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Let’s attack Cancer metaphors


Oxford Dictionary

People fight cancer – get over it

In the past 12 months, I’ve read about 6 similarly slanted blogs on the subject of cancer metaphors and in particular their use in describing cancer experiences with the words ‘fight’, ‘battle’ and other ‘military’ sounding terms.  The authors say that perhaps this is not the best language to use.  I just read another yesterday where the author used the term ‘violence’ to describe these type of metaphors.  What utter nonsense and recklessness.

Let me put my cards right on the table as I would hate to twist the meaning of words or the inference of any metaphors I might use.  I don’t like Cancer – it attacked me, it attacked my family, it attacked others I know, it has killed people I know……. it has killed millions of people and changed many lives. I’m ‘fighting’ Cancer.  I’m in a ‘battle’ with Cancer.

Clearly I need help in my fight with Cancer.  Fortunately, I have access to ‘reinforcements’ and ‘allies’; and their ‘weapons’.  There are many options including surgical strikes with invasive and minimally invasive forays. The use of WMTD (weapons of mass tumour destruction) is authorised if applicable. Using these ‘weapons’ and deploying them both strategically and tactically, I can put up the best fight possible and by adjusting the disposition of my ‘forces’ when required, I can delay the advance of the enemy, protect my flanks and force it to change its course or retreat. The use of WMTD (weapons of mass tumour destruction) is authorised if applicable, i.e. I have a chemical and nuclear option.

Not happy with infiltrating your body, Cancer also wants to take advantage of your fragile state by playing with your mind. It does this by creating the illusion of an uncertain future, makes you worry about your family and makes your family and friends worry about you. I’m therefore also deploying psychological warfare to counter this threat.  Can’t have Cancer thinking it’s winning!

If it finally gets me, I know I’ll have tried my best and I will go down fighting hoping to be mentioned in despatches.  I know that others will carry on the ‘fight’ in my absence until Cancer is defeated (and it will be defeated).

One of the arguments used by these ‘trendy’ bloggers against the use of what they perceive to be ‘military’ or ‘violence’ metaphors, is that people die of Cancer and therefore they are seen to have ‘lost’ their battle or fight.  It’s always sad when anyone dies of any illness, particularly at a young age before their time.  However, I believe people naturally ‘fight’ in their own way and there are even parts of the human anatomy whose job it is to fight illness and infection without us even realising they are doing it.  In fact, to ‘fight’ has many contexts and not just the contrived ones used in the blogs to which I refer.  If you check the Oxford/Cambridge dictionaries (the Supreme Headquarters of the English language), you will see that ‘fight’ has numerous meanings including “to struggle to overcome, eliminate or prevent” or “to strive to achieve or do something”.  What that means is that some people will use the word fight to describe the ability to get out of bed in the morning, to walk to the local shops, to go to a restaurant for a meal.  I fight cancer by writing a blog.  The context is really important.

As for me, I have no intention of ceasing the use of words such as ‘fight’ and ‘battle’ in my war of words with Cancer.  In fact, this has stirred me into increasing the tempo of that particular campaign.

Read this post to know why – WHY I FIGHT

Ronny

Disclaimer
My Diagnosis and Treatment History

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Let’s stop dehumanising NET patients


hoofbeats

The build up to NET Cancer Day has begun and I can hear hoofbeats becoming louder every day.  Is it a horse, is it a zebra etc etc.  However, is this aged equine medical adage still applicable as an awareness tool for Neuroendocrine Cancer or should we be looking for something which is more impactful, up to date, more compelling and more likely to attract new audiences?

For those unaware, the term ‘Zebra’ is an American medical slang for arriving at an exotic medical diagnosis when a more commonplace explanation is more likely – thus the term “When you hear hoofbeats, think of horses, not zebras”.

The use of an adjusted version of this phrase might be a great ‘rallying cry’ within the NET Cancer community but in my opinion we need a human face and voice fighting our corner and more of a partnership with the Medical community and potential advocates, and more importantly, if we want to be taken seriously. I also believe the use of the zebra analogy is fundamentally flawed.  Contextually, the zebra represents a term for a diagnosis (i.e. a disease) but the patients are not their diagnosis, they are not their disease – they are humans.  So when someone says “I am a zebra”, they are in effect saying “I am a disease”. I think most NET advocate organisations tend to agree with this view as they mostly do not have zebra icons in their own branding (i.e. they get it, even though they might not admit it).

Moreover, the term is heavily associated with diagnostics (i.e. it has a very narrow scope). It does not sit nicely with the increasingly important long term maintenance of patients – crucial when you consider this is mostly a slow growing and therefore highly prevalent disease.  Incidentally, the term ‘Zebra’ is not exclusively used by the Neuroendocrine Cancer community, it can be, and is used by, other cancers which quite often leads to confusion.

In my opinion, we really need to stop dehumanising patients. 

I’ve made no secret of the fact that I believe we need a paradigm shift in the way we (the Neuroendocrine Cancer community) spread external awareness of this less common type of cancer. I think everyone agrees we need a lot more public awareness of Neueoendocrine Cancer and also that we need some high-profile ‘ambassadors’ (preferably themselves patients) in order to help promote our cause.  Yes, money is useful too but in a ‘chicken and egg’ sense, we need a compelling case to attract the funds.  We need new audiences outside the ‘bubble’ I think we appear to be trapped inside.

Here’s my beef.  If you speak to any primary care doctor, you’ll find they are very well aware of the conundrum when faced with a patient who presents with vague and odd symptoms and negative tests. Almost all will say they don’t need reminding that it might be an oddity.  They will definitely accept that some conditions are more difficult to diagnose than others and if you think that there are over 200 different types of cancer and literally thousands of conditions out there, you can see they have a really difficult job. Let’s be realistic, very few people are going to be diagnosed with Neuroendocrine Cancer at their very first visit to a doctor.  The same could be said for the majority of cancers and many other illnesses. Why, therefore, do we keep harking on about this fact? NET Cancer is much more likely to be diagnosed at secondary care and we should be equally or even more focussed at that level.

You might also take a view that if doctors focussed on the ‘zebras’, it’s likely  common diseases could be missed or delayed and more people will suffer as a result. It’s also likely to turn out to be a very expensive way to do business.  Common things are common! I’m not saying those who are destined to be diagnosed with an ‘oddity’ should be ignored for the ‘greater good’, I’m saying that hoofbeats are in actual fact normally the sound of horses in both equine and medical terms – thus why the saying was invented in the first place.  What I’m also saying is that perhaps we should stop ‘beating up’ and potentially insulting medical staff using the zebra analogy in our (flawed) PR.  I’m afraid cartoon zebras (diagnoses) looking sanctimoniously down on doctors is perhaps not the way to win friends and influence people.

I also know that many people (including patients) are both confused and incredulous at the NET communities use of this out of date and single issue awareness message.  For example, we need our awareness to cover the whole spectrum of being diagnosed and then living with Neuroendocrine Cancer.

I’m fairly certain my sequence of events (not the symptoms) is generally common. I presented with weight loss and low haemoglobin blood count – this (correctly) pointed to iron deficiency anaemia.  However, I was fortunate to be referred to a Gastroenterologist who was immediately suspicious that I looked so well (sound familiar?) and he therefore decided to go straight for a CT scan – bingo!  At no time up to this point did the Gastroenterologist suspect I had NET Cancer – he was simply following his instincts (I actually think he suspected Bowel Cancer).  Despite what you read on forums and in patient surveys (fact – a very small snapshot of the NET patient population), many NET Cancer patients will show some activity on a CT scan and in most cases this will lead to further localisation checks and tests including biopsies where possible. I’m sure that earlier access to diagnostic testing (scanning in particular) will lead to earlier diagnosis. That’s a resource/process issue rather than just a training one.  To suggest that NET Cancer always presents with years of vague symptoms and requires several visits to a physician before diagnosis is confirmed is simply not true.  And to suggest that an international patient survey of 5000 accurately represents the experience of hundreds of thousands of NET patients out there is way off beam, particularly when the source of the patient cohort is taken from those affected most.

Finally, I think the patient has a big part to play in diagnosis.  Thanks to the internet and the stellar rise of social media, many patients are now much more savvy and are presenting to doctors and specialists with lists of their symptoms and a diary.  Some will even have already compiled a list of questions to ask and have their own suggestions about what might be wrong with them.  Others may take an advocate with them.  Add in better diagnostic testing and greater access to it (including via primary care), then I think there are positive times ahead for the earlier diagnosis of Neuroendocrine Cancer.  You might say it’s a bit of a dark horse.

By the way, it isn’t as rare as we keep being told.

Ronny

Disclaimer

My Diagnosis and Treatment History

Please ‘Like’ my NET Cancer Blog Facebook page  (click here please)

PRRT and the NHS England Cancer Drugs Fund


cost cutting vs life cutting?

cost cutting vs life cutting?

As of 4 Nov 15, PRRT was delisted from the NHS England Cancer Drugs Fund. Appeals were made but were rejected, despite the glowing results from the NETTER-1 trial.  Although a replacement system is now in place, PRRT remains barred from routine NHS use.

I was extremely disappointed to learn of the decision to remove PRRT (Lutetium or Yttrium) from the Cancer Drugs Fund (CDF) as reported by the NET Patient Foundation. You can read the detail of the decision here: CDF Statement.  PRRT has regularly been described by NET specialists and patients as the “magic bullet” due to its potential to shrink or kill tumours.

This is the second Neuroendocrine Cancer treatment to be withdrawn this year, after the earlier decision on Everolimus (Afinitor) in April . In fact, the recent cuts to the CDF were described in the media as a “massacre” as the list was reduced by two-thirds.  You can see the current CDF list by clicking here.

The timing of these cuts is extraordinary and when you look at the output from recent trial reports presented at the Europetwo-thirdsCongress (ECC) for both Neuroendocrine Cancer related drugs recently cut:

Everolimus

The RADIANT-4 trial said that Everolimus had a significant effect in non-functional NETs which are very difficult to treat.  This is particularly important for Lung NETs as no treatment currently exists.  The RADIANT-2 trial had already proven the efficacy of the drug for advanced carcinoid (in conjunction with Octreotide) and the RADIANT-3 trial proved good data for treatment with advanced functional pNETs.  Read the report here.

PRRT – 177Lu-DOTATATE

The ECC also reported a significant finding from the NETTER-1 trial.  Treatment with the novel peptide receptor radionuclide therapy (PRRT) Lutathera significantly increased progression-free survival (PFS) over Octreotide LAR (Sandostatin) in patients with advanced midgut NETs.  It shows a PFS that has never been shown before in this type of cancer adding that this was significant because these patients have a real unmet medical need.

Lutathera is a 177Lu-DOTATATE PRRT that targets somatostatin receptors, which are overexpressed in about 80% of NETs, to deliver cytotoxic radiation directly to the tumor – See more by clicking here.

To fully understand the background to the problem, you need to understand both PRRT and the Cancer Drugs Fund and a quick primer on both follows.

What is PRRT?

For those who are not entirely sure what PRRT is, here’s a quick primer from The Society of Nuclear Medicine and Molecular Imaging:

Peptide receptor radionuclide therapy (PRRT) is a molecular therapy (also called radioisotope therapy) used to treat a specific type of cancer called neuroendocrine carcinoma or NETs (neuroendocrine tumors). PRRT is also currently being investigated as a treatment for prostate and pancreatic tumors.

In PRRT, a cell-targeting protein (or peptide) called octreotide is combined with a small amount of radioactive material, or radionuclide, creating a special type of radiopharmaceutical called a radiopeptide. When injected into the patient’s bloodstream, this radiopeptide travels to and binds to neuroendocrine tumor cells, delivering a high dose of radiation to the cancer.

The cells in most neuroendocrine tumors have an abundance (called an overexpression) of a specific type of surface receptor—a protein that extends from the cell’s surface—that binds to a hormone in the body called somatostatin. Octreotide is a laboratory-made version of this hormone that binds to somatostatin receptors on neuroendocrine tumors. In PRRT, octreotide is combined with a therapeutic dose of the radionuclides. Yttrium 90 (Y-90) and Lutetium 177 (Lu-177) are the most commonly used radionuclides.  

What conditions are treated with PRRT?

PRRT may be used to treat NETs, including carcinoids, islet cell carcinoma of the pancreas, small cell carcinoma of the lung, pheochromocytoma (a rare tumor that forms in the adrenal glands), gastro-enteropancreatic (stomach, intestines and pancreas) neuroendocrine tumors, and rare thyroid cancers that are unresponsive to treatment with radioiodine.

PRRT is an option for patients:
• who have advanced and/or progressive neuroendocrine tumours
• who are not candidates for surgery
• whose symptoms do not respond to other medical therapies.

The main goals of PRRT are to provide symptom relief, to stop or slow tumor progression and to improve overall survival.

These video’s on Nuclear Medicine are by Professor Val Lewington – the UK’s most experienced person on PRRT.  I was at this presentation and she is absolutely amazing. It’s slightly dated but still very current.  This presentation also covers Octreotide and Gallium 68 scans under the heading of Nuclear Medicine – if you are still unsure about PRRT or Nuclear Medicine in general, these videos are definitely worth a watch.

The Role of Nuclear Medicine in NETs

Q&A Sessions

This is also a great source of information maintained by NET Patients in the USA.  Click here

What was the Cancer Drugs Fund?

The Cancer Drugs Fund was money the UK Government has set aside to pay for cancer drugs that haven’t been approved by the National Institute for Health and Care Excellence (NICE) and aren’t available within the NHS in England. This may be because the drugs haven’t been looked at yet. Or it may be because NICE have said that they don’t work well enough or are not cost-effective. This was introduced as a ‘political statement’ by the then Conservative/Liberal Democrat coalition government in 2010/11.  The aim of the fund is to make it easier for people to get as much treatment as possible.

The Cancer Drugs Fund was for people who live in England. The governments of Scotland, Wales and Northern Ireland decide on how they spend money on health and so far haven’t decided to have a similar programme.

Worth noting that on 1 April 2013, NHS England took on responsibility for the operational management of the Cancer Drugs Fund (CDF). The NHS spends approximately £1.3 billion annually on the provision of cancer drugs within routine commissioning. The CDF was established as an additional funding source to this.

There was a national list of drugs available through the fund – you may have heard this called the priority list. If you met the conditions for a drug that was on the list, you should have been able to have it on the NHS if you live in England. The Fund would also have considered applications on behalf of individual patients for other drugs that are not on the list.  However, under the new system, Individual funding requests (IFRs) relating to cancer drugs will no longer be considered via the CDF process.  All IFRs relating to cancer drugs will now be considered using NHS England’s single, national IFR system, which was updated in January 2016.

The new system came info force on 29 July 2016 and you can read more if you click this link

Summary

Although the decision is shocking to most, it was not totally unexpected as the Government and NHS have been hinting for sometime that the costs of the fund need to be reined in.  In any case if was only ever a temporary arrangement until a another model could be put into place.  There is a political element as the fund was set up by David Cameron with healthcare experts suggesting that it made no sense as a response to rising drug prices.  Moreover, by topping up the fund, the same experts claimed this was making the manufacturers the real beneficiaries of the fund as they have been able to sell their drugs to the NHS at prices that are unaffordable (and therefore unsustainable) for the NHS.

UK NET patients who have advanced and/or progressive neuroendocrine tumours which cannot be removed by surgery and whose symptoms do not respond to other medical therapies, still need help.

Ironically, the UK seems to be intent on cutting provision of the treatment (at least for NHS patients) as the US is trying very hard to formally introduce it.  This is a disgraceful situation and advanced Neuroendocrine Cancer patients and those who may need this treatment in the future are being terribly let down.

I will keep this blog ‘live’ in order to add information as things progress.

Thanks for reading

Ronny
Disclaimer
My Diagnosis and Treatment History

Screw that diagnosis and get on with it!


 

Screw that diagnosis

Screw that diagnosis and get on with it!

Every now and then I see a positive story during my travels around the internet.  When I saw this one from K**** in Pennsylvania, I had to share.  If you’re feeling a little bit down and need cheering up, dig out this blog and take a read 🙂

K**** wrote:

“I began my Carcinoid journey about 7 years ago, newly married to a wonderful man and his daughter at the age of 43.  I was also newly retired (from CPA and also Large Animal/Equine Surgical Veterinary Assistant) and was looking forward to a nice, peaceful, fun, loooong life.

But, things get in the way and can get bumpy – cancer, being one of them (and a now, 16yo hormonal female teenager).  I took my diagnosis, thought about it for awhile, hung out on the sofa…ate a few bonbons and then, pulled my head out of my a**.  I went back to work as a Patient Care Assistant at our local hospital (feeling the need to go “medical career” again), trying to figure out what to do next – needing to get my outrageous health insurance premium off my husband’s back.  I was pissed, I had to go back to work, I had CANCER, for God’s sake – I should be looking into disability or anything that will bear this burden – but, I was well enough to bear it myself.

Continued to pull my head out of my a** and decided to pursue a career as a Registered Nurse, knowing that I, at the ripe age of (now) 53, still had a whole boatload of stuff to offer.  So, 4 years ago, I strapped my pump (yes, I’m a “pumper”) and my ‘kahoonas’ on and I went back to school full-time, working part-time, raised my hormonal daughter, rode my (new) gloriously wonderful old Off the Track, Thoroughbred “Gryphon”, got my Harleys back out and got my game on.

Yesterday, I sat for the Pennsylvania State Nursing Board test and today….I found out that I PASSED!  I am now officially, K**** ******** RN

If you’ve got the health (screw that diagnosis) and you’ve got the need to make a change – MAKE IT and make it count!  As of 15 minutes ago…I applied for an Oncology Nurse position 🙂 “

Go K**** !

Thanks for reading

Ronny
Disclaimer
My Diagnosis and Treatment History

 

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