Individualized Treatment

gdpawel

Neil Love, M.D. reports in a survey of breast cancer oncologists based in academic medical centers and community based, private practice oncologists. The academic center-based oncologists do not derive personal profit from the administration of infusion chemotherapy, the community-based oncologists do derive personal profit from infusion chemotherapy, while deriving no profit from prescribing oral-dosed chemotherapy.

The results of the survey show that for first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists prescribed an oral dose drug (capecitabine), while only 13% perscribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug docetaxel.

In contrast, among the community-based oncologists, only 18% prescribed the oral dose drug (capecitabine), while 75% prescribed infusion drugs, and 29% prescribed the expensive, highly remunerative drug docetaxel. The existence of this profit motive in drug selection has been one of the major factors working against the individualization of cancer chemotherapy based on testing the cancer biology.

This is not to imply that the academic center-based oncologists are without their fair share of collective guilt. They were misguided in not recognizing that they were trying to mate notoriously heterogeneous diseases into one-size-fits-all treatments. They devoted 100% of their clinical trials resources into trying to identify the best treatment for the average patient, in the face of evidence that this approach was non-productive. However, such unsuccessful experiments will never be viewed as such by the thousands of people whose careers are supported by these experiments.

Henderson, et al, entered 3,100 breast cancer patients in a prospective, randomized study to compare cyclophosphamide/doxorubicin alone versus cyclophosphamide/doxorubicin plus Taxol (in the adjuvant, pre-metastatic setting). The results were microscopically positive, at best, and cannot begin to justify the enormous financial and human resources expended (while making no effort at all to test and improve methods to individualize treatment).

But these results changed the face of the adjuvant chemotherapy of breast cancer. Cyclophosphamide+Doxorubicin+Taxol became standard of care. Taxol recently went off patent. Now the thrust is to identify on-patent therapy which is microscopically better in clinical trials of one-size-fits-all treatment. Already, the community-based oncologists are migrating to Cyclophosphamide+Doxorubicin+Docetaxel (expensive/remunerative) so what was the purpose of doing that 3,100 patient prospective, randomized Henderson study?

http://patternsofcare.com/2005/1/editor.htm

inkblot

Hey there:

Read your info carefully. Nothing new under the sun. Cancer treatment is one huge financial "web", as we all know and most of us accept. We accept because we cannot change that status quo.

While we may often wonder how many medical recommendations are profit based, as opposed to "patient based", it's still our own decisions which matter most. While what's best for the patient may not necessarily be best for the profit margins of the prescriber, it's not a situation which should intimidate us too much. Money rules as it always has. Still we have options if we choose to exercise them. Most of us accept this on one level or another and in our struggle to combat at least some of the effects of falling victim to that possibility in our particular case, the best we can do is to utilize all the resources available to us, become as well informed as possible and be a strong and active participant in our treatment and the decision making process. Accept responsibility for our choices and carry on. What else is there really?

Since a tremendous amount of funds are allocated to research "studies" which later, in retrospect, may seem a waste of time and resources, no one really knows at the time what any one study may reveal. Research funds are often the only thing which keeps some organizations afloat, thus they pursue the available funding with a highly competetive vengence. Often researching things which have already been researched, seemingly to the max. Why? Because that's the way the system operates. There is sometimes little accountability and no one questions as long as the money flows in and the research continues.
Practically any research involving the word cancer, will almost always be considered legit.

While we all want a cure for cancer, in the meantime, we also want better, more effective and
successful drugs for treatment. It's kind of difficult to get caught up in wondering how viable a particular research project (obscure or notorious) may be, while we're facing cancer treatment.

On the other hand we have serious, ground breaking research going on around the world which has the potential to change the face of cancer treatment completely, in the future. So, for the sake of preserving that noble research, we tolerate the piddly, seemingly nonsensical research without too much questioning. You've probably heard of some of the strange research involving things such as snake venom, etc.?

Just my personal thoughts about it. Educating ourselves is always worth the time and effort, as by doing so, we arm ourselves with knowledge which can be invaluable in helping us to make
our best treatment decisions, based upon what's available to us "now". Not worrying too much about what's in the pipeline. That's my real interpretation of "INDIVIDUALIZED" treatment. It's what WE want, what WE choose and what WE'RE willing to accept responsibility for, after educating ourselves to what's available to us, getting differing opinions and researching reliable info. concerning our options. Talking with other's who've been there and then deciding what's best for us. Side effects and all, we know that we made our best choices and can move forward with peace of mind about our decisions. If something surfaces later, which wasn't available or that we didn't find at the time, then, we still did our best for ourselves and that's valuable. Always. Drug patents expiring is not something, I'd venture to guess, that many of us want on our list of things to consider.

Nothing about cancer is certain, aside from the fact that we have a diagnosis in hand. No guarantees, no refunds, no rainchecks. And while that may serve to greater fuel the money wheel, it's all that's out there, if we choose a strictly medical approach to treatment.

While we sometimes live and die by our choices, I think as patients, we have far more at stake than our doctor's, researcher's, fundraiser's or anyone else in the chain and owe it to ourselves to actively participate in our care and treatment choices.

Love, light and laughter,
Ink

hummingbyrd

inkblot said:

Hey there:

Read your info carefully. Nothing new under the sun. Cancer treatment is one huge financial "web", as we all know and most of us accept. We accept because we cannot change that status quo.

While we may often wonder how many medical recommendations are profit based, as opposed to "patient based", it's still our own decisions which matter most. While what's best for the patient may not necessarily be best for the profit margins of the prescriber, it's not a situation which should intimidate us too much. Money rules as it always has. Still we have options if we choose to exercise them. Most of us accept this on one level or another and in our struggle to combat at least some of the effects of falling victim to that possibility in our particular case, the best we can do is to utilize all the resources available to us, become as well informed as possible and be a strong and active participant in our treatment and the decision making process. Accept responsibility for our choices and carry on. What else is there really?

Since a tremendous amount of funds are allocated to research "studies" which later, in retrospect, may seem a waste of time and resources, no one really knows at the time what any one study may reveal. Research funds are often the only thing which keeps some organizations afloat, thus they pursue the available funding with a highly competetive vengence. Often researching things which have already been researched, seemingly to the max. Why? Because that's the way the system operates. There is sometimes little accountability and no one questions as long as the money flows in and the research continues.
Practically any research involving the word cancer, will almost always be considered legit.

While we all want a cure for cancer, in the meantime, we also want better, more effective and
successful drugs for treatment. It's kind of difficult to get caught up in wondering how viable a particular research project (obscure or notorious) may be, while we're facing cancer treatment.

On the other hand we have serious, ground breaking research going on around the world which has the potential to change the face of cancer treatment completely, in the future. So, for the sake of preserving that noble research, we tolerate the piddly, seemingly nonsensical research without too much questioning. You've probably heard of some of the strange research involving things such as snake venom, etc.?

Just my personal thoughts about it. Educating ourselves is always worth the time and effort, as by doing so, we arm ourselves with knowledge which can be invaluable in helping us to make
our best treatment decisions, based upon what's available to us "now". Not worrying too much about what's in the pipeline. That's my real interpretation of "INDIVIDUALIZED" treatment. It's what WE want, what WE choose and what WE'RE willing to accept responsibility for, after educating ourselves to what's available to us, getting differing opinions and researching reliable info. concerning our options. Talking with other's who've been there and then deciding what's best for us. Side effects and all, we know that we made our best choices and can move forward with peace of mind about our decisions. If something surfaces later, which wasn't available or that we didn't find at the time, then, we still did our best for ourselves and that's valuable. Always. Drug patents expiring is not something, I'd venture to guess, that many of us want on our list of things to consider.

Nothing about cancer is certain, aside from the fact that we have a diagnosis in hand. No guarantees, no refunds, no rainchecks. And while that may serve to greater fuel the money wheel, it's all that's out there, if we choose a strictly medical approach to treatment.

While we sometimes live and die by our choices, I think as patients, we have far more at stake than our doctor's, researcher's, fundraiser's or anyone else in the chain and owe it to ourselves to actively participate in our care and treatment choices.

Love, light and laughter,
Ink

Bravo Ink and Greg!
Bottom line is both of you are advocates for the patient, just with different approaches.
I'll say this much for the ACS, they are quite diligent with the monies they spend on research. They spend an estimated 100 million a year, and while I do have issues with some things they ignore, like alternative complementary medicine, I understand with the amount they are alotted there is just so much that they can do. After visiting ACS National Headquarters in Atlanta, GA and going through the Peer Review Training Course I have to honestly say we are at least 10-15 years ahead of where we would be if the ACS was not into research.
Don't get me wrong now. Cancer IS big business and probably 5 of those advanced years can be accredited to the advent of the internet and the "information" age. Nontheless, whatever the reason, my main goal is to see us continue in a forward motion with more "patient friendly" drugs. I don't even expect a cure at this point. I am perfectly satisfied with making cancer a "chronic" condition. Research continues, cancer institutes serve patients, pharmaceutical companies have a valuable market resource and the patient doesn't have to die. Everybody wins!
Surviving cancer is hard work. Treatment must be individualized. What they don't tell you is that as the patient it is your responsibility to figure out your own individual treatment, in most cases. Few institutions incorporate all facets of treatment such as conventional medication, surgery, diet, vitamins, herbs, spirituality, relaxation, exercise, etc. There is so much to learn and Ink you are so right, no one cares as much about the outcome of treatment as the patient.
As for IV meds vs. oral I'm a bit biased there as my meds were given in the hospital. When I did try xeloda I called my doc and told him he didn't have to worry about me dying from cancer as I was going to have a heart attack when the pharmacist said it's $1,400 for a 10 day supply. Then I had a horrendous reaction called foot and hand syndrome. Blisters on my feet so bad I couldn't walk, so no there is no love loss there for me. Now what I do not understand is why we aren't getting these CSRA's - Chemotherapy Sensitivity and Resistant Assays. From my understanding they take a tumor sample, test it with different chemo agents and see what kills the tumor. Sounds reasonable enough to me, but the ASCO (oncologists) and BCBS (insurance company) is fighting the use of it. Why? I do not know!
At any rate, thank God for the ACS and Herceptin, and for them opening up their research process to the people it matters to the most.
Little ol' patients like me!
hummingbyrd