Patrick Swayze, the popular actor perhaps known best for his role in the 1987 hit movie “Dirty Dancing,” died today of pancreatic cancer. My thoughts are with his family in this time of grief.
Pancreatic cancer is among the more deadly forms of cancer. I asked GI oncologist, Heinz-Josef Lenz, M.D., professor of medicine and professor of preventive medicine in the Division of Medical Oncology at the Keck School of Medicine at the University of Southern California, to explain why that’s so.
Dr. Val: Why is pancreatic cancer so much more deadly (i.e. less treatable) than many other forms of cancer?
Dr. Lenz: Unfortunately we don’t have very effective drugs for pancreatic cancer, which makes it one of the deadliest cancers of all. The median survival is about 8 months with metastatic disease. Even when the tumor is successfully removed there is a very high risk for tumor recurrence. We need more funding to better understand the risk for pancreatic cancer and identify and develop more effective therapies.
Dr. Val: Can you describe the typical course of metastatic pancreatic cancer?
Dr. Lenz: Unfortunately, the 5 year survival rate for pancreatic cancer is only 15 to 20%. The average survival after diagnosis is 12 to 19 months. The best predictor of long term survival is if the tumor is found and removed before it reaches 3 cm in size. Patients with metastatic pancreatic cancer are usually treated with a combination chemotherapy consisting of gemcitabine, tarceva, xeloda or oxaliplatin. However the response rates are (despite using aggressive combination therapies) low. Large clinical trials recently did not show any benefit from erbitux or avastin, again demonstrating that pancreatic cancer therapy is a difficult clinical challenge.
Dr. Val: Are certain populations at higher risk than others for pancreatic cancer?
Dr. Lenz: Age is the most important risk factor for this cancer. It is most common in individuals over age 50 and increases in frequency with age. Black men and women are slightly more likely to get pancreatic cancer (though the reasons for this are unclear), and men are slightly more likely than women to get the cancer. Other risk factors are smoking, diabetes, and obesity.
Dr. Val: If you suspect that someone is “high risk” for pancreatic cancer, what tests should he/she have?
Dr. Lenz: Patients with a genetic predisposition for breast cancer known as BRCA are also at higher risk for pancreatic cancer. There is also a familial form of pancreatic cancer. These high risk families are being followed up with specific screening plans. However there is not a reliable test for pancreatic cancer. Imaging with CT or MRI can miss pancreatic cancer and there is no reliable blood marker. The most common used is CA 19-9, which can be used for monitoring and diagnosis but is not elevated in all patients.
Dr. Val: What if the cancer is caught very early? Does that increase likelihood of survival?
Dr. Lenz: Absolutely. The best chance of survival is when the cancer is limited to the pancreas, and is surgically removed before it reaches a size of 3 centimeters. There are certainly people who have been cured this way, but unfortunately it’s very rare to catch the cancer at such an early stage since it usually has no symptoms until it’s quite advanced.
***
There is a wonderful advocacy group for those whose lives are touched by pancreatic cancer: PanCAN. One of PanCAN’s founders, Paula Kim, is a friend of mine and was inspired to create the organization after her dad was diagnosed with pancreatic cancer in 1999. At that time there was very little advocacy for this deadly disease. PanCAN helps people with pancreatic cancer find help and support.
Nurse Andrea Bartlett is literally having a meltdown. She is in the midst of her midlife crisis. Nurses like her are easy to spot. She’s having a hot flash, note the hand to her forehead and the look on her face that says, “Crap, I’m going to pass out,” and she’s reliving her hippy Peace Corps days by working as a Congo nurse. I bet she is kicking herself for leaving home, especially at her age. After all, who in their right mind would give up their Mac computer and iPhone.
It’s official. I’m having my midlife crisis. I knew I had hit crisis mode the day one of my patients tried eloping from the unit. I saw the patient racing down the hallway towards the door, and my brain said, “Run, catch the patient,” and, after a few strides, my joints started screaming, “Brain, we hurt. Go to hell.” Fortunately, the techs and a few nurses, all of whom are youngsters, ran right pass me like little gazelles and effortlessly caught the patient before he bolted off the unit. I felt like a relic. I wanted to cry all day long.
If anyone over the age of 55 tells you that they aren’t going through their midlife crisis, they are in denial, or they are lying through their teeth. I started making some changes at home after that fateful day at work. I can’t afford a facelift, a tummy tuck, or a red sports car, so I started redecorating my living room, a la Peter Max. I said goodbye to my Martha Stewart country living room by replacing everything that was made from gingham and lace with burgundy silk pillows, hand blown glass bottles, and Bakhtiari carpets. I even scored this 1960s leather chair, matching footstool, and hoop lamp from one of my best friends. Yeah, they’re groovy. I can’t wait for my husband to finish off my bookshelves. Maybe I’ll start a new hookah collection when he’s done.
Having a midlife crisis isn’t just about getting gray hair, saggy boobs, and a wider girth. It’s about getting to know who you really are as you hit the midpoint of your life. This midlife journey is especially bewildering and fear provoking for nurses. Everyone is in a big hurry to get an advanced nursing degree before “it’s too late.” Too late for what? I see nurses frantically checking out school websites, and exchanging information about online classes. Some nurses want to expand their knowledge base so they won’t have to work as bedside nurses anymore, while others want to go back to school because of a mandate put out by the ANA. The ANA doesn’t recognize anyone without a nursing degree as a professional nurse. The ANA can kiss my ass. I’m not going back to school, and I refuse to burst one brain cell over a class assignment that has no relevance in my life.
God willing, I have at least twenty-five years before I check out of the world and I plan to have some fun before I head for the Pearly Gates. My short-term goal is to buy the new Beatles Boxed set in stereo and to finish redecorating my house. I’m going to light up some incense, play my tunes, and party on. My long-term goal is to make love, not war, get on the peace train, and to follow the sun.
From an old HS buddy (also a Navy Man) now in healthcare:
Texas law makes almost any item with a doctors prescription exempt from
sales tax.
(most details at : RULE §3.284 Drugs, Medicines, Medical Equipment, and
Devices (Tax Code §151.313) Item 11 is the sort of catch all.
What is most odd item you have been asked for a prescription for purely for
tax-free purposes?
Sellers of the Select Comfort beds, and hot tub/spa dealers are very aware
of this law. Presciption needed for bed, letter and presciption needed for
hot tub/spa.
Oddest request received at clinic where I work: one for in ground pool,
heated and deep enough for water aerobics.
While I don’t notice it on that list, food for helper animals is exempt
from sales tax.
Interesting also, repair parts for devices are exempt, but not
*improvements*. If you replace like for like wheel on a walker, it is tax
free. Replace with improved wheel-taxable.
I’ve never been asked to write a prescription for anything like that in the ED, but I’d be willing to bet my office-based colleagues have. Care to share?
*This blog post was originally published at GruntDoc*
Last night, President Obama made a pitch for preventive care in his address to a joint session of Congress on health care:
“And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there’s no reason we shouldn’t be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.”
As a doctor who has held the hands of patients dying from totally preventable illnesses, I couldn’t agree more. The largest number of deaths in the United States are caused by two preventable causes – tobacco smoking and high blood pressure – killing an estimated 467,000 and 395,000 people respectively in 2005. The list goes on and on, including obesity, physical inactivity, and poor diet.
When I was working in the emergency room as a medical resident, it was heartbreaking to see a patient with poor routine medical care roll into the emergency room with a devastating stroke that could have easily been averted with regular office visits and blood pressure medication – both relatively inexpensive compared to the cost of caring for the stricken patient.
We’re not preventing enough deaths by the types of cancer screening tests mentioned by President Obama. One reason is the technology is still not good enough. We need to develop better screening tests that pick up problems early but don’t lead to an unacceptable number of unnecessary biopsies, procedures, and further tests. And not enough patients are screened. Only about about 60 percent of women get mammograms and about 50 percent of men and women get routine colonoscopies.
Lack of insurance coverage is certainly a big reason why some patients don’t undergo screening. Another reason is patient fear and misunderstanding. In order to educate the public about the risks of colon cancer and the benefits of screening exams, Katie Couric underwent a colonoscopy on national television in March, 2000. Three years later, researchers at the University of Michigan found that colonoscopy rates jumped by 20 percent across the country following Katie’s procedure, calling the rise the
“Katie Couric Effect.”
It’s almost 10 years later and we’re still not screening enough patients. Although the death rate from colon cancer has dropped in recent years – likely mostly because of screening efforts – colorectal cancer still strikes almost 150,000 Americans every year and kills about 50,000.
As a gastroenterologist, I have seen patients’ lives saved by the removal of polyps and early cancers found by colonoscopy. I have also taken care of patients whose colon cancers were found too late to save them. Over the years, I must have heard every excuse for ducking a colonoscopy. The top four (and my answers):
I have no symptoms (most colon cancers start small and have no symptoms until they grow larger.)
I have no family history of colon cancer (that’s true in about 70 percent of patients with colon cancer.)
I’m afraid it will hurt (that’s why we use sedation and, if needed, anesthesia.)
I can’t do the prep (we’ll figure out a way to clean out your colon that you can tolerate.
And even if you have a tough night, it sure beats chemotherapy.)For this week’s CBS Doc Dot Com, I follow Katie’s lead and undergo a colonoscopy with cameras rolling in an attempt to remind people that a screening colonoscopy can save your life. I had the benefit of a house call the night before by my office nurse, Debbie Fitzpatrick, who held the video camera and offered advice and encouragement as I had a taste of my own medicine: the colon cleanout solution. The colonoscopy was performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
For more information about the Jay Monahan Center,click here.
For more information about screening for colon cancer, click here.To watch my colonoscopy, click below:
“We already have two girls at home and we want a son. We have too many girls.” My eyes welled with tears as I thought of the fate of this poor, helpless baby who had no voice, no rights, and who was about to be “attacked just because she was female.”
I pulled the ultrasound image from the chart and my heart quickened. The image was of the perfect outline of the precious little baby girl sucking her thumb. The timing of the ultrasound image was perfect.
I proudly showed them the image, and the look and emotion on their faces changed.
“That is our baby?” they inquired. “We didn’t think it had that much form, and she is sucking her thumb already?”
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Patrick Swayze, the popular actor perhaps known best for his role in the 1987 hit movie “Dirty Dancing,” died today of pancreatic cancer. My thoughts are with his family in this time of grief.
Nurse Andrea Bartlett is literally having a meltdown. She is in the midst of her midlife crisis. Nurses like her are easy to spot. She’s having a hot flash, note the hand to her forehead and the look on her face that says, “Crap, I’m going to pass out,” and she’s reliving her hippy Peace Corps days by working as a Congo nurse. I bet she is kicking herself for leaving home, especially at her age. After all, who in their right mind would give up their Mac computer and iPhone.
If anyone over the age of 55 tells you that they aren’t going through their midlife crisis, they are in denial, or they are lying through their teeth. I started making some changes at home after that fateful day at work. I can’t afford a facelift, a tummy tuck, or a red sports car, so I started redecorating my living room, a la Peter Max. I said goodbye to my Martha Stewart country living room by replacing everything that was made from gingham and lace with burgundy silk pillows, hand blown glass bottles, and Bakhtiari carpets. I even scored this 1960s leather chair, matching footstool, and hoop lamp from one of my best friends. Yeah, they’re groovy. I can’t wait for my husband to finish off my bookshelves. Maybe I’ll start a new hookah collection when he’s done.
God willing, I have at least twenty-five years before I check out of the world and I plan to have some fun before I head for the Pearly Gates. My short-term goal is to buy the new Beatles Boxed set in stereo and to finish redecorating my house. I’m going to light up some incense, play my tunes, and party on. My long-term goal is to make love, not war, get on the peace train, and to follow the sun.
