Something Evil This Way Comes

This article probably won’t be much of a surprise to anyone who has lived it, but…

Thursday, 29 May 2008 01:13 UK

Cancer survivors ‘left in limbo’

Many long-term survivors of cancer are not getting the help they need to cope with the after-effects of the disease, experts warn.

More than 60% of adults with cancer can expect to live five years or more, according to an article in the European Journal of Cancer.

Yet they are left “in limbo” to deal with ongoing symptoms from their disease or harsh cancer treatments.

The government said it was working to improve services for cancer survivors.

Professor Marie Fallon, an expert in palliative medicine at the University of Edinburgh, said the number of people living with the effects of cancer was rising as more and more people were surviving the condition.

There is an enormous population of long-term survivors of cancer, many of whom are living with a range of symptoms
Professor Marie Fallon

She added that cancer survivors would suffer ongoing symptoms but often be confused about whether they were treatment-related or whether they were a sign the cancer had come back.

“Traditionally, palliative care has been aimed at one end of the spectrum where it is used to help patients near the end of their lives,” she said.

“However, there is an enormous population of long-term survivors of cancer, many of whom are living with a range of symptoms.”

“These patients exist in a limbo.

“They fall between two stools – they have finished being treated by oncologists, but are not receiving the care and support from palliative care teams that patients at the end of life receive.”

She added the ongoing problems, which included pain, swelling and depression could result in poor quality of life.

Better provision

Better integration was needed between oncology services and palliative care to prevent people falling through the gap, she said.

And there needs to be a clear agreement of where patients can access help and who should be responsible, she added.

Professor Alexander Eggermont, president of the European Cancer Organisation, said: “To be cured from cancer, but living with symptoms that are related to often complex multi-disciplinary treatments involving surgery, radiation therapy and chemotherapy is already difficult enough.

“To reintegrate into society, resuming work full or part-time adds to the complexities and socio-psychological pressure that an ever-increasing number of former-patients have to deal with.

“We better start tackling these issues now as they will only increase in number and magnitude.”

A Department of Health spokesperson said deaths from cancer in people under 75 fell by 17% between 1995 and 2006.

“The Cancer Reform Strategy published in December 2007, recognised that the services and support available to those living with and beyond cancer needs to be improved and announced the establishment of a new National Cancer Survivorship Initiative to deliver this.”

This news story is all over the internet today. This is the Globe and Mail’s version of the story. I gotta say, I am relieved that cancer researchers have finally decided to work *together* and share their research results so maybe we could make some headway with this nasty business.

Here’s how the Globe said it:

Ten countries co-ordinate cancer fight

CAROLYN ABRAHAM

Globe and Mail Update

April 29, 2008 at 12:14 PM EDT

Research groups from 10 countries are announcing today an unprecedented global effort to combat cancer, one of the world’s leading killers.

The collaborative project, dubbed the International Cancer Genome Consortium, will hunt the genetic mutations that drive 50 different types of cancer – from breast to bone. The consortium, in which Canada will play a lead role, plans to share results rapidly, widely and freely so scientists can quickly develop new diagnostic tests and treatments to counter them.

Each member country plans to spend roughly $20-million (U.S.) tackling at least one subtype of the disease, collecting specimen samples from 500 patients, and studying the genetic glitches they find in their cancerous cells. With 50 cancers to be studied, not all of them have been assigned a country yet.

But China, for example, intends to study liver cancer, since the country has particularly high rates of that disease. Japan will take on gastric cancer. India has an interest in oral cancers, France in sarcomas – cancers of the bone and connective tissue. Several countries will focus on breast cancers, including Britain and the United States, where research groups are also interested in brain and colon cancers.
Internet Links

* International Cancer Genome Consortium Popup
* ICGC Goals, structure, policies and guidelines (pdf) Popup

The Globe and Mail

Canada, which is to store, crunch and share all the data collected, will take on the pancreas.

”We picked a hard one,” said Dr. Tom Hudson, scientific director of the Ontario Institute for Cancer Research in Toronto, which will be the project’s home base as the ICGC Secretariat. ”There’s been research (into pancreatic cancer) but not much success. There’s just no survivor community.”

Dr. Hudson, who has helped to spearhead the consortium, noted pancreatic cancer is the 12th most common form of the disease, but one of the deadliest. More than 98 per cent of patients die within six months after diagnosis.

”In 2008, there will be 3,800 new cases and 3,700 deaths in Canada,” Dr. Hudson said. ”It’s almost always found too late.”

The consortium has come together in a whirlwind of meetings, conference calls and funding commitments during the past six months, driven by swift advances in computing technology that allow researchers to rapidly and cheaply read DNA. It is expected to amass 25,000 times more data than the international Human Genome Project, which produced the first draft sequence of human DNA in 2001.

DNA, the three-billion-chemical base-pair code that contains the operating instructions for human life, can be found in the nucleus of nearly every cell in the body. In cancer cells, however, that genetic code can be riddled with hundreds of mistakes, spawning cells that can multiply madly into deadly tumours.

”We know when you look at cancer cells, there can be thousands of mutations in that tumour cell…that were not inherited,” Dr. Hudson said. Specifically, he added, scientists are chasing the ”driver mutations” that allow a cancer to grow and spread and these are often different in different types of cancers.

Certain mutations have already proved worthwhile targets for treatment. Dr. Hudson pointed to the successful drug Gleevec as a prime example that has triggered remission in many patients. First approved to treat chronic myeloid leukemia, Gleevec works by blocking the abnormal version of a protein that a certain gene produces in the leukemia patients.

The treatment, which has since also been approved to treat a form of gastric cancer, represents a new class of drugs that selectively kill cancer cells without harming healthy ones. The lauded breast cancer drug Herceptin is another example of a therapy that selectively targets a specific molecule over-expressed in malignant cells.

There are few other examples, however, of such effective therapies, Dr. Hudson said, largely because it has been slow and expensive to find targets. He estimates that the consortium will run a 10-year effort, but ”we don’t have to wait 10 years (for a result), we will release it as we find it.”

The results will be made available to researchers worldwide and all those involved in the consortium have agreed ”not to file any patent applications or make other intellectual property claims on primary data from ICGC projects.”

The Ontario Institute for Cancer Research, with a five-year, provincially funded budget of $347-million, plans to spend $30-million on the project. At a press conference Tuesday morning, however, Ontario Premier Dalton McGuinty said the province will also contribute an additional $10-million to fund the OICR’s role as Secretariat.

Mr. McGuinty noted that Ontario, as a sub-national government, beat out the United States and Britain to lead the ICGC, and is essentially punching above its weight.

”Cancer is devastating to families and that’s why we’re doing all we can to help save lives,” Mr. McGuinty said. ”This investment puts Ontario at the forefront of international research that will save lives around the world.”

The money has so far allowed the institute to purchase 10 ultra-fast DNA-sequencing machines and lure top talent from the United States to take on the task. Among those recruited for ICGC job to Toronto, Dr. Hudson said, are Lincoln Stein, a pathologist turned bio-informatics ”guru” from Cold Spring Harbor, N.Y., and John McPherson, a Canadian scientist returning home from Baylor College of Medicine in Houston after 20 years in the United States.

Dr. Hudson said it is hoped the federally funded Genome Canada will contribute more money for the project, which would allow Canadian researchers to study other cancers, namely those of the brain and ovaries.

”We don’t want the pancreas to be the only one we do,” he said. Dr. Hudson is no stranger to science on a massive scale, having played an early role in the human genome project, and the international Hap Map, which was the first effort to chart genetic differences between four of the world’s major ethnic populations.

Duplicating efforts by studying the same cancer types in different countries is crucial, Dr. Hudson said, because ”tumours of the colon look different in Singapore than they do in Toronto.”

Researchers suspect environmental, dietary and genetic differences can impact the way cancers develop in different regions of the world.

More countries are expected to join the consortium in the coming months. The list so far includes: Australia, Canada, China, Europe, France, India, Japan, Singapore, the United Kingdom and the United States.

The whole thing went like this….

I went out with some friends from work. They went outside to smoke a cigarette. I stayed behind, having given up that vice a couple of years ago. I decided to read the local free rag while they smoked.
Savage Love is a column in that paper.
Savage Love is the column I read while my friends smoked.
Savage Love is the column that made me all weepy and misty-eyed in a far from strategic setting.
The story is here:

For those of you too weary to click the link, and also somewhat curious about copyright law and whether I might get tonked, here is the text.

At a Loss
April 3, 2008
By Dan Savage

I thought I could bang out a column today—a regular column, a column about my readers’ problems and their freaky fetishes and all those asshole politicians out there. You know, the usual.

The day my son was born, I managed to slip out of the maternity ward and write a column; I wrote one the day I was indicted by the state of Iowa for licking Gary Bauer’s doorknobs. (I was actually indicted for voter fraud—on a trumped-up charge, your honor—but Bauer’s knob needs all the attention it can get.) I’ve written columns on days that I was dumped and on the morning of 9/11. So I figured that I could bang out a column today.

I opened my laptop and started reading your letters. I love reading your letters—I do. But I couldn’t get into it. I just don’t have a column in me this week. I’m disappointed in myself. I write this column at Ann Landers’s desk, for crying out loud, and the old lady banged out a heartbreaking, truncated column when her marriage collapsed. If Landers could bang one out under that kind of emotional strain, then I could damn well bang one out, too. Just do it, right? Just fucking do it. But I just fucking can’t.

My mother died on Monday.

Perhaps a sex-advice column isn’t an appropriate place to eulogize an articulate, elegant woman, a practicing Catholic named for the patron saint of hopeless causes and, perhaps consequently, a Cubs fan. I mean, really. Eulogizing my mother back here with the escort ads? So let’s not think of this as a eulogy. Let’s think of it as a thank-you note, the kind of nicety that my mother appreciated.

Forgive the cliché: My mom gave me so much. She gave me life, of course, and some other stuff besides: her sense of humor, her bionic bullshit detectors, her colossal sweet tooth. She also gave me—she gave all four of her children (Bill, Ed, Dan, Laura)—her unconditional love. Long after I came out, she told me she always suspected that I might be gay; I was the quiet one, the boy who liked Broadway musicals and baking cakes and shared her passion for Strauss waltzes. When I asked my parents to take me to the national tour of A Chorus Line for my 13th birthday, that should have settled the matter. Your third son? Total fag, lady. But my parents were Catholic and religious and it somehow still came as a shock when I told them. My mother came around fast and she came out swinging—rainbow stickers on her car, a PFLAG membership card in her wallet, and an ultimatum delivered to the whole family: Anyone who had a problem with me had a problem with her.

But the real reason I feel compelled to thank her in this space, back here with the escort ads, is because I wouldn’t have this space if it weren’t for her.

My mother, as my brother Bill likes to say, made friends like Rockefeller made money and George W. Bush makes mistakes—and she was that friend you confided in and went to for advice. I was a mama’s boy—hello—and I spent a great deal of time in my mother’s kitchen listening to her tell her friends exactly what they needed to do. Sometimes gently, sometimes brusquely, always with a dose of humor. My mom liked to say that her son got paid to do something that she did for free—and isn’t that the way the world works? Women cook, men are chefs; women are housewives, men are butlers; she gave advice, I got paid to give advice. (And for a few years, she did too; my mother and I wrote a joint column for a couple of websites in the 1990s.)

So I want to thank my mom. I wouldn’t be writing this column today if it weren’t for her gifts and her ability to find the humor in even the most serious of subjects.

Even death, even her own.

After a long struggle, we had to go into my mother’s hospital room and tell her that nothing more could be done. She didn’t go into the hospital expecting to die and she was not ready to go. But she took the news with her characteristic grace. She said her farewells, asked us never to forget her (as if), and paused for a moment. Then Mom lifted an eyebrow, shrugged, and said…

“Shit.”

My mother wasn’t crude; I didn’t get my foul mouth from her. She used profanity sparingly and then only in italics and quotation marks. When she said “shit” on her deathbed, we understood the joke. What she meant was this: “Now, the kind of person who casually uses profanity might be inclined to say ‘shit’ at a moment like this. But I’m not the kind of person who casually uses profanity—and certainly not at a moment like this. But if I were the kind of person who casually used profanity, ‘shit’ might be the word I would use right now. If I were that kind of person. Which I’m not.”

Everyone gathered around her bed—my mother’s husband (my son has two fathers and so do I), my sister, my aunt—knew what Mom wanted: She wanted us to laugh. This woman, so full of life, who wanted so badly to live, having just been told she would not, she was trying to lift our spirits. (“Shit,” for the record, wasn’t her last word. Those were just for the family.)

Anyway, my mom is dead, and I am not in the mood, as she used to say. (“You are so,” one of us kids would usually respond. “You’re in a bad mood.”) So I’m going to take a week or two off, from the column and the podcast, hang out with the boyfriend and the kid, and burst into tears in coffee shops and grocery stores. I’ll run some greatest hits in this space while I’m away—I’ll find a column or two featuring Mom—and then I’ll be back, just as filthy minded as ever. In lieu of flowers, please send pictures of your boyfriends’ rear ends. (Lesbians may send flowers.) If you’re the donation-making type and you’re so inclined, my mother would be pleased to see some of your money flow to PFLAG (www.pflag.org) or the Pulmonary Fibrosis Foundation (www.pulmonaryfibrosis.org).

Oh, one last thing: I was supposed to take my mother to see the national tour of The Drowsy Chaperone in Chicago this Friday, April 11. It was her birthday present. I got us great seats: seventh row, on the aisle. But I won’t be able to use our tickets now. Not because it would be too depressing to go without my mother—not just because—but because, as rotten, stinking fate would have it, I’m going to be at my mother’s wake on Friday night.

But I’m practical, like Mom, and I’d hate to see perfectly good tickets to a national tour of a hit Broadway musical go to waste. And it occurs to me that there has to be a teenage boy out there—in Chicago or close enough—who likes musicals and has a mother who loves him for the little musical-theater queen that he is. If you know that boy or you are that boy or you were that boy a decade ago or if you’re that boy’s mother or grandmother, send me an e-mail and I’ll arrange to get these tickets to you.

Like I said, they’re great seats. I would go if I could. But I can’t.

Shit.

mail@savagelove.net

If Dan Savage wants to sue me for copyright violation, I guess he and I can duke it out at the orphanage.

I just found this post on the Best of Craigslist.
Sort of a primer for how to deal with people with cancer.

http://www.craigslist.org/about/best/pdx/465030621.html

Filed under the heading of

“Oh crap, sorry about that.”

ANDRÉ PICARD

From Wednesday’s Globe and Mail

February 27, 2008 at 9:51 AM EST

Drugs commonly given to cancer patients because they are anemic after chemotherapy appear to increase their risk of dying, according to a new study.

The research, published in today’s edition of the Journal of the American Medical Association, suggests that the drugs, called erythropoiesis-stimulating agents (ESAs for short), may actually provide fuel to cancerous tumours.

“It’s troubling that 15 years after the drug came out, we finally came to this realization,” said Charles Bennett, an oncologist at Northwestern Memorial Hospital in Chicago and lead author of the study.

He said accepted practice is that using ESAs in moderation is safe but the new research challenges that view, “raising the concern that the drug may be stimulating cancer and shortening cancer patients’ survival.”

The new study is a meta-analysis, a compilation and analysis of previously published research. A total of 51 studies were included with 13,613 patients.

The analysis showed that patients who received ESAs to treat anemia had a 10-per-cent increased risk of death compared with cancer patients who did not receive the drugs.

Anemia is a common side effect of chemotherapy. Chemotherapy helps kill cancer cells, but it also eliminates good, healthy ones such as blood cells. It can decrease red blood cell levels, causing anemia and exhaustion.

Anemia can be treated with blood transfusions, but, in recent years, it has become common practice to treat the condition with one of two drugs, erythropoietin or darbepoetin, which stimulate production of red blood cells.

Last year, the U.S. Food and Drug Administration issued a public health warning about ESAs, particularly their use in cancer patients not undergoing chemotherapy.

Safety concerns are related to the fact that these drugs can cause life-threatening blood clots.

The new study confirms that concern, showing that patients receiving ESAs see their risk of blood clots in the legs or lungs jump by 57 per cent.

About 7.5 per cent of cancer patients treated with ESAs developed blood clots compared with 4.9 per cent who took placebos in the study. Dr. Bennett said that the increased rate of death does not appear to be due to blood clots, but rather by a return of cancer.

Another researcher involved in the study, Stephen Lai, an assistant professor at the University of Pittsburgh Medical Center, did laboratory work that showed cancer cells were stimulated when he exposed them to ESAs.

“We saw dramatic change,” he said. “Giving cancer patients EPO [a type of ESA] for their anemia may actually cause their tumours to progress.”

Dr. Bennett said he believes the findings should have an influence on clinical guidelines and oncologists should rethink their use in cancer patients.

“If I had cancer and needed a blood transfusion, I would be much more conservative about taking ESAs,” he said.

ESAs such as darbepoetin (brand name Aranesp) and erythropoietin (brand names Epogen and Procrit) are used to treat kidney disease as well as chemotherapy-related anemia.

According to the paper, ESAs generate sales of more than $6-billion (U.S.) annually in the United States.

Hope for a reliable, early detection test

Phase III evaluations have begun on a blood test developed by
researchers out of the Yale School of Medicine. So far the test has
detected newly diagnosed ovarian cancer with 99.4 percent accuracy by
using six protein biomarkers. “We hope this test will become the
standard of care for women having routine examinations,” says lead
author Gil Mor, M.D., associate professor at the department of
Obstetrics, Gynecology and Reproductive Sciences at Yale.

The test requires further study and extended follow-up with more
patients, however the news represents an encouraging development in the
search for a reliable, early detection test for ovarian cancer. Results
from the phase II clinical trials were published in the February 15
issue of the journal Clinical Cancer Research.

It certainly has been a wild ride these last few years and I find myself becoming reluctant to talk about any of the details of my ever so melodramatic life because it all seems so very over the top. It’s been hard. I guess I am just paying in advance for the salad days that are just over my horizon. When my address changes to “General Delivery, Easy Street, Vangroover, BC Canada”
I’d like to believe that.

Anyway, not to come out and sucker punch folks now that I have you thinking about other stuff but my dad died last week.
I haven’t really been talking about it because I can’t really think of anything to say about it. It’s all sort of surreal, and then that sounds like a stupid thing to think since the man has been dreadfully ill for the last couple of years. I sort of think that since my mom died, he didn’t think there was so much left to fight for. I dunno. I do tend to believe that he finally gave himself permission to let go, but I wasn’t there and I don’t really know what happened inside his head.

Anyway, he’s gone.
And she’s gone.
I confess, I don’t harbour images of a verdant and pastoral place where they are goofing around now, but I’d like to. If he threw in the towel because the woman he loved his whole life was gone, then I hope that somehow, they get to be 18 and together again.

Rodger Dodger
over and out.

Yesterday was, or depending on your perspective, would have been my mom’s birthday. One of the strange things that comes up around my mom’s death is which tense to use in which situation. Like, was yesterday her birthday? Do dead people have birthdays? I really don’t know.

It’s also strange because my parents’ house is being put on the market. Now, I stumble when I say “my parents’ house” because it seems to me I really should have erased my mother from that equation and updated it to “my father’s house”. Except the ironic part is, my father hasn’t even been in that house since my mom died. And on that technicality, I feel I am allowed to continue referring to it as my parents’ house.

It’s also strange because my mother spent a lot of time telling us, her three kids, which bits of Harris treasure we would get or inherit when the time came. Well, the time has come. What is it they say about the best laid plans?

We ain’t no kin to the Rockefellers but when my parents bought something, which wasn’t that often, they bought good stuff. We had a very nice dining room suite that was promised to my brother. As a kid, it always annoyed me that he got the most cherished chunk of the inheritance pool. Now it’s time to move all that stuff from my parents’ home, and my brother has no room for that dining room suite. In a different life, I would love to have it, but simply don’t have the space and I shudder to think what my cats would do to it. My sister also is suffering from space restrictions.

It’s just a very strange feeling to have been told for your whole life that one day you will own this thing. And the thing has been assigned value by the very act of someone wanting to pass it along; of making a point of passing it along, because it mattered to them. And now there is nowhere for it to go, except maybe to an auction house. It’s caused me to look around my place and imagine what bits of stuff that I have that might get passed on to someone else, and what parts will end up in the landfill cuz most of us have very little room for more stuff.

So, my parents’ home has to be emptied out so someone else can move into it. And while I have never lived in that house, I still feel a strange loss. It’s not the loss of “my home”, per se. Only twice in my life have I felt like the house I lived in was “my home” and this house doesn’t qualify. But there is the loss of some sort of safety net. I suppose it’s another step in finalizing the growing up thing. There is absolutely no safety net anymore. That’s okay, it’s just a new feeling.
I try to imagine what it will be like, in the future, to drive along that highway and *not* take the exit that leads to my parents’ home, to just keep on driving till I land in a motel room further on up the road.

It also means facing the fact that lots of things that were important to my mom have no place to go and so they will probably go to the Goodwill or to the dump. That process, the throwing away of something she valued and in many cases made by hand, that’s the part that almost kills me.

Sometime in the next month or so, between work and school, I will go and help my siblings empty out my parents’ home. And I feel an astounding level of dread whenever I think about that, for quite a few reasons. A big one is that emptying out the house, the house I don’t care about, will bring a whole new level of finality to the situation. It feels a bit like closing a door on my parents.

I’m still working through it all.