Easing the Pain

Pain and cancer frequently go hand in hand. Studies suggest between 20 and 50 percent of cancer patients are experiencing pain at the time of their diagnosis. But while pain is common in cancer patients, it’s not always easy to treat. In fact, pain management can be one of the more challenging areas of cancer care. That’s why I decided to write about it for the spring issue of Cancer Today.


Easing the Pain

Pain is no gain for patients during or after cancer treatment.


In 2009, Mike Richardson was diagnosed with melanoma, an aggressive skin cancer, following removal of a suspicious-looking mole near his collarbone. He had surgery to remove the area around the mole, and all appeared well. But two years later, a biopsy of a swollen lymph node in his neck confirmed the cancer had returned. To corral the cancer, Mike had surgery to remove that node and others nearby, followed by radiation. That’s when the pain began.

“Mike started having general soreness,and then he started to have some pain,and then that pain began to become extreme,” recalls his wife, Eryn Richardson. “It was unbearable. He couldn’t sit or lay down. He would say ‘everything hurts.’ ” The pain would make the 40-mile drivefrom their home in Black Diamond, Alberta, Canada, to the Tom Baker Cancer Centre in Calgary seem even longer. Yet when her husband, who died in March 2013, told his oncologist about his discomfort, the physician had little to offer, Richardson says. “Her response was ‘just take some Tylenol or Advil,’ ” she says. “She didn’t seem concerned.”

But to those close to him, it was clear Mike was not doing well. After two months of chemotherapy, the 50-year-old had dropped 50 pounds, and his clothes hung on his 6-foot-plus frame. “He wasn’t the same person,” says Richardson. “He didn’t have a lot of go to him anymore and he didn’t have any drive. And he was frustrated because he didn’t feel his oncologist was taking his pain seriously. His complaints about pain didn’t seem to resonate with her.”

One day, following a routine appointment, a nurse handed Mike a pamphlet about support for cancer patients. Using a phone number on the pamphlet, he scheduled an appointment with a psychologist who had experience with melanoma patients. At the first meeting, the psychologist asked Mike to rate his pain on a scale of one to 10. “When Mike said eight,” says Richardson, “he was flabbergasted.”

The psychologist made an appointment for Mike at the pain clinic at the Tom Baker Cancer Centre for the following day. It took a few more weeks for the specialists there to get Mike on the right dose of the right medications. But after that, his pain was better managed. “He got his appetite back,” says Richardson, “and he began to feel more human.” Still, the Richardsons couldn’t help but wonder: Why had it taken nine months for Mike to get proper pain management?

Read the full article in the Spring 2016  Cancer Today.

Honor Your Body

Coming to terms with feelings and emotions about weight gain and weight loss is often part of a cancer patient’s experience.

48-body-Image-250x324-WEBWhen Laura Walker was diagnosed with breast cancer in October 2012, how much she weighed was the furthest thing from her mind. She was more concerned about the side effects of chemotherapy, surgery and radiation. Then, a year after her mastectomy, Walker, a mother of four from West Columbia, Texas, went to see a plastic surgeon at the University of Texas M. D. Anderson Cancer Center in Houston to discuss her breast reconstruction. The surgeon didn’t ask Walker to undress or take a look at her scar. “Just looking at me, she knew I was too big,” she says.

It was January 2014. Walker was 41 years old and weighed 328 pounds. Her body mass index (BMI) was 53. She had been overweight for more than a decade. To have surgery, she learned, her BMI would have to be 35 or less. “I didn’t even know what BMI was,” says Walker. “I was just living my life. I was happy. I gave no thought to what I was eating or what I weighed.” That would need to change. Her body was carrying a 100-pound obstacle that stood between her and a new right breast.

Read the rest of the article, which I wrote for the winter 2015/2016 issue of Cancer Today.

Breaking the Blood-Brain Barrier

During the past five years, oncologists have reported an uptick in cancer patients with brain metastases—and it’s not clear why. I explored the impact of this development in my feature story “Breaking the Blood-Brain Barrier” in the Fall 2015 issue of Cancer Today.

Here’s an excerpt:

As the calendar turned to September 2014, Leslie Falduto was feeling at the top of her game. The cancer survivor was running six miles, three days a week. Her oncologist had recently told her she was doing great. And at work, Falduto, a registered nurse, was returning to her favorite post, the neonatal intensive care unit.

BrainMets_175x175Talking about her diagnosis of stage III breast cancer in September 2008 still made her feel anxious. But in the world of cancer, five-year survival is one of those measures that is supposed to make you think, OK, maybe now I can pop the champagne. And Falduto, a mother of two from St. Paul, Texas, has passed that marker the year before. 

But on Sept. 7, when she went to leave the neonatal unit, an odd thing happened. “I couldn’t remember how to open a door,” recalls Falduto, 38. After that, “I couldn’t remember how to walk.” Her right leg started shaking uncontrollably. Then, she passed out. When she awoke, Falduto was in the emergency room, where she was told she’d had a seizure. A neurosurgeon requested an MRI. The scan revealed a tumor the size of a pingpong ball—metastasized breast cancer–deep in her brain.

Read the full story.

The Ways We Approach Death

On Thursday, the California state Senate passed a measure that would give terminally ill patients the legal right to end their lives with a doctor’s assistance. The measure now heads to the Assembly.

Only three U.S. states—Oregon, Vermont and Washington—have laws that allow doctors to give mentally competent, terminally ill adults a prescription medication that ca36-The-Way-We-View-Death-600x200-WEBn hasten their death. California is one of about two dozen states where lawmakers are considering similar legislation.

In many ways, this legislative activity is a direct result of the advocacy efforts of Brittany Maynard. After Maynard received a devastating cancer diagnosis, she and her family worked closely with the Colorado-based organization Compassion & Choices to publicize her decision to end her own life, on her own terms. This effort included the release of a six-minute video in which Maynard explained why she had moved from California to Oregon to take advantage of that state’s Death With Dignity Act. That video, along with a guest column for CNN and a People magazine cover story, captured the nation’s attention.

My article, “The Ways We Approach Death” in the Spring 2015 issue of Cancer Today uses the stories of Maynard and MTV star Danielle Michelle “Diem” Brown, another hard-charging young woman facing cancer, to explore the difficult decisions we all will face at the end of life. You can read the entire article here.

It’s A Beautiful Day In The Neighborhood

“Please won’t you be my neighbor?”

Hearing Fred Rogers sing those welcoming words as he donned his trademark cardigan sweater and blue tennis shoes signified a comforting kind of children’s television programming. Parents could be sure a visit to
Mister Rogers’ Neighborhood would be educational and age-appropriate. For children, hearing the familiar song meant they were about to spend time with a man who understood their hopes and fears, never talked down to them, and always reassured them that “I like you just the way you are.”

That’s the opening paragraph from my article “A Beautiful Neighbor” on the life and times of Fred Rogers, who died from stomach cancer in 2003. The article, published in the Winter 2014/2015 issue of Cancer Today couldn’t have been easier to write. Who didn’t love Mister Rogers?

‘Sir’ and ‘Ladies’: Can We Tell You About Cancer?

On the international front, a brief article I wrote on a cancer education campaign in Ghana: ‘Sir’ and ‘Ladies’: Can We Tell You About Cancer?

The Africa Oxford Cancer Foundation and the European Society for Medical Oncology Developing Countries Task Force launched a five-year pilot program in Ghana to develop and implement cancer-prevention and early-detection programs that can be models for other developing countries.

Afrox1Currently, most Africans do not have access to screening, treatment or palliative care. For instance, Ghana, with a population of 25.9 million, has only two oncology centers and four oncologists. There are no oncology nurses.

Afrox2The pilot program includes the distribution of 13 different posters (like those seen here) to health centers  and the general public. Developed with the support of the Cancer Society of Ghana, the posters can be downloaded for free and used by any organization or individual, and in any country.

This article originally appeared in the Winter 2014/2015 Cancer Today.

Elmer Huerta: A Champion for Prevention


Dr. Elmer Huerta is the founder of the Cancer Preventiorium, a cancer prevention clinic specifically for Latino immigrants. Since opening its doors in the mid-1990s at the Washington Cancer Institute in Washington, DC, the Preventorium has served close to 33,000 people.

How did the Cancer Preventorium get started?
While Dr. Huerta was at the National Cancer Institute, he started a radio show, Cuidando su Salud (Taking Care of Your Health), and as his show became more popular, he was asked to provide cancer prevention presentations at Latino churches and community centers. In these settings, women frequently shared their frustrations about having to go to one doctor for a Pap test, another for a colorectal cancer screening test and then yet another so their husband could have prostate cancer screening. They wanted everything in one place. Dr. Huerta thought they were on to something—and Washington Hospital agreed. “The interest of the community was so huge,” says Huerta, “we started then and haven’t stopped.”

Read more about the Cancer Preventorium in my interview with Dr. Huertra  in the Winter 2014/2015 Cancer Today.

Cancer Today: Spring 2014

The release of the Spring 2014 issue of Cancer Today was timed to align with AACR_SPR14_CVR_HIGHRES-158x203-WEBthe annual meeting of the American Association for Cancer Research.

I’m pleased to report that our editors who attended the conference earlier this month received a lot of positive feedback about the magazine and its importance to the cancer community.

Included in this issue’s Forward Look section, which I assign and edit, are these articles:

Push Needed to Increase HPV Vaccination Rates, an article I wrote on a new report by the President’s Cancer Panel that describes what needs to be done to increase the number of girls and boys in the U.S. who are vaccinated against HPV, the virus responsible for cervical and other cancers.

An Herbal Surprise, which discusses a recent study that showed that the herbal supplements you take may not contain the ingredients you thought you bought. Some herbal supplements include ingredients not listed on the label while others fail to even include the primary plant ingredient.

Moving Closer to a Menthol Ban? This story describes the work anti-tobacco advocates are doing worldwide to get countries to outlaw menthol in tobacco products. Will the U.S. Food and Drug Administration take action?

• Clues to Stomach Cancer Discovered in South America. Did you know that more than half the world’s population is infected with a stomach bacteria called H. pylori, which is the primary cause of stomach cancer? This article describes new findings that may help researchers understand why in some people the infection causes no problem while in others it can be deadly.

ACA to Cover Breast Cancer Reduction Drugs, an article I wrote on the two drugs that are available for high-rsk women for chemoprevention, and why they are underused.

11-Forward-Look-Gazing-on-Cancer-250x354-WEBYou can also read a short piece I wrote, Gazing on Cancer, about a new Italian ad campaign featuring a bald Mona Lisa that was recently launched by Fondazione ANT Italia. (And a shout out to Google Translate, which made it effortless to write my email in Italian to their press contact.)

Lastly, to get a good understanding of the new cancer treatments that are attempting to harness the power of the immune system, take a look at Unleashing the Immune System. All eyes (and lots of money) are on this new approach to cancer.

News from Cancer Today

As a contributing editor for Cancer Today, the magazine published by the American Association for Cancer Research, I’ve been quite busy keeping on top of the latest cancer research; developing, assigning, and editing news and feature stories; and enjoying getting to know the people behind our bylines.

Some highlights include:

Telling the Tale, my Q&A with medical oncologist Siddhartha Mukherjee, the Pulitzer Prize-winning author of The Emperor of All Maladies

The Proof of the Proton Is in the Result, a piece I assigned and edited that notes that, despite the buzz over this new technology, “ForardLook_ProtonTherapy_350x227webno one knows if proton beam radiation is really better than standard X-ray treatment—an important consideration particularly for the prostate cancer patients to whom it is already heavily marketed.”

Paying a Steep Price, an article  I assigned and edited on new laws that are pushing health insurers to make oral cancer drugs affordable. As this story explains, “Over the past five years, cancer organizations and advocacy groups has pushed 26 states and the District of Columbia to pass oral parity laws,” which require that oral cancer medications be treated as chemotherapy given in a doctor’s office and billed as a routine visit.

Lung Cancer Screening for Smokers, an article I wrote on the new recommendation by the United States Preventive Services Task Force P10-Lungs-350x257-WEBto screen individuals at high risk for lung cancer with low-dose CT scans. The recommendation followed National Lung Screening Trial results which showed that current and former smokers who received regular CT scans were 20 percent less likely to die of lung cancer than those receiving routine chest X-rays.

Changing Perceptions of Palliative Care, a Q&A with Judith Redwing Keyssar on the importance of pallliative care, which I assigned and edited. As the article explains, “Studies have found that 70 percent of the U.S. public is unfamiliar with palliative care … which can be offered from the moment a patient begins treatment.”

African-American Women May Benefit Less From HPV Vaccine, an article I assigned and edited after research results showed that less than 40 percent of African-American women carried HPV-16 and HPV-18, compared with 65 percent of white women. HPV-16 and HPV-18, the two HPV subtypes the HPV vaccines target, are responsible for 70 percent of all cervical cancers.

New Insights Into Pediatric Cancer, my article on a recent discovery that may help explain tumor growth in children. It typically takes decades for normal cells to accumulate all the genetic errors necessary to become cancer cells—this helps explain why a person’s cancer risk increases with age. But when it comes to pediatric cancers this explanation falls short, as it cannot account for the speed with which cancer develops in children. The new finding suggests one reason may be how cellular pathways spur cancer growth in these tumors.

Cancer Today—Winter Issue 2012-2013

The Winter issue of Cancer Today is now available.

I encourage you to take a look at the stories covered in Forward Look, which I developed and edited. It includes stories on genetic ancestry, the link between childhood obesity and adult cancer risk, lung cancer’s stigma and the role of patient navigators, and more.

This issue also includes my article “Missing the Mark,” which continues my exploration into cancer clinical trials. Many people are not aware that only one-third of new cancer therapies or drug combinations tested in phase III clinical trials prove to be better than the standard of care. This article explores why—and how researchers are aiming to improve the odds.

Missing the Mark

If you are a person who likes to gamble, the Super Bowl may be the event for you. Some Vegas oddsmakers have correctly predicted 16 of the last 21 winners—a 75 percent success rate. 

Even so, odds are just that: odds. Time after time the team that just can’t lose does. In the wake of such upsets, sports announcers typically turn to clichés like “misplaced expectations” and “false hopes.”

 Similar platitudes are often heard when a large phase III clinical trial falls short—when a therapy or drug combination that companies have often spent hundreds of millions of dollars and more than a decade developing doesn’t do better than the current standard of care, or does even worse. The difference, however, is that cancer is not a game. Read more

[Note: Special thanks to Larry and Scott for their deadline oddsmaker insights.]

The Winter issue also includes my interview with Margareta Timofti, the new first lady of Moldova. Timofti is committed to lowering her country’s cancer death rates, and she and I spoke (through a translator) while she was in San Francisco on an educational mission sponsored by the Institute of International Education.

Q&A  Gaining the Benefits of Early DetectionWhen Nicolae Timofti was elected president of Moldova by the country’s parliament in March 2012, his wife, Margareta Timofti, rose to international prominence as well. As the country’s new first lady, Timofti intends to use her position to draw attention to women’s health issues—in particular, the thousands of deaths that could be prevented through cancer screening programs.​ Her work will not be easy. Moldova, which is about the size of Maryland and is home to nearly 4 million people, is one of the poorest countries in Eastern Europe. The parliamentary vote that brought her husband to office followed nearly three years of deadlock between Moldova’s ruling, pro-Western Alliance for European Integration and the opposition Communist Party. Even so, since 2009, with the assistance of the International Atomic Energy Agency’s Programme of Action for Cancer Therapy, the country has been taking steps toward implementing its first national comprehensive cancer program. Timofti’s work can build on this foundation. Read more

This issue is also special to me because In the Moment includes this lovely photograph of my friend Julia, who was diagnosed with stage IV breast cancer in 2010. Julia and I first met in the early 1980, when we worked at the UCSD Food Coop selling fruit, vegetables and other new-fangled organic goodies. We’re both still organically inclined, but now we talk about kids, college, new restaurants—and cancer.