The anti-vax movement is generally (and justifiably) treated with a good dose of scepticism and ridicule and it’s likely any anti-radiation movement will suffer the same fate But as lead story this week explains not everyone swears by radiation treatment.
The second story looks at treatment delays – a nightmare when it’s the medical community that seems at fault, but likely a lot worse when it is the insurance industry. (This is an American’s story.)
# We are living a day which is going to be an exam question in a history class 50 years from now
# Turtles cannot be claustrophobic.
# 1 of the most amazing sounds in the world is the sound of a baby’s laughter. Unless it is 3am...and you don't have a baby
A debate for oral cancer treatment: radiate or not?
(U.S.) Arjun Joshi knows what he’s up against. Innovation can be slow and methods entrenched when it comes to the fight against cancer. The 40-year-old threatens to disrupt a $5 billion industry by steering patients away from radiation, long considered an essential element in the anti-cancer arsenal, alongside chemotherapy.
Radiation can destroy salivary glands, limit range of motion in the neck and wreak havoc with taste buds. Joshi also thought a different kind of tumor could use a new approach: The sexually transmitted infection HPV has surged as a cause of head and neck cancers, rather than the usual smoking and drinking.
Joshi developed a surgical specialty in head and neck cancers — he now practices and is a faculty member at George Washington University School of Medicine and Health Science
For select patients with HPV-related tumors, he has adopted a strategy of starting with three rounds of chemo and then operating — rather than risk the side effects involved with the more conventional radiation-chemo combo. He’s careful to point out that he is not ditching radiation altogether: If patients don’t respond to the first round of treatment, he will advise radiation therapy. The American Cancer Society estimates that more than 37,000 men will be diagnosed with oral cancer this year — making it the eighth most common form of the disease for men.
At this point, Joshi’s way of attacking this form of the disease only has a few dozen documented cases in the medical literature versus thousands for radiation. In a clinical trial published in 2017, Joshi and five co-authors studied 19 patients diagnosed with a type of throat cancer. They were treated first with chemotherapy, followed by robot-assisted surgery once the tumors had shrunk by 80 percent or more.
Of the 14 patients available for follow-up analysis, one died, and three more whose cancer recurred were treated with radiation. The results, the authors declared, were “promising” but require further study. “It appears effective while avoiding adverse effects of” radiation therapy, they concluded.
Dr. Daniel Ma, a radiation oncologist who treats head and neck cancers at the Mayo Clinic, is less impressed. While he commended the “innovative trial,” he says seeing cancer recur in 21 percent of patients is not great — and when you add in the patients unavailable for follow-up, the misses rise to 42 percent. “Based upon this failure rate, it is difficult for us to be enthusiastic about this approach,” Ma says.
Joshi points to a more recent follow-up study at George Washington in which 17 of 20 patients (85 percent) were successfully treated without radiation, while two died and one more survived after being treated with what’s known as “salvage” radiation.
“The fact that we can follow this induction chemotherapy protocol and surgery with radiation therapy [when necessary for these aggressive tumors] with still excellent outcomes underscores the flexibility and safety of such a treatment plan,” Joshi says.
Battling insurers for life-saving treatment
(U.S.) AS I LOOK BACK on 2017, I am just happy to be alive. In the past 12 months, I dealt with two major threats to my life. The first came in the form of a devastating double cancer diagnosis. While that’s awful enough, the bad news was compounded when my insurer flouted state laws intended to protect patients like me, refused to pay for my treatment and dragged out a lengthy appeals process when every passing day increased the risk to my life.
After I experienced nosebleeds and fainting episodes early last year, my doctors ran a series of tests that revealed an unimaginable double whammy: leukemia, along with a large, deep and rare tumor inside my head.
I underwent chemotherapy for the leukemia and, in May, surgeons removed a malignant carcinoma from my parotid gland, a major salivary gland just in front of the ear, along with 36 lymph nodes. But they were unable to get all my cancer and, in July, I was told that the only way to reach the remaining cancer, without disabling me for life, would be for me to begin proton beam radiation therapy. The alternative — traditional radiation — would have caused me to lose the ability to speak, swallow and move one side of my face.
After I was told that the proton therapy was my only chance for survival, my insurer repeatedly denied my claims for it, claiming that the therapy is “experimental and investigational.” When my doctors insisted during a peer-to-peer review session that this therapy was my only chance, a company representative justified the denial by crassly reading a single paragraph from the company’s health policy brochure. Even my doctors, who have seen a lot, were appalled.
Contrary to the insurance company’s assertions, proton therapy is far from experimental. In fact, proton therapy is Medicare-approved, widely accepted as an effective treatment and scientifically proven. For many patients like me with head and neck cancers, or those with cancers in the spine, lung, breast or prostate, it’s the best option for survival with any quality of life.
But I found myself fighting two types of cancer while simultaneously fighting with my insurer as time was running out.
Author Daniel Bauder lives in Yorktown.