Tuesday, September 22, 2015

A Small Dose of Good Medicine



A week in the woods with kids and grandkids…
 
Good medicine can take many forms—it doesn’t always have to be pills, injections, drips, X-Rays, etc. It’s easy to focus on diseases, side effects, pain, and whatever can go wrong—so we decided to focus on the ‘good’ stuff for a while. 

We organized a week-long get-together and invited all our kids (5), spouses, and available grandkids to come and stay in a large six-bedroom rental in the woods. It all came to be and we had our week in Sunriver, Oregon. All five kids appeared on cue, spouses, some grandkids, and even friends and relatives in the general area dropped by. 

No cartoon for this article—can’t improve on the real thing!

The age range was five-and-a-half (youngest grandson) to 75 (oldest geezer: me); some people came several hundred miles, others several thousand miles. After each day of hiking, jogging, swimming, museums, and eating too much, the clan gathered to talk and laugh into the night (actually 9:30 or 10:00 seemed to be our limit). At the risk of sounding too sentimental, it was a good time to soak up good feelings. I’m sure we’ll do it again. Thank you to everybody for the gift of being together.

axman

Wednesday, September 2, 2015

Drug Costs Revisited



And the costs go onward and upward…..
 
I have written a blog or two (or more) about the high and still rising costs of prostate cancer (and other cancers, too) treatment drugs.Here is another one!

The list of current FDA approved treatments for prostate cancer is rather long. Some of the approved drugs have been around long enough to be generic and not nearly as expensive as the new drugs.
I googled the drug names and drug costs of a selected few of the newer ‘miracle’ drugs. I use the term ‘miracle’ advisedly here. In clinical trials some of the drugs provided an extended lifespan or symptom free time of only a few months. So I consider these drugs to be ‘small miracle’ drugs. We are still in an era of “one size fits all,” and all patients do not receive the same benefit from a particular drug.

Personal disclosure: I worked my way through the generic drugs and graduated to one of those zillion dollar miracle drugs. For the past several years my PSA and my side effects have been more or less under control—thanks to the new medication. I discovered in my searches it is sometimes hard to pin down the actual retail cost of these drugs. Numbers seem to vary slightly depending on what site you look at and what day it was updated, so the sample list I have compiled is more or less accurate. I have included the ball park average cost. These are the basic full price costs for a few selected drugs.

A few spendy drugs
1.      Abiraterone (Zytiga): Pills taken daily. Approximately $8,500 per month.

2.      Cabazitaxel (Jevtana): Injection every three weeks. Approximately $48,000 for one course of treatment—ten injections.

3.      Enzalutamide (Xtandi): Pills taken daily. Approximately $9,000 per month.

4.      Leuprolide Acetate (Lupron): Injection. Approximate cost of three month 11.25 mg injection is $6,800.

5.      Radium 223 Dichloride (Xofigo): injection (six treatments at four week intervals) $69,000 for six injections.

6.      Sipuleucel-T (Provenge): Injection, three infusions in one month. $93,000.

Paying the Piper
Most of us don’t (and couldn’t) pay that amount, of course. The average age for prostate cancer diagnosis is 66, so most of us have Medicare, most likely Part D, and often a supplemental or med advantage program. So our yearly copays are more likely in the $5,000 to $10,000 range. Substantial but still possible for us lucky ones. Some older patients are forced to choose between meds and food and rent.

A man with no insurance would have to be rather well-to-do to afford any of these treatments. In reality, men with no health insurance just don’t take these meds. Cancer patients are at the bottom of the food chain and pay what the traffic will bear. We know it is very expensive to develop these drugs. But the cost of many drugs has increased each year since they were approved by the FDA, even after research costs have been met.

There are Co-Pay Assistance programs to help those who can’t afford the high co-pay costs. My experience several years ago was not good—I applied, filled out forms, waited, there were delays, letters, personal information, more delays, etc. I finally gave up because I needed to get started on the prescription. If you have experiences with the copay assistance programs (good or bad) please share that with me and the blog readers.

If you were to buy these same drugs in Canada, India, Japan, or many other countries, the cost would be substantially less because other countries negotiate prices with the drug companies.

Factoid: The most common cause of bankruptcy in older Americans is massive medical bills they can’t pay. 

Final Note 
Growing old ain’t for sissies—especially if you have cancer.
 
axman


Thursday, August 13, 2015

On Becoming 75!


I try to post a new entry every few weeks. There has been no formal schedule. Some posts share important and breakthrough information about prostate cancer treatment. Some posts lament the rising costs of medications, strange and nasty side effects, and the slow progression of clinical trials. Others are more tongue and cheek and personal (as you probably know).

This entry is mostly silliness and celebration. When I was diagnosed with prostate cancer 12 years ago and then found that it was incurable about 10 years ago, I was not at all sure I would reach 75. But, for the most part, I am healthy, active, moderately alert, and ornery. Carol, my wife and best friend, and I travel, laugh, garden, play with chain saws to cut firewood and clear land, and frequently visit friends and family. Life is good (as it should be).

 Although I am not Shakespeare, Longfellow, or even Dr. Seuss, I am waxing poetic on this occasion. Forgive me if I take extreme poetic license with the facts and just about everything else.

           Being Alive at 75!

 I’m pleased I've survived to be 75.
Albeit I'm old and decrepit and barely alive.

So stand up now and give me a cheer,
Please make it loud ‘cause I can’t hear.

I could tell you wild stories about my life,
But I can’t remember, so go ask my wife.

You look happy and cheerful there sipping your drink.
I can’t really see you, but that’s what I think.

Now, dear friends, won’t you give me a hand…
I mean, of course, to help me stand!

But after all is done and all is said,
I’d rather be 75 than flat out dead!

axman

Sunday, August 2, 2015

Five Types of Prostate Cancer—British Study Finds



In a recently published article in the Journal EBioMedicine, researchers reported they were able to identify five distinct types of prostate cancer. The team took both healthy and cancerous prostate tissue from 259 men and looked for abnormal chromosomes and measured the activity of 100 genes known to be linked to prostate cancer. 

This prostate cancer study is a preliminary step in being able to identify which newly diagnosed cancers need immediate treatment and which are slow growing and can be safely observed instead of starting radical treatments immediately. This would help avoid too much treatment and make sure treatment was immediately available for the most aggressive cancers. Early stage have shown that doctors were better able to identify rapid growing, aggressive tumors than when using the PSA and Gleason Grading system. 

The study authors did not actually list the five types of prostate cancer. When this information becomes available I will publish it here.

A similar study several years ago identified ten unique types of breast cancer and those results have been helpful in the early treatment of aggressive breast cancers. 

Is this likely to help those of us who already have prostate cancer? Probably not. But hopefully future diagnoses will be more accurate, treatment more targeted, and results better.

Disclaimer
Many studies claim to be game changers, breakthroughs, and cutting edge. This is true sometimes and other times results are less than hoped for. We’ll wait and see what happens with further study.

axman

Monday, June 22, 2015

A Funny Thing Happened…



Or could have happened, should have happened, or didn’t happen
 
About half of all of us with incurable cancer (incurable means that it likely will kill us someday) also have to deal with depression and anxiety. Actually, it’s not so surprising.

In many cases there is a predictable progression of events and often it doesn’t end well:
·        Doctor: You have cancer.
·        You: OMG, I’m going to die!
·        Doctor: Maybe not, there are treatments and possibly a cure!
·        You: Oh boy, I’m going to be cured!
·        Doctor: Whoops, the treatment didn’t work completely and the cancer came back. This time it’s not curable.
·        You: OMG, I’m going to die!
·        Doctor: Maybe, but there are treatments to slow cancer growth and give you a better quality of life.
·        You: What’s the use? I’ll just wait for the inevitable…, or
·        You: Then it’s time to finish off my bucket list, visit friends, and write that memoir…

When it seems hopeless there is professional help, medications, counseling, and support groups—but you have to make the choice whether or not to get assistance.

How we react to a bad situation varies a lot. Nobody knows how they will do it until it happens to them. We all have good days and bad days—I definitely hope I have more good days. My approach for the past dozen years with incurable prostate cancer has been to spend time with family and friends, laugh a lot, stay very, very busy, write blogs and books (often humorous—hopefully), and draw and publish hundreds of cancer-related cartoons. I have tried not to offend anyone with cancer—but, I maybe take a shot or two at doctors and drug companies—and bring a smile or little laughter into some lives.

Some have thanked me and even asked to borrow the articles and cartoons for use in other publications. A few others have become angry with me and told me how inappropriate humor is when dealing with cancer. One person, with late stage cancer, told me, “Cancer is not funny!” And suggested I not use humor in communicating with others who have cancer, ever. Of course I know cancer is not funny but I believe a sense of humor can help—it has helped me. Being able to laugh at the ironies of growing old, the strange side effects from medications, those body parts that don’t work very well anymore, and becoming more and more dependent on doctors, pills, injections, and even Depends, makes me smile—at least a little! I know that won’t be the case for everybody. 

Nobody knows if the meds will stop working or we’ll get hit by a bus or the big 9.5 earthquake will hit or…. So I’m trying to enjoy every day and maybe help some others enjoy their days a little bit more. What works best is probably different for each person‑‑find what works best for you. There are many sources of information out there. There are numerous cancer organizations, blogs, support groups, and publications. Find those that fit your needs, beliefs, and comfort levels.

axman