Unmet Needs of Cancer People

Finally someone figured out that there might be unmet needs of people after a cancer diagnosis.  A study was recently done:

"Cancer [people*] face unmet needs. These are needs which lack enough service or support for survivors to achieve optimal well-being. Understanding the needs of cancer survivors can help guide services and support to meet the needs of [people*]."

To complete this study, they asked over 9000 people one question: "Please tell us about any needs you have now as a cancer [person*] that ARE NOT being met to your satisfaction". Only one question. But they could answer how they wanted and then they sorted out all the results.

Here are the answers:

Physical needs: 38.2% needs affecting the body, including pain, symptoms, sexual dysfunction, diet, exercise, and rest. 

Financial problems: 20.3% 

Education and information needs: 19.5% needs which were related to unanswered questions and the lack of information about cancer. 

Personal control problems: 16.4%  related to one's ability to maintain autonomy over one's body. Health care system needs: 15.5% 

Access to supplies, medications, and transportation services: 13.8% 

Emotional and mental health problems: 13.7% had emotional and mental health problems

Social support needs: 12.7% 

Problems with social norms, discrimination, misinformation, and policy: 10%

Communication needs: 8.5% 

Problems with their relationship with healthcare workers: 8.25% 

Some groups had more than one problem, in fact women with breast cancer had an average of 2.88 unmet needs.

I was glad to see some kind of research into this. I feel that the medical profession takes care of you during diagnosis and treatment and then that's it. You get a 'come back and see me in 6 months'. And the patient is left grasping at straws. So of course there are more needs for the patients. But the bottom line didn't do much for me at all:

"The authors concluded that the needs of cancer [people*] are important and should be researched further."
I'll just hope for more research.
*I can't use the S-word, I find it offensive.

Star Trek Tricorder

Do you remember the Star Trek Tricorders? No not the phasers (always set to stun) but the tricorders that could diagnose people instantly of cancer or all sorts of other ailments. Dr whatshisname had one. I would love it if they were available to diagnose me and skip all the medical misadventures that make our lives so 'fun'. But it is really possible? I don't know at this point.

Google's biotech section, Verily, said that they could develop one in six months. That was three years ago and it still doesn't exist. (Who woulda thunk?)  And based on what has been said by a former employee that if employees said it was a bit 'out there' they were frozen out of future decisions.

"Tricorder is not the only misfire for Google’s ambitious and extravagantly funded biotech venture, now named Verily Life Sciences. It has announced three signature projects meant to transform medicine, and a STAT examination found that all of them are plagued by serious, if not fatal, scientific shortcomings, even as Verily has vigorously promoted their promise.

The Tricorder, as Conrad and others at Verily call the device, is “in the realm of not only science fiction, but beyond that — science fantasy,” said David Walt, a Tufts University chemistry professor and nanoscience expert who met with Verily scientists and engineers last year to share his concerns. “And I’m not sure it will ever be science reality.”"

Science fiction or science reality?

"Verily appears to be having more success with less world-changing projects, but it still chooses to showcase its most ambitious ones — perhaps, some critics suggest, to promote itself as a company poised to defeat disease.

“One needs to balance how much these toys are used mostly for marketing and for giving a sense of a company really working on something impressive — the brave new world — or if we’re talking about something that will have clear and immediate clinical impact,” said Dr. John Ioannidis, a professor of disease prevention at Stanford University. “The latter is very hard to imagine.”"

So if its a marketing splash? What are the ethics of this? If it makes a big splash and helps the company with its stock values, how does that help us patients? It doesn't but just make the company lots of money. 

Star Trek also had all those little communication devices. We have those - our cell phones. But the rest of what was used on the show may be a bit too far in the future.

The Little B****rds

I'm sorry I just don't have a better word for cancer cells which spread.We'll just call them the little B's. Anyway, some new research has been done on metastatic cancer cells. The goal is to find them and snuff them out, obviously.

Dr Rauscher of the Wistar Institute's cancer center recently discussed some new information discovered about breast cancer metastatic cells:

"Solid tumors such as breast cancers grow their own blood supply, a process called angiogenesis. It's clear that breast tumors shed malignant cells into the bloodstream. And it's clear that most of these cells get killed by the stress of shearing off from the primary tumor, or by the immune system. But in some patients, a tiny subset of sloughed-off cells develop the colossal powers that are required to become metastatic. At what point does that happen? "That's one of the questions we still have to answer," Rauscher said.

Recently, the ability to rapidly sequence whole genomes (the entire genetic code of a cell) has enabled scientists to analyze differences between primary tumor cells and metastatic cells. Surprisingly, Rauscher said, "there is not much genetic difference."

That finding has big implications. First, metastatic cells may not have a distinctive mutation that can be used as a neat molecular target for new drugs. Second, the important difference between primary tumor cells and metastatic cells may involve which genes are turned on and off by biochemical processes. These outside-the-gene activation processes are called "epigenetic."

Depending on the organ the metastatic cells travel to, varying genes may be activated because each organ has a different "microenvironment," controlled by distinctive cellular signals. That brings up another question: Why do certain types of metastatic cells gravitate to certain organs? Metastatic breast cells, for example, often colonize the bones first, then other vital organs. So far, Rauscher said, the explanations are unclear.

When these incredibly versatile marauders arrive at a new organ, they have the characteristics of all-powerful stem cells. That means they can go dormant for long periods, then suddenly start multiplying uncontrollably. While dormant, metastatic cells are basically invisible to the immune system, as well as impervious to chemotherapy, which works by disrupting the DNA of fast-multiplying cells.

A significant recent discovery is that metastatic cells don't travel and resettle individually. Rather, they detach from a tumor and move in clusters, the better to invade and take over a new microenvironment. It's sort of like moving a whole house, rather than just the furniture, Rauscher said.

While metastatic cells may not have a neat genetic Achilles' heel, researchers areuncovering vulnerabilities. "One therapeutic approach is to find the signals that turn dormant cells on, then block those signals," Rauscher said. "In mice, we've done this.""
So there is work in progress. If its up to the mouse stage, it is progress. But it still has a long way to go. Unfortunately.

Don't Believe Statistics

Back in college, I took a statistics class and had to write a paper about the skewing of statistics particularly as done in the media. I think I did pretty well on it. And I did learn not to believe statistics as presented anywhere without thinking about them.

Here's an example: A recent study said that being married or having a college education made you more likely to get brain cancer. I'll bet that result was a surprise to the researchers. But you really need to dig a little deeper into the research to understand that isn't really the truth.

"Using a huge registry of health and other data on all Swedes, European researchers found that people with at least three years of college had about a 20 percent higher risk of glioma (the most common brain tumor) as those with only an elementary-school education. And married men had a 23 percent higher risk of glioma than never-married men." 

This is how they did the research. But it is important to realize that there is more to this than that. Let me clarify on two points: College educated people tend to be wealthier than those with lesser education. Well off people usually go to the doctor more frequently than others, simply because they can afford it. They also might be more aware of differences in their health (slurring words) that would cause them to go to the doctor themselves. Married men also have been shown to go to the doctor more often (at their wives' behest) than unmarried men.

These cancers are also very rare anyway and may not even kill you if you have one. They are slow growing and are often found at autopsy with other causes of death.

So the end verdict on this study:

Being married or educated seems linked to being diagnosed with some kinds of brain tumor, likely because of socioeconomic rather than biological differences — a useful reminder that when studies count diagnoses they’re not necessarily counting every case.

The lesson learned is do not believe statistics. This is why often additional studies are required to verify the results.