Cancer, Divorce & The Holidays

BadLast year, I had finally gathered enough strength and courage to file for divorce. A decision that was extremely difficult to make after the devastation our family had faced with two cancer diagnoses within 3 years of each other. I often wondered why the woman my husband made such a poor decision to have an affair with did not question his actions, or would question hurting his wife after cancer, or the impact this affair would have on the children. I also had the fear of finding love again after having had cancer, dating, and living my life on a ticking time clock between scans.

The real truth was, it was not about me, or the kids, or this woman. It was about “him.” A selfish decision he made without remorse, guilt, or shame. Today, he still has taken no accountability for his poor decisions or actions. It has been almost a year and a half since I filed for divorce, and the pain, the anger, and the hurt never goes away completely. My psychologist described all the emotions of divorce relating to a “tossed salad”. You have all these ingredients that are tied to each emotion, and they come to surface during different times and triggers. He was absolutely right with this analogy. And, it helped me understand how I was teetering between each one, and not in any specific order.

Cancer causes you to loose control. It teaches you that there is no certainty, and that fear can debilitate you if you allow it to happen.

Divorce, has the same emotions, combined with the other stages of grief, such as denial, anger, bargaining, guilt, depression, and finally acceptance.

The common stages of all of these emotions is that you can overcome them. The grief surely can be overwhelming, and at times it can make you question your strength and ability to rise above the adversity.

This year, I am choosing to embrace every moment that God has given me to celebrate MY life, I chose so hard to fight for. Not once, but twice. Not to mention, my two greatest blessings, my children.

You can take a diagnosis like cancer, or a devastation like divorce and allow it define you – OR – you can let it inspire, empower, and strengthen you to overcome the worst moments of your life. When I have moments of sadness or anger, I like to take a moment to reflect on the many blessings around me, and focus on what I am most grateful for. You see, I have lost a lot of friends to this horrific disease, and I choose to remember them, and honor their memory each and every day with the work that I do. The lives that were lost are always way too soon.

Should I spend my life, allowing cancer, or divorce to define me?

Not this holiday season.

Kimberly Jewett Consulting, Inc. Hires Veteran Advocate

Beth Fairchild Brings Years of Experience to Patient Advocacy

SAN ANTONIO, TX – December 8, 2015 – Kimberly Jewett Consulting, Inc., a leader in patient advocacy for life sciences markets, is pleased to announce the addition of Virginia “Beth” Fairchild to their team during the 2015 San Antonio Breast Cancer Symposium.

Beth, a seasoned professional, will hit the ground running as she brings several years worth of hands-on client and management expertise, backed by her personal experience as a metastatic breast cancer survivor and passionate patient advocate. Her qualifications include a successful track record in healthcare marketing and sales, and her extensive experience in specifically, metastatic breast cancer with a comprehensive understanding of this sophisticated arena.

As an associate, Beth will be contributing to the growth of the organization by concentrating on enrichment of client satisfaction. In her new role, Beth will act as a conduit to clients when she designs and implements new strategies, and as a liaison to new opportunity development – translating client needs into viable product enhancements and solutions.

When asked about her new role with KJC, Beth replied, “I joined Kimberly Jewett, Inc. because I wanted to be part of a team actively involved in driving patient needs and public understanding of this disease. One hundred and twenty-three women and men will die today from METAstatic Breast Cancer, and one day I will be one of those 123. I look forward to working Kim and moving forward with the pharmaceutical industry to build pharma/patient relationships and to create support and advocacy programming.”

CEO and Founder, Kimberly Jewett adds, “We are excited, honored, and grateful to have Beth join our team, supporting the needs of our clients. Our passion, combined with our purpose and professional skillset, will truly impact the lives of cancer patients and their families, and we are both blessed to have the opportunity to be that voice. While honoring the patients who are fighting, surviving, and thriving every day of their fight, and remembering the ones who lost their lives way too soon. Together, WE CAN make a difference in the lives of cancer patients and their families. People just like US.”

Giving Bad News by Phone May Be the Better Way

Communicating the news that a biopsy result indicates malignancy by telephone may be better than delivering the news in person, a team of researchers from the University of Michigan, in Ann Arbor, suggests. Two outside experts do not altogether agree.

“Telemedicine approaches can potentially relieve much of the anxiety associated with in-person consultations while delivering bad news in a timely, compassionate, and patient-centered manner,” write Naveen Krishnan and colleagues in a viewpoint published in the November issue of JAMA Oncology.

Getting the bad news over the telephone can give patients time to absorb their diagnosis and take greater advantage of their next in-person consultation, Krishnan and colleagues write.

“The initial in-person office visit to communicate malignant biopsy results is arguably less interactive than expected. Patients are not only trying to absorb devastating news but also engage in challenging conversations,” they write. “On the other hand, communication of biopsy results through telecommunication can serve as a buffer to the initial in-person visit and provide time for patients to process the results alone or with family.”

The authors cite examples of oncologic services delivered through telemedicine.

One is the Arizona Telemedicine Program’s Telehealth Rapid Breast Care Process, which lets patients receive their breast cancer diagnosis the same day as their biopsy. The program is conducted under the auspices of the University of Arizona.

Another example is the Ontario Telemedicine Network, located in Canada. With more than 1600 sites and 3000 systems, the OTN is the largest teleoncology service in North America, according to the authors.

“The Ontario Telemedicine Network has overcome a number of barriers, including cost, physician compensation, and resistance to telehealth technology adoption,” they write. “In fact, telehealth technology is now an everyday part of health care delivery in Ontario.”

Krishnan and colleagues claim that for patients, message content and timeliness are the two most important factors in relaying biopsy results. Patients are less interested in nonverbal communication on the part of the physician delivering the bad news, they say.

“In this respect, telemedicine allows physicians to focus on content rather than nonverbal communication that patients may not appreciate at the initial in-person visit,” the authors write.

“With increasing clinical time constraints and the shock of hearing a cancer diagnosis in person, telemedicine encounters can facilitate more meaningful future in-person discussions of complex therapeutic options and their adverse effects,” the authors write.

Read more.

 

PSA Testing and Cancer Diagnoses on Decline

The Washington Post (11/18, Bernstein) reports on two studies published in JAMA finding that in the wake of a finding by the US Preventive Services Task Force in 2012 that the prostate-specific antigen test “causes more harm than good,” that the number of tests and the number of prostate cancer diagnoses “have both declined sharply.” With testing of men 50 and older falling from 40.6 percent in 2008 to 30.8 percent in 2013, and prostate cancer diagnoses falling to 416.2 per 100,000 in 2012 from 534.9 per 100,000 in 2005.

The New York Times (11/18, Grady) reports that in one of the studies, the authors said that the decline in testing and diagnoses “could have significant public health implications,” but that it was not yet clear whether they would have an effect on death rates. JAMA also contains an editorial by Dr. David F. Penson, chairman of urologic surgery at Vanderbilt University Medical Center, arguing that it may be time to reconsider the role of testing and urged a move to “smarter” screening by “focusing more on those at high risk.” In one study, American Cancer Society researchers focused on the decline in “early-stage diagnoses of prostate cancer” which they attributed to the decline in testing. The second study “also found a significant decline in PSA testing” in relation to the USPSTF recommendation.

 

NPR (11/18, Stein) reports in its “Shots” blog that the studies “don’t settle” the question of whether the USPSTF recommendation was sound, “but they do shed light on the effect” in that they show a decline in both screening and diagnoses. Dr. Brawley said the studies show “the American public actually did listen” to the recommendation.

FDA “Stepping Up Its Plans” To Regulate Laboratory-Developed Tests

This will have significant implications for patients who have tests performed by companies/laboratories that bring to market to their own tests they have validated and market for clinical testing. FDA, while it has always reserve the right to do so, has largely not regulated laboratory-developed tests.  This appears to be changing with some support by clinical organizations. Further discussions with the FDA, companies, laboratories and clinical diagnostics organizations are going to be required to balance patient safety, quality assurance and access for patients to important tests that are coming to market.

Stat (11/18, Fong) reports in continuing coverage that the Food and Drug Administration “is stepping up its plans to regulate all medical laboratory testing,” as a report released by the agency this week found 20 examples of laboratory-developed tests that may have harmed patients. Dr. Peter Lurie, FDA associate commissioner for public health strategy, said in a blog post, “FDA oversight would help ensure that tests are supported by rigorous evidence, that patients and health care providers can have confidence in the test results, and that LDTs have more scientifically accurate product labeling.”

Modern Healthcare (11/18, Dickson) reports that Lurie also said, “These tests may suggest that a patient doesn’t have a disease or condition, when in fact they do.” Dr. Patrick Conway, the chief medical officer of the Center for Medicaid and Medicare Services, the agency that currently has jurisdiction over the lab-developed tests, said, “The CMS does not have a scientific staff capable of determining whether a test is difficult to successfully carry out or likely to prove detrimental to a patient if carried out improperly.” Medical societies, including the American Society of Clinical Oncology, support FDA regulation of lab-developed tests. Fortune (11/18) and The Scientist (11/18, Vence) also covered the story.

Increased Risk of Second Nonmelanoma Skin Cancer Among Patients Receiving Immunosuppressive Therapy

Patients with rheumatoid arthritis treated with methotrexate had an increased risk of a second nonmelanoma skin cancer, and adding anti–tumor necrosis factor (TNF) may increase that risk, according to results of a retrospective cohort study reported in JAMA Dermatology. A similar association was seen for anti-TNFs among patients with inflammatory bowel disease, Scott et al noted, but this finding was not statistically significant.

Immunosuppressive therapy is the standard of care for rheumatoid arthritis and inflammatory bowel disease, the authors noted, and “both immune dysfunction and therapy-related immunosuppression can inhibit cancer-related immune surveillance in this population.” Drug-induced immunosuppression is also a risk factor for nonmelanoma skin cancer, particularly squamous cell tumors.

Read more.

ASCO Convenes Panel on Costs, Benefits for Patients and Families

cancer-costs1The Philadelphia Inquirer (11/16, Bauers) carries an interview with Dr. Adam Dicker, professor and chair of the Department of Radiation Oncology at Thomas Jefferson University’s Sidney Kimmel Medical College, who is a coauthor of guidelines developed by the American Society of Clinical Oncology “to help physicians, patients, and their families assess efficacy, toxicity, and costs of the various treatment options.” Dicker said, “The good news in oncology is that…there are now a number of new drugs that have clinical benefit.” He explained that ASCO organized a panel to “look at the best-quality data available” in order to calculate cost of treatment and expected benefits. The panel produced “a very useful visual called ‘Evidence Blocks’ that play a pivotal role when having a conversation with a patient and their family.”

‘Substantial Number’ of Patients With Stage IV NSCLC Are Over-treated

An analysis of data from 46,803 patients with stage IV non–small cell lung cancer (NSCLC) who received palliative chest radiation therapy found that 49% received radiotherapy for longer than 15 fractions and 28% received more than 25 fractions. This treatment pattern “is inconsistent with the results of published phase III studies,” Matthew Koshy, MD, of the University of Chicago, and colleagues reported in the Journal of the National Cancer Institute. In addition, approximately 19% of the patients received concurrent chemoradiation therapy, “a practice that is not only unsupported by the evidence, but one that places the patient at increased risk of toxicity without an established palliative or survival advantage,” the investigators stated.

“This demonstrates that a substantial number of patients requiring palliative thoracic radiotherapy are overtreated, and further work is necessary to ensure these patients are treated according to evidence-based guidelines,” the authors concluded.

Read more.

 

Liquid Biopsy Promotes Precision Medicine by Tracking Patient’s Cancer

A team of researchers, including scientists from the Translational Genomics Research Institute (TGen), has reported that analyzing circulating tumor DNA (ctDNA) can track how a patient’s cancer evolves and responds to treatment.

In a study published in Nature CommunicationsMuhammed Murtaza, PhD, of TGen and Mayo Clinic, and colleagues, describe an extensive comparison between biopsy results and analysis of ctDNA in a patient with breast cancer.

The researchers followed the patient over 3 years of treatment.

“When patients receive therapy for advanced cancers, not all parts of the tumor respond equally, but it has been difficult to study this phenomenon because it is not practical to perform multiple, repeated tissue biopsies,” said Dr. Murtaza, Codirector of TGen’s Center for Noninvasive Diagnostics.

“Our findings empirically show that ctDNA analysis from blood samples allows us to detect cancer mutations from multiple different tumor sites within a patient and track how each of them responds,” said Dr. Murtaza.

This type of blood test—known as a liquid biopsy—is less invasive, less costly, and less risky than conventional tissue biopsies. Obtaining liquid biopsies could occur more frequently, too, thus providing physicians with up-to-date information about how a patient’s cancer might be changing. This, in turn, could help in the selection of the best possible treatments to combat the cancer.

Read more.

Cancer Patients with Strong Religious or Spiritual Beliefs Report Better Health

When Gregg Carr was diagnosed with lung cancer, he turned to his faith to help him find meaning during difficult times. “This cancer has helped me renew my spirituality. I’m convinced God wants me to help more people,” said Carr. After 4 months of aggressive and often painful treatment, Carr says he now feels well enough to return to work. In his small town in Illinois, he often counsels others facing their own cancer diagnosis.

Carr is far from alone in finding comfort and meaning through religion during cancer diagnosis, treatment, and recovery. According to the US Centers for Disease Control and Prevention (CDC), 69% of cancer patients say they pray for their health. A recent study published in Cancer, a peer-reviewed journal of the American Cancer Society, suggests a link between religious or spiritual beliefs and better physical health reported among patients with cancer.

“In our observational study, we found people who found feelings of transcendence or meaningfulness or peace reported feeling the least physical problems,” said lead author Heather Jim, PhD. “A lot of cancer patients have a reaction when diagnosed of ‘Why me?’ or feel like they’re being punished or get angry. This is a normal part of coming to terms with a cancer diagnosis.”

For the report, researchers from Moffitt Cancer Center and colleagues looked at the results of several published studies on the topic, which included more than 32,000 cancer patients combined. They found a link between patients with higher levels of spiritual well-being and reporting better physical health. The researchers did not look at whether spiritual well-being affected patient survival or cancer recurrence.

The authors defined religion as belonging to a religious organization and attending organized services, while spirituality is a connection to a force larger than oneself. For some people, religion is an expression of their spirituality, while others find spirituality outside of organized religion.

The authors say religion and spirituality can help cancer patients find meaning in their illness and provide comfort in the face of fear. These patients might also be more likely to get practical help that aids in their recovery, because they are often connected to a community of people who share their beliefs and can provide meals, help around the house, rides to medical appointments, and other types of hands-on care.

Read more.