Chemo Angels

Last week I heard about Chemo Angels. Below is some information they provided me about their program. 

The Chemo Angels program offers support to those who find themselves battling a cancer diagnosis and undergoing IV chemo treatment. 

     The angel volunteers support their “buddy” throughout their journey with weekly cards, uplifting messages, supportive words and lots of positive energy. The encouragement the Angels provide helps give patients the comfort and confidence of knowing they are not alone in their fight. 

     The goal of Chemo Angels is to help fuel a positive attitude and aid in the road to recovery.  

    For more information and to submit an application, please visit the web site at www.chemoangels.com

    Some recent 'graduates' of the program have shared these comments:

• " Thank you for your wonderful program - it was a great support during difficult times " (from E.P.)
• " Thank you so much!! I truly appreciate you and the angels!!! I don't know what I would've done without you all.  " (from S.S.)
• 
  
• "I would like to thank your organization and the "chemo angels" who took their time to write to me.
• It was very much appreciated at a difficult time" (from D.R.)
• " Thank you so much! Please let my Angels know how much I was uplifted by their cards and gifts." (from P.L.)
• " Thank you so much for allowing me to be the recipient of your program. My two angels were wonderful. It certainly was uplifting on my journey thru chemo!" (from D.B.)
• " Thank you for everything.  It has been an amazing experience." (from N.L.)
• " Thank you so much for this program which is so uplifting." (from D.B.)
• " Please thank both of the ladies. It was helpful to have a friendly note & inspiring prayer from them." (from E.U.)

I know when I was in chemo I appreciated every card and gift that arrived in the mail. It made me feel I had many people on my side. So check out  www.chemoangels.com whether you are a patient who would love support. Or if you are someone who would like to be an angel for a patient. All cancers types are as long as you are getting IV Chemo. 

Dee 

Every Day is a Blessing!

ASCO Knowledge Part III: Value Concepts in the Management of OC

This education session at ASCO covered a number of important topics early detection, personalized medicine, treatment choices and treatment costs. 

Early Ovarian Cancer : Can we find it, Can we stop it, Cane we afford it?

Usha Menon

Dr Menon practices in London , England. She  explained that ovarian cancer screening is a process . She noted that:

• picking up low grade Ovarian Cancer (OC) is different that picking up high grade OC
• 50% of OC  cancer arises in the fallopian tubes
• OC takes an average of 4 years to develop, stage 1&2 disease size is < 1cm
• Focus should be on finding low volume disease 

Her suggestions for following low risk women include:

• CA-125 over time
• Autofluorescense high resolution imaging
• Ultrasound with microbubbles
• ctDNA (circulating tumor DNA)

For high risk women Dr Menon recommended CA-125 every 4 months. In the ROCA
(Risk of Ovarian Cancer Algorithm) study 53% of the women had a CA-125 < 35 yet had invasive ovarian cancer. 

Personalized Treatment in OC:Fancy Science or Expensive Hype

Douglas Levine

There is a broad applicability of personalized medicine.

We have developed treatments for BRCA mutations so we know what to do with those but we are not too sure what to do when we learn about these other mutations. 
Some points Dr Levine made include:

• Genomic scarring may occur. It is a mechanism of DNA repair which leaves a scar or signature . Those signatures can be used to classify tumors . 
• Chemoresistant tumors contain an extensive number of alterations – including BRCA1& BRCA 2
• There are other mutations (6% of the women have a pTen mutation) but we few to date are clinically actionable. In other words we know about mutations but there are no treatments currently available for that mutation.
• Tumor tissue will change and evolve over time so it is important to profile the tumor in the time it needs to be treated.
• ctDNA ( circulating tumor DNA) can be found in blood plasma. It may be able to be used to monitor for recurrence and response .

Crossroads in Treatment :Primary Treatment Choices , Consolidation, and Postplatinum Endgame

David Spriggs

Value is patient centric. It drives care during primary treatment. Treatment cost for patients is heavily loaded in 1^st year (hospital / treatment /diagnostic /drugs) . The actual amount the physician charges is a very low percentage of that total cost.Primary surgery done by a gynecologic  oncologist increases  5 year survival of women with OC. (gynecologic -oncologist 38% , non gynecologist 30% )

Dr Spriggs presented a few new terms that I was unfamiliar with so I want to share them with you. The quality-adjusted life-year (QALY) measures the value of health outcomes. QALY combines the value of the length of life and quality of life in one number. Researchers are evaluating the cost of drugs using the ICER(incremental cost-effectiveness ratio) . From the ASCO DAILY NEWS article “Cost of Cancer Drugs Should be a part of Treatment Decisions” The estimated ICER range for the US is between $50,000/QALY and $200,000/QALY. Dr Spriggs in his presentation mentioned that the ICER for Olaparib a newly FDA Approved Parp inhibitor was $193,000 .

 Dr Spriggs noted that IP ( interperitoneal ) treatment continues to show an survival advantage and that consolidation treatment for OC using paclitaxel is more cost effective than bevaciszumab (Avastin)( Lesnock) .

Tomorrow’s post will report on ASCO’s CancerLINQ  a health information technology platform.

Dee 

Every Day is a Blessing!

ASCO: Knowledge Part II, Managing OC in Older Women

This early Sunday morning education session presented information on how to manage ovarian cancer in the older women. Many women including myself do get diagnosed at an early age but the median age for diagnosis of ovarian cancer in women is 63 years of age.

Ovarian Cancer Surgery in the Older Woman : Keep It Short and Sweet

Dr Linda Duska

Chronologic age is not the same as physiologic age and age does not define the ability of a woman to undergo surgery or medical treatment. Retrospective studies have showed that women with ovarian cancer who have no gross residual disease after surgery have better outcomes. Older women overall have a worse prognosis stage for stage than younger women. The GOG182 study found that there was a lower chemo completion rate among older women and that toxicity was higher. It has also been found that for women of age 65 and older surgery complications increase and there is higher mortality. It was recommended that an assessment tool like ones for frailty be used before considering surgery in women over 65. It was found that frail women were more likely to be obese and to have post-op complications.

Ovarian Cancer in the Older Women : Less is More

Dr Kathleen Moore

Studies that focus on the older woman are limited. SEER Medicare data shows that the use of chemotherapy in women decreases as age increases. Women > age 70 have higher hematologic toxicity and stop treatment early. A study done in France showed that while in pre-treatment and during treatment the geriatric assessment showed that depression was a poor prognostic factor. A US study, GOG 273 (women age 70 +)  showed that dose modifications , timing changes and variations on chemo schedule may help the older woman complete chemotherapy.

The EWOC ( Elderly Women with OC) studies showed that chemo toxicity could be predicted by 3 factors – depression, dependence and performance status.  The MITO-5 and MITO -6 studies found that weekly carbo taxol was associated with lower toxicity and higher quality-of-life scores.

Clinical Trials in the Older Patient: Who,When and Why?

Dr William Tew

There are not many clinical trials for older patients.

Dr Tew stated that it is important to define who your patient is and what they want. He also recommended assessing functional age not chronologic age. The Cancer and Aging Research Group has developed and assessment tool that can be used before starting chemotherapy. The assessment tool looks at factors that can predict grade 3-5 toxicities in older patients. Some of the tool variables are age, impaired hearing, inability to walk a block, decreased social activity etc.

From this session I learned that:

• better outcomes occur when older women finish chemotherapy- even if that means the dosage/timing needs to  need modified.
• Depression and poor functional ability can impact treatment success
• Age itself does not predict whether or not a woman can undergo surgery or treatment .
• Assessment tools ( fraility / performance status) should be used before surgery

Tomorrow’s post will be on Value Concepts in the Management of Ovarian Cancer

Dee

Every Day is a Blessing!