Tuesday, June 2, 2015
Emperor of All Maladies (9June)
Watch at least the final episode, which discusses genetics. Note what surprised you (in that or any episode -- be sure to explain clearly what episode & segments you are referencing)? How does what you are viewing in the videos relate to what you've read for this week? Be specific -- use examples from the videos and specific passages/quotes from the readings. (you might need to jot down notes while you are watching the videos for better recall)
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Ok this may be and probably will be a long winded blog!!
ReplyDeleteWhen I viewed the final episode of the Emperor of All Maladies I found numerous segments to be very interesting. At the beginning of the episode as it was discussed many years ago(in the 1970's) they stated they were "on the verge of a single cure for cancer". Here we are forty plus years later and they are still on the verge of a cure for cancer. Great strides have been made in the cure and treatment of cancer but yet a cure is still just out of reach. It was very alarming how there is so much work and research being done and there are many drugs that have been tested but still not a cure. With all the studies and it is now known that cancer is genetically linked it seems as if it would be easier to find a cure. Cancer is like a terrorist attack on the body. Search and destroy is its mission. Destroy is what it does. Not only the person with the diagnosis but it also takes an emotional toll on the family, friends and caregivers of the patient.
I was also surprised by the treatments that are available but are too expensive for some to be able to afford. With the amount of donations and funds that are put forth for the research of treatments and drugs I would think that if something is found to be successful it would be available and affordable to those whom need it. What I also found interesting was that even when an experimental drug was found to be somewhat successful in treating a cancer that on average it only gave those who were successfully treat a 7 month longer life span. it then makes me wonder was it even worth the try? During that 7 months were these people too sick to enjoy life verses if they had not done the treatment. I guess if you are faced with the fact that you have been told you are going to die regardless, what would it hurt to try the treatment and buy yourself a few more months with your loved ones.
I also loved the segment that included Dr. Suzanne Cole. She was a very dedicated oncologist that took her job very seriously and did not look at just the medical, curative aspect of the patient but looked at them as a whole. It was vey touching to see how she address the subject when a treatment was no longer working. I liked that she said "it was not for the doctor to keep the patient from their information that could impact their life". She brought this up early on in her medical profession as she noticed that death and dying was a very hard subject for many doctors to approach with their patients. if a physician knows that a patient is not responding to treatment and they are no longer getting the benefit I believe it is the physicians moral duty to inform that patient and let then make the decision as to what to do with that information. One of the things that Dr. Cole said that stuck in my mind is when she said, "I want you to have the information to make the best choices for the context of your life, knowing that you might be on limited time". What a wonderful thing to do for someone. This may allow someone the time to tie up loose ends of their life that most avoid or put off. Even on limited time someone may be able to fulfill their "bucket list". You may be able to mend a broken relationship that has burdened your life. Even though we should live every day to its fullest if given the opportunity and information gives up even an extra chance.
ReplyDeleteTalking about Hospice and Palliative Care is very near and dear to my heart. It is hard to believe that it was considered taboo to even take about not all that long ago.
Talking about death and dying is not what anyone wants to talk about but it is very much a part of life. Having Hospice and Palliative care involved goes way beyond just death. It involves addressing psychological issues, spiritual issues which does not always refer to religion, physical aspects such as pain and also emotional components. Hospice does also give a patient and their family many choices. As stated by Dr. Cole, "what is a good death"? That could be being surrounded by the ones you love, in a familiar place such as your own home, without the poking, prodding and test that are no longer helping being done. Dr. Cole said it well, "healing is not always eternal life, giving someone a peaceful death can be just as healing".
For me working in Hospice has been a life changing event. It has made me look at my life and evaluate what is really important for me.
The thing that was most profound for me in this video series was the quote made by one physician "patients can't afford to get cancer" the expense of treatments, radiation, the frequent hospitalizations and treatment of side effects coupled with transportation costs , all add up to one very expensive diagnosis. Employment of the nurse navigator should be available to every patient who is diagnosed to help them identify and maximize the resources available.
ReplyDeleteThe other profound thing for me was the absolute commitment of these researchers and physicians to their patients. They in many cases considered them a part of their team , and were thankful for the opportunity to treat them in hopes of helping others.
Last October my older brother was diagnosed with cancer, since that time it has spread to his lungs despite treatment. HIs physician has been outstanding with not only him, but our family as well. I'm not sure I see this commitment in other specialties like I do in the oncology setting. Just as Dr. Cole in video # 3 was there for her patients no matter what their choices, so do we know we have the full support of his physician. Perhaps more than any other specialty these physicians are faced with life and death on a daily basis , and I am thankful that instead of shying away from the topic. they speak of it openly and often.
It is amazing to see how dedicated these physicians are to their patients. I also think that healthcare providers forget about the impact that a disease like cancer has on families.
DeleteI agree with you the commitment that the researchers have to find a cure is profound. How they have to keep trying new things even after one thing has failed, when they thought they had found the answer. This video really showed how cancer keeps evovling over time.
DeleteIt is very disappointing how expensive cancer treatment is. These patients are probably fighting the hardest fight of their life. Then they have to worry about being able to afford the financial burden. It seems very unfair.
DeleteI agree with the relationship that cancer physicians share with their patients. Out of all the areas in medicine, these physicians appear to have the most invested in their patients.
It amazes me how much research for the past several decades to find a cure for cancer and there is still no "real" answer. In the second episode, it was mentioned that there was three theories why normal cells change to bad cells. It was explained that virus, chemicals, and genetic make up are the driving factor to getting cancer. These theories still stay true today.It was also explained in episode two, that a radical mastectomy was automatically the first line of intervention for breast cancer and patients didn't even question the MD's. Almost like a since that a physician is entitled to fix everything and having a since of "god like" power. I think this was when I realized for myself of how medicine has changed not just focusing on the cure but the wishes of the patients are just as important. I think the third episode listening to Dr. Suzanne Cole she really did a wonderful job keeping the patients wishes her first priority for treatment and being honest with them. I believe that in the practice of medicine in this century, she is an excellent example of a great physician.
ReplyDeleteDr. Cole did really showe how keeping the patients wishes a prority. When watching her talk to her patients I wish are staff of physicians would do the same at our hospital.
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DeleteI found the beginning of the video interesting where they showed many Presidents in the past 30 years or so. Each of the Presidents were making statements that we are near finding the answers we need. In watching the videos you can see how much progress really has been made but we still are not there.
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ReplyDeleteCancer research is a catch 22. We have come a long way but we still don't have the answers. It is amazing to see how much money is spent on cancer research but we yet have found a real cure. Watching the 3rd episode and hearing about the billions of dollars that is spent on failed research was very eye opening to me. Then for them to raise the cost of the treatments that we are currently using for patients to offset the cost of the failed research was something I really hadn't thought much about. The video of coarse made me cry several times, my aunt was just dx this month with stage 4 lung ca. She has no insurance and no money saved up for something like this. Very eye opening hearing about the cost that people pay out of pocket for their drugs. Thought the quote: worst economic thing to happen to someone was very interesting.Poor people, uninsured people and even insured people will cause devastating financial hardships but also emotional ones. No one should have to make a decision on weather to eat, pay rent or to buy their drugs that might make them live a little longer. These stressors should not be something that someone has to worry about with a terminal or life changing diagnosis.Seeing how many patients were being helped with the financial adviser was great. I also liked how some focus now is more turned toward cancer prevention instead of just cancer treatment. Mammograms, prostates screenings, colonoscopy are just of few of the things that can help aid in early detection but they are not 100%. Thought it was interesting in hearing that obesity is a focus for cancer prevention. Last but not least I loved the last part of 3 hearing about the advances of immuno therapy. Allison and June have made great accomplishments in this field.. Loved the quote that Immuno therapy was the talk of the town. I think it should be because both of these men are on to something. Just a thought for everyone to think about: what if we really already had a cure for cancer but we weren't using it. Think about the money that the Dr's, drug companies, hospitals make with cancer diagnosis. What if they didn't have that money anymore.How many people would be out of jobs? This was just something that someone said to me after my aunts diagnosis. Just thought it was a interesting statement
ReplyDeleteI hadn't realized the cost of cancer medications had risen so drastically in the past 15 years or so, from 5-10 thousand dollars per year before 2000 to more than 100 thousand dollars per year for medications after 2012. I cried many times watching these videos also. My husband, hearing the videos periodically, even made the comment that this was a lesson in depression.
DeleteI agree that it seems like a business. Most people will pay anything to extend their or their loved one's life. Who or what to believe seems to be the challenge! In reality, it seems that we have much more to conqueror. I think the best goal is to keep the patients wishes in mind!
ReplyDeleteWell, I have to say Dr. Cate made me tear up again. In the final episode of The Emperor of All Maladies there is so much to take in. There was a lot of information on this video that I myself was not aware of. Frist of all, one thing that surprised me was that the last cigarette ad was ran back in January of 1971. I thought it was a much longer time ago. It stated that smoking and lung cancer was first linked in 1954, so that shows how long it took to fright the cigarette companies to pull their TV ads off the air. I also really like how this video showed all of the different trails and studies done though time. It really shows much effort is put into learning about all different types of genetic changes and how the human body works and fights off illness? Dr. Cole was amazing how she talked to her patients and really wanted to know how much they wanted to fight or how they wanted to live with their cancer in the best possible way. She really made it clear to them that either choice is ok. Also, when the statement was made “patients can’t afford to get cancer” was a little shocking to me. I know that this disease is costly but when you put it into terms such as “how much do I want to spend on a few more months of life?” that is a BIG QUESTION.
ReplyDeleteThe cost in unbelievable. I think a person should not be denied treatment based on ability to pay. When I went through my chemo treatments if I was unable to pay all my bills that month I was always sure to pay my oncologist because I saw first hand people turned away for payment. The offices do have people to help patients get in touch with drug companies for discounts, but for the average middle class person not being able to work but trying to stay a float is hard!
DeleteI didn't realize how long ago it had been since a cigarette ad had been on air. I am so grateful that these ads are off air. The united states has a big enough issue with cigarette abuse.
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DeleteWhat surprised me the most was the statement within the first few minutes of the first video, Magic Bullets, "1 in 2 American men and 1 in 3 American women will be diagnosed with cancer in their lifetimes." That is a profound statement! That means that 1/3 of our class falls into that category.
ReplyDeleteI too cried many times throughout all 3 movies. I look at cancer in a new way now. I feel so blessed to get all the information that I received. I'm also glad that they have started to focus on preventative concepts. I now want to keep up with my mammograms and get my first colonoscopy. I understand now why my Dr. keeps insisting on keeping up with preventative care every time I visit. I also have changed my mind somewhat with regards to gene therapy. I'm really glad they have mapped the human genome. I think there is a lot of good information to be had from this information. I still agree with being selective with what we do with this information. I believe like Sandel about giftedness, reverence, and beholding are all important characteristics of human abilities and achievements.
Brock touched on the issue of fairness and inequality. This concept was demonstrated in the first 30 minutes of the third video with the cost of medications being 100,00.00 up to 150,000.00. Using the excuse that it covers the cost of failed research. BS! Funding pays for the research while it is being conducted, when/if it fails the money stops coming in. We don't need to raise the cost of other medications to compensate for this loss. Where is the equality in that? Also,one would think that with all the funding that is out there someone might set aside a few dollars to assist with the cost to the common people. Just a thought.
I worked with a woman who's mom and aunt had colon cancer. She was a pharmacist who was a vegetarian and ate very healthy. She exercised, did not smoke or drink alcohol, and maintained a healthy weight. Because she had frequent colonoscopies she caught her colon cancer early. I just couldn't believe that even though she was doing everything right she still got cancer. Now I know why.
References
(7 June 2015). http://www.pbs.org/kenburns/cancer-emperor-of-all-maladies/home/
The changes that occur in cancer treatment seems to constantly be changing. During the last segment of the third episode I found the advancements in immunotherapy against cancer fascinating. I had no idea they are able to educate T-cells so they are able to find the previously hidden cancer cells. With the rate that cancer mutates and becomes resistant to medications it seems like using our cells to fight the cancer cells would be very effective. It definitely makes the future very hopeful.
ReplyDeleteIt is amazing what advancements have been made. It is a shame the cost of research and development are so high. Otherwise we would already have a cure for many cancers.
DeleteWhat I found interesting was that we have been on the verge of a single cure for a long time, ironically, the single cure can only treat one type of mutated cell. It seems virtually impossible to come up with cures for each and every possible mutation to treat all cancers. It is insane the amount of money spent on cancer research when you consider how hard it is to isolate the the cancer cell and effectively kill it off and all the remnants of it. I believe we have come a long way, but still so far to go and it just seems so out of reach with cancer. In episode 3, Bert Vogelstein studied mutated genes with a focus on colon cancer. He was excited to see the trends and changes as the genes mutated, but the problem was that as few as 3 and as many as 110 genes were altered in one person. Fairly difficult to come up with treatment for that type of cancer. Even drugs they did find that worked, only extended lives by a few months more, maybe not even that because the toxicity from the drugs did additional damage as well. It is also insane how much money is spent on cancer treatment. Knowing there are no guarantees and that it could extend your life only minimally, yet bankrupt your life and future. I don't see how they can eliminate cancer with genetic enhancement. Since cancer is acquired sometimes and sometimes due to gene mutation, I just think there is no guarantee or perfect answers.
ReplyDeleteMy mother died of lung cancer when I was in high school, because of that I made the decision to be a nurse. I wanted to help people, but I didn't have any interest in the field of oncology. Fast forward 14 years and I was diagnosed myself with cancer. I felt lost because I had no idea what was happening. My biggest bit of advice is to listen to your body and one of the doctors actually said that in the show. My concerns were passed by and it took several doctors before I was listened to.
ReplyDeleteI don't think I will ever go through anything as nasty as chemo for the rest of my life. Looking back the entire stent of my treatment is a blur. I think I suppressed most of it. As tough as it was for me to endure my family had a hard time too. My husband had to work and care for me and our 2 year old son, while I felt helpless. The biggest thing I took away from my experience is to be able to share with my patients. I've had every test and procedure under the moon and feel like I can relate and help them cope with things they may be experiencing also.
The numbers mentioned in this film are astounding. 1 in 2 men and 1 in 3 women will get diagnosed with cancer. Researchers devote their entire lives searching for a cure or better treatment options. All the medicines and treatments come at a high cost for patients. Help isn't really available for the average middle class patient. I struggled to pay my bills and still paying to this day. Treatment is not optional for young patients, I understand when a person gets a terminal illness and choses not to treat because of their age and quality of life. There needs to be assistance for people that work but while in treatment can't work, all programs go off of the previous years W2 which won't.
Shelley, I am sorry to hear about you and your mother's experiences with cancer. I am sure that it has made you a more sympathetic, caring nurse to have been through such a difficult time. It saddens me to know that through your stories, patient experiences, and the videos that the cost to receive the latest treatments can cost a patient and their family so much!! It really shouldn't come a such a high price! No one should have to rationalize their decision to receive treatment for x number of months to prolong their life, only of which they would possibly be able to afford. It just doesn't make sense. Thanks for sharing your story.
DeleteShelley, I am sorry to hear about you and your mother's experiences with cancer. I am sure that it has made you a more sympathetic, caring nurse to have been through such a difficult time. It saddens me to know that through your stories, patient experiences, and the videos that the cost to receive the latest treatments can cost a patient and their family so much!! It really shouldn't come a such a high price! No one should have to rationalize their decision to receive treatment for x number of months to prolong their life, only of which they would possibly be able to afford. It just doesn't make sense. Thanks for sharing your story.
DeleteDr. Cole stating that "patients can not afford to get cancer", is in all honesty a very true and sad statement. Cancer now days is extremely expensive and very intimidating for families to even think about paying. A lot of patients that find out they have cancer don't want to feel like a burden and cost their families so much money, so they may decide to receive no treatment. In all honesty I feel that our government should be helping these cancer victims out with treatments versus using so much money on people that abuse the system that receive WIC and food stamps and medicaid that don't really need these services. I completely understand using these services for people truly in need but after working in the hospital, I know this system is abused. Every cancer victim is very scared of all the unknowns and being able to help them out with the costs of their care would be incredible.
ReplyDeleteI also thought the drug LDK that is used to help get rid of the cancer and patients actually notice a feeling of health quickly. But unfortunately the cancer can still come back from the gene mutating and becoming resistant to the drug. I feel very optimistic after watching these videos on cancer. I do feel that someday a cure will be found and I pray that day comes sooner than later!
It is a shame what people have to go through. People are afraid and it is instinctual to want to live and do everything to prevent death, but many give up the fight because it seems to them, life is essentially over and they have become a burden on society.
DeleteThe story of 6 year old Emily Whitehead was so optimistic! She had been diagnosed with ALL and had tried chemotherapy. Here this little girl was on death's doorstep and her parents took the opportunity to enroll her into T cell immunotherapy. This treatment was experimental at the time, the last hope for their daughter to survive. In this type of therapy doctors take Emily's T cells and reengineer them, infuse them back into her system, and the T cells are now programmed to kill B cells that cause cancer. She did have a set back when a certain protein became elevated and she ended up in the PICU. (This protein is also elevated with rheumatoid arthritis). So the doctor was grasping at straws and decided to give her a medication that treats RA. Overnight she responded and has been doing great ever since. The advancement of research has come such a long way, which gives great hope for future discoveries.
ReplyDeleteI could not believe it when they decided to trial the use of the RA drug to reverse her condition!! How amazing!!! It blows my mind that these professionals are so incredibly intelligent and such amazing critical thinkers!! This little girl's story was definitely an emotional one to watch!
DeleteI could not believe it when they decided to trial the use of the RA drug to reverse her condition!! How amazing!!! It blows my mind that these professionals are so incredibly intelligent and such amazing critical thinkers!! This little girl's story was definitely an emotional one to watch!
DeleteI feel medicine has been on the brink of a cure for some cancers for many years. Research is so daunting and costly, I feel it may take many more years to finding a cure. Indeed, the drug companies have a great expense in developing the drugs, but the average person may well lose their will to fight because of the cost. I know my aunt worked until she was too sick with metastatic breast cancer. The Cobra law enabled her to keep her health insurance, but at an inflated cost. It nearly cost her home and all possessions for her to just be kept comfortable during her final months. This was in the mid 1980"s, and after a couple of remissions, she eventually succumbed. Some cancers will be cured eventually, but at what cost? It cannot come too soon.
ReplyDeleteWOW! These videos along with the readings this week have put on new perspective on cancer for me. I too was shocked with the rates of cancer diagnoses in men and women!! How terribly sad that this ever-changing, rapidly growing, commonly-deadly diagnosis has yet to find a definitive treatment. I think the third episode was most interesting and emotional. I never thought of cancer as being similar to infectious diseases, specifically that they are continually building a resistance to treatment the same as a bacteria would.The immunologic advances were, by far, the most amazing!! I am shocked at what the researchers, physician, and nurses can come up with for treatments, and the development of injecting one's own T-cells to practically cure a large portion of the treated population, is wonderful!! It was neat to see that through the last several decades that the development of ideas builds from previous research, eventually becoming more successful or proven inadequate.
ReplyDeleteI also found it interesting that until the 1960s, the primary focus on cancer was curative and not preventative. It wasn't until the anti-smoking campaign, preventative screenings, etc that the rates of cancer were actually on the decline. There was finally a motto that early detection meant better results. I think palliative care plays a huge role today in the plans for patients and families. It was interesting to see that prior to the 1960s, medicine considered palliative care as defeat until Sonders promoted it and the concept spread. I think its important when patients have exhausted all possibilities, to have a comfortable transition to an alternative concept of the diagnosis.
As terrifying and complicated that cancer is, I do not agree with concepts in the readings of genetically altering an embryo or disposing of embryos affected by genetic disorders. I feel like everything is created for a reason, maybe of a higher power than we can conceive, but not argue.
WOW! These videos along with the readings this week have put on new perspective on cancer for me. I too was shocked with the rates of cancer diagnoses in men and women!! How terribly sad that this ever-changing, rapidly growing, commonly-deadly diagnosis has yet to find a definitive treatment. I think the third episode was most interesting and emotional. I never thought of cancer as being similar to infectious diseases, specifically that they are continually building a resistance to treatment the same as a bacteria would.The immunologic advances were, by far, the most amazing!! I am shocked at what the researchers, physician, and nurses can come up with for treatments, and the development of injecting one's own T-cells to practically cure a large portion of the treated population, is wonderful!! It was neat to see that through the last several decades that the development of ideas builds from previous research, eventually becoming more successful or proven inadequate.
ReplyDeleteI also found it interesting that until the 1960s, the primary focus on cancer was curative and not preventative. It wasn't until the anti-smoking campaign, preventative screenings, etc that the rates of cancer were actually on the decline. There was finally a motto that early detection meant better results. I think palliative care plays a huge role today in the plans for patients and families. It was interesting to see that prior to the 1960s, medicine considered palliative care as defeat until Sonders promoted it and the concept spread. I think its important when patients have exhausted all possibilities, to have a comfortable transition to an alternative concept of the diagnosis.
As terrifying and complicated that cancer is, I do not agree with concepts in the readings of genetically altering an embryo or disposing of embryos affected by genetic disorders. I feel like everything is created for a reason, maybe of a higher power than we can conceive, but not argue.
I agree with you. It is hard to see so much hope in something that you feel is wrong.
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ReplyDeleteThere were many interesting situations from the documentary. One thing that stood out to me was the discussions between physicians and the patients or the parents of the patients. Dr. Cole, an oncologist from West Virginia, talked about memories from rounds during med school. She described physicians telling patients they were getting better and would go home soon, only to step outside in the hallway and indicate that the same patient had a bleak prognosis and likely wouldn’t live much longer. Dr. Cole described information that physicians have as information that belongs to patients. The conversations that took place between physicians and parents of pediatric cancer patients were gut wrenching. Emily, the 6 year old with leukemia treated with T cells and Olivia, the 17 month old with leukemia both come to mind. The description by the parents of the experiences of being at the brink of their child’s death is heartbreaking. Olivia’s mom and dad are offered the opportunity for Olivia to take part in another phase of treatment to hopefully prevent recurrence of the disease. This made me think about Jesse Gelsinger and his participation in the gene-therapy experiment. It seems that the discussions between the pediatric oncology physicians and the parents are different from some of the adult oncologists and their patients. There is much more for the pediatric patients. In my opinion, these pediatric oncologists, nurses, and medical personnel have a special place in Heaven.
Over the past 7 years three close relatives have dealt with cancer. Two did not survive. All three however had what I would call good outcomes. Of the two that died, my sister-in-law Julie was the most difficult. It was a cancer of her throat that took her slowly and painfully. All along and inn the end, she and her husband had say over her care. When she made the decision to end treatments and enter hospice one of her doctors who was really not even involved in her care at that point came to say goodbye. He was so honest and compassionate. He placed his hands on her shoulders and told her how sorry he was that they were unable to have cured her and he was sorry that her family would have to go on without her and that he would be praying for all of them. To this day, when I see him, I want to hug him! In contrast, uncle Mike was diagnosed with a brain tumor and was given what turned out to be very accurate information about how the disease would progress (rather quickly). He was able to make decisions with his wife and grown children about retiring, buying a place in Florida where he would be able to play tennis and they could both continue to square dance with their friends. He didn’t put anything off. My sister was diagnosed with ovarian cancer quite by accident and has been cancer free for nearly five years. From diagnosis to surgery was three days and she had her first chemo treatment before leaving the hospital.
ReplyDeleteThe common thread in all cases was the communication between physician and patient which allowed the patients to live the life they chose. Having worked in oncology before some of the excellent curative treatments were being used, I know those conversations are painful for all involved. Having a physician not initiate those conversations is a disservice at least to the patient.
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ReplyDeleteIn the third episode I was shocked that the price of cancer drugs has increased at such a steep rate. I have seen this first hand through a patient that I care for weekly. He is privately insured with Humana. He has advanced prostate cancer that went unnoticed even though he had a yearly PSA completed. He has taken a turn for the worse over the last 2 months. The oncologist has started him on a new medication that the insurance pays $9000 a month for. He is concerned that if his prescription coverage runs out for the year he will not be able to afford the medication. He has planned for his retirement and owns a modest home. Even with the best of planning I am unsure how anyone could afford $9000 a month. It is certain that he will die from this cancer and the drug is only prolonging his life. We have had conversations about stopping the drug due to his fear that his wife will not be able to live on what is left of their retirement.
ReplyDeleteIt was disheartening to hear that most of the medications that are working, only extend life for half a year. Imagine to come so far only to be told again your cancer is worse.
In an odd way cancer research is amazing. To see how your body and cells can replicate and change. It truly shows the complexity of the human body and how much we do not know. It is funny to think that researchers will look back at us 200 years from now and say how we thought this type of research was the cure for cancer.