This is why a computer algorithm cannot ever fully replace a doctor’s judgment
The past year had been a tremendously exciting time to be an oncologist, and to be a lung cancer oncologist in particular. It seems we hardly have time to get used to one newly approved agent before another one becomes available. In 2015, we have seen gefitinib (don’t I know you from somewhere?), afatinib, nivolumab (twice), pembrolizumab, necitumumab, and osimertinib all become approved or have approvals broadened to new populations of patients with lung cancer, which has to be a record for one disease in one year. It is possible we aren’t even done yet, with several additional drugs under FDA priority review.
While t...
Source: Kevin, M.D. - Medical Weblog - December 15, 2015 Category: Journals (General) Authors: Nathan A. Pennell, MD, PhD Tags: Physician Cancer Medications Source Type: blogs
The Three Types of Lung Cancer
Researchers have identified three types of lung cancer. The most prevalent is non-small cell lung cancer, followed by small cell cancer. Both types of cancers have similar risk factors that include smoking and inhalation of secondhand smoke. Interestingly, the third type – lung carcinoid tumor – is not tied to the use of tobacco products.
Non-Small Cell Lung Cancer
This type of lung cancer, which currently does not have a... (Source: Dorian Martin's SharePosts)
Source: Dorian Martin's SharePosts - December 9, 2015 Category: Consumer Health News Authors: Dorian Martin Source Type: blogs
A cancer patient who had bad luck with clinical trials
I am superstitious, and I freely admit it. I don’t use the word “cure” with patients until the 5-year scan has come and gone cleanly. I don’t celebrate the scans showing tumor response until I see them myself and make sure I am not mixing up the new scan with the old. And one of my most closely held superstitions is that the nicest patients seem to have the worst luck. We used to note morbidly in fellowship that sweet dispositions were a poor prognostic sign, as if our patients’ bad outcomes were punishments to us for coming to care about them. Nonsense of course, and yet absolutely true. Wait, what’s recall bi...
Source: Kevin, M.D. - Medical Weblog - October 30, 2015 Category: Journals (General) Authors: Nathan A. Pennell, MD, PhD Tags: Conditions Cancer Source Type: blogs
The doctor-patient relationship is even more complex than you think
I am often asked by friends and acquaintances how I am able to do what I do for a living, which is care for patients with advanced lung cancer. Depending on the setting and how well I know the person asking, I might say that the treatments are improving all the time (i.e., the casual dinner party response), that the research into lung cancer is very promising (i.e., talking to the family over the holidays) or that I want to help people who are suffering (wait, I think that was my med school admissions essay). While these are all true, the reality is that this can be a terribly emotionally taxing job and that the real reaso...
Source: Kevin, M.D. - Medical Weblog - September 2, 2015 Category: Journals (General) Authors: Nathan A. Pennell, MD, PhD Tags: Physician Cancer Source Type: blogs
Palliative Care Everywhere!
by Cory Ingram, MD This Wednesday I look forward to a conversation on how palliative care principles and practices are able to be embedded across health systems in to various disciplines and delivery forms. Palliative care principles when applied in various clinical situations improve the quality of care for patients and families and even their longevity and care affordability. For the first time in history our society is experiencing an unprecedented medical and social situation. It is unprecedented that people are living longer, requiring more complex care, and experiencing more burdens of illness and treatment and dying...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 14, 2015 Category: Palliative Carer Workers Tags: ingram palliative care social media The profession tweetchat twitter Source Type: blogs
CMS Proposes Coverage With Evidence Development For Lung Cancer Screening With Low Dose CT
On November 11, the Centers for Medicare and Medicaid Services (CMS) released its Proposed Decision Memo for Screening Lung Cancer with Low Dose Computed Tomography (LDCT), which is expected to be finalized in mid-December. Despite a negative assessment by its own advisory committee, CMS has proposed coverage with evidence development (CED) for an annual “lung cancer screening counseling and shared-decision-making visit” and, for appropriate beneficiaries, additional screening with LDCT.
Under CED, Medicare provides conditional coverage for a new treatment or technology while additional data is collected to confirm its...
Source: Health Affairs Blog - December 9, 2014 Category: Health Management Authors: Dora Hughes Tags: All Categories Chronic Care Medicaid Medicare Policy Research Science and Health Source Type: blogs
Top stories in health and medicine, September 30, 2014
From MedPage Today:
Data Confirm Anti-ALK Activity in Rare NSCLC. Objective responses occurred in 72% of patients with mutation-specific non-small cell lung cancer (NSCLC) treated with crizotinib (Xalkori).
Case Reports: PET Imaging in Dementia. In two cases of progressing dementia, PET imaging with amyloid and tau tracers helped to clarify the diagnosis by ruling out Alzheimer’s disease.
Screen for Pre-Diabetes, Experts Say. Four prominent diabetes experts have called on physicians to screen essentially everyone for pre- and early diabetes and to initiate treatment in those with these conditions.
A New Standard of...
Source: Kevin, M.D. - Medical Weblog - September 30, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Cancer Diabetes Endocrinology Neurology Source Type: blogs
Top stories in health and medicine, September 29, 2014
From MedPage Today:
Plans Wrestling With Narrow Networks, Accurate Doc Lists. Narrow provider lists are only one of several network adequacy issues that insurers and regulators are grappling with.
Ebola: ‘Magic Bullets’ or Current Tools? European health authorities want to compile an overview of all the available data on experimental medications for Ebola. The World Health Organization is planning to issue guidance on the potential therapeutic use of serum from Ebola survivors.
Data Confirm Anti-ALK Activity in Rare NSCLC. Objective responses occurred in 72% of patients with mutation-specific non-small cell l...
Source: Kevin, M.D. - Medical Weblog - September 29, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Cancer Infectious disease Source Type: blogs
AstraZeneca Partners with Roche on Development of a Companion Diagnostic
This article illustrates the dual use of companion diagnostics. First of all, the test can be used to determine whether a patient is a candidate for a particular drug therapy -- compound AZ9291 in this case. The fact that the drug does not yet have a proprietary name is evidence of the very early stage at which the companion diagnostic is being developed. Secondly, the diagnostic test can also be used to identify circulating tumor DNA in the plasma.
NSCLC, a confusing term, is the most common type of lung cancer. Unfortunately and as noted above, some 70% of NSCLC patients have advanced disease at the time of diagnosis tha...
Source: Lab Soft News - July 29, 2014 Category: Pathologists Authors: Bruce Friedman Tags: Clinical Lab Industry News Clinical Lab Testing Laboratory Industry Trends Medical Research Source Type: blogs
DALLAS BUYERS CLUB meets SCIENTIFIC INTEGRITY
DALLAS BUYERS CLUB is a biopic about an unlikely hero, directed by Québécois Jean-Marc Valle and written by Craig Borten and Melisa Wallack. In case you get a call from your local AIDS-Walk coordinator, remember 50,000 cases of AIDS (Acquired Immune Deficiency Syndrome) still occur in the USA annually. Transmission is largely preventable with education, testing and early intervention. Ethnic peoples of color are disproportionately affected in new cases. Thirty-five years ago, I never imagined AIDS would be the defining disease of my career and then some. After my AIDS-Walk call, I ...
Source: blog.bioethics.net - July 20, 2014 Category: Medical Ethics Authors: September Williams, MD Tags: Health Care syndicated Source Type: blogs
SNAI1 functional variant associated with decreased risk for lung cancer
This article adds another layer of complexity and I post it (rather belatedly) now because I find in it such an intriguing finding that a variant protein could have functional consequences that are observable as a clinical outcome with regard to COPD and NSCLC. Moreover, this variant was discovered to attenuate Snai1’s ability to specifically up-regulate mesenchymal biomarkers (i.e., fibronectin and vimentin) expression, and to promote EMT-like changes, including morphologic changes, cell migration, and invasion. (Source: The Daily Sign-Out)
Source: The Daily Sign-Out - June 26, 2014 Category: Pathologists Authors: Mark D. Pool, M.D. Tags: Cancer Biology Epithelial-to-Mesenchymal Transition Lung Cancer Non small cell lung cancer Source Type: blogs
Major Driver Mutations in Adenosquamous Lung Carcinomas
The June 2014 issue of Journal of Thoracic Oncology (abstract) features a thorough study of major known driver mutations (EGFR, KRAS, ERBB2, BRAF, PIK3CA, AKT1, RET, and ALK) in a series of 76 patients from Fudan University Shanghai Cancer Center with resected adenosquamous lung carcinoma (AdSqLC) by Wang et al. and compared this group with a group of 646 patients with resected adenocarcinoma (ADC) during the same study period. This is a nifty paper that will serve well as a useful contemporary reference when you next encounter a patient with adenosquamous lung carcinoma.
From their "Table 1" data, it is o...
Source: The Daily Sign-Out - June 23, 2014 Category: Pathologists Authors: Mark D. Pool, M.D. Tags: Lung Cancer Non small cell lung cancer Source Type: blogs
Extratumoral lymphatic permeation as prognostic marker in NSCLC
Matsumura and colleagues from the National Cancer Center Hospital East in Chiba, Japan recently reported in the Journal of Thoracic Oncology (abstract) their study of the location of lymphatic permeation in relation to the tumor and the effect on outcome.
Since 2001, this group has been classifying lymphatic permeation in patients with resected NSCLC into 3 catagories: no lymphatic permeation (ly0), intratumoral permeation (ly1), and extratumoral permeation (ly2). This is a follow-up to a previous study reported in 2007 that found that NSCLC patients with ly2 developed more recurrence than patients with ly1--b...
Source: The Daily Sign-Out - June 20, 2014 Category: Pathologists Authors: Mark D. Pool, M.D. Source Type: blogs
Hospital bills should not outlive our loved ones
In 2010, I lost my mother to cancer. She was a fighter and had survived well past her prognosis, but her hospital costs outlived her.
Let me go back to late 2004. That was the year the doctors suspected she had cancer. My mother, who was not a smoker, was officially diagnosed with non-small cell lung cancer early on in 2005. When the biopsy confirmed that the small lesion in the lower lobe of her right lung was indeed cancer, the surgeons performed a lobectomy. We, of course, realized that this would come at a cost, but we had decent insurance coverage at the time. We certainly were not anticipating the cost to rival a...
Source: Kevin, M.D. - Medical Weblog - June 18, 2014 Category: Journals (General) Authors: Nadi Nina Kaonga Tags: Conditions Cancer Hospital Source Type: blogs
Top stories in health and medicine, March 10, 2014
From MedPage Today:
Preop PET Cuts Lung Cancer Surgery. Routine preoperative PET imaging led to a significant reduction in unnecessary surgery for non-small cell lung cancer (NSCLC).
A Cure for Chlamydia Arthritis? Increased understanding of the biology and survival tactics of Chlamydia trachomatis is suggesting that the post-infectious chronic arthritis experienced by many patients may actually be curable.
Efavirenz Tops Lopinavir in Pregnancy. A new study bolstered World Health Organization recommendations to treat HIV-infected pregnant women with an efavirenz (Sustiva)-based therapy.
High-Tech TB Test Fails to Cut Mor...
Source: Kevin, M.D. - Medical Weblog - March 10, 2014 Category: Family Physicians Tags: News Cancer Infectious disease Pulmonology Radiology Source Type: blogs
