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In memoriam: two ROS1+ lung cancer patients, bound by rodents

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The original ROS1ders: Stuart Grief, Lisa Goldman, Tori Tomalia, Janet Freeman-Daily, Lysa Buonanno

I first “met” my friend Tori Tomalia in an online lung cancer community in 2013. A gifted writer, she already had a well-established blog that was funny, informative, and poignant. I admired the way she sculpted words to show how life continued despite all the downsides that accompany a deadly disease.

Tori was diagnosed with ROS1+ lung cancer about a year after me.  We formed a connection through blogging and shared lung cancer advocacy activities, such as promoting #LCSM (Lung Cancer Social Media) Chat on Twitter.  Her blog explored areas of life that I would never know: how to tell your young child you have a deadly cancer, how to make memories with the kids when you feel like crap. Her lung cancer journey was much different than mine.  She had recurring brain mets that required radiation and sometimes brain surgery. While my clinical trial drug gave me years of no evidence of disease, for her it caused constant nausea.  Clinical trial drugs failed her quickly.  Yet her blogs and social media posts, though honest and at times raw, often found something positive to share, even if it was that she was still alive. Tori embraced life.

The first time Tori and I met in person was when five ROS1+ cancer patients found each other in a bar at LUNGevity Hope Summit in April 2015—a gathering that sparked the creation of The ROS1ders. I don’t remember much of that whirlwind weekend in Washington DC, but I clearly remember chatting with her on the bus coming back from the awesome Saturday dinner at a historic carriage house. Her quiet confidence inspired me.  As I got to know her, I learned about her fierce inner advocate, ability to get the job done, and devotion to family.  I also learned we shared a love of Buffy the Vampire Slayer.

Shortly after that event, Tori set up the private Facebook group that became the focus of The ROS1ders. She was often the first person with whom new members interacted; she had a gift for making them feel welcomed and hopeful through a computer screen. As we worked together, Tori often brought sparks of insight and inspiration to our discussions.  She coined our name “The ROS1ders,” revised posts to make them understandable to a greater number of people, and frequently provided a reasoned, compassionate alternate viewpoint.  One time when we needed a post to describe using mice to study our cancer, I asked Tori if she would write it.  She was nervous about it, pointing out that she and I had different writing styles (I tended towards science geek, while she tended towards improv comedy).  I told her different styles kept things interesting, and I knew I’d like whatever she wrote.  When the blog was posted, I actually laughed with delight at her chosen title: “The ROS1ders meet the rodents.”  (You were wondering why the title referenced rodents?  Now you know.)

I think The ROS1ders have succeeded as much as they have because of the indescribable bond that the cofounders Tori, Lisa Goldman, and I shared.  We never had a fight. We just talked things through. I feel blessed to have experienced this magic.

I was thrilled in 2018 when Tori and I discovered our clinical trial visits to the University of Colorado in Denver would be happening at the same time!  I eagerly waited in the DIA terminal for her flight to arrive. As she came off the elevator, she gave me a big smile, and I smiled in return at her awesome high-top red-sequined sneakers (reimagining Dorothy in the Wizard of Oz).  I played chauffeur for her that trip, and helped her navigate the CU campus as she went through all the tests and procedures required to enroll in the trial.  We connected on a few more trips after that, including one where she accompanied me to the offices of the International Association for the Study of Lung Cancer and helped with early planning for the STARS program (which she named). Eventually Tori was able to move her clinical trial participation closer to home in Michigan. We didn’t see each other in Denver again.

My last meeting with Tori was in New York City in May 2019, when The ROS1ders were finalists for a precision medicine award.  Tori and I wandered around NYC near our hotel looking for a mutually agreeable take-out restaurant. Later, we connected with Lisa Goldman and another ROS1der, Jess Wittebort, in the park outside the NY Public Library (where the event was held). We talked about life, death, and everything in between. We could talk about anything. It was a wonderful evening.

Tori did everything she could to stay in this world and share the adventure of living with her beloved husband, children, and extended family.  In the end, the weariness of years dealing with treatments and side effects wears one down.  I hope this story helps her children see the side of Tori that was so dedicated to helping others live better and longer despite ROS1+ cancer.

Zander, Mikaela, and Autumn:  
Your mama is amazing.  She made a difference to hundreds of people.  Thanks for sharing her with the lung cancer community.

#Cancer patient vs unmasked worker in the era of #COVID19

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This morning (Saturday) I had to ship scan CDs overnight from Washington state to my cancer doc in Colorado for my virtual appointment on Tuesday. Don’t fret, it’s routine follow-up–I’m not attending in person because I do not want to fly during a pandemic.

When I entered the UPS store, neither employee behind the counter was wearing a mask. Masks are required in Washington State as of yesterday, due to increasing cases of COVID-19.

When I politley asked the clerk serving me to put on a mask, he emphatically stated, “No, I’m not going to do it.” And stared at me.

Wow.

I needed to send the package ASAP, so I proceeded anyway.

I told the clerk I was sending medical records to my cancer doctor in another state because I don’t feel safe flying during this pandemic. I said needed them to arrive on Monday for my virtual medical appointment on Tuesday. He processed my package efficiently, but told me he couldn’t guarantee on time delivery due to COVID-19. Fingers crossed that it arrives on time.

I debated whether to say anything more about the mask. Despite being a somewhat outspoken patient advocate, I usually won’t make waves over customer service snafus that cost me a minimal amount of money–I have other ways to spend my time that will make more of a difference in the world. In this case, however, I decided the possibility of helping someone come to realize how masks help prevent the spread of COVID-19 was worth the effort.

When our business was done, I thanked the clerk, and (to acknowledge his viewpoint) said I understood he had a right not to wear a mask, that it can be inconvenient or uncomfortable. I then said if he wore a mask, he would help protect people like me, who are in the high-risk group for severe COVID-19. He looked at me and said simply OK. Then he called for the next customer.

I thought that’s all one can do in real time.

I posted about this incident on Facebook, and learned a number of my friends (many of them also in the high-risk group for COVID-19 due to age, health conditions, or both) had encountered hostility from unmasked workers in places of business. The suggestions my friends offered got me thinking about additional actions to address the issue of the unmasked during a pandemic.

I believe the science and data shows wearing a mask DOES help protect others and reduce the spread of the virus. I want more people to accept that they should wear a mask, even though it may be inconvenient or uncomfortable.  Pressure from employers may change minds when compassion can’t.

However, I think confronting and/or intimidating the unmasked is not particularly safe–some people feel quite strongly about this topic, and will aggressively defend their “right” not to wear one. Besides potential verbal unpleasantness and bodily harm, confrontation may also generate shouting, which will only spread virus droplets further. If the individual does not respond to a respectful request, I think leaving the establishment is the safer route.

But I can continue to press after I get home. UPS will be hearing from me. Which leads me to the approach I’ve decided to take.

RESOLVED:
When being served during the COVID-19 pandemic by an unmasked (or improperly masked) person at a place of business, I will do the following:

  1. Calmly tell the person I would appreciate them wearing a mask to protect me (a person at high risk of severe COVID-19). If they are wearing a mask but it’s not properly positioned to cover both the mouth and nose, I will ask them to position the mask properly. If they don’t comply, I won’t press further.
  2. After I’ve left the establishment, I will contact the store’s manager and remind them if they want customers to come in, they must respect customer requests to be protected from infection.  If applicable government regulations require wearing a mask, I will remind the manager of this.
  3. If the store is a franchise, I’ll repeat #2 with corporate headquarters via phone, email and/or Twitter (many businesses scan Twitter to catch posts that could generate bad public relations).
  4. If applicable government regulations require wearing masks, I will contact the appropriate health department to report the health violation.

Applying pressure through employers increases the chances that the unmasked will start wearing masks in public. I encourage you to participate in this!

Please share in the comments what approach worked for you.  Please remember to keep yourself safe — avoid escalation!

Thanks to everyone who responded to my Facebook post on this subject for their great suggestions!

What Mt. St Helens Taught Me About Life After a Disaster

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Forty years ago today, Mt. St Helens exploded.  I heard and felt the blast at my home 150 miles away in Tacoma. I could see the 15-mile-high cloud of ash from my front yard. I saw the lahar in real time on the evening news as a house rammed into a bridge over the I-5 freeway. I spoke to a friend in Pullman, Washington, as her day turned to night at Washington State University, just days before she graduated.

The true impact of the eruption and the losses were discovered in the following weeks. A vulcanologist tending instruments near the crater had died shortly after warning, “Vancouver, Vancouver, this is it.” Half-buried vehicles were found on the mountainside.  Forests had been flattened, with sturdy fir trees snapped off like toothpicks six feet above the ground. Spirit Lake on the side of the mountain, as well as Spirit Lake Lodge and its caretaker 80-year-old Harry Truman, had vanished. A total of 57 people died. The Toutle River, which flows from glaciers on the mountain, was clogged with mud and logs all the way to the Columbia River, obstructing boats and barges. The I-5 between Seattle and Portland was closed for weeks for cleanup and safety inspections. The entire area looked more barren than a moonscape. The devastation was unimaginable.

Yet, even a few years later, life returned to the mountain. Flowers bloomed.  Animals roamed through the ash. A new Spirit Lake began to form, and frogs that had been buried alive under scalding ash re-emerged, alive and kicking. Communities that had been desolated by the eruption and its aftermath came together, supported each other, and received assistance from neighbors outside the blast zone.

That was my first major disaster. It taught me that life goes on, nature finds a way, and silver linings can be found. I have some beautiful pieces of art created from Mt St Helens ash–they are unique reminders that the world does not end because major change occurs. The poster above hangs on my wall to commemorate.

Since then, I have coped with various disasters–parents stricken by dementia, a metastatic lung cancer diagnosis, and now COVID-19. Each of these rocked my world. But life goes on, and even in disaster, beauty can be found. We must be willing to adapt, to care for one another, to find a way.

When life kicks your ash, make beauty.

On #COVID19, ventilators and triage

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

In the age of COVID-19, patients may find themselves in a hospital or emergency department that does not have enough resources to give ICU beds or ventilators to all patients who need them. In an attempt to prepare for such a situation, some hospitals drafted “triage” policies that state who would be prioritized to receive a ventilator or ICU bed.

I want to share my perspective on triage as a both a science geek and a metastatic lung cancer patient in active treatment.

A not-yet-implemented triage policy from the Henry Ford Healthcare System in Michigan was shared online in late March, and caused an uproar in social media.  The metastatic cancer community learned that if resources were limited and that policy were in force, they would be denied a ventilator, along with those who had severe heart, lung, kidney or liver failure, or severe trauma or burns.  Over the next several days, other triage policies surfaced (some that included dementia or disability as a reason to deny care).  Articles about triage policy appeared in medical journals,  opinion pieces, and general media.

Many of my fellow lung cancer patients are horrified by the impact such triage policies would have on their lives.  I too am worried about the possibility of not receiving treatment simply because I have metastatic lung cancer.

The lung cancer community has been battling treatment nihilism for years. It angers us—and rightly so—whenever we hear that someone did not receive the most effective treatment available simply because a doctor was unaware of changing statistics in lung cancer survival or the terrific response rate to targeted therapy or immune checkpoint inhibitors.

But this triage thing is not a matter of doctors being unaware of changes in lung cancer treatment, or not believing cancer patients deserve to live. This is an issue of resource shortages. Everyone deserves to live, but emotional pleas don’t give doctors a way to make a fair choice about who lives and who dies.

Reality check:  COVID-19 is redesigning hospital services out of necessity. Surgery theaters are being converted to ICUs. Hospital staffing is being reduced in an attempt to keep healthcare workers healthy and sane. Ventilators are in short supply.  When two patients need a ventilator-equipped ICU bed (whether they suffer from severe COVID-19 pneumonia or a heart attack), and only one bed or ventilator is available, someone will have to decide who gets the scarce resource. The patient who gets it will hopefully live. The patient who doesn’t will probably die. It’s a horrible Sophie’s Choice for healthcare providers who took the hippocratic oath.

This is not a human rights violation. It’s a medical ethics problem born of resource shortages. How should the medical world decide who lives and who dies?  Obviously, no one wants to hear that they are the one who will likely die.  But simply saying everyone has an equal right to life does not solve the resource problem.  We need a fair way to make a gut wrenching, impossible decision.

How can we make a fair decision? One possibility is to assess who is most likely to survive if they were given the respirator. The problem is, we don’t have much data to use in making this assessment. We have some data that cancer patients who get really sick with COVID-19 are less likely to survive, but only a few of those had lung cancer, so it’s not a good sample size on which to base a decision. We have some data that shows people who are 80+ years old are unlikely to survive COVID-19 once their disease has progressed to the point of needing a ventilator.  Thus one could say that when having to choose between a 20-year-old and an 80-year-old, all other things being equal, the younger patient has a better chance of survival and so gets the ventilator.  But what if the younger patient has metastatic pancreatic cancer and no cancer treatment is likely to work for them?  Then the choice isn’t so easy.

The US healthcare system—certainly most healthcare providers—have never faced these sorts of decisions before.  They need time to figure it out. Hospitals are attempting to create triage policies so that individual doctors are not continually faced with violating their Hippocratic Oath by deciding who lives and who dies. Our healthcare providers are already under tremendous pressure by long hours, patient overload, watching patients die alone without being able to offer a comforting touch, being repeatedly exposed to COVID-19 due to lack of personal protective equipment, and separation from their families to avoid infecting their loved ones.  They could use some guidelines.

In the March 28 Axiom Zoom webinar on “COVID-19 and the Impact on Thoracic Oncology” (recording available here), I asked the the assembled thoracic oncology experts what they tell their lung cancer patients (especially those with metastatic disease) who are scared that they will be denied treatment simply because of their lung cancer diagnosis. The doctors acknowledged that they too were concerned about this. One surgeon emphasized that doctors must continue advocating for their lung cancer patients to fight the historic nihilism faced by lung cancer patients. Another stated the importance of informing all critical care team members about the improved prognosis for lung cancer patients so that they wouldn’t be automatically left untreated. But no one had a solution that would solve the problem as a whole.

In the follow-up Axiom webinar on April 4 titled “COVID-19 and The Impact on Cancer Patients” (recording available soon), the doctors addressed the topic again. One doctor said she wrote a clinic note for each cancer patient, which the patient could download online and print to keep with them. She didn’t elaborate on the contents of the note, but presumably, the note listed the patient’s diagnosis, treatment and prognosis.

This raises another ethics issue.  What if that patient has a poor prognosis?  What if that patient doesn’t WANT to know their prognosis?  What if the patient is in a clinical trial and the doctor doesn’t know their prognosis?

While some lung cancer patients (such as myself) have had long runs with no evidence of disease on targeted therapy or immunotherapy, there are still many for whom prognosis is not so rosy: Patients who have extensive small cell lung cancer that has progressed after chemo. Patients who have oncogene-driven lung cancers and have blown through all their treatment options. Patients whose cancer is progressing rapidly despite immunotherapy. Patients, advocates, and advocacy organizations won’t have any credibility if we claim that all lung cancer patients have the same likelihood of surviving a severe case of COVID-19 as a healthy person.

Lung cancer patients are not the only group facing discrimination via triage.  This also affects people with disabilities, elders with dementia, children with heart issues, diabetics on insulin, and many others.  I don’t feel right saying lung cancer patients deserve a chance to live, but these other people don’t.  I support the statement published by the Disability Rights Education & Defense Fund (DREDF), The ARC of the United States, and many other disease and disability advocacy organizations (including the GO2 Foundation for Lung Cancer and LUNGevity Foundation) titled “Applying HHS’S Guidance For States and Health Care Providers on Avoiding Disability-Based Discrimination in Treatment Rationing.” This is the sort of reasoned ethics discussion needed to help the medical community develop guidance on this tough topic.

Speaking as a member of a special interest group (metastatic lung cancer patients), this is a time to search for solutions that are right for EVERYONE, not just for one special interest group. I don’t think my right to live outweighs anyone else’s right to live. Ethically, when resources are limited, decisions on who gets care should be based on who has the better chance of survival based on available facts.  This is a very sensitive issue that could have a significant impact on how patients AND the medical community view lung cancer advocacy organizations.

I prefer to seek solutions to problems that work for the community as a whole. News flash: we are ALL going to die someday–and none of us know when. Patients living with advanced and metastatic lung cancer have become experts on living well despite uncertainty. You can take some steps to make the uncertainty easier for you and those you love.

  1. Identify which events or activities make your life worth living. Is it walking in the woods every day? Visiting distant family? Watching your youngest child graduate from kindergarten? Having lunch with a good friend? Indulging a good book? Petting the cat? Write all of them down, and then make plans to help them happen.
  2. Have an honest discussion with your doctor about your health status, goals of care (see #1), and prognosis. Ask if you are immunocompromised, have scarred lungs or limited breathing capacity, or are at risk of complications if put on a ventilator. Be honest about your fears and your health challenges.
  3. Ask your doctor to provide you with a BRIEF letter (2-3 sentences at most) on letterhead, signed and dated, stating your diagnosis and prognosis. Carry a copy with you in case you must go to the hospital. (It must be brief, or no ED doc will read it).
  4. Think about how you would prefer the end of life to look. Talk with your family NOW about your preferences–if disaster strikes, you might not have another chance. If you need help getting started, visit The Conversation Project.
  5. Prepare legal estate documents, especially a Durable Power of Attorney and Advanced Healthcare Directive. Learn more from the National Institute on Aging.  There are ways to do this even if you are Sheltering at Home during the pandemic–check out “Estate Planning Goes Digital as Many Families Explore Options.”

We can’t control the COVID-19 pandemic, lung cancer, or medical resource shortages. However, we CAN control how we react to them.  Prepare. Stay home. Practice social distancing. Wash your hands. And stay as healthy as you can.

“Disaster gentrification” is now a thing

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“Disaster gentrification” has become a thing.

When people flee urban areas to second homes or rural areas to avoid the COVID-19 pandemic, they put the locals who live permanently in the area of their “disaster” home at risk, and strain local services. Small town groceries are not designed to supply large populations. Small town medical center are not equipped to handle several (if any) critically ill people. Rural Internet does not have the capacity to support work from home or streaming video.

“Shelter in Place” and “Stay at Home” do not translate as “travel to an escape home.” You’re supposed to stay put and avoid spreading the disease.

It doesn’t matter that you feel healthy. Current estimates say 50% of people who are infected with the novel coronavirus will exhibit absolutely no symptoms, yet they are still able to spread COVID-19 to others. And some who feel healthy today might develop symptoms in the next two weeks.

Stay home. Stay safe. Save lives.

The article below is long, but worth the read.

This Pandemic Is Not Your Vacation (Buzzfeed 31-Mar-2020)

Better lung cancer treatment lowers overall cancer death rate–yet stigma persists

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STAT News published an article today titled “U.S. cancer death rate drops by largest annual margin ever, report says.” An excerpt says:

The overall cancer death rate has been falling about 1.5% a year since 1991. It fell 2.2% from 2016 to 2017, according to the new American Cancer Society report. That’s the largest drop ever seen in national cancer statistics going back to 1930, said Rebecca Siegel, the lead author.  ‘It’s absolutely driven by lung cancer,’ which accounts for about a quarter of all cancer deaths, she said. Take lung cancer out of the mix, and the 2017 rate drop is 1.4%, she added.

Experts mainly credit advances in treatment. Topping the list are refinements in surgery, better diagnostic scanning, and more precise use of radiation.

They also celebrate the impact of newer drugs. Genetic testing can now identify specific cancer cell mutations, which allow more targeted therapy using newer pharmaceuticals that are a step beyond traditional chemotherapy.

This news reinforces National Cancer Institute (NCI) data published in 2019 that the lung cancer 5-year survival rate rose to 19.4% for all types of lung cancer.  When I was diagnosed with lung cancer in 2011, the 5-year survival rate for lung cancer was only 16%, and the majority of lung cancer patients survived less than one year. As the STAT article says, it has a LOT do with newer lung cancer diagnosis and treatment options. A major contributor is genomic testing of tumors, and the targeted therapies that can inhibit cancer cells driven by altered genes.  Patients on some targeted therapies have a median survival of over five years! About 30% of non-small cell lung cancer patients are currently eligible to take some form of targeted therapy, and that number may soon rise to 50%.

The benefits of targeted therapies have just begun to affect the NCI’s five-year survival stats. The first successful lung cancer targeted therapy clinical trial (crizotinib for ALK-positive non-small cell lung cancer) began in 2007, and the drug was approved in 2011. The NCI’s 2019 stats are based on data collected between 2009 and 2015. The survival rate will continue to go up due to approval of more targeted therapies, as well as the advent of immunotherapy (first approved in 2014), more precise radiation treatments, better surgical techniques, and early detection with lung cancer screening. When lung cancer is caught in early stages, 80% of patients are CURABLE.

However, despite obtaining their information from same source (the Associated Press), some media outlets have emphasized different angles of this story. An National Public Radio (NPR) article states, “What’s behind the decline [in cancer deaths]? In part, smoking rates have fallen steadily, which means the biggest risk factor for lung cancer has fallen appreciably. New cancer treatments are also playing a role, Siegel says.” (That’s ALL NPR’s article says about the contribution of better lung cancer treatment to the reduction of cancer deaths).

I wish the media would stop emphasizing smoking cessation as the cure for lung cancer death, instead of the significant advancements lung cancer treatment. Anyone with lungs can get lung cancer. An increasing number of lung cancer cases (currently around 20%) occur in never smokers. While overall lung cancer deaths have been dropping slightly, the death rate in young women who have never smoked is actually RISING. The World Health Organization has acknolwedged that air pollution is a risk factor for lung cancer, as is exposure to radon gas and other environmental exposures.

Crediting smoking cessation as the primary reason for reduction in lung cancer deaths perpetuates stigma, which contributes to worse lung cancer outcomes through physician nihilism, patient anxiety depression, and reduced funding for lung cancer research. Once a person has been diagnosed with a serious disease, they should receive the same compassion and treatment regardless of their personal characteristics. Blaming the patient and telling them to stop smoking never cured anyone.  But it may prevent the patient from experiencing the best possible outcome for their disease. Why won’t the media emphasize very real contribution–and the hope–offered by better lung cancer treatments ?

So, when you see news about the reduction in cancer deaths (and lung cancer in particular), please look past the errant “due primarily to smoking reduction” emphasis.  Focus instead on the hope offered by cancer research and the increasing number of new lung cancer therapies.  We don’t have a lung cancer cure for everyone, but researchers are working on it. Those touched by lung cancer need that hope.

We’re getting better at killing lung cancer.  Stigma is SO much harder to kill.

 

An Oncologist’s Perspective on Medical Aid in Dying

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HuffPost Camidge MAID

Thank you Dr. Camidge for sharing your experience as an oncologist with Medical Aid in Dying (MAID). All terminally ill patients deserve the right to have their wishes honored this way.

Why I Wrote The Rx That Helped My Cancer Patient Die

in HuffPost 26-Jun-2019

 

When am I old enough to die?

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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.

 

Farewell, Stephen Hawking, and thanks

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Physicist Stephen Hawking died yesterday at age 76. As a science geek, I was awed by his amazing intellect and ability to explain difficult science clearly. As a metastatic cancer patient, I admired how he made the most of life despite a crippling health condition and grim prognosis.

Below is reprint of a Facebook post (with permission) by feisty science fiction author Pat Cadigan, a friend and ovarian cancer patient. She also knows about making the most of life.

——

I never met Stephen Hawking, exactly. One day, I was in Covent Garden and as I walked along a sidewalk, two carers were getting him out of a specially-equipped van. I felt it would be inappropriate to stop and gush—the carers were in the act and I would have been interrupting. So I kept going—but I gave him a great big I-know-who-you-are-and-I-think-you’re-great smile. I like to think I saw a twinkle in his eye. I smiled at the carers, too, and they smiled back at me.

(Sometimes I think that they smiled at me because I didn’t look like I was pitying Prof. Hawking.)

When Stephen Hawking was diagnosed with motor neurone disease, he was given two years to live. He spun those two years into nearly half a century. This is practically unheard-of for people with motor neurone disease—it is a terrible, merciless condition that, at the time Hawking developed it, was not even as treatable as cancer. 76 is still too young an age to leave the building; I really hoped he would stay longer.

But while he was here, he made it count, even though he was unable to move, and then unable to speak for most of his life. His mind was lively, energetic, indomitable. He defied his circumstances and his prognosis. Hell, he even left his wife for his nurse—probably not his finest hour, but the heart wants what it wants, even when it’s confined to a wheelchair, unable to speak.

Most of us never achieve Hawking’s level of intellectual brilliance. But we can all try to ‘defy our prognosis,’ so to speak. We can confound expectations. We can make every moment count. We don’t have to accept what we’re told to accept. We don’t have to settle.

Maybe we won’t succeed in defying our prognosis, so to speak. But if we don’t try, we’ll never know.

You don’t have to lie down quietly. Even if you’re paralysed, you can go down swinging.

Did Lung Cancer Claim Your Loved One? Invest 20 Minutes to Help Researchers Find New Treatments!

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If your loved one was treated for lung cancer at a community hospital, and has since died, you can help find new lung cancer treatments that might spare other families the anguish you’re feeling.

Lung cancer is the biggest cancer killer. Fortunately, researchers have discovered several new therapies that are helping to turn metastatic lung cancer into a chronic illness instead of an automatic death sentence.  Some of these therapies are effective for 70-80% of patients whose tumors have certain biomarkers .

Unfortunately, not all types of lung cancer have such effective treatments — yet.  Researchers need to find more lung cancer biomarkers and develop more drugs to target them. Discovering these biomarkers and new therapies requires studying LOTS of lung cancer tumor tissue.  If more tumor tissue from different patients were available for researchers to study, we might find new biomarkers and effective targeted therapies faster.

How can I help?

If your loved one was treated for lung cancer at a community hospital, and has since died, you can help by donating your loved one’s archived tumor tissue. 

Researchers usually obtain tumor tissue from lung cancer biopsies and surgeries performed at their academic cancer centers.  However, most lung cancer patients (about 80%) are treated at community and clinics, not academic cancer centers.  Those hospitals generally just archive any tumor tissue that is not needed for guiding patient care, and destroy those tissues five to ten years after the patient has died.  This means a lot of tumor tissue that could be used for finding new lung cancer therapies never gets to researchers.

The National Cancer Institute’s Lung Cancer SPORE at the University of Colorado (I’ll call it CU Lung SPORE for short) aims to help lung cancer researchers find cures faster.  Like other NCI SPOREs, CU has a biorepository (some people may call it a biobank) where they store patient specimens and medical records.  The biobank provides the tissues along with the important clinical background to scientists studying new ways to treat lung cancer, not only from the University of Colorado, but to institutions all around the country. Researchers can search for available specimens and request them for research projects.

The CU Lung SPORE created a pilot study to collect archived tumor tissue and medical records of deceased lung cancer patients, and place these in their biobank so that researchers can use them.  This study focuses on deceased patients because they have no further need of the tissues (living patients may need their specimens for tumor testing later).  The study needs five to ten more family members to submit signed release forms so we can complete the pilot study and assess whether this a feasible way to gather more lung cancer tumor tissue for research.

HIPAA laws forbid a research center from asking patients or family members about donating tissues and medical records if the patient wasn’t treated at their facility. But advocates (like me) CAN ask.

What do I have to do?

To participate, all you need do is:

  • Download the release form (by clicking on this link Family member Release Form (revised 2016-06-23) and fill in some information about you, your loved one, and where your loved one was treated,
  • Sign the release form, and
  • Mail the completed, signed release form to:
    • Mary K. Jackson
    • Team Manager – Specialized Program of Research Excellence [SPORE]
    • University of Colorado Cancer Center
    • 13001 E 17th Place MS B-189
    • Aurora, CO 80045

Filling in the release form only takes about 20 minutes (assuming you have to look up the contact information for the hospital).  Pretty easy, isn’t it?

What happens next?

The SPORE will contact the hospital where your loved one was treated and request your loved one’s archived tissue and medical records. Once these documents are received at CU, they will be reviewed by the study team, de-identified (which means personally identifying information is removed), and placed in the CU Lung SPORE’s biobank.

THAT’S IT!

PLEASE consider donating your deceased loved one’s archived lung cancer tissue and medical records for research through this project. You can learn more by contacting me (the patient advocate for the CU Lung SPORE) at jfreeman.wa@gmail.com, or the CU Lung SPORE at the address above.

Do it to honor your loved one.  Do it for the next family stricken by lung cancer. Whatever your reason, please do it.  We’ve lost too many to this disease.

 

Note: This research study’s official project title is “Patient-Initiated Biobanking of Deceased Lung Cancer Patient Tissues” and its study number is COMIRB# 15-1294.  It is not a clinical trial dealing with live patients, so you will not find it listed on clinicaltrials.gov.