When am I old enough to die?

This Photo by Unknown Author is licensed under CC BY-SA

Barbara Ehrenreich’s new book has a title that makes a much-needed point: Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer.   

As a metastatic cancer patient, this resonates with me.  The fact is, people die. Nothing can change that–not doctors, not preventative check-ups, not healthy living. NOTHING. Our bodies have built-in components that can cause disease (cancer being one) and tissue breakdown.  All living things will eventually wear out and reach a natural end, like the potato in image above.

The Western World is so obsessed with not dying that we sometimes forget to live. Knowing how best to keep our bodies healthy is important, but at some advanced age we should stop worrying about lifestyle elements that aren’t perfectly healthful, stop intrusive testing for things that **might** kill us, and just focus on living as well as we can given our circumstances.

Ms Ehrenreich excerpted parts of the book in her article in The Guardian 31-Mar-2018. In it, she addresses society’s compulsive need to blame someone for dying. Did they eat the wrong things? Drink too much? Exercise too little? Smoke? Stress over work?  Essentially, it’s the same issue we wrangle with lung cancer stigma, but applied to all health conditions.  Why does dying have to be someone’s fault? Reality is, we’re all going to die of something.

Another article in the Guardian interviewed Ms Ehrenreich about her perspective.  It starts with, “Four years ago, Barbara Ehrenreich, 76, reached the realisation that she was old enough to die. Not that the author, journalist and political activist was sick; she just didn’t want to spoil the time she had left undergoing myriad preventive medical tests or restricting her diet in pursuit of a longer life. While she would seek help for an urgent health issue, she wouldn’t look for problems.”

Those sentiments reflect my own thinking nowadays.  I recently had several preventative health appointments: annual physical, Hep C screening, 3D mammogram, gynecological exam, and colonoscopy. Some of the procedures  seem reasonable: for instance, a new vaccine can prevent more types of pneumonia (I know from experience that pneumonia reduces my quality of life), and having a polyp snipped is an effective and painless way to prevent colon cancer. However, I wonder if I should be spending money (mine as well as the insurance company’s) to undergo screening for cancers other than the one I’ve already got, given that I’m not sure I would undergo aggressive treatment for whatever they might find.  Chances are, my metastatic lung cancer will eventually recur, and sooner rather than later.  If the colonoscopy had detected advanced colon cancer, and my only option to treat it was radical surgery to remove a section of my colon, I’m not sure I’d do it given my lung cancer is not cured. If I have limited life remaining, why would I spend it recovering from a significant surgery that can’t cure me?

Each person will have their own answer to the question, “Am I old enough to die?” because each has their own set of priorities. I know some terminal cancer patients who would subject themselves to any level of discomfort in order to have more time with their small children. Others would find life is not worth living if they were unable to walk in the woods every day. Whether or not to undergo a cancer treatment should an individual’s decision based on personal priorities, overall health, effectiveness and quality of life impact of available treatments, and cost.  But at some point, regardless of our priorities or treatment decisions, death wins.  Many of us waste a lot of time, energy, and resources denying that fact.

For my two cents, Barbara Ehrenreich gets it right. I hope people listen to her and consider changing their perspective on life and death. It could make a big difference in their quality of life, and perhaps in the overall burden of healthcare costs as well.

I’m going to eat some chocolate now.

REFERENCES

Why are the poor blamed and shamed for their deaths?  (Barbara Ehrenreich, The Guardian, 31-Mar-2018)
https://www.theguardian.com/lifeandstyle/2018/mar/31/why-poor-blamed-shamed-their-deaths-barbara-ehrenreich

When do you know you’re old enough to die? Barbara Ehrenreich has some answers  (Lucy Rock, The Guardian, 7-Apr-2018)
https://www.theguardian.com/lifeandstyle/2018/apr/07/barbara-ehrenreich-natural-causes-book-old-enough-to-die?

Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer  by Barbara Ehrenreich, available 10-Apr-2018 on Amazon.

 

Medicare approves genomic testing for cancers

Today the Centers for Medicare and Medicaid announced they will cover Next Generation Sequencing (NGS) for cancer! This is a major victory for all cancer patients.

Decision Memo for Next Generation Sequencing (NGS) for Medicare Beneficiaries with Advanced Cancer (CAG-00450N)

#LCSM Chat Topic 3/8/2018: Cancer Advocacy 101–Patients & Conferences

Chemist Jean Cui at #ASCO17 posters with #ALK & #ROS1 NSCLC patients who thrive on drugs she helped develop

As cancer patients and caregivers transform into active cancer advocates, they may think about attending medical conferences.  On March 8, at 8 pm Eastern Time (5 pm PST), #LCSM Chat will discuss various aspects of cancer advocate participation in medical conferences.

Some reasons for cancer advocates to attend medical conferences are to:

  • Learn more about cancer and treatment options for cancer
  • Get details about new research
  • Meet the top doctors who treat their type of cancer
  • Support an advocacy organization’s outreach booth
  • Network with other advocates, as well as clinicians and researchers
  • Share an advocate’s perspective on a specific topic, sometimes as an invited speaker

As more advocates participate in conferences, the conference organizers, professional societies, and medical practitioners are coming to understand the benefits of including advocate voices in their programs. #LCSM Chat member Janet Freeman-Daily was recently interviewed by the International Association for the Study of Lung Cancer about her participation in conferences–read the resulting article here: Why Should Advocates Attend Academic Lung Cancer Conferences?

Tools exist to help advocates navigate cancer conferences and understand the content they will see:

If you know of other resources, please share them in the comments on this page or in the chat.

Some professional societies and cancer nonprofits sponsor programs that enable cancer advocates to attend conferences and learn more about medical research:

  • AACR’s ScientistSurvivor Program
    Participants receive travel grants and participate in special educational programs at cancer research meetings.
  • ASCO’s Conquer Cancer Foundation Patient Advocate Scholarship Program
    Provides need-based grants to cover travel and registration for a variety of ASCO meetings, including the huge Annual Meeting in Chicago each June. Applications for the Annual Meeting are usually accepted during a window in early March.
  • RAN’s Focus on Research Scholar Program
    Scholars participate in preparatory conference calls, virtual classroom (webinars), learning materials and mentoring for research advocates to improve skills and understanding of biomedical research, and attend the ASCO Annual Meeting.
  • International Association for the Study of Lung Cancer (IASLC) Travel Awards for World Conference on Lung Cancer (WCLC)
    Provides travel grants to WCLC, which is held in a different international city each year—it will be in Toronto Canada September 2018.

Our moderator Janet Freeman-Daily (@JFreemanDaily) will lead our discussion using the following prompts:

  • T1: When a cancer patient/caregiver attends a medical conference, what are benefits to the patient/caregiver? Benefits to medical professionals?  To the conference?
  • T2: If you have attended a medical conference in which patients/caregivers participated, what did you like most about that conference? (Pls state whether you attended as patient, caregiver, or med professional)
  • T3: If a cancer patient or caregiver wanted to attend a medical conference, which would you recommend for their first conference, and why?
  • T4: What tips would you give a cancer patient or caregiver for making the most of their conference experience?
  • T5: What programs help cancer patients and caregivers attend and/or afford conferences? Do you have experience with any of them?

We hope you’ll join our #LCSM Chat on Thursday 3/8 at 8 pm Eastern Time (5 pm Pacific). If you’re new to tweet chats, please read our primer “To Participate in #LCSM Chat.”

An opportunity to support patient-driven ROS1 cancer research

I hope you’ll support me and the Global ROS1 Initiative as we strive to accelerate research, find better treatments and hopefully cure ROS1 positive (ROS1+) cancer — which I have. Here’s a National Cancer Institute blog about the Initiative. This project is very dear to me.

If you’ve been meaning to contribute, or you have friends or family you’ve been meaning to ask to donate, do it today, or sometime before the end of the year!  The recently-signed US tax law revisions may affect whether you can claim a tax deduction for your charitable contributions after January 1, 2018.

GO TO MY FUNDRAISER BY CLICKING HERE:
Janet Freeman-Daily’s ROS1 Research Fundraiser

Thanks for supporting ROS1+ cancer research—you could help save someone’s life someday. For those who want more detail about the project and fundraiser, read on!

Why research ROS1 Cancer?

My type of cancer is driven by an alteration in the ROS1 gene. Medical research has made it possible for me to live well with aggressive, metastatic ROS1+ lung cancer since 2011. However, ROS1+ cancer is uncommon (only 1%-2% of lung and other cancers) and not well understood. Only one approved ROS1-targeted drug exists, and patients eventually develop resistance to it. Little is known about how this disease begins, progresses and develops resistance to treatment.

Is my donation tax-deductible?

This fundraiser directs funds to the Bonnie J. Addario Lung Cancer Foundation (ALCF), a 501(c)(3) nonprofit (view their Guidestar page); monies are placed in an ALCF account designated for our ROS1 project. Donations  are tax deductible under US tax laws.

What is the Global ROS1 Initiative?

I helped to create the Global ROS1 Initiative, a unique collaboration between ROS1+ patients, caregivers, researchers, clinicians, and industry. This is the first-ever effort initiated by patients to focus on cancer driven by a single genomic alteration anywhere in the body. We are initially funding projects in the US (takes time to learn about international research collaboration), but our patient group is global, with patients in 19 countries to date.

How did the Global ROS1 Initiative get started?

Who are the Global ROS1 Initiative partners?

What research will the Global ROS1 Initiative fund?

Funds in the ROS1-designated account will be distributed by a panel of Global ROS1 Initiative representatives (including patients) to our projects. We are funding two projects at present:

  • A survey conducted through Stanford University, which collects personal and health history data on ROS1ders. Researchers will study the data to look for possible causes of ROS1+ cancer, and evaluate effectiveness and sequence of treatment options.
  • The ROS1 Cancer Model project, which is creating new models of ROS1+ cancer for drug development and research into our disease. In early 2017, only a few ROS1+ models existed, and they did not represent all the dozens of variations of ROS1+ cancer. In this project, we ROS1ders agree to donate our cancer tumor cells collected in the normal course of care to create cell lines and mouse models that researchers can use to study our disease.

How will the Global ROS1 Initiative accelerate research?

As part of our patient-driven approach, we aim to make our data and models widely available to the cancer research community instead of holding it in silos at individual institutions.  We will be creating a biorepository of our specimens with annotated patient data, including making use of patient registries (like the Lung Cancer Registry) that share de-identified data will validated researchers. The cancer models we create will be distributed at minimal cost to researchers.

The ROS1ders also help spread vetted information about ROS1+ cancers to patients, caregivers, and the public.  We donate our time to maintain and write content for the ros1cancer.com website  which shares up-to-date information about ROS1+ cancer, names of ROS1+ experts, known treatments and their approval status globally, and available clinical trials focused on ROS1+ cancers.  We also administer a private Facebook group in which ROS1+ patients and caregivers share their experiences, news about our cancer, and tips for living with our disease (more info on joining this group is here).

Join the Life & Breath Rally for Lung Cancer in DC on Nov 2

Please register for your free ticket(s) here:
https://LABRally.eventbrite.com/  

Life & Breath (LAB) is a grassroots effort comprised of lung cancer survivors, caregivers, and advocates. We volunteer with various lung cancer organizations but have decided to come together as individuals for a common cause:

The Life & Breath Rally
Thursday, November 2, 2017, 11 a.m. – 1 p.m.
U.S. Capitol Building, Washington, D.C.

Email: lablifeandbreath@gmail.com
Facebook: https://facebook.com/lablifeandbreath/
Instagram: lifeandbreathrally
Twitter: @LABLifeBreath

Lung Cancer is a National Emergency and must be declared as such. This step will allow an increase in desperately needed research funding. We represent the 433 Americans who die every day because of this disease, the deadliest of all cancers. Our goal is to have enough participants to stage a die-in of 433 people. We need Congress to see what this disease actually looks like.

The Rally will be held in Area 1 on the Capitol grounds from 11 a.m. until 1 p.m. (see this linked map): https://www.uscp.gov/sites/uscapitolpolice.house.gov/files/wysiwyg_uploaded/U.S.%20Capitol%20Grounds%20Demonstration%20Area%20Map.pdf

Participants are encouraged to bring their own signs, posters, etc., to the Rally, with the understanding that these items may not be brought into or near the Capitol Building. Members of the media will be invited.

Speakers will include members of the Congressional Lung Cancer Caucus (Rick Nolan, Debbie Dingell, Jamie Raskin as of 10/18) with cooperation from the office of Congressman Nolan, founder and co-chair. Congressman Nolan’s daughter, Katherine Bensen, a Stage IV lung cancer survivor, will also be in attendance, as well as former NFL player and noted lung cancer advocate Chris Draft, who lost his young wife to the disease, and Greta Kreutz, former D.C. news personality and lung cancer survivor.

As this is an unbranded, grassroots event, participants are free to wear clothing representing their favorite lung cancer organizations, if desired. All organizations and their volunteers are welcome. There will be no fundraising as we are not a nonprofit nor do we represent one. Our goal is to provide a unified presence for the purpose of Lung Cancer advocacy.

Participants are encouraged to make appointments on their own to see their elected U.S. Representative and Senators to occur after 1 p.m. when the Rally is scheduled to conclude. We can provide an informational packet, or participants are free hand out their own organizations’ literature when these visits are made.
You can find your elected officials here: http://act.commoncause.org/site/PageServer?pagename=sunlight_advocacy_list_page

Getting to the Capitolhttps://www.visitthecapitol.gov/plan-visit/getting-capitol

Please contact us directly if you are interested in room and/or ride sharing. We will do our best to accommodate you.

Please register for your free ticket(s) here so we can get an idea of attendance numbers before the Rally: https://LABRally.eventbrite.com/  

This page will be updated on a regular basis, so check back often.

Please join us for this important event!

Lung Cancer Updates from 2017 ASCO Annual Meeting

Chemist Jean Cui with some lung cancer patient/advocates who have been treated with drugs she designed

Each year in early June the American Society for Clinical Oncology holds its Annual Meeting (called simply “ASCO”) in Chicago. The theme for the 2017 meeting was “Making a Difference in Cancer Care WITH YOU.” Over 39,000 cancer researchers, clinicians, patient advocates, and industry representatives from around the world gathered to discuss the latest scientific advances in cancer care, such as clinical trial results, new technologies, and best care practices.

WHAT HAPPENS AT ASCO?

ASCO takes place in McCormick Center on Lake Michigan in Chicago—few other conference centers are large enough to host it. My Fitbit claims I average five miles a day walking between sessions!  ASCO fills the hotel rooms throughout the city, some of them nearly 6 miles away, and runs a fleet of a more than a dozen shuttle buses to ferry attendees between their hotels and the conference center.

A typical day for researchers starts around 7 AM and finishes around 10 PM. Many sessions are happening simultaneously, and it’s literally impossible to attend all sessions that mention lung cancer. The poster sessions alone have hundreds of posters to view, and you likely run into people you know either presenting their poster or talking about someone else’s poster. Fortunately, those who register have online access to the videos, slides, and posters so they can catch the sessions they missed.

In addition to conference sessions, attendees can wander a HUGE exhibit hall filled with pharmaceutical firms, biotech companies, publishers, cancer advocacy groups, and vendors of support services.  Many attendees also schedule meetings with current or potential collaborators, funders, and trial sponsors, or are expected to attend one of the many cancer-related committee or steering group meetings that are held at a nearby hotel. Some patient advocates are so busy meeting with their grant recipients, researchers, and scientific advisory board members that they never get to attend a conference session! In the evening, attendees might attend a Continuing Medical Education meeting (complete with a free dinner), a reception hosted by an exhibitor or medical society, enjoy the many activities and entertainments Chicago has to offer, or meet with colleagues they only get to see at ASCO.

Below are highlights selected from over 2400 presentations relevant to non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), and mesothelioma. For more news from ASCO 2017, check out these resources:

Immunotherapy clinical trials

Lung cancer already has approved immunotherapy drugs, and new drugs are in development.  These drugs are relatively new, and we still have much to learn. Researchers are studying how to detect which patients will be most likely to benefit from them, when they should be used in the treatment sequence, how they might best be combined with other drugs and with each other, how to detect and manage potentially severe side effects, and when to continue or discontinue treatment. Experts are still debating about the value of immunotherapy for patients who have driving mutations.

TARGETED THERAPY CLINICAL TRIALS

Targeted therapy drugs bind to specific mutated proteins in cancer cells and inhibit the cell’s cancer-like behavior, instead poisoning both healthy and cancer cells as chemo does. Those that treat cancer for lung cancer are usually in a group called tyrosine kinase inhibitors (TKIs), and each drug targets genomic alterations in specific genes. In lung cancer, approved TKIs exist for alterations in EGFR, ALK, ROS1, and BRAF genes.  However, many more drugs are in clinical trials to target alterations in other genes such as HER2, MET, TRK, and RET, and research is being conducted on other genomic alterations as well.

Other Treatments

Cancer research involves more than just developing new drugs.  Clinical trials are also used to improve existing treatments.

Diagnostic Testing

Precision medicine means personalizing cancer treatment to a specific patient’s situation as well as their cancer’s characteristics.  In addition to presentations about treatments, ASCO has an increasing number of presentations about ways to identify the best cancer treatment for each patient, and to ensure patients get accurate and affordable diagnostic testing.

  • Biomarkers for immunotherapy: Several presentations explored “tumor mutational burden” (a measure of the number of mutation present in a cancer tumor) as a biomarker to indicate which patients might benefit from immunotherapy.  Other presentations sought to define how PD-L1 should be used to identify patients for immunotherapy. Some blood tests that look for certain proteins may be useful in identifying whether an immunotherapy is working before evidence is detectable on a scan.
  • Biomarkers for targeted therapy: Genomic testing of cancer tumors can identify patients who may benefit from targeted therapy. New technologies and methods are being evaluated to determine the most accurate and cost-effective testing methods. A French study of 1,944 patients (http://www.ascopost.com/News/55703) found widespread genomic profiling was feasible, but not all patients tested positive for a treatable mutation.
  • Liquid Biopsies: Several studies explored the value of ctDNA blood tests (one type of liquid biopsy) for early detection, monitoring patients for progression or recurrence, and identifying tumor characteristics that might be used to guide treatment. Several academic cancer centers are now using liquid biopsies to identify potential targeted therapies for a patient, with the understanding that such tests are have not yet achieved high accuracy. If the liquid biopsy results find an actionable mutation, they will prescribe the associated targeted therapy; if the tests are negative, many experts say they will pursue a tissue biopsy to validate the results. One study that used blood and urine tests to detect the T790M mutation found drug response to a positive tissue biopsy was similar to the response to a positive blood or urine biopsy (http://www.cancernetwork.com/asco-lung-cancer/plasma-urine-tests-can-help-detect-egfr-t790m-mutations-nsclc ).

Patient Care

Treating a cancer patient involves more than just prescribing a treatment that hopefully will shrink a tumor.  ASCO sessions also address ways to make patients more comfortable, deal with psychological needs, and improve communication between patients and healthcare providers. Patient reported outcomes (pat

  • Cost or financial toxicity of cancer care were topics in 174 sessions, some of which included patient advocates as presenters and/or panel members.
  • Goals of care discussions and shared decision making (both of which involve the patient as a member of their own care team) were topics in 21 sessions.
  • Patient reported outcomes (quality of life measures reported by patients to their healthcare providers) were the topic of 112 sessions.
  • Results from a clinical trial of 766 people with advanced cancer showed that a simple web-based tool can help patients live longer. The tool allows patients to report their symptoms in real time and then alerts their health care team if severe or worsening symptoms are reported.
    https://www.asco.org/about-asco/press-center/news-releases/web-based-system-self-reporting-symptoms-helps-patients-live
  • “Conquer Fear” face-to-face therapy program lowered fear of cancer recurrence more than relaxation training provided over the same 10-week period.
    http://abstracts.asco.org/199/AbstView_199_186249.html
  • An 8-week, web-based stress management program called STREAM lowered distress and improved quality of life for people newly diagnosed with cancer.
    http://abstracts.asco.org/199/AbstView_199_187932.html
  • Advanced cancer patients in a talk therapy program called CALM had fewer symptoms of depression and improved psychological well-being than those who received only screening for distress and basic psychosocial care.
    http://abstracts.asco.org/199/AbstView_199_193726.html

This document was distributed at the July 18, 2017 Bonnie J. Addario Lung Cancer Foundation’s Lung Cancer Living Room.

And they said streaming was easy …

I feel so 21st century. I’m streaming my first Amazon Prime movie on our home TV.  Not a bad bit of tech work for a 60-something.

It’s amazing how many choices, purchases, technologies, services, and connections this effort required:

  • research and buy a digital TV (years ago)
  • research and buy a Blu-Ray player (many months later)
  • research and contract with a high-speed Internet service provider
  • upgrade Comcast service to faster Internet
  • order upgraded cable modem from Comcast
  • activate new cable modem and upgrade its software
  • buy new Wi-Fi router with range and bandwidth to reach the TV
  • ensure I have all necessary cables (whoops, another trip to the tech store)
  • set up router
  • wire modem to router and confirm connection
  • set up home Wi-Fi network
  • wire TV to Blu-Ray player and confirm connection
  • connect Blu-Ray player to home Wi-Fi network
  • update Blu-Ray player software (from version 2007 to 2021)
  • use networked PC to subscribe to Amazon Prime
  • install Amazon app on Blu-Ray
  • find Amazon app amidst other apps on Blu-Ray player
  • login to Amazon app
  • use Blu-Ray player find and select a movie
  • start streaming …

… and discover that so many neighbors are streaming movies at the same time on Comcast that your movie won’t play.

Who knew home entertainment could be so complicated?

Good thing fixing healthcare only takes some quick legislation.