December 29, 2012 — A Donor’s Story

Here’s a story that makes me feel good — especially so, since I could potentially be on the receiving end of this sort of generosity someday.

These words were spoken by William Hudson, a CNN producer, after making a bone-marrow donation to save the life of a total stranger:

“I knew that no matter how much time and money I did or did not donate to nonprofits and charities doing important work, this was different. Here was a patient with a blood cancer whose particular immune system resembled my own. Turns out I, among potentially everyone in the world, was in the best position to save her life. It’s an awesome responsibility and opportunity.”

The most important thing, in making this sort of life-saving difference for someone else, is to join the national bone marrow registry. As Mr. Hudson explains it:

“Joining is a small time investment — all it takes is a few cotton swabs of saliva — but understandably seems to have no payoff. The chances of ever becoming a donor are only about 1 in 540.... I was on the registry for five years before I received a potential donor letter.”

According to the article, should a member of the network be selected as a donor, there are two ways the necessary stem cells can be harvested: an actual bone-marrow harvest (a minor surgical procedure), or the much easier peripheral blood stem cell donation, or PBSC — which is not much more difficult than taking a pill for five days, then donating blood. Procedures have improved to such a degree in recent years that, for most adult recipients, either procedure works well. In the case of some children, an actual bone-marrow donation is preferred.

I’ve had the preliminary tissue-typing done at the Hackensack University Medical Center so that, should my indolent lymphoma flare up in a dangerous way, I could receive a bone-marrow donation. I’ve struck out with both my brothers — both were tested, but were not good matches for me — so in that event I’d be dependent on an anonymous donor. According to the best medical science today, the only potentially curative treatment for the sort of lymphoma I have is a transplant (although at this time, when my disease appears to be dormant, the potential side effects outweigh the advantage of seeking a transplant).

Becoming a donor — even joining the registry — is a beautiful thing.  To find out more about joining the registry, go to marrow.org.

December 27, 2012 - Profit Centers

If you’re a cancer patient who has received chemo treatments in your doctor’s office, here’s an article that may give you pause.  It’s a Reuters article by Andrew M. Seaman, dated yesterday: “Some cancer docs say their income tied to treatments.”

As the article makes clear, it’s not a question of whether oncologists actually do make more money administering treatments in their offices (as opposed to referring patients to a hospital’s outpatient clinic). The question is whether the doctors THINK they do.

If they do think that’s the case, then there’s the potential for a disturbing conflict of interest.

Here’s the $50,000 (or more) question: “In the case of oncologists who also run chemo clinics, what takes first priority in their minds — the medical necessity of a given round of treatment or their potential to realize a higher profit?”

I’d like to think most doctors are above such venal considerations. Yet, I’m also enough of a Calvinist to believe no one is immune to that sort of temptation. Better to eliminate the temptation, I say, than to count on human nature to always pursue the most ethical course, when there are pecuniary considerations at work.

Speaking for myself, I have to say I still have great personal confidence in Dr. Lerner, my oncologist, even though he and his colleagues in the medical group do own a chemo clinic (where I did, in fact, receive my treatments). That’s because of a certain experience I've had. When, just after my R-CHOP chemo treatments had ended, the question came up about the advisability of maintenance Rituxan treatments in my case, Dr. Lerner recommended against it. He said, at the time, that in his view the body of research was still not there to declare that this was, indeed, the right thing to do.

I do realize it’s now over 6 years later, and the results of some more recent clinical trials would perhaps lead my doctor to give different advice today, but  the important thing, to me, is that he declined on medical grounds to recommend that expensive treatment that would have put more profits in his pocket.

It’s these very same maintenance Rituxan treatments, that can continue monthly for many years after initial chemo treatment, that some doctors refer to as their “Rituxan retirement plan.”

The historic pattern, with most medications, is for doctors to write a prescription and for a pharmacy to fill it. Unless the doctor also happens to own the pharmacy, there’s no conflict of interest. When doctors own outpatient chemo clinics, however, it’s as though the doctor owns the pharmacy.

The same is true for the “outpatient surgi-centers” that have sprung up all over the place — which are typically owned by the very same doctors who refer patients to them (and, in most cases, perform the surgeries as well). They’re essentially little freestanding, specialized operating-and-recovery rooms. They make it possible for patients to undergo outpatient surgery, complete with general anesthesia, without ever setting foot in a hospital. (An ambulance is permanently parked out back, to whisk patients to the hospital, should complications develop.)

The problem — for non-profit hospitals, anyway — is that the for-profit surgi-centers siphon off many of the operations that typically bring in more money than they cost to perform. This leads to underused hospital operating-rooms and a corresponding decline in hospital income. The hospitals, then, are stuck with paying all the costs of operations and outpatient treatments for uninsured or underinsured patients, who would never make it through the door of the doctor-owned facilities.

At the very least, I think you’ll agree: this is something worth pondering, right?

December 21, 2012 - Good News on the Lymphoma Research Front

Here's an encouraging article about developments in treatment for Follicular Lymphoma - a few years old now (2008),  though I hadn't seen it before. I may or may not have that type of NHL now - my biopsy tissue samples were pretty small, so the docs can't say for sure whether the indolent lymphoma I now have, post-chemo, is the Follicular type, or some other variety of small B-cell lymphoma.

In any event, I take this to be positive news for my situation:

Natural History of Follicular Lymphoma Changing for the Better
CARLSON, ROBERT H.

LUGANO, Switzerland-The prognosis for patients with follicular lymphoma has greatly improved over the past decade, and oncologists/hematologists should tell their patients to be optimistic. So said James O. Armitage, MD, in his John Ultmann Memorial Lecture here at the 10th International conference on Malignant Lymphoma.

Improved treatments are the main reason for increased survival, particularly immunotherapy, said Dr. Armitage, Professor of Internal Medicine in the Section of Hematology/Oncology at the University of Nebraska Medical Center. Our treatments are getting better, and there is a subset of patients, albeit small today, who survive for a very long time free of the disease. Patients in that subset may actually be cured of follicular lymphoma, and we can hope with our patients that they might be in that group.

Dr. Armitage's presentation took the audience through studies and analyses all pointing to the fact that the natural history of the disease is changing for the better.

He concluded that clinicians should take advantage of the new treatments: "Based on data I showed today, a new patient should always be treated with some form of passive immune therapy, if the drug is available. For most patients that would be rituximab, because there is really striking data that that improves survival."

He added that some data show that rituximab should be included in the initial therapy for follicular lymphoma, but he said that issue is not completely resolved.Despite the fact that we know much more about this disease than we did in the past, there is still very much to be learned, and we should encourage our patients whenever possible to participate in clinical studies.Dr. Armitage said many oncologists believe follicular lymphoma to be a fairly simple disease to diagnose and treat. Survival is long, and patients respond to many different therapies and continue to respond after relapse unlike in many other malignancies.

For the rest of the article, go to the source of the story, the website of the British medical journal, Oncology Times.