In discussing upcoming topics for the MNCC, ZenTrainer and I decided it would be good to have a regular feature in which we had a chance to discuss up-and-coming cancer treatments. So that's what we're starting tonight.
In ideal circumstances, we'd schedule one of these at least every quarter, perhaps more often if news warrants it. That way we can ask all of you to keep an eye out for interesting developments, which would in the best case result in some of you writing these up for a Monday diary. Otherwise, you'd be welcome to share the news you come across in any MNCC comment thread, or in a group Kosmail.
Please join me after the doodle for tonight's notable news.
Monday Night Cancer Club is a Daily Kos group focused on dealing with cancer, primarily for cancer survivors and caregivers, though clinicians, researchers, and others with a special interest are also welcome. Volunteer diarists post Monday evenings between 7:30-8:30 PM ET on topics related to living with cancer, which is very broadly defined to include physical, spiritual, emotional and cognitive aspects. Mindful of the controversies endemic to cancer prevention and treatment, we ask that both diarists and commenters keep an open mind regarding strategies for surviving cancer, whether based in traditional, Eastern, Western, allopathic or other medical practices. This is a club no one wants to join, in truth, and compassion will help us make it through the challenge together.
The first news item on our review list concerns the under-diagnosis and -treatment of depression for people with cancer, particularly terminal cancer. Yes, there are studies about that very topic, all related and recently published in the UK medical journal The Lancet and related publications. [The abstracts are all available at links provided at the end of the MSN article, but the full reports are behind a paywall.]
According to one retrospective study, gathering data from over 21,000 cancer patients in Scotland from 2008 to 2001, who were also screened for depression,
Major depression is an important complication of cancer. However, reliable data are lacking for the prevalence of depression in patients with cancer in different primary sites, the association of depression with demographic and clinical variables within cancer groupings, and the proportion of depressed patients with cancer receiving potentially effective treatment for depression.
People with lung cancers, then those with gynecological cancers, then those with breast cancers, had the highest rates of major depression (over 13% of those with lung cancer, down to 11% for the gyno cancer patients, and about 9% of the BC patients). About 73% of patients who had depression were not adequately treated.
The observations from another study indicate that
Compared with patients in the usual care group, participants allocated to the depression care for people with cancer programme also had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all timepoints (all p<0·05).
In the
last of these associated studies, oncology practices tracked some people with lung cancer into a group receiving depression-related care. Outcomes were compared with those receiving no psychological counseling or support. Depression severity was reduced for those in the study group, while
Self-rated depression improvement, anxiety, quality of life, role functioning, perceived quality of care, and proportion of patients achieving a 12-week treatment response were also significantly better in the depression care for people with lung cancer group than in the usual care group.
It may seem obvious that someone who is terminally ill would be depressed. In my unserious moments, I might think that myself. But that would be missing the point.
Depression as a clinical condition is not only an emotional response, but a whole body-mind-spirit response, with strong physiological and psychological aspects that seriously interfere with one's quality of life. When someone has a terminal condition, it seems to me that much worse for that person not to have the chance to live life fully, all the way to the end. Untreated depression cheats one out of those last precious days. (As an aside, let me add that of course we are all dying. Some of us have evidence to suggest we know the method and timing of it more exactly than others. But no one should have to suffer from depression, regardless of the precarity of one's physical health. It is a shame that such a response tends to be normalized for people with serious medical problems.) /end soapbox
I don't know whether this is a peculiarity of the National Health Service that may now be remedied, or whether all of you have encountered similar lack of interest in your oncology practices. At the Comprehensive Cancer Center where I am treated, there is a Psych Onc[ology] clinic available to all patients. From what I've heard as well as what I've experienced, that counseling has had mixed results: some are very grateful, while others think there's not much support to be had in the end.
Depression and anxiety are very widespread among the population of people with cancer. Without disclosing anything you'd rather not, you're also welcome to relate how your own oncology practice deals with people who are struggling with these conditions following a cancer diagnosis, for good or ill.
The second of our updates tonight concerns FDA approval of a new class of cancer treatments called anti-PD-1 drugs. They work by activating certain attributes in our own immune systems, allowing our bodies to act against the cancer more decisively. The first to be approved here is pembrolizumab, to be marketed by Merck under the trade name Keytruda, primarily to treat resistant or inoperable melanoma. A bit more information about the testing and approval process is available here in the FDA press release about the drug.
This could indeed be a breakthrough treatment, not only in terms of clinical results and the relative lack of side effects but also in terms of the mechanism by which the drug achieves benefit. I don't know what other types of drugs like this are in the pipeline; do you?
If you have other tidbits you'd like to share, please feel free to do so. As always, this is also an Open Thread.