The following article describes in detail the benefits of exercise.
http://www.onclive.com/#
Read and deploy.
Saturday, May 25, 2013
Monday, May 20, 2013
International Clinical Trial Day-May 20
Ask questions. know your rights, know your responsibilities but participate to improve health care, improve science.
Thursday, May 16, 2013
Breast Cancer Risk-BRCA and Angelina Jolie
Thanks to Angelina Jolie, the awareness about Breast Cancer has hit the roof. Any kind of publicity is good! Those interested in reading her op-ed and comments can click here, here, here.
You can read some interesting views and points worth considering here and here.
If you are a person with BRCA 1 or 2 mutation what should you do?
What are the questions you should be asking?
Here the list goes.....
1. What is the sensitivity and specificity of BRCA testing? To put it more crudely how many times does the testing give a positive report when the person does not have BRCA and how many times does it miss the positive ones!
Will not complicate it with introduction of positive predictive value.
2. What do you mean by 60-80% risk of developing breast cancer when i am BRCA positive?
Normal woman have 2-10% risk. That is out of 100 woman 2 to 10 women can develop cancer. But at what age?
Ok. In BRCA positive ladies, the chance of developing cancer is more. That is out of 100 ladies with BRCA positivity 56 to 84 of them will develop breast cancer. They are also at increased risk for ovarian cancer.
3.Important question to ask, at what age does my risk peak? If at all i have to get mastectomy done, what is the optimum age?
In one study the mean age of people who underwent surgery and showed to have benefit had median age of 40 years.
4. What other modalities are there? Tamoxifen, oophorectomy? that is removal of ovary. How good are these options?
5. What are the risks of various treatments?
When you visit your doctor or genetic counselor, please ask these and any other question which you want to.
You can read some interesting views and points worth considering here and here.
If you are a person with BRCA 1 or 2 mutation what should you do?
What are the questions you should be asking?
Here the list goes.....
1. What is the sensitivity and specificity of BRCA testing? To put it more crudely how many times does the testing give a positive report when the person does not have BRCA and how many times does it miss the positive ones!
Will not complicate it with introduction of positive predictive value.
2. What do you mean by 60-80% risk of developing breast cancer when i am BRCA positive?
Normal woman have 2-10% risk. That is out of 100 woman 2 to 10 women can develop cancer. But at what age?
Ok. In BRCA positive ladies, the chance of developing cancer is more. That is out of 100 ladies with BRCA positivity 56 to 84 of them will develop breast cancer. They are also at increased risk for ovarian cancer.
3.Important question to ask, at what age does my risk peak? If at all i have to get mastectomy done, what is the optimum age?
In one study the mean age of people who underwent surgery and showed to have benefit had median age of 40 years.
4. What other modalities are there? Tamoxifen, oophorectomy? that is removal of ovary. How good are these options?
5. What are the risks of various treatments?
When you visit your doctor or genetic counselor, please ask these and any other question which you want to.
Monday, May 13, 2013
Tuesday, May 07, 2013
Beta Blocker-Old Drug, New Uses-Ask Your Oncologist
Recent retrospective study published in Annals Of Oncology made me sit up and notice beta blockers closely.
Beta blockers are predominantly used as anti-hypertensive and anti-arrhythmic drug. They are also used to control tremors in Parkinson's disease. But here i am talking about its role in improving survival of lung cancer and breast cancer patients.
The article in Annals of Oncology from M D Anderson Cancer Center estimates a 22% improvement in median overall survival for those who took beta blockers.This was in a cohort of patients who had received definitive radiotherapy. The molecular mechanism being hypothesized for the benefit from beta blocker should improve survival for all kinds of lung cancer patients. There is a need to do a prospective study but practitioners and patients should explore the use of beta blockers considering the data available for its safety.
Improvement in overall survival is not a small thing when most new costly agents struggle to show meaningful difference in progression free survival!
Reach out today to your doctor and if you are a doctor read more and start thinking!!
The benefit of beta blocker is also there for patients having breast cancer and melanoma.
References:
1. http://www.medscape.com/viewarticle/777342
2. http://annonc.oxfordjournals.org/content/early/2013/01/01/annonc.mds616.full
3. http://jco.ascopubs.org/content/29/19/2635.abstract?ijkey=dc966043b03d255244605330d386a363baad8d7a&keytype2=tf_ipsecsha
4. http://www.nature.com/nrclinonc/journal/v8/n9/full/nrclinonc.2011.123.html
Conflict of Interest None.
There may be publication bias but asking questions and searching available data can help us in using old weapons against new targets. Academic institutes can do this kind of study.
Beta blockers are predominantly used as anti-hypertensive and anti-arrhythmic drug. They are also used to control tremors in Parkinson's disease. But here i am talking about its role in improving survival of lung cancer and breast cancer patients.
The article in Annals of Oncology from M D Anderson Cancer Center estimates a 22% improvement in median overall survival for those who took beta blockers.This was in a cohort of patients who had received definitive radiotherapy. The molecular mechanism being hypothesized for the benefit from beta blocker should improve survival for all kinds of lung cancer patients. There is a need to do a prospective study but practitioners and patients should explore the use of beta blockers considering the data available for its safety.
Improvement in overall survival is not a small thing when most new costly agents struggle to show meaningful difference in progression free survival!
Reach out today to your doctor and if you are a doctor read more and start thinking!!
The benefit of beta blocker is also there for patients having breast cancer and melanoma.
References:
1. http://www.medscape.com/viewarticle/777342
2. http://annonc.oxfordjournals.org/content/early/2013/01/01/annonc.mds616.full
3. http://jco.ascopubs.org/content/29/19/2635.abstract?ijkey=dc966043b03d255244605330d386a363baad8d7a&keytype2=tf_ipsecsha
4. http://www.nature.com/nrclinonc/journal/v8/n9/full/nrclinonc.2011.123.html
Conflict of Interest None.
There may be publication bias but asking questions and searching available data can help us in using old weapons against new targets. Academic institutes can do this kind of study.
Volunteering For Clinical Trials-Story of CML
The link provided below to an article describes beautifully the story of Chronic Myeloid Leukemia (CML). It also captures the treatment options for CML, their risks and benefits. It brings out the advancement and innovation which has happened in CML.
And above all HOPE!!
http://thestar.com.my/health/story.asp?file=/2013/5/5/health/12990835&sec=health
A story worth reading....
And above all HOPE!!
http://thestar.com.my/health/story.asp?file=/2013/5/5/health/12990835&sec=health
A story worth reading....
Sunday, May 05, 2013
Breast Cancer
In the previous post mentioned about the story of a lady suffering from breast cancer. For those who want to delve deep into scientific understanding the following resources should help.
For latest treatment options and any other questions who can mail me.
For latest treatment options and any other questions who can mail me.
Breast Cancer from fondas vak
Hormonal treatment of breast cancer from Santam Chakraborty
Tata Memorial Hospital treatment algorithm for metastatic breast cancer https://tmc.gov.in/cancerinfo/breast/Popup/clinical%20staging%20algorithms-MBC.pdf
Tata Memorial Hospital treatment algorithm for metastatic breast cancer https://tmc.gov.in/cancerinfo/breast/Popup/clinical%20staging%20algorithms-MBC.pdf
A Sad Story Of A Doctor's Wife With Breast Cancer
In month of February I met a doctor, a surgeon, who is working for government insurance hospital. As i needed by certificates to be attested, i had approached this hospital and had bumped into him. As he came to know that i am an oncologist he started asking about breast cancer. His questioning made me realize that someone known to him is suffering from breast cancer and has also developed metastases. He mentioned that the lady is post menopausal and has hormone positive breast cancer. I drew the algorithm of breast cancer treatment and recommended him to start letrozole 2.5 mg and a bisphosphanate. I mentioned that letrozole may cause osteoporosis.
The surgeon intermittently kept calling me. Also i had to help him get letrozole as it was not available easily in local pharmacy shops. This non availability was also a result of restriction on its supply because it was being rampantly misused in treatment of infertility. Pharmaceutical companies used to sell letrozole for more than 35 Rs when marketed for infertility but same for breast cancer patients was available for around 2 Rs!!
Yesterday made a house call to the surgeon's home. The patient was none else than his wife. She was using a walker to help her walk and appeared tired. She had pain in thoracic and lumbar spine. It was tender on palpation. From what she mentioned made the clinical judgement that the left ischium, left side of pelvis are also involved. Went through her reports.
She was diagnosed of breast cancer in December 2010. She had undergone surgery in early 2011. Was advised adjuvant chemotherapy and radiation. She had declined to take them both. This fear of chemotherapy and radiotherapy was from what she had read and seen. Her mother had suffered from carcinoma cervix and had some side effects from radiation therapy.
This lady is well read, runs a trust and a school. Takes pride in social activities and is respected and consulted in local area. She surfs the internet for answers.
What she had gathered she has refused to take main stream medicine. She takes HOMEOPATHIC medicines. She is reluctant to stop taking homeopathic medicine.
When i asked the surgeon whether she is taking letrozole for last 3 months, he sheepishly mentioned that he had brought the tablets but she has not taken them because i had mentioned that it may cause osteoporosis. Ah! I regretted!
I gave them assurance, explained about observational bias. Somebody else had recommended MRI but since she is claustrophobic they did not want to get it done.
I strongly recommended that they should get 8 gray single fraction radiation to the painful bone areas. It should hardly take 60-90 minutes inside the hospital-from registration, X-ray to getting radiation done. Start letrozole immediately.
I did feel sorry for the doctor. Being a relative and a doctor is never an easy task. His decision making was hampered because of his emotions.He was concerned and also feeling guilty. But he was not making the right decisions.
I am hurt and angry. This is because there is no need for the lady to suffer in pain. She deserves a good palliative treatment.
What do we learn?
1. The scientific community fails to educate its own members about the risks and benefits of present and emerging evidence based treatment.
2. Fear handicaps and paralyses us. It also makes us take wrong decision.
3. Allowing homeopathic treatment to be available, accepted and taken by patients? Why do we not demand the same scientific rigor from homeopaths? The scientific community by being quite about it, is also equally responsible for nurturing unscientific treatments. I would love to be proved wrong about homeopathic medicine by good scientific research. See the reference section to what i could assess.
4. Anecdotal experience can wrongly influence doctors and patients decisions.
I know it is not easy to take decisions. I do not suggest that you should blindly accept experts. But please make an informed decision. Consult different doctors, take second opinion, speak to survivors.
This is only one of the stories which i have narrated. I have had multiple patients, educated and uneducated who have taken ayurvedic, herbal, homeopathic only to come back for palliative treatment.
References:
1. Bannerji protocol-Homeopathy http://www.homeopathyeurope.org/media/news/beneficial-effect-of-homeopathic-medicines-on-breast-cancer-cells
2.Homeopathy in general: http://rationalwiki.org/wiki/Evidence_for_homeopathy, http://www.guardian.co.uk/notesandqueries/query/0,,-9542,00.html
3. Treatment of metastatic breast cancer: http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page7
4. Treatment algorithm: https://tmc.gov.in/cancerinfo/breast/Popup/clinical%20staging%20algorithms-MBC.pdf
The surgeon intermittently kept calling me. Also i had to help him get letrozole as it was not available easily in local pharmacy shops. This non availability was also a result of restriction on its supply because it was being rampantly misused in treatment of infertility. Pharmaceutical companies used to sell letrozole for more than 35 Rs when marketed for infertility but same for breast cancer patients was available for around 2 Rs!!
Yesterday made a house call to the surgeon's home. The patient was none else than his wife. She was using a walker to help her walk and appeared tired. She had pain in thoracic and lumbar spine. It was tender on palpation. From what she mentioned made the clinical judgement that the left ischium, left side of pelvis are also involved. Went through her reports.
She was diagnosed of breast cancer in December 2010. She had undergone surgery in early 2011. Was advised adjuvant chemotherapy and radiation. She had declined to take them both. This fear of chemotherapy and radiotherapy was from what she had read and seen. Her mother had suffered from carcinoma cervix and had some side effects from radiation therapy.
This lady is well read, runs a trust and a school. Takes pride in social activities and is respected and consulted in local area. She surfs the internet for answers.
What she had gathered she has refused to take main stream medicine. She takes HOMEOPATHIC medicines. She is reluctant to stop taking homeopathic medicine.
When i asked the surgeon whether she is taking letrozole for last 3 months, he sheepishly mentioned that he had brought the tablets but she has not taken them because i had mentioned that it may cause osteoporosis. Ah! I regretted!
I gave them assurance, explained about observational bias. Somebody else had recommended MRI but since she is claustrophobic they did not want to get it done.
I strongly recommended that they should get 8 gray single fraction radiation to the painful bone areas. It should hardly take 60-90 minutes inside the hospital-from registration, X-ray to getting radiation done. Start letrozole immediately.
I did feel sorry for the doctor. Being a relative and a doctor is never an easy task. His decision making was hampered because of his emotions.He was concerned and also feeling guilty. But he was not making the right decisions.
I am hurt and angry. This is because there is no need for the lady to suffer in pain. She deserves a good palliative treatment.
What do we learn?
1. The scientific community fails to educate its own members about the risks and benefits of present and emerging evidence based treatment.
2. Fear handicaps and paralyses us. It also makes us take wrong decision.
3. Allowing homeopathic treatment to be available, accepted and taken by patients? Why do we not demand the same scientific rigor from homeopaths? The scientific community by being quite about it, is also equally responsible for nurturing unscientific treatments. I would love to be proved wrong about homeopathic medicine by good scientific research. See the reference section to what i could assess.
4. Anecdotal experience can wrongly influence doctors and patients decisions.
I know it is not easy to take decisions. I do not suggest that you should blindly accept experts. But please make an informed decision. Consult different doctors, take second opinion, speak to survivors.
This is only one of the stories which i have narrated. I have had multiple patients, educated and uneducated who have taken ayurvedic, herbal, homeopathic only to come back for palliative treatment.
References:
1. Bannerji protocol-Homeopathy http://www.homeopathyeurope.org/media/news/beneficial-effect-of-homeopathic-medicines-on-breast-cancer-cells
2.Homeopathy in general: http://rationalwiki.org/wiki/Evidence_for_homeopathy, http://www.guardian.co.uk/notesandqueries/query/0,,-9542,00.html
3. Treatment of metastatic breast cancer: http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page7
4. Treatment algorithm: https://tmc.gov.in/cancerinfo/breast/Popup/clinical%20staging%20algorithms-MBC.pdf
Thursday, May 02, 2013
Drugs Targeting Epigenetics
In a previous post have talked about the fascinating concept of epigenetics. You can read it here.
There are four drugs approved which target the epigenetic mechanism. Two drugs are in, MDS, myelodysplastic syndrome named 5-azacitidine and decitabine. They marginally improve the survival and do have myelosuppression as toxicity but have scope for further refinement and improvement.
The other two drugs are Vorinostat and Romidepsin, HDAC inhibitors (histone deacetylase) approved in Cutaneous T Cell Lymphoma (CTCL).
Better understanding of acetylation, methylation in cancer. Better targeting by newer drugs. Possible combination therapies limiting toxicity but improving efficacy are much needed in the use of these new drugs.
For those interested to know in detail..
Ref: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615839/
There are four drugs approved which target the epigenetic mechanism. Two drugs are in, MDS, myelodysplastic syndrome named 5-azacitidine and decitabine. They marginally improve the survival and do have myelosuppression as toxicity but have scope for further refinement and improvement.
The other two drugs are Vorinostat and Romidepsin, HDAC inhibitors (histone deacetylase) approved in Cutaneous T Cell Lymphoma (CTCL).
Better understanding of acetylation, methylation in cancer. Better targeting by newer drugs. Possible combination therapies limiting toxicity but improving efficacy are much needed in the use of these new drugs.
For those interested to know in detail..
Ref: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615839/
HDACI from Vahid Nikouei
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