Category Archives: Oncology

Long Distances To Treatment Centers May Be An Obstacle For Some Women Seeking Breast Reconstruction Following A Mastectomy

breast_cancer06142HealthDay (1/7, Dallas) reports that research indicates “long distances to treatment centers are a significant obstacle for some women seeking breast reconstruction after a mastectomy.” The study authors wrote, “While greater patient awareness and insurance coverage have contributed to greater breast reconstruction rates in the United States, geographic barriers to access this service remain, particularly to academic centers.” The research was published in Plastic and Reconstructive Surgery (abstract below).

Background: Inadequate access to breast reconstruction was a motivating factor underlying passage of the Women’s Health and Cancer Rights Act. It remains unclear whether all patients interested in breast reconstruction undergo this procedure. The aim of this study was to determine whether geographic disparities are present that limit the rate and method of postmastectomy reconstruction.

Methods: Travel distance in miles between the patient’s residence and the hospital reporting the case was used as a quantitative measure of geographic disparities. The American College of Surgeons National Cancer Database was queried for mastectomy with or without reconstruction performed from 1998 to 2011. Reconstructive procedures were categorized as implant or autologous techniques. Standard statistical tests including linear regression were performed.

Results: Patients who underwent breast reconstruction had to travel farther than those who had mastectomy alone (p < 0.01). A linear correlation was demonstrated between travel distance and reconstruction rates (p < 0.01). The mean distances traveled by patients who underwent reconstruction at community, comprehensive community, or academic programs were 10.3, 19.9, and 26.2 miles, respectively (p < 0.01). Reconstruction rates were significantly greater at academic programs. Patients traveled farther to undergo autologous compared with prosthetic reconstruction.

Conclusions: Although greater patient awareness and insurance coverage have contributed to increased breast reconstruction rates in the United States, the presence of geographic barriers suggests an unmet need. Academic programs have the greatest reconstruction rates, but are located farther from patients’ residences. Increasing the number of plastics surgeons, especially in community centers, would be one method of addressing this inequality.

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.

 

Media May Overhype Some Unproved Cancer Meds

According to USA Today , a report published online in JAMA Oncology indicates that “the media often use” words or phrases like “breakthrough,” “game changer,” or “miracle drug” when discussing “new cancer drugs, even when the drugs are unproved.”

The Washington Post  “To Your Health” blog reports that near the end of June, “not long after the annual conference of the American Society of Clinical Oncology,” researchers did a Google News search for “the phrase ‘cancer drug,’ along with nearly a dozen superlatives, such as ‘revolutionary’ and ‘miracle.’” Their “inquiry turned up 94 articles from 66 separate news outlets, referencing 36 different drugs.” The researchers found that “despite the glowing adjectives, half the treatments had not yet been approved by the Food and Drug Administration; a handful of them had not yet even been tested in humans.”

Modern Healthcare  “Vital Signs” blog reports that “when the researchers examined who made the superlative comments about the drugs, they found that while physicians (27%), patients (8%) and industry experts (9%) made several of the comments, 55% had no attribution—in other words, the superlative assertions were being made by the journalists themselves.”

HealthDay (10/30, Thompson, 22K) reports that “cancer patients are most harmed by this hype, said Dr. Lidia Schapira, editor-in-chief of Cancer.Net and an oncologist at Massachusetts General Hospital in Boston.”

 

4 Lessons I Learned From My Cancer Scare

home-advocateIn my original post, going back to June, I mentioned that I had received a positive PET scan.  I met with 4 of the top gynecologic oncologists in the Chicagoland area, and each one was consistent in telling me that I had metastatic breast cancer to my ovary that would require a full hysterectomy and bilateral oophorectomy. Divorce? Cancer-again? Surgery? Loose my uterus and ovaries? Was this really happening to me, right now?

With the best opinions in the area from top gyn oncs, I proceeded to surgery, prepared for the next chapter of my life, without estrogen and more surgery and potentially more chemotherapy if the surgery found additional sites of disease.

I was angry & fearful, and could not believe this was happening again.

On the day of surgery I had asked that if the growth was not cancerous to keep my uterus and other ovary. Despite support for that plan pre-operatively,  I was actually in the pre-op holding area and my surgeon was recommending the initial plan of full hysterectomy and to remove both tubes & ovaries. What was going on here? We prepare for weeks and on the morning of surgery we change the entire game plan?

Nonetheless, my wishes were followed and the involved ovary was sent for a frozen section which was read as a benign cyst. The surgeon removed both of my Fallopian tubes, and a small piece of my liver, which also turned out to be benign.

NO CANCER! NO EVIDENCE OF DISEASE! I felt like I was just given another chance at life, for the third time.

This specific experience taught me many very valuable lessons.

Multiple opinions are better than one. If I had stopped at the first or second consultation I may have had radical surgery for a benign disease. This is because PET scans can be very non-specific. Every “hot spot” is not the same, particularly in this disease and in the ovaries for pre-menopausal women, as in my case. While PETs can be “positive” or “negative” they can also be “in-between” and depending on the organ involved, may have differing sensitivities (probability disease is present if test is positive) and specificities (probability disease is absent if test is negative).

Secondly, physicians will advise you of what they think is best for you based on the evidence, literature and their experience with similar patients or “cases”. You have to remember your “case” may be different. In reality, my PET scan was “hot” but could have been “hotter” and because of the differences in how the test is performed, it may not have been as “hot” somewhere else.

Thirdly, no single test, as in PET scan, or anyone’s opinion may be that accurate and should not alone guide what YOU want to do. Physicians are trained to battle disease and as medicine has become more sub-specialized with physicians focused in narrower areas, it becomes harder for them to consider the person in as much as the disease or the psychologic impact their recommendations may have for the patient.

Lastly, be your own best advocate. Get multiple opinions, read up on what tests can and can’t tell physicians, search the literature to see the best approach to similar “cases” and finally, read first-person testimonials from other patients about their experiences, treatment and post-operative feelings.

I sincerely appreciate all the support, prayers, and kind words of encouragement. I am fully recovered, and ready to continue enjoying life, while doing the work that I have so much passion for.

 

Diagnosis in Eye of Beholder and the ‘Rita Wilson’ Effect

Since Angelina Jolie’s public statements about her testing for BRCA and subsequent surgeries including bilateral mastectomies and removal of her fallopian tubes and ovaries, many oncologists and laboratories have mentioned reports of an increase in BRCA testing across North America. Her awareness of her personal health and potential risk combined with her celebrity status raised awareness of need for early diagnosis and treatment. This is part of the ‘Angelina Jolie’ effect.

Another star, Rita Wilson, has also made headlines recently with her own call to action about the need for second opinions in breast pathology if you have a biopsy. According to one pathology blog, Dr. Keith Kaplan mentions the need for some form of second opinion in questionable cases to ensure patient safety and quality. Pathologists have many quality assurance processes in place and collaborate with one another on challenging cases. Check out this resource on Understanding Your Pathology Report.”

Yesterday I read a post from Dr. Susan Love on The Huffington Post that detail a little more than initial reports about Rita Wilson’s own breast cancer journey.

The takeaway message from Ms. Wilson’s situation is this: Individuals read pathology slides. And the diagnosis is often in the eye of the beholder. We encourage second opinions about treatment, but most people don’t realize that when they ask for a second opinion on the diagnosis, the opinion should be based on examination of the actual biopsy slides, not simply the original pathology report. Some cases are clear-cut but if there is any question, the more eyes looking at the tissue, the more accurate the diagnosis, and the more confident a woman can feel in the decisions she makes.

Too often, celebrities who publicly share their health stories leave out key information, which in turn can cause confusion and sometimes stimulate people to take action that may not be necessary or advised. We applaud Ms. Wilson’s willingness to include the details of her specific situation so that other women can better understand the rationale that drove her personal treatment decision.

Having traveled to many hospitals and cancer centers, I know this process all too well with many delays by both the referring and receiving hospitals to get my slides for review. I would also like to leverage the future vision of digital pathology that can help all of us ensure that our slides are read accurately and in a short amount of time by many pathologists. This technology can make the diagnostic process much easier for patients as well. The time is now for second opinions enabled by digital pathology.

Who is ready to stand alongside of me to make it happen?

Is My Breast Biopsy Being Read Accurately?

This might be a question several patients find themselves asking in light of a recent study published in a recognized prestigious medical journal.

The accuracy of pathology diagnoses of breast biopsy results was recently called into question in the study published in the March 17, 2015, issue of the Journal of the American Medical Association (JAMA). Researchers reported that practicing pathologists incorrectly diagnosed nearly 25% of breast biopsies presented to them in a test study.

These findings did not go unnoticed by the national media. On the same date the study was published, The New York Times ran a headline referring to “room for doubt” among breast biopsies with a PBS NewsHour video by the same name.

I think that it is important for patients and the public to know that by design, the study itself is not an accurate reflection of what happens in “real world” clinical practice of pathology. It is a very common practice for pathologists to obtain second opinions in difficult cases such as ductal carcinoma in-situ (DCIS) and atypical hyperplasia to avoid both under- and over-interpretation. The participating study pathologists were only presented a single glass slide without the ability to “show the case” to others or obtain stains that are sometimes used to diagnosis breast biopsies accurately.

If a woman (or man) receives a diagnosis of DCIS or atypia, they may consider getting a second opinion to ensure there is no invasive cancer. Because DCIS and atypical ductal hyperplasia do not represent invasive cancer, patients have time to make informed decisions about their health, including time to obtain a second opinion.

There are several options patients can take to help ensure their breast biopsy is read accurately. Here a few:

  • Ask if the laboratory that will examine your tissue sample is accredited by the College of American Pathologists (CAP). The CAP accredits thousands of laboratories worldwide and provides an online directory for patients.
  • Make sure the pathologists who are examining your tissue sample are board-certified.
  • Find out if the hospital has a multidisciplinary breast conference or “breast tumor board”. These are teams of physicians and other health care professionals that meet regularly to discuss diagnosis and management of patients with breast disease, guaranteeing more consultation about the best approach for your care.
  • If your hospital doesn’t have a multidisciplinary breast conference, consider getting a second opinion. Have your doctor send the biopsy slides to another laboratory and request they be read by a pathologist who specializes in breast pathology.
  • As you seek out additional clinical opinions be sure to request your slides be reviewed at the other hospitals. Pathologists can use technologies such as digital pathology to make available your slides to be viewed with several pathologists in many hospitals for timely and accurate diagnoses.
  • Seek out accurate and credible resources to help you understand your pathology report and diagnosis, such as the CAP’s resource, “How to Read Your Pathology Report“.

If you have questions, pathologists are willing to speak and meet with patients about your diagnosis and how your biopsy sample is processed and reviewed.

As with any biopsy sample, be sure to get a copy of your pathology report and use resources such as those from CAP to insure your laboratory and pathologist have the resources to provide you the best possible care.

Understanding Your Pathology Report: A Patient’s Story

Honored to share my story in this video produced by the College of American Pathologists (CAP) to help advise patients on engaging with their pathologists and the importance of understanding their pathology reports. Drs. Carey August and Keith Kaplan, practicing pathologists, describe how pathologists generate a pathology report and interact with the patient’s care team, such as Dr. Rosalinda Alvarado, to formulate a treatment plan. Be sure to ask for a copy of your pathology report and ask for the opportunity to review it with your pathologist. These doctors do amazing work everyday and the reports they generate are critical to formulating your treatment plan. Be your own best advocate!