PEN Blog Archives

Receive Personalized Support Through PEN’s New Text-Line

Now, you can receive personalized support from our Network Managers by texting +1-833-213-6657. Each of our Network Managers is a compassionate volunteer who can offer you their first-hand experience with specific cancer types. Whether you’re a cancer patient, or caring for someone who is, PEN’s Network Managers will be here for you at every step of your journey. 

To introduce how you can benefit from the PEN Text-Line, we’ve shared the following FAQs, but please let us know if you have feedback or further questions.

What number do I text?

+1-833-213-6657

Who will receive and respond to my text messages?

Your text will be received by PEN’s Network Manager Coordinator, who will then connect you to the Network Manager best-suited to support your needs. Additional Network Managers may also respond, as we know it can be helpful to receive more than one perspective.

Your initial message to the PEN Text-Line will receive an auto-response, but please know that it will soon be read and personally responded to by a member of the PEN team! 

What types of support can I receive from the Network Managers?

Through their personal experiences with cancer, PEN’s Network Managers are here to offer you community and connection. You can ask us anything! For example:

  • Cancer-focused guidance
  • Online and in-person support groups for patients or care partners
  • Financing options for cancer treatment
  • Identifying clinical trials
  • Recommended webinars
  • What questions to ask your healthcare team
  • Methods for managing stress, and for living in the moment
  • How to share the news of your diagnosis with loved ones and colleagues

We also encourage you to reach out even if you don’t have a specific question; you are not in this alone—there will always be someone from the Patient Empowerment Network team here to listen and offer encouragement. 

Are there other reasons to engage with PEN’s Text-Line?

Definitely! 

Send us your suggestions for our online content and services. For example: 

  • What topics would you like us to cover more, or less often?
  • Do you have suggestions for PEN’s future Empowered #PatientChats
  • Would you like to contribute articles to the PEN blog
  • Do you want to inspire others by sharing the story of your own path to patient empowerment?

Be the first to receive the latest PEN news by texting the word EMPOWER to the Text-Line. You will then be prompted to choose what notifications you would like to subscribe to. For example:

  • Upcoming PEN webinars and other events
  • New content releases from the Network Managers
  • Wellness boosts, such as notes of encouragement and health tips

Is my interaction with the PEN Network Managers Text-Line HIPAA compliant?

Your messages will always be kept in strict confidence, however the PEN Text-Line is not HIPAA compliant. Therefore, we encourage you to use discretion when discussing specific information such as your or other individuals’ names, diagnosis details, etc. Please note that any advice provided by the PEN Network Managers is not medical advice. We also recommend patients refrain from giving other patients medical advice.

Who can I contact for more information or to provide feedback?

Feel free to email Nykema Mpama at kema@powerfulpatients.org.

Message and data rates may apply 

 

Patient Profile: Alexis Chase, PhD

Patient Profile

Alexis Chase, PhD

“To be empowered you have to be open, to want to do it, and to accept where you are.” – Dr. Alexis Chase, An MPN Empowered Patient

Dr. Alexis Chase has had a pretty interesting life, but she doesn’t think that makes her unique. She says she thinks all women have interesting lives. Born congenitally blind in her right eye she was given the name Alexis Elizabeth Lucia Chase. “I’m very proud of my name,” she says explaining the origin. Alexis was the name of a doll her mother had as a girl, and it means protector of mankind. Elizabeth is a family name, and Lucia represents Saint Lucia, the patron saint of the blind. Her mother was a nurse and her father, who was the first to recognize she had a vision issue, had a degree in biology. She was very close with her parents who instilled in her a strong foundation in her Roman Catholic faith. While she was born in Connecticut, she spent most of her adult life in Georgia as a divorced mother who built a successful 27-year career in the prison corrections system. She worked her way up to warden and earned two PhDs, one in religious counseling and one in criminal justice and corrections. After her retirement she became an international advocate and consultant of gender and women’s rights issues that include vocational training, post-incarceration reintegration, and female prisoners with children. She has travelled as far as Afghanistan in her advocacy work, and she is also the proud nana to a cat named Nathan Edgar Chase. She’s done a lot, and much of what she’s accomplished, she’s done while living with cancer.

The first time she was diagnosed with cancer was in 1976. She was in the first trimester of a high-risk pregnancy when she was diagnosed with ovarian cancer. Her doctors thought it would be best to terminate the pregnancy, but she refused. She was determined to have the baby, her daughter, and as soon as she was born, Dr. Chase began treatment for her cancer, opting for an experimental drug that she says saved her life.

At the time, her parents, her desire to live for her daughter, and her strong faith gave her the support she needed. “They were right there with me,” she says of her parents who she is grateful to for her faith. “It’s my great equalizer. My rope of hope,” she says and adds that she can pull on her faith anytime and in any place. “You’ve got to believe in something greater than yourself because definitely we’re not it,” she says.

She’s had no recurrence of the ovarian cancer, but in 1996, during a regular wellness checkup, she was diagnosed with myeloproliferative neoplasms (MPNs), a group of blood cancers that affect the function of bone marrow and can cause a number of complications. In Dr. Chase’s case her MPNs includes iron deficiency, anemia, diseases of the blood and blood forming organs, and hypothyroidism. MPNs are chronic conditions that can transform into another blood cancer and can affect people at any age but are more common in older adults. MPNs are also progressive. Dr. Chase had no symptoms for the first four years after her diagnosis, and wondered if she’d been misdiagnosed, but in 2000 she says she just started to feel like something wasn’t right and that’s when her blood counts started to change. She began taking medication, but in 2020 it stopped working and her cancer team worked to find other medications and therapies to treat her.

MPNs are rare and she doesn’t know anyone else with the same diagnosis, but she says she has an incredible support network through her daughter, her friends that are like family, her church, and her cancer team. “They take great care of me,” she says, but she also takes great care of herself. In fact, she’s very meticulous about taking care of herself. She carefully takes her medications, and she makes herself a priority. She focuses a lot on her mental health and she stresses the importance of mental health for all cancer patients. She says she finds three ways to laugh at herself every day and she chooses six words every day that represent how she’s doing and to help her feel empowered. A recent example, “I feel surrounded by grace today”. Also, part of her self-care is taking the time to listen to calming and soothing sounds and inspirational messages and quotes.

She says it’s a blessing to have the cancer she has because she is able to handle it and it makes her take time to smell the roses. She’s handled it so well that during her career as a prison warden she never let on that she was sick. She managed to schedule her appointments around her work so no one would know. She didn’t want her illness to affect her career.

Always an empowered patient, she’s been known to walk out of a doctor’s office when a situation doesn’t feel right. “It’s important for people to feel like they are being heard and more importantly that they are being listened to.” She says “It’s also important to know what’s going on with your care. You know your body better than anybody.” Dr. Chase likes the Patient Empowerment Network (PEN) because of the resources it provides to help others feel empowered in their own care. “I found PEN and love that I can access it anytime,” she says. She feels it’s important for patients to take charge of their own care plans. “To be empowered you have to be open, to want to do it, and to accept where you are,” she says. Her recommendation to other patients is to read, and comprehend, everything they can about their illness. “If you don’t understand it, you need to have someone explain it to you,” she says and also recommends keeping a journal. “We have to have something tangible. We can’t remember everything.”

While she continues to accomplish a great deal while living with cancer, it’s not always easy. “The chronic cancer fatigue, it will get me. I fight it because I feel like once I give in it would overtake me,” she says. She does experience shortness of breath and plans her days around her energy level. “It slows me down, but I don’t let it stop me. I push myself because I know the next day or the next day I won’t be able to.” Along with continuing her consulting and advocacy work, Dr. Chase loves to travel and hopes to go to Turkey to see the Virgin Mary’s house. “You never know what God has laid out for you,” she says. “I’m still here. I’ve been symptomatic for 20 years and I’m still here.”

#patientchat Highlights: The Engaged Patient: Utilizing Digital Health

Last week we hosted a “The Engaged Patient: Utilizing Digital Health” Empowered #patientchat, the community came together on Twitter for a lively discussion. Take a look at the top tweets and full transcript from the chat.

Top Tweets

Shared Decision Making is Key

Advocate for Access and Equity

The Patient is a Respected Member of their Care Team


Full Transcript

Bright Hope on the Horizon – Part Four

See the beginning of Sajjad’s story in Part One, Part Two, and Part Three.


Swimming Upstream: My Struggle and Triumph Over Cancer and the Medical Establishment: New Hope in Cancer Treatment

(Jan 2020)

In February 2014, two groups of scientists in New York City presented the early data of what can only be described as a phenomenal study with phenomenal results.

In a study using sixteen adult leukemia patients, scientists took samples of each patient’s T-cells and samples of his or her cancer cells. Under laboratory conditions, they trained those T-cells to recognize certain specific traits of that patient’s leukemia cell and then attack to kill it—it was like teaching a drug-sniffing dog to find the cache of heroin. These were called “smart T-cells.”

The next step was crucial, dangerous, and amazingly clever.

The researchers cloned millions of these specially trained T-cells and then went back to the patients and gave them very toxic chemicals that destroyed their “dumb” T-cells—those that were still fooled by the cancer’s camouflaging. They then replaced them with the trained smart T-cells. 

Once infused, the trained T-cells set out like an elite commando force equipped with exact GPS coordinates and hunted down and killed the cancer cells.

The success rate of achieving a complete response was an astounding 88 percent!

The incredible success of that small study, and several others since, has sparked an explosion of interest and further studies by various medical centers and pharmaceutical companies worldwide, who are spending billions of dollars in similar research. These investments are sure to be returned many times over, of course. But it can only mean good things for cancer patients. Costs for adoptive T-cell transfer treatments now are prohibitive for individuals—upwards of $500,000 for one patient, which is totally unacceptable. But that will change in the near future.

And there were complications, of course, with ominous results for one patient. 

In one unfortunate patient, a man from New York City with Her2-positive colorectal cancer, doctors infused T-cells trained to seek out and kill Her2-positive cancer cells. The man went into respiratory arrest within fifteen minutes. His health continued to deteriorate over the next few days despite the best efforts of the medical experts. He died after four days when his lungs shut down completely. There was nothing they could do to save the patient.

An autopsy showed that the patient’s normal lung cells had traces of Her2. The “smart” T-cells had been attacking and killing the healthy lung tissues as well as the cancer.

These trained T-cells are like heat-seeking missiles. They will attack and kill as they have been trained to do—and there was no reversing this once they were set loose.

You lose any control over the missile once it is fired.

This unfortunate incident led to a temporary halt of all further experimentation in this area. The focus was shifted to try to find a way to control these smart T-cells after they were infused into the patient’s bloodstream. How do you stop these commandos if they go rogue? How do you destroy a wayward missile? 

A few different strategies have been developed to accomplish that. One of those is the development of what is called a “suicide gene”—and it is truly the stuff of science fiction. Now scientists can tag T-cells with this suicide gene. If they go haywire and start attacking normal cells, doctors can prompt them to destroy themselves, or commit suicide.

The first couple of the CAR-T Cell Therapies, as these are called, have already received an FDA approval and the newer & better ones are sure to follow.

It is nothing short of amazing. Today we are on the cusp of advances that were not even imagined just a few years ago. Now when someone disconsolately calls me for advice and tells me they have been given no more than two years to live, I tell them not to panic or lose hope. I emphasized that two years is an eternity when it comes to medical advances, the way science is exploding in its efforts to cure cancer.

“Take heart,” I tell them. “Every year, new drugs and modalities are being developed. In two or three years, you have no idea what new miracle drug may come out.” I suggest optimism and advise they focus on positive thoughts, avoid negativity and depression, refuse to panic, eat healthily, remain physically active, meditate, enjoy every little pleasure in life, and, as much as possible, avoid stress. Most of all, do not give up hope.

All that will boost your immune system and will go a long way toward beating this dangerous enemy.

Two years—or even a year—given the ways that science is moving ahead, is a terrific pronouncement. This, in no way, is meant to paint an unrealistically rosy picture. Cancer has been and continues to be an extremely deadly disease. Even though the death rate from cancer has gradually and steadily declined since 1990, there are still far too many patients dying from it. In the United States, cancer continues to be the second biggest cause of death, behind heart disease only. Over half a million patients die from cancer each year in the United States alone. More than eight million lives are lost worldwide.

I am fully aware of all that. Yet, there is no doubt that we are entering a much better and far more hopeful era. At no other time in the history of medicine have we been this tantalizingly close to achieving a major victory against cancer, a game-changing victory that could, possibly forever, change the cancer outlook. 

I believe this with all my heart.

MPN Patient and Caregiver Explain How Colors Impact Their Lives

MPN Patient and Caregiver Explain How Colors Impact Their Lives from Patient Empowerment Network on Vimeo.

Are you conscious of the colors in your home? MPN Network Manager Summer and her care partner Jeff have their respective homes filled with colors that bring them joy. They prioritize mindfulness and positivity as part of Summer’s healthcare journey.

Jeff challenges you to surround yourself with colors that put your mind and body at ease.

Want to connect with Jeff and Summer? Email them at question@powerfulpatients.org

Myeloma Treatment Decisions: Insist on Essential Testing

In this podcast, myeloma expert Dr. Amrita Krishnan explains the essential testing that should follow a diagnosis, how the results could impact myeloma therapy, and discusses new and emerging treatments.

Dr. Amrita Krishnan is Director of the Judy and Bernard Briskin Center for Multiple Myeloma Research at City of Hope in Duarte, CA. Learn more about Dr. Krishnan: https://www.cityofhope.org/people/krishnan-amrita.


Don’t miss an episode and subscribe to PEN’s Empowered! Podcast wherever podcasts are available.

Patient Profile: Liz Sarris

Patient Profile

Liz Sarris

Liz Sarris knows the world of healthcare pretty well. Not only has she had a 40-year career as a nurse, but she’s also had a host of chronic illnesses, which means lots and lots of doctor appointments. As if that weren’t enough, Liz has also been diagnosed with cancer three times – with three different and unrelated cancers! “I’m being watched closely from many angles,” she says. “But the great news is I live to tell the story.”

Her cancer story began in 1988. Her primary care doctor found some unexplained blood in her urine and, unable to dismiss it, referred Liz to a urologist. A scope of her bladder revealed a tumor that was about the size of a pea. Fortunately, it was non-invasive, had not invaded the bladder lining, and was removed. No treatment was required, but she did have to be monitored regularly. For the first two years she was checked every three months, then every six months for the next several years. After that she graduated to annual checkups that continue to this day.

Fast forward to 2014 when she was diagnosed with chronic lymphocytic leukemia (CLL). This time, Liz was seeing an endocrinologist for a thyroid issue when the doctor noticed some abnormalities in her blood work. Further testing led to her CLL diagnosis, which, so far, hasn’t required any medications or treatments other than quarterly check ins. “It is a watchful waiting situation,” she explains.

Then in 2017 things took a turn. Liz’s gastroenterologist, who she sees regularly for two chronic gastrointestinal issues, said that there was a spot on her scans that needed to be checked out. It was a spot they had been watching, but now it was starting to change. The spot turned out to be a neuroendocrine tumor of her pancreas. It was a slow growing tumor and not aggressive, but it was malignant and had to be removed, and there was a chance that it was a lot worse than the doctor thought it was. It meant major surgery that was not at all routine, and because her tumor was in the middle of her pancreas, it was possible that she might lose part of her pancreas and her spleen. Liz wanted the best possible outcome from the surgery, which meant keeping as much of her pancreas as possible, so she started to search for a surgeon. “I wanted to see the right people who were specific to this type of cancer and who do neuroendocrine tumors every day,” she says. “If he’s going to poke around my pancreas, I want to know he’s doing 10, 12, 15 of these surgeries a month.”

First, Liz narrowed her search geographically. She lives in an area that is relatively close to several high-quality medical facilities, and she knew that she didn’t want to be too far away from her family and support system after such a big surgery. Then she started asking questions and doing research. “Because I had engaged myself with good local physicians, I reached out to them for referrals,” she says. She asked her doctors who they would send their wives to and who they themselves would go to. Then she started calling surgeons and made appointments to interview three of them. When she had it narrowed to the surgeon she felt best about, she visited him a second time. “I don’t know if it’s the nurse in me or just who I am,” says Liz about her research process. She says that the doctor she chose made her feel confident, and his approach was more hopeful because he was willing to perform the surgery using a rare technique that meant he would remove the tumor from the center and then reconnect the two sides of her pancreas. Her doctor was upfront with her about all the possible risks and made sure she knew that his plan could change if the surgery revealed a different situation than they were expecting. “Do whatever you have to do to give me the best chance at a healthy life,” she told him and added that she hired him to do the job he would do for his mother, his sister, or his daughter and that she didn’t want to see him again in five years.

Her eight-hour surgery was a success. The tumor was removed, and her pancreas was put back together in what Liz describes as a “creative way.” After her surgery she didn’t require any treatment other than regular monitoring, and so far, all her scans have been good. She credits her successful outcomes in part to having a supportive family, good insurance, and good doctors, but she didn’t have good doctors by accident. She’s very proactive in her own healthcare. “I had the recipe for a good situation, but that doesn’t mean I didn’t have to do the research,” she says.

Her background as a nurse helped her know what questions to ask, but she wants others to know they can ask the same questions and can be just as informed. “You can navigate your care more than you think you can,” she says. “You really have to utilize your resources.” Liz says resources like the Patient Empowerment Network, where patients have access to free online tools such as a checklist of questions to ask the doctor, are great for cancer patients. “There needs to be more empowering,” she says. “Much of what I’ve done my entire career is try to empower patients.” She says that being empowered means being educated, identifying your expectations, and asking questions. “We are willing to ask questions of our auto mechanics about our car’s maintenance and repair, but not of our doctors about our own bodies,” she says.

These days Liz is adjusting her expectations for her own life. In March, Covid-19 interrupted the career she’s been so passionate about when her oncologist told her it wasn’t safe for her to continue to work during the pandemic. “This is not how I anticipated retiring,” she says. With her unique perspective as experienced patient and medical professional, she has a lot of knowledge to share, so now Liz is exploring how she can continue to help other patients learn more about how to navigate the healthcare system and take charge of their own care plans. She’s empowered to empower others.

Meet a Recent Graduate of Our New Course, Digitally Empowered™

We’d like for you to meet Andrea Caldwell, a recent graduate of our Digitally Empowered™ course and digital sherpa™ program, conducted in partnership with the Cancer Support Community.

Andrea is already using her newly-gained digital literacy skills to access online healthcare resources. And not just for herself, but to support her Mom’s cancer journey, too. She was kind enough to share the details of her experience in the following video:

Andrea Caldwell Testimonial | I Hope That Other People Join In from Patient Empowerment Network on Vimeo.

Andrea enthusiastically encourages others to participate in these free programs:

“I recently had an emergency situation during which time I wasn’t able to use my cell phone. Thanks to the training I received from PEN’s virtual digital sherpa™ program, I was able to use my computer to communicate, which I never would have thought to do before. Thanks to this technology training program, I’m now reconnected to the world.”

If you know an older cancer patient who needs a technology skills boost, tell them about Digitally Empowered™, our free and easy-to-complete course that develops the skills necessary to harness online health resources, including telehealth. 

These and all of our programs are made possible thanks to the generosity of Patient Empowerment Network donors and volunteers like you.

Digital Advocacy and Health Equity for CLL Patients

Telemedicine or telehealth – remote access to healthcare – has become widely used after the arrival of the coronavirus pandemic, especially by cancer patients. But the rise in telemedicine has also brought challenges to the vulnerable populations of Americans over age 65 and to low-income Americans who have struggles getting online. Among patients who are over age 65, only 55 percent to 60 percent of them have broadband access from home or own a smartphone. These patients also have challenges with completing information online, with only 60 percent who have the ability to send an email, to complete a form, and to locate a website. Among low-income patients, only 53 percent are digitally literate, and they also have lower rates of Internet use, broadband access, and smartphone ownership compared to other patient groups.

As an avenue toward reducing inequities, the Patient Empowerment Network (PEN) and Diverse Health Hub (DHH) have partnered to help foster change toward achieving equitable healthcare for all. In order to provide practical usage of telemedicine tools, PEN created the TelemEDucation Empowerment Resource Center for chronic lymphocytic leukemia (CLL) patients and their loved ones. Another resource, the digital sherpa™ program, helps cancer patients and their families become more tech-savvy by learning to use technology to their advantage during their cancer journey and beyond.

Here’s a summary view of the knowledge gained about telemedicine to help provide optimal care to CLL patients: 

How to Optimize a Telemedicine Visit

Just like in-person care visits, telemedicine visits are scheduled with a time limit in mind. Some things to remember about telemedicine visits:

  • If a video conferencing tool is needed for your visit, install the tool on your laptop, tablet, or smartphone ahead of time so that you aren’t rushed when your appointment time arrives.
  • Just like in-person doctor visits, your doctor or care provider may run a few minutes late.
  • Try your best to remain flexible and to be patient.
  • Try to write down your questions before your appointment to keep on track about things you want to learn during your visit.
  • Remain focused on the main purpose of your visit as much as possible. Polite small talk is fine but keep it to a minimum so that you can get the most out of your visit. 

CLL Patients Who Benefit the Most From Telemedicine

Not every CLL patient will be a good fit for telemedicine visit. Things to keep as top of mind for telemedicine visits:

  • CLL patients who are on active surveillance from their care providers are a natural fit for telemedicine. They can get periodic blood tests from a local laboratory, and the results can be sent electronically for their CLL specialist to evaluate.
  • Patients with high-risk genetic features or rapidly progressing CLL are not the ideal patient for care via telemedicine.

In the time of the coronavirus pandemic, remote monitoring has become part of standard healthcare terms. Some things for CLL patients to know:

  • Though it may be a new healthcare method for many patients, monitoring has actually been used for decades in the care of CLL patients and others with suppressed immune systems.
  • Remote monitoring is used to reduce the risk of infection to those with reduced immune system function, such as those with cancer and CLL.
  • Remote monitoring is a completely safe medical practice for CLL care when a patient’s blood work is monitored on a regular basis. Always ask your doctor if you’re unsure if you’re a candidate for remote monitoring or if you have questions about the frequency of your blood tests.

How Telemedicine Can Improve CLL Care

Now that even more CLL patients have become accustomed to using telemedicine care tools, CLL experts are looking to the future. Looking ahead:

  • Telemedicine can help CLL patients who live in very remote areas to gain access to clinical trials that weren’t accessible to them in the past.
  • CLL therapies will continue to improve for patients as a higher percentage of CLL patients participate in clinical trials.
  • The improvements in remote monitoring will bring more tools for CLL patients to do routine things like sending their heart rate and other things to their care provider in real time. 

Telemedicine Glossary

Here are some helpful telemedicine terms to know:

  • HIPAA – HIPAA, or the Health Information Portability and Accountability Act, is a healthcare compliance law providing data security and privacy for the safeguarding of patient medical information. In telemedicine, provider-patient communication must take place through HIPAA-compliant secure platforms.
  • Patient portal – a secure Internet sign-on that allows patients to contact their provider, review medical tests and records, access health education materials, and seek appointments. Most provider networks develop a patient portal before they move to full video appointments.
  • Remote monitoring – type of ambulatory healthcare where patients use mobile medical devices to perform a routine test and send the test data to a healthcare professional in real-time.
  • VPN – a VPN, or virtual private network, is a secure and private way to connect to the Internet over public wireless connections. VPNs are particularly important for those living the digital nomad lifestyle and connecting in foreign countries where networks may be more vulnerable to communication transmission interference.

Now that telemedicine tools are gaining both in usage and numbers, CLL patients can feel hopeful about improved care and treatment toward the future. As a step in that direction, take advantage of the resources below and continue to visit the TelemEDucation Empowerment Resource Center for informative content about CLL and telemedicine.


Resources for Telemedicine and CLL

Dr. John Pagel’s Top Tips for Preparing for Your CLL Telemedicine Visit

Telemedicine Challenges and Opportunities for CLL Patients

Will Telemedicine Mitigate Financial Toxicity for CLL Patients?

What Subset of CLL Patients Should Utilize Telemedicine?

Will Telemedicine Be Part of Routine Management for CLL?

How Will Telemedicine Impact Time-Limited Therapy in CLL?

What CLL Population Will Benefit Most From Telemedicine?

Remote Monitoring

TelemEDicine ToolBox Visit Checklist

TelemEDicine ToolBox Glossary

 

Will Telemedicine Give More CLL Patients Access to Clinical Trials?

Will Telemedicine Activate More Remote Monitoring for CLL?

Will Telemedicine Improve My Quality of Life with CLL?

Will Telemedicine Be a Long-Term Survivorship Tool for CLL Patients?

What CLL Symptoms Can Be Monitored via Telemedicine?

Is Remote Monitoring for CLL Patients on CAR T Therapy the Future?

digital sherpa™ program

Bright Hope on the Horizon – Part Three

See the beginning of Sajjad’s story in Part One and Part Two


Swimming Upstream: My Struggle and Triumph Over Cancer and the Medical Establishment: New Hope in Cancer Treatment

(Jan 2020)

We all are familiar with the miracle of modern antibiotics. Most infections, even the serious and life-threatening kind, can usually be cured by the proper use of antibiotics. But antibiotics cannot work without help from the patient’s immune system. 

Every day, literally hundreds of times a day, various bacteria and viruses invade our bodies. Yet, we are not constantly sick. Why? Because our immune system is always on guard, ready to fight and destroy every potential enemy. The invaders are promptly killed and the threat is eliminated without us ever becoming aware of it. 

It is only when the bacteria manage to establish a beachhead that we show signs of illness. Even then, the immune system plays a critical role in helping the antibiotics conquer the infection. Antibiotics simply cannot work if the immune system is diseased and unable to help, as in HIV. That is precisely why in HIV even a minor infection can threaten the patient’s life despite the use of antibiotics. Our immune system is the most powerful, sophisticated, efficient, and elite fighting army one can imagine.

So, why does it not fight the cancer and kill it off? For decades, medical scientists have struggled with precisely this question. Why was the immune system actually ignoring the horrid invasion? Why was it sitting quietly by while the cancer invaded and destroyed one vital organ after another until it killed the patient?

It has been only in the last few years that we have realized what was happening.

Cancer is wily and cunning. That, of course, is not a surprise. But researchers have begun to understand that cancer cells actually make themselves invisible to the immune system. We still do not have a complete understanding as to how, but we have learned a few things. 

This we do know: The immune system fights off various invasions through a system of checkpoints. Say, for example, you have strep throat. When the germs first invade, an alarm is triggered which serves to mobilize the body’s immune forces. They attack the strep germs and kill them off. Soon, the immune forces reach a checkpoint where they must stop to receive fresh orders. If the threat persists, the order will be to continue the attack. On the other hand, if the threat has been eliminated, that information will be conveyed to the immune forces, thereby shutting them down. Obviously, we do not want our army to keep firing after the enemy is dead. It will only cause harm to the civilians. Similarly, our immune system must not go on unchecked in order to prevent damage to the normal and healthy tissues. 

So, our immune response is a pattern of repeated starts and stops regulated by a series of checkpoints. 

Scientists have learned that cancer has the ability to trigger checkpoints or manipulate the checkpoint signals. As soon as the immune forces attack the cancer, it initiates a checkpoint signal to terminate that immune response. Cancer has a way of making the checkpoint say—to continue the analogy—”No problems here. The threat is gone. All clear now.” 

So far, we only know about a couple of different ways this is accomplished. But it is very likely that the wily cancer has many other ways to fool the immune system. Our knowledge is still growing by the day.

Once scientists understood that mechanism, they began to develop medicines that neutralized the false checkpoint signals created by the cancer, thus allowing the immune system to continue to attack and kill the cancer cells. These drugs are called checkpoint blockade therapies.

In clinical trials, these medicines have produced a 66 percent success rate against an extremely deadly cancer, malignant melanoma. This is an astonishing success, and we may even improve upon that success as we learn to use different drug combinations and newer and better drugs are developed. Each day brings the dawn of a new hope.  One of the newer checkpoint blockade drugs, Pembrolizumab (Keytruda) has consistently shown encouraging results in a variety of, hitherto untreatable, cancers. 

Another prong in the battle that has brought jaw-dropping positive results is something called adoptive T-cell transfer. This is the stuff of science fiction. And the exciting results it is producing have turned cancer research on its ears.

Using T-cells to kill cancer will put medicine on the cusp of being able to say we have found a cure for cancer. Adoptive T-cell transfer therapy is the most promising technique we have to finally attain the Holy Grail of cancer medicine—to be able to utter those three magical words to the patient: “You are cured!” 

T-cells are our immune system’s killer cells. Think of them in a way as an elite commando force that can seek out and destroy the enemy. The challenge is this: because of mechanisms we are still trying to fully understand, cancer cells camouflage themselves from T-cells. So, how do you make the T-cells “see” this enemy called cancer? If they can see it, they will attack it and destroy it. 

The Best of 2020

As 2021 begins, we would like to take a moment to highlight a few of our most popular posts from 2020 and to thank the people who contributed to the popularity of these posts. We cannot thank the authors and organizations enough that have contributed to make 2020 one for the books, even during a trying year. Your efforts to Patient Empowerment Network are greatly appreciated!

January

Patient Profile: Perseverance and Positive Thinking Helped This Young Mother

Stage IIB Hodgkin Lymphoma patient, Lindsay, shares her cancer journey from searching for a diagnosis to adjusting to her new mantle of ‘cancer survivor’.

10 Body Signals Warning Health Problems

We should always be aware of what our body is trying to tell us. Here are ten ways our body is signaling that we should be more concerned with our health.


February

How Can You Best Support A Friend With Cancer?

What happens when someone close to you has been diagnosed with cancer? Here are some tips and advice to be the most helpful to cancer patients.

Confused About Immunotherapy and Its Side Effects? You Aren’t Alone

Patients need to be aware of the side effects of immunotherapy and vigilant in addressing them with their doctor as they can signal complications.


March

Practicing Self Care In The Time of Coronavirus – How To Mind Your Mental Health And Well-Being During Covid-19

While this is naturally a worrying time, there are many things we can do to mind our mental health and boost our immunity and well-being at this time. In this blog, you will find tips to help you navigate your way through this time of global crisis.

Health Fraud Scam – Be Aware and Careful

This blog explains what healthcare fraud is and provides tips to help you avoid falling victim to these scams.


April

Cutting Through the Panic in a Pandemic

A list of trusted sources to help you cut through all the information that is being share online about the coronavirus pandemic.

Fact or Fiction: Finding Scientific Publications Infographic

This infographic from our PEN Powered Activity Guide shares her tips for finding and understanding scientific publications.


May

Cancer, COVID, and Change

Cissy White gets used to her new normal dealing with having ovarian cancer during a pandemic, and the challenges and benefits that presents.

Diversity in Clinical Trials Benefits Everyone

It is critical that minority groups are included in clinical trials because, as the broader population, their data will affect the outcome of precision medicine for everyone.


June

Social Determinants of Hope

Casey Quinlan explains that everyone’s social determinants of health have been impacted by COVID19, but she is seeing strong signals of hope.

Music as Medicine: The Healing Power of Music

For cancer patients, music can be a powerful therapeutic tool in coping with a cancer diagnosis and treatment. Here is a list of some crowd favorites.


July

Dealing with a Cancer Diagnosis During COVID-19

There’s never a good time for a cancer diagnosis, especially during a global pandemic. Here are some recommendations from cancer treatment experts.

Quotation Inspiration: 10 Quotes to Inspire, Motivate and Uplift Cancer Patients

A list of 10 quotes and messages of hope and inspiration from patients that can bring you that much needed boost in your day.


August

Turning Your Home Into a Sanctuary

These days we are spending more time at home, so you need to feel like your happy place. Turn your home in a sanctuary in 5 simple steps.

Oncology Social Worker Checklist

Oncology Social Worker, Sara Goldberger, MSSW, LCSW-R, shares her checklist for resiliency during the time of a global pandemic.


September

The Nitty Gritty on Care Partnering

Casey Quinlan provides a short checklist that can be used in any patient-with-a-bedside-care-partner situation.

Are Cancer Survivors More Susceptible To Respiratory Illnesses When Air Quality Is Poor?

A recent study published examines the connection between air pollution and respiratory health among cancer survivors.


October

Patient Empowerment Revisited

In this Part 2, we’ll look at the role of peer to empowerment and explore whether the term “empowerment” is even the right term to use.

The Power of Journaling During Cancer Treatment

This article is meant to help cancer patients understand just how much journaling can help them emotionally and physically during their treatments.


November

The Caregiver Impact: A Vital Part of Healthcare

Network Managers, Carly Flumer and Sherea Cary, team up to discuss the importance caregivers and some quick tips for caregivers.

5 Ways a Patient Portal Can Improve Your Health Care Experience

This blog shares 5 helpful tips for utilizing your patient portal to the fullest.


December

“Wait, There’s a Good Cancer?”

Carly Flumer shares her thyroid cancer diagnosis story and what it’s like being told you have the “good” cancer.

Chronic Myeloid Leukemia (CML) Patient Profile

A patient story from a chronic myeloid or myelogenous leukemia (CML), an uncommon cancer of the bone marrow, patient.

Essential First Aid Tips For Cancer Caregivers

First aid is an essential skill — however, 70% of Americans feel unprepared for a cardiac emergency because they either don’t know how to administer CPR or their training has significantly lapsed. It’s important for caregivers of cancer patients to be trained in first aid, so they’re fully-prepared and ready to act in emergency situations. This includes knowing how to administer CPR, looking out for the common signs of infection, and helping patients manage the emotional symptoms of cancer.

Administering CPR

Chemotherapy damages healthy cells in the body, including cells in and near the heart. As a result, cardiac toxicity and conditions like arrhythmias (abnormal heart rhythms), congestive heart failure, cardiomyopathy (the heart struggling to send blood around the body), angina (chest pain), and myocarditis (inflammation of the muscular layer of the heart wall) can occur. In these situations, a cancer patient may need CPR, which, if unsuccessful, may need to be followed up with an AED (automated external defibrillator). An AED can help restart the patient’s heart and re-establish the natural rhythm of the heartbeat. First aid training is essential for anyone caring for cancer patients as it covers how to administer CPR correctly. Caregivers should also inform themselves of the patient’s resuscitation wishes in advance.

Preventing infection

Cancer and cancer treatment weakens the immune system, which in turn increases a patient’s risk of infection. Additionally, cancer patients can have a low white blood cell count (neutropenia), which further weakens the body’s ability to fight infection. Symptoms of infection to look out for in cancer patients can include: fever, sore throat, shortness of breath, belly pain, and chills potentially followed by sweating. In this case, caregivers should check the patient’s temperature with a thermometer, keep the patient hydrated, and help them take their medication on schedule. If the patient has a high or low temperature, can’t take fluids, or simply doesn’t seem “right,” take them to the emergency room and let the staff know they’re in treatment for cancer.

Emotional first aid

One third of all cancer patients experience high levels of mental or emotional distress that meets the strict diagnostic criteria for mental disorders, including depression or anxiety. As such, emotional first aid becomes an important part of caring for cancer patients and their emotional health. In particular, anxiety can result in shortness of breath, hyperventilation, and chest pain. It’s therefore essential to learn deep breathing techniques to help affected patients stay as calm and pain-free as possible. Alternatively, depression can manifest symptoms like low mood, irritability, insomnia, excess sleepiness, and suicidal thoughts. Be sure to familiarize yourself with the signs and symptoms of depression and begin an open dialogue with the affected individual to provide them with support and treatment if necessary.

First aid knowledge and skills are an essential part of caring for people with cancer. It’s important caregivers have the right first aid training, knowledge, and skills to help patients in emergency situations.

We survived 2020! Now what?

I may be tempting fate by saying we survived 2020 when there are still 10 days left in the year as I write this, but I’m willing to take the risk. 2020 was officially “a lot,” with a global pandemic, a US presidential election marked by a level of vitriol not seen since the run-up to the Civil War, and systemic racism laid bare for all to see – not like it wasn’t plenty visible before, but now it cannot be swept under the rug anymore.

Not that everything has been dark and dire – medical science has long pursued “real world evidence,” the idea that all the data collected over the course of the delivery of medical care across a population could be synthesized into better medical treatment. The COVID pandemic pushed that concept onto the actual dashboard of care delivery, accelerating treatments and vaccines at a speed not seen before in the history of science.

But that same real world evidence data synthesis also made clear just how much systemic bias – gender, race, socio-economic status – is baked into healthcare systems and healthcare delivery, in the US and globally.

As we drag ourselves across the 2020 finish line, I’d like to present some pros, some cons, and some open questions we’re left with as we move into 2021.

First, the cons:

  • The world is drowning in a misinformation flood that prevents rational decision making about issues related to public health, civil rights, and even what facts are – figuring out how to combat this will take massive, concerted, global efforts
  • The global economy is a hot mess – the real downside here is how the fortunes of the ultra-wealthy have grown during the pandemic, with most of humanity left to figure out how to keep themselves going during shutdowns and job loss, along with loss of health coverage through their employers if they did lose their jobs
  • Any thought that humans are Earth’s apex predators should be completely erased by now – nope, viruses and bacteria rule the planet’s roost, we’re just along for the ride, with every other living thing
  • Systemic bias and racism are totally a thing – it’s up to us, all of us, to work together to erase it from medicine, from science, from civil society (this is actually a “pro” opportunity, too)

On to the pros:

  • Science has moved at light speed in the face of the pandemic – SARS-CoV-2 emerged in late 2019; the virus’ genomic profile was published in January 2020, making scientific study of transmission and possible treatments easier
  • Development of vaccines to combat the novel coronavirus happened within a calendar year – the usual timeline on vaccine development is 5 to 10 years
  • The world has been able to watch science happen in near real-time – as someone who tracks #epitwitter and #medtwitter and #EmergencyMedicine has gotten a front row seat to how medicine, and the science that informs it, isn’t a white-coated academic process, it’s a battle against time involving uncertainty and human cognition – “here’s what we know right now” is as good as it gets, moment to moment; adding those moments together is what reveals the scientific basis for vaccines and treatments

The open questions we’re taking into 2021:

  • How long with vaccine immunity last? That’s a question only time and data can answer.
  • How can we humans finally recognize that we’re a species, not separate groups of [insert ethnic or national identification here], and start working together to solve human problems? Like, say, income inequality and racism?

You’ll be hearing me again on all of the above through 2021. If you have any ideas on either of those “open question” bullets, hit me up on the Twitters at @MightyCasey.

Here’s to all of us surviving 2021, too.

December 2020 Notable News

This month there is a lot of promising news giving hope to the possibility of a brighter, better new year. A better understanding of why humans are prone to advanced cancers and more knowledge about obesity as a risk factor, coupled with advances in targeted therapies and combinations of medications to better treat myeloid leukemias, breast cancer, and get the immune cells involved are all helping to bring about better treatments and outcomes for cancer patients. However, the technology used to create the vaccine for the novel coronavirus Covid-19, that dominated the year and changed the world for us all, just may be the biggest game changer of all. It could revolutionize the way we treat cancers and many other diseases.

The Covid-19 vaccines use a technology that could lead to managing other diseases, like cancer and heart disease, reports bloomberg.com. The technology, called mRNA therapeutics, uses messenger RNA in the vaccines to turn the body’s immune system into a factory with the healthy cells producing viral proteins that create a strong immune response. The approach has never-before been used outside of clinical experiments, and many researchers are stunned by how well it works. Cancer researchers have been studying the technology for 20 years, and the vaccine was able to be created so quickly due to what they knew from working on developing cancer vaccines. These vaccines could lead to a whole new field of medicine, with mRNA drugs for treating cancer expected to be approved in two or three years. It’s possible all infectious disease vaccines will use the technology in the next ten to 20 years, as the method is faster and cheaper than current options. The hope is to use mRNA to create flu vaccines, heart failure treatments, an HIV vaccine, and much more. Learn more about the exciting mRNA possibilities here.

When compared to our closest cousin, the chimpanzee, humans have a high risk of developing advanced cancers, and researchers now think they know why, says sciencedaily.com. New research shows that there is an evolutionary genetic mutation that is unique to humans. The SIGLEC12 gene was eliminated by the body because it lost its ability to distinguish between self and invading microbes. However, it’s not completely gone from the population, and it can be a problem for the 30 percent of people who still produce SIGLEC12 proteins. Those people, when compared to people who don’t produce the proteins, are at more than twice the risk of developing an advanced cancer during their lifetimes. Researchers are hoping to use the information to help determine who is most likely to get advanced cancers, and have developed a simple urine test to detect the proteins. Learn more about this evolutionary snafu here.

In another story about cancer risk from sciencedaily.com, researchers better understand the relationship between obesity and cancer. Obesity is linked to increased risk for more than a dozen types of cancer, as well as a worse prognosis and chance of survival. Researchers at Harvard Medical School have discovered that obesity provides the right environment for cancer cells to take fuel away from cancer-fighting T cells. Cancer cells respond to increased fat availability by reprograming themselves to eat fat molecules and thus deprive T cells of fuel. Get more information here.

When it comes to treating cancer, better therapies are discovered all the time, and now researchers have found a new class of targeted cancer drugs that may effectively treat some common types of leukemia, reports medicalxpress.com. The drugs target and eliminate leukemia cells with TET2 mutations, which are one of the most common mutations found in myeloid leukemias. The findings show that a synthetic molecule called TETi76 can target and kill cancer cells in both early and fully developed phases of leukemia and may be more effective than current targeted therapies. Find out more here.

Speaking of more effective treatments, it turns out that some women with breast cancer might not have to undergo chemotherapy for treatment, reports nih.gov. Initial results from a clinical trial show that postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER 2)-negative breast cancer that has spread to one to three lymph nodes and has a low risk of recurrence won’t benefit from adding chemotherapy to hormone therapy. The trial also showed that premenopausal women with the same HR-positive, HER2-negative breast cancer characteristics did benefit from chemotherapy. The trial was made up of more than 9,000 women who were monitored for an average of five years and will continue to be followed, so more insights about breast cancer are expected to come out of the trial. Get more information about the trial here.

Another advancement in breast cancer treatment was reported by cancernetwork.com. The U.S. Food and Drug Administration (FDA) approved margetuximab-cmkb (Margenza) in combination with chemotherapy to treat patients with metastatic HER2-positive breast cancer who have received 2 or more prior anti-HER2 regimens. A study showed a 24 percent reduction in the risk of disease progression or death. More information is available here.

Immunotherapies have helped change the way many cancers are treated, and the process is still evolving. Researchers at Purdue University have created a new immunotherapy treatment, reports purdue.edu. The new treatment focuses on the immune system and has been shown to work in six different tumor types by reprograming the immune cells within the tumor to kill the tumor rather than giving it the chance to grow. The technique could be used to treat many types of cancers because the nonmalignant immune cells that are in the different types of tumors tend to be similar. Folate, a type of vitamin B, is used to deliver the anti-cancer drugs to the cells. The new therapy could be available within ten years. Learn more about the new therapy here.

Immunotherapies used to treat advanced cancers don’t always work for everyone, but now researchers have found that two cholesterol lowering drugs might improve the effectiveness of these therapies, reports cancer.gov. Studies show that when evolocumb (Repatha) and alirocumab (Praluent) are used on their own and in combination with immune checkpoint inhibitors, they slowed the growth of tumors. The drugs, approved by the FDA since 2015 are considered safe, can be taken at home, and are less expensive than many cancer therapies. Learn more here.

Bright Hope on the Horizon – Part Two

Swimming Upstream: My Struggle and Triumph Over Cancer and the Medical Establishment: New Hope in Cancer Treatment

Click Here to Read Part 1

(Dec 2020)

I would like to think—hope in fact—that no future cancer patients will have to fight the way I did to get certain treatments, that doctors today could help them prevent that. Oncologists now universally accept this novel concept that each patient’s cancer is different and must be treated differently. Treatment needs to be based, not on it’s  location, but on the unique pattern of gene mutations it exhibits. This understanding has led to the development and increasing usage of a test called Genome Typing. In the simplest explanation, genes are microscopic particles (nucleotides) located on the chromosomes of a cell. The genes instruct the cell to behave in a certain way and perform certain functions. Cancer alters, mutates, a gene to send a different signal to the cell so it  performs, not its normal function, but a function suitable for the cancer’s growth. This pattern of Genetic Mutations is unique to each cancer. Discovering and, possibly, attacking these mutations is called Targeted Therapy. Let’s assume that one patient’s parotid cancer shows the same gene mutations as the other patient’s breast cancer. Therefore, both these cancers need to be treated with the same medicine. The location of the cancer is totally irrelevant.

The problem is that federal agencies and the health insurers are still stuck in the past. My cancer, the salivary duct carcinoma of the parotid is practically a twin of the ductal carcinoma of the breast. It stands to reason that a drug that worked against one is likely to work against the other too. Because breast cancer is very common and parotid cancer is exceedingly rare, it is far, far easier for researchers and drug companies to test a new drug against breast cancer than against parotid cancer. Therefore, they can present convincing data to the FDA to show that a particular new drug works against breast cancer and thus get the approval for its use in breast cancer treatment. Unfortunately, parotid cancer patients, due to their small numbers, are left out in the cold. There are plenty of drugs that are FDA approved for use for breast cancer but none for parotid cancer. This allows the health insurers to refuse payment for most new drugs for patients like me. It becomes an uphill battle, often futile, to fight. I am blessed to have had the wherewithal I did, but not everyone survives the fight.

The simple logic is that if a drug blocks Her2 and successfully treats Her2-positive breast cancer, its use should be approved for any cancer anywhere that is Her2 positive. Unfortunately, this simple logic is lost on many in the hierarchy.  Lately, there have been some encouraging signs that the FDA is moving in this direction. Insurers are still slow to respond but ultimately they will.  Tomorrow is looking better and brighter.

I think of the whole thing in this way: The evolution of cancer treatment is similar to the evolution of how we used telephones. Years ago, in the 1940s and 1950s, we had neighbors sharing the same line, first the crank-up type and then old rotary phones—party lines they were called. It would not be unusual to pick up the phone and learn that your next-door neighbor was already talking on it. You would have to wait—and hope that your neighbor would not blather on for another hour before you could make your call.

Later, we began to see home phones—one house, one line. But still, everyone in the house was on the same line. If you picked it up to make a call, you might hear your brother talking to his girlfriend. You couldn’t get on until he hung up.

Today we have cell phones and the days of the house phone are almost over; the concept of a party line is simply laughable. 

Cells phones of today are highly personalized and sophisticated communication tools. They are configured exactly to specific users’ specifications: their own phone number; the exact amount of memory they need; the number and kinds of apps they want installed; their contact list; their choice of songs, photos, videos, and documents; and even their very personal and confidential data. It is a highly personalized gadget now.

So is cancer treatment.

And that wonderful news is why if there were a better time to have cancer, to have a doctor drop the bad news on you, it is today—right now.

Why is this happening?

On one front, medical science continues to make extraordinary strides. Each new kernel of knowledge accelerates and expands what was previously known—one new discovery leads to five more. Targeted therapy is one example—but a very good one.

On a second front, doctors have begun to expand their knowledge about how to marshal the body’s own defenses, its own immune system, to attack cancer.

Former President Jimmy Carter astounded the world in December 2015 when he announced he was cancer free. Only months before, he had said it was unlikely he would survive the late-stage malignant melanoma that had spread to his brain.

He might have astonished the general public, but medical insiders were not as surprised. Mr. Carter was the beneficiary of a new wonder drug, Nivolumab, and the relatively new concept of immunotherapy for cancer—checkpoint blockade.