Mesothelioma Help Cancer News
Mesothelioma Patients May Benefit from Blood Thinner for Reducing Risk of Developing Blood Clots
In September, Duke researchers warned cancer patients of the potential of developing blood clots, or venous thromboembolism (VTE), during treatment, and up to one year after receiving chemotherapy. Now, the SAVE-ONCO study, funded by Sanofi, reports that in patients who were treated with an experimental form of heparin the risk of developing a blood clot was reduced by 65%. For mesothelioma patients facing other life-threatening complications, the addition of a blood thinner, such as heparin, to their treatment regimen may make a difference in their prognosis.
Low-molecular-weight heparin (LMWH) is often used during surgical procedures to limit the risk of VTE. However, many doctors are hesitant to use heparin during other forms of treatment for fear that the risk of bleeding complications outweighs the risk of a patient having a VTE.
In an editorial in the New England Journal of Medicine, Drs. Elie Akl and Holger Schünemann of McMaster University discussed the potential benefits of adding ultra-low-molecular-weight heparin semuloparin during cancer treatment. The doctors referred to the results of the SAVE-ONCO study where patients receiving chemotherapy were also given a preventive dose of the medicine once daily for just over three months. The study demonstrated the benefits of the drug “without increase in major bleeding.”
The two doctors reported that the SAVE-ONCO study, taken together with prior similar studies, confirm their conclusion of “a likely small survival benefit” from the use of the drug.
The pair of doctors estimated “if 1,000 patients with cancer were to use a prophylactic dose of LMWH, approximately 30 would avert death, 20 would avert a clotting complication and one would suffer a major bleeding episode over a 12-month period.”
They added that daily injections of the LMWH could avert hospitalizations, and potentially, increase survival.
Duke researchers reported in their study that the average increase in costs associated with a VTE was $35,000 over patients without blood clots. Some doctors estimate that mesothelioma treatment already costs anywhere from $150,000 to $1 million. The added expense would place an undue, additional financial burden on the patients.
Akl and Schünemann added that patients looking for survival from their cancer will be faced with “some uncertainty” with the benefit from LMWH. They also added that more research is needed and “they are planning a sophisticated analysis of the published trials.”
Mesothelioma is a unique cancer affecting the lining of the lungs, and other organs, due to past exposure to asbestos. Treatment varies for the disease, depending on the stage of the cancer, but often involves surgery, chemotherapy and radiation. 3,000 Americans are diagnosed with the disease each year.
Symposium To Focus on Lung-Sparing Therapies for Malignant Mesothelioma Patients
Medical doctors and researchers will gather on May 12 in Santa Monica, California for the 2nd Annual International Symposium on Lung-Sparing Therapies for Malignant Pleural Mesothelioma. Mesothelioma is an aggressive cancer of the lining of the lung and abdominal cavity caused by asbestos exposure.
Approximately, 2,500 to 3,000 people are diagnosed with malignant mesothelioma in the United States each year. The incidence of mesothelioma has increased in recent decades.
The symposium promotes less invasive alternatives to the radical surgery that involves extensive removal of tissue and organs in mesothelioma patients and prolonged recoveries. Dr. Robert Cameron, director of the UCLA Mesothelioma Comprehensive Research Program and an advocate of lung sparing therapies, will lead the symposium.
The radical surgery attempted on some mesothelioma patients is known as extrapleural pneumonectomy. Also known as EPP, extrapleural pneumonectomy is a procedure that involves removal of a lung, the lining of the lung, the diaphragm and the lining around the heart.
Participants at the first symposium last year reviewed the Mesothelioma and Radical Surgery (MARS) trail conducted in Great Britain from 2006 to 2009. The U.K. Mesothelioma and Radical Surgery trial tracked 50 patients—24 who underwent extrapleural pneumonectomy and 26 mesothelioma patients who did not undergo radical surgery. According to the results, 52 percent of the mesothelioma patients who underwent radical surgery lived 12 months, compared to 73 percent of the patients who had treatment that did not involve removal of a lung.
Participants concluded that the study offered no evidence that extrapleural pneumonectomy offered an advantage to patients over less invasive surgery. They said mesothelioma patients should no longer be subjected to debilitating lung-removing surgery.
The symposium is part of an ongoing debate within the medical community about mesothelioma treatment options and the value of radical surgery for mesothelioma patients. Some physicians advocate highly invasive surgeries for mesothelioma patients with less advanced cancer who are healthy enough to withstand the operation. Other doctors say that lung sparing pleurectomy/decortication procedures are effective and less debilitating.
The distinguished faculty will include experts from Houston, San Francisco, New York and as far away as South Africa.
“This symposium brings the best scientific and medical minds together to advance the treatment of mesothelioma,” Dr. Cameron said in a prepared statement. “Research and practice over the past several years have continued to evolve, working to improve cancer outcomes without unnecessarily sacrificing the affected lung. Clearly, it is best for the patient to treat mesothelioma as a chronic illness while preserving the function of both lungs.”
Many workers and veterans who develop mesothelioma were exposed to asbestos dust on the job, though disease symptoms typically take 20 years to 40 years to be diagnosed.
For more information about mesothelioma, click here.
FDA Addresses Drug Shortages Impacting Mesothelioma Patients and Young Cancer Patients
In November, President Obama issued an executive order to address the drug shortage that has affected mesothelioma and other cancer patients. Now, the EPA is taking action to bring relief to some patients that have not been able to receive critical treatments for their cancers due to the lack of two key drugs, doxorubicin and methotrexate. Methotrexate is used to treat childhood leukemia. Doxorubicin is one of many platinum-based drugs used to fight mesothelioma, as well as ovarian cancer and multiple myeloma.
The FDA announced Tuesday that it will allow temporary imports of Lipodox as a replacement for doxorubicin. The FDA anticipates the influx of the drug will “fully meet patient needs in the coming weeks.” The FDA noted that temporary importation of unapproved foreign drugs is only considered in rare cases when the shortage cannot be met with existing FDA-approved drugs.
The Agency has approved a new manufacturer to supply methotrexate that is “expected to further bolster supply and help avert shortage of this lifesaving medicine.”
“A drug shortage can be a frightening prospect for patients and President Obama made it clear that preventing these shortages from happening is a top priority of his administration,” said FDA Commissioner Margaret A. Hamburg, M.D. “Through the collaborative work of FDA, industry, and other stakeholders, patients and families waiting for these products or anxious about their availability should now be able to get the medication they need.”
The FDA also reiterated the requirements for both mandatory and voluntary notifications from drug manufacturers to provide quicker notice of impending shortages and to improve communication with the government agency in order to address supply issues early.
Mesothelioma, a rare, asbestos-caused cancer is typically treated with chemotherapy drugs. The drugs are usually given in combinations of two or more during treatment, with the preferred combination being gemcitabine and cisplatin for mesothelioma.
Are Mesothelioma Patients Getting the Straight Story From Their Doctors?
The results of a recent survey of doctors found that an alarming number of them believe it is okay to tell a patient an “untruth” or to put a positive spin on a patient’s prognosis. This is counter to the trust that mesothelioma patients place in their physicians to act in their best interest. When facing life-threatening diseases, such as mesothelioma, patients believe they are presented with the complete, honest facts about their prognosis, disease progression and treatment options so they can take an active role in their treatment plan.
Empowering patients to take charge of their treatment is an important step in cancer care. “You are in charge of your own health, and you are your best health advocate,” says Elizabeth Cohen in her book, “The Empowered Patient: How to get the Right Diagnosis, Buy the Cheapest Drugs, Beat Your Insurance Company, and Get the Best Medical Care Every Time.” However, taking charge could lead a patient down the wrong path if that patient is not fully informed.
Mesothelioma is a fatal cancer of the lining of the lung and abdomen that has been directly linked to asbestos exposure. Treatment often includes chemotherapy and radiation, but researchers have recently begun focusing on patient-centric care with treatments targeting the patients’ unique characteristics. Personalized mesothelioma care optimizes the potential for success. An effective personalized plan requires full disclosure from both the patient and the physician.
Data recently compiled from a 2009 survey of 1,891 U.S. physicians, and published in Health Affairs, found “behavior that is in conflict with at least some of the tenets of the Charter on Medical Professionalism,” according to an article in News @JAMA. In the survey, the doctors were asked questions regarding honesty as laid out by the Charter. The Charter, according to the survey authors, “requires openness and honesty in physicians’ communication with patients.”
The survey found that more than half of physicians in the previous year had described a patient’s prognosis in a more positive manner than warranted. In addition, 20% of the physicians surveyed did not completely agree that a doctor should always tell the truth. In fact, 10% admitted to telling a patient “something untrue” in the previous year.
The authors concluded that their findings “raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible” unless physicians focus more on open, honest communications.
Study lead, Lisa Iezzoni, MD, MSC, professor of medicine at Harvard Medical School and director of the Mongan Institute for Health Policy at Massachusetts General Hospital, in Boston, admitted that there are different reasons for doctors to not be fully truthful. However, she said, “at the end of the day, patients need accurate information about their health.”
In January 2011, the American Society of Clinical Oncology published guidelines encouraging physicians to discuss a patient’s treatment options and preferences immediately after their terminal diagnosis so the treatment can be individualized from the start. The guidelines pointed out that physicians should assess a patient’s options, goals and preferences early in his treatment. This conversation cannot happen if the doctor has not given the patient an honest prognosis.
Close to 3,000 new cases of mesothelioma are diagnosed each year in the United States. Although there is no cure for mesothelioma, it can be treated with varying degrees of success through the use of surgical procedures, chemotherapy and radiation. The prognosis for mesothelioma patients is usually grim, with the average survival time varying from 4 – 18 months after diagnosis.
Sources :
- Health Affairs
http://content.healthaffairs.org/content/31/2/383.abstract - News @JAMA
http://newsatjama.jama.com/2012/02/08/survey-some-physicians-not-always-honest-or-frank-with-patients/
McGill Reviews Research After Questions Raised About Links to Asbestos Industry
The dean of Medicine at McGill University said in a statement Thursday that the prestigious Canadian research university will conduct a preliminary inquiry into accusations that a McGill researcher had allowed his research to be influenced by the asbestos industry. Canada remains one of the world’s leading producers of asbestos, a mineral fiber that causes serious respiratory diseases including lung cancer and mesothelioma, a cancer of the lining of the lungs and abdomen.
Dr. David Eidelman, vice principal of health affairs and dean of medicine at McGill, said a review was being undertaken to ensure that the research of Prof. J. Corbett McDonald, who is now retired, was conducted according to rigorous scientific standards. “The allegations in the media … are very serious and must be address,” Eidelman said in the statement.
A documentary last week on the CBC, Canada’s national public television and radio network, outlined how an institute established by the Quebec Asbestos Mining Association paid McGill Prof. Corbett McDonald and other researchers at least $1 million between 1966 and 1972 for research on the health effects of chrysotile asbestos. In the documentary, Professor David Eidelman of Brown University, claimed that some of the researchers altered the literature to minimize or misrepresent the health effects of chrysotile asbestos. The documentary suggested the research was still being cited by the asbestos industry and Canadian government to support Canada’s continued involvement in asbestos mining.
According to McGill University, Prof. Corbett McDonald and colleagues began in 1966 to investigate the mortality rates of approximately 11,000 Quebec miners and millers of chrysotile, a type of asbestos fiber. Asbestos exposure remains an occupational hazard for many workers. The researchers published their findings in articles in peer reviewed scientific journals from 1971 to 1998. The researchers acknowledged in the journal articles that the research was funded in part by the Institute of Occupational and Environmental Health of the Quebec Asbestos Mining Association.
In the research, McDonald demonstrated that asbestos is a carcinogen linked to lung cancer and mesothelioma. But the research also suggested that the health risks of chrysotile asbestos could be greatly minimized by reducing exposure and that chrysotile asbestos —the type of asbestos mined in Canada—was significantly safer than other types of asbestos.
Eidelman said it is true that Prof. McDonald drew different conclusions about the possible safe use of chrysotile asbestos than most scientists do today. “Holding scientific views that are different from those of the majority does not constitute research misconduct,” Eidelman said.
Eidelman said the outcome of the preliminary review conducted by a Canada Research Chair would determine whether there is a need for further investigation.
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