outweigh dangerous and toxic side effects. FDA is not required to follow the panel's advice, although it often does.

At issue is how the agency judges the effectiveness of cancer treatments. Traditionally, FDA only approved cancer drugs that extended the lifespan of patients. However, in recent years companies have studied alternate measures of a drug's effectiveness. One of the most controversial measures is so-called progression-free survival, or how long the drug halts the spread of cancer.

[dropkickpa]

18. Looking just at extended lifespan

is pretty narrow-minded. It's the current holy-grail of cancer treatment, but that has limited research in other areas in the past. Bold and underline everything you want, doesn't change the fact that the nature of cancer treatment and research is changing. Just making people live longer is no longer enough. Sorry, but I see the benefits of treatment with Avastin everyday.

[flashl]

19. There wasn't much about patient benefits was it? But, lots of good news about boost in revenues. nt