Lung Cancer (MD Anderson Cancer Care Series)
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After being diagnosed with multiple myeloma 12 years ago, she depleted all her assets, including selling her co-op in Brooklyn, New York, and now lives on disability with her partner in Takoma Park, Maryland. Despite the growing backlash, prices continue to climb an average of 10 percent a year. What's fueling this trend, says Dr.
Food and Drug Administration greenlights drugs if they're proved safe and effective. But new isn't necessarily better. Zaltrap, which was approved in for metastatic colon cancers, is a notable example. Yet Medicare, the nation's largest insurer, with 54 million enrollees , is required to cover every cancer drug the FDA approves, and it is not allowed to negotiate drug prices.
Essentially, these two provisions robbed Medicare of any cost-cutting leverage, because it can't bargain or threaten to drop a costly but only marginally effective medication. Compounding this is the problem of treatment resistance. Conventional therapies—whether chemo or the newer biologics that target genetic mutations that prompt unchecked cell growth—eventually stop working once the cancer cells learn to outwit them. At which point, desperate patients move on to the next drug in the therapeutic arsenal, until they've exhausted all their options.
Yet even if those treatments add only a few weeks of life, oncologists feel morally obligated to prescribe them to dying patients, which means that drugs with minimal benefits can become a bonanza for their makers. In other industrialized nations, state-run health systems have the latitude to decide what drugs will be covered under their health plans, which enables them to negotiate deep discounts on pricey medications.
But in the U. Drugmakers justify the high price tags because development costs are staggering. However, critics counter that those development costs are artificially inflated because they factor in losses for dry holes. Only For every potential blockbuster like Yervoy, there are dozens of costly disappointments.
In the past 15 years, 10 new lung cancer drugs came on the market, but promising compounds foundered in the development pipeline. Similarly, seven new melanoma treatments were approved, while 96 experimental therapies fell by the wayside. And drugmakers can burn through millions concocting these mind-bogglingly complicated meds. Then there are the opportunity costs—in other words, the Plus, more than half of the breakthrough drugs devised in recent decades—like Gleevec, a drug for leukemia , and the breast cancer treatment Herceptin , as well as Yervoy —were largely developed by taxpayer-supported researchers at academic institutions.
In a way, drugmakers are victims of their own success: The number of cancer survivors has risen steadily in the past decade. Today, there are nearly 14 million American cancer survivors, up from less than 3 million in , the year President Richard Nixon declared war on cancer and signed the National Cancer Act.
That's attributable in large part to earlier detection and better treatments. And companies do have a right to recover their investment—if prices tumble once meds have been on the market for a while. For the nearly 90, patients who will go to the center in Houston this year, that mission cannot be fulfilled soon enough. Some rent apartments or stay in mobile home parks near the hospital. They enter through a soaring lobby, with cheery aquariums and exuberant volunteer greeters eager to help in any way.
They come looking for hope. But there is no mistaking what this place is: the front line of the frustrating war on a still largely incurable disease.
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Doctors are encouraged to try everything, and when insurers balk, they pick up the phone, repeatedly, hoping to persuade them to pay for what may be unconventional treatments. The federal government gives more cancer research money to this hospital than to any other, and the hospital has an abundance of specialists in many forms of cancer, including rare ones.
Medicare offers more generous reimbursement, and the hospital offers treatments that often go far beyond what can be offered at most other places. Martin Raber, an oncologist — and a cancer patient himself — at Anderson. The odds are still grim, and while there are exhilarating recoveries, the exhausting, dispiriting road traveled by many patients comes into sharp relief.
They are patients like year-old Mindy Lanoux of San Antonio, who has melanoma that has spread to her liver and lungs, her odds of surviving in the single digits. She has been to the hospital 16 times in nine months, spending a week there each time for treatments so debilitating she wanted to give up. Lanoux said.
It takes your brave edge off. Then she and her father go to her room and start putting her things away. It is like an army setting up to do battle. Planet Cancer. With more than 17, employees and warrens of color-coded hallways so vast that even employees get lost, M. Anderson is its own parallel universe, where nothing matters but cancer.
The University of Texas MD Anderson Cancer Center ranked best cancer hospital in country
Patients sit in the lobbies and compare notes. Every patient at Anderson has cancer. Anderson is a quiet place. No loud pagers.
The walls are decorated with vivid photographs of serene scenes, like water views. The muted colors in the hallways, soft cranberry and dull green, are meant to be soothing. There is a library and a cybercafe. It is a place meant to give hope. Sometimes, as happened with Frances Anderson of Shreveport, La. She discovered three years ago that she had a brain tumor , but it did not start in her brain.
In fact, it is not clear where it started. After being told by a doctor elsewhere that she had four to seven months to live, she ended up at Dr. At 66, wearing pressed jeans, her short blond hair carefully styled, Ms. Anderson has vision problems from the surgery to remove the brain tumor, and she gets tired. She still has cancer, but she exercises every day and is living with her disease, returning to Anderson every six months for checkups and scans. Others are not so fortunate. One morning last month, Joe Maxwell , 52, sat in a chair next to his hospital bed, a compression bandage around his now-useless swollen left arm, a large bandage over his left shoulder.
He was going home to sit on his deck in Kerrville, Tex. He had tried everything Anderson had to offer and decided that, with an estimated two weeks left, he would go home to die. At Anderson, doctors tried everything they could think of — surgery, round after round of chemotherapy , a clinical trial of an experimental drug.
Nothing worked. Finally, the doctors suggested yet another drug. Maxwell said. But leaving late last month was bittersweet. He died 10 days later, early in the morning of Oct. Even those who finish their treatments and live cancer-free are forever changed by the experience. Toland learned that lesson from her son, George Toland. Twenty-four years ago, when he was 21, he was a sarcoma patient at Anderson. His mother tried to reassure him, telling him that he would be fine, that he would go on to a perfectly normal life. Toland knew he was right.
You lost yours all at once. Battling the Odds. Donald Berry, a statistician who is head of the division of quantitative sciences at Anderson, says part of his role at the cancer center is to provide a reality check. Yes, it is true, as doctors and nurses there repeatedly say, that treatment has improved. Anti-nausea drugs have all but eliminated the constant vomiting that once accompanied chemotherapy.
New drugs are attacking genes that go awry in cancer. Most cancer patients come and go over a period of years, for checkups, scans, treatment if the cancer is still there. In between they go on with their lives. But there is still little that can be done for most of those whose cancer has spread. And, Dr. Anderson can have a hard time facing, understandably so. Russell Harris, an associate professor of medicine at the University of North Carolina and a member of a board that evaluates cancer therapies for the National Institutes of Health, said the temptation at major cancer centers like Anderson was to try treatment after treatment.
Harris said. Such a no-holds-barred stance, he added, is spurring a growing debate in the cancer community. An aggressive — and expensive — course of treatment can place a huge burden on patients. Lanoux knows that all too well.
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She came hoping for a cure for her advanced melanoma , but got her first dose of reality the day she walked into the main lobby. She saw patients in wheelchairs, their heads sunken on their chests. She saw patients who had lost their hair, patients wearing sky-blue masks to protect them from infections.