What is “Step Therapy” and Why Should We Care?

What is step therapy and how is it affecting cancer patients?What in the world is “step therapy”? Maybe a new type of fitness routine? Unfortunately, it’s nothing of the kind. And this benign sounding term can sometimes mean bad news for cancer patients and others who need newer, but often more costly, medications that have been prescribed by their doctors.

This February, I joined a group of advocates for meetings at our state legislature here in Virginia. One of the major issues on our agenda was the need for reform of the practice of step therapy, which has increased significantly across the country in recent years with the rising prices of prescription drugs.  Continue reading

A New Year: Where Do We Go From Here?

A new year and improving health careOne of the things I enjoy about the holiday season is that it usually includes some down time to reflect a bit on the past year and opportunities the new year brings.

As we start this new year, I’m looking forward to (hopefully) a wonderful year ahead, but it’s hard not to also recognize that there are many uncertainties at play in the larger world today.

I’ve been thinking lately about some of the lessons I’ve learned going through difficult times in the past. One of those lessons was recognizing that even when our world seems to be veering off course, there are things we can control. And those are the small and large (mostly small) choices we make and actions we take every day that add up to the kind of year we have and the life we live.

Continue reading

Cancer and Health Policy: Some Things I’m Watching

Issues to watch in cancer and health policyThe last month has been full of discussion about where we’re headed as a country following the November 2016 election.

Health care policy is a big part of that discussion. There’s been much opining on what the leadership in Congress will likely be seeking to do. Right now, we are mostly faced with a huge amount of uncertainty.

Discussions of health care issues are often presented in ideological terms. But here’s the thing about cancer: once you’ve had to deal with it, you’re perspective changes. Whether you identify with Republicans, Democrats–or neither–you realize that many of the things that matter most are the same for everyone.

Continue reading

Metastatic Breast Cancer: How Can We Accelerate Progress?

Genomic studies will play an important role in precision medicine for metastatic breast cancer.For a long time, there has been a critical need for research that is focused specifically on metastatic breast cancer. That means understanding what causes metastasis and how we can intervene to shut down this process even after it has started. Although a true “cure” may not be possible, the question is whether we can treat the disease in such a way that patients live for a very long time with good quality of life.

That should not be so far-fetched an idea. HIV/AIDS not long ago was usually fatal, and now this disease can be managed as a chronic condition with a combination of drugs that patients take for the rest of their lives. Could something like this be possible for breast cancer that has become metastatic?

There have been some amazing advances in the treatment of metastatic melanoma and metastatic lung cancer using immune system therapies. Why have we not seen similar advances in treating metastatic breast cancer?

Continue reading

Clinical Trials: How Can Patients Benefit More?

Sharing of data from clinical trials could help accelerate progress against cancer.These days the media hype around cancer “breakthroughs” seems to have reached a new high. There have been advances, but there is still such a long way to go before we can say we have real breakthroughs that are changing the outlook for most patients.

There are likely many reasons why progress is so slow. But one thing that would almost certainly make a big difference is if there were true collaboration among researchers conducting clinical trials.

Clinical trials are expensive and time consuming. Patients in clinical trials have chosen to participate not just for their own benefit but also to make a contribution for the greater good. And yet, the knowledge we as a society draw from many clinical trials is often incomplete or even nonexistent.

Continue reading

Cancer Risk and the Environment

The development of cancer is heavily influenced by external factors, a recent study finds.About a year ago, a study published in the journal Science received a lot of attention and comment because it seemed to suggest that most cancers were mainly the result of random mutations or “bad luck.”  I wrote about the study, including what commenters identified as some of its major weaknesses, in a post last January on Cancer Risk and “Bad Luck.”

A new study by a different team, published recently in Nature, revisits the question. It expands on the analysis in last year’s study and examines the question using several different approaches. It arrives at the conclusions that the development of cancer is heavily influenced by external factors. Continue reading

Breast Cancer: How Much Progress Have We Made?

How much progress have we really made against breast cancer?It’s October, and Breast Cancer Awareness Month in now well underway. As always during October, we’re surrounded by pink products, business promotions displaying the pink ribbon and pink-themed advertising–all in the name of breast cancer “awareness”. But how much real awareness does all this bring? Does it actually help patients at all?

Why not take a step back from all the craziness for a moment and take a look at where we actually are in the fight against breast cancer. Breast Cancer Awareness Month has been around for 30 years. It seems fair to ask: with all this awareness, how much progress have we actually made against breast cancer? And if it’s not enough: how can we, or will we, do better? Continue reading

Camp Lejeune, Environmental Toxins And Breast Cancer Risk

What are the links between environmental toxins and breast cancer risk?It’s recognized that environmental factors play a role in the development of many types of cancer, including breast cancer.  But, unfortunately, there are more questions than there are answers right now about the extent of that role. Studies so far have not been able to clarify how and to what extent exposures to harmful substances in the environment increase our risk for breast cancer.

An opportunity to gain some insight on this issue could potentially come from a study now underway of male breast cancer and exposure to contaminated drinking water at Camp Lejeune in North Carolina.  Results from the study are expected some time this year.

Continue reading

Cancer Risk and “Bad Luck”

How much cancer risk is related mostly to random genetic mutations?Are a large proportion of cancer cases mainly the result of “bad luck”? That is certainly the impression given by recent media reports about a study conducted by researchers at Johns Hopkins University and published in the journal Science.

What did the researchers do and what did this study actually show? Is it really time to reconsider our understanding of cancer and its causes? Continue reading

Breast Cancer “Standard of Care”: Standard for All?

Many women diagnosed with breast cancer in the United States are not receiving what is considered to be "standard of care."When we look at the progress that has been made against breast cancer over the last twenty years, an essential measure is mortality, how many lives are actually being saved.

The big picture story is that mortality from breast cancer for the U.S. population as a whole has declined somewhat, but not nearly as much as might have been expected given the emphasis on screening over the last twenty years.

But looking deeper reveals an even more disturbing story. Continue reading