The Unexpected Costs of Beating Cancer

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Cancer is a scary word for most people.  The C-word — some refuse to say its name — in the past has meant lengthy treatment with poisons and uncertain results.  If identified later in development, its often a death sentence.  The side effects of treatment (radiation and chemotherapy) are at best unpleasant.

We have a new class of drugs to treat cancer.  The class is called hypnotherapy, and it works by enabling the body’s own immune system to attack and destroy cancer cells.  Immune system cells (T-cells) see cancer cells as “normal.”  Immunotherapy changes the system by which T-cells identify alien cells to attack, allowing them to go after cancer cells.  For a lot of patients, this can be very effective in eliminating cancer.

The problem, as discussed in a New York Times story today, is that changing how T-cells identify targets can also allow them to attack cells that are truly normal and useful to the body — cells that make up the liver, lungs, pancreas and heart.  For some of the new drugs in this class, side effects can occur between 30% and 50% of the time and can range from mild to lethal.

Typical side effects can include:

  • Fatigue
  • Chills
  • Nausea
  • Reaction at the infusion site

More advanced reactions can include:

  • Pneumonitis (inflammation of the lungs resulting in cough and difficulty breathing)
  • Colitis (inflammation of the large bowel leading to diarrhea)
  • Hepatitis and pancreatitis
  • Skin rashes
  • Endocrine disorders including thyroid abnormalities and adrenal insufficiency (1)

People who survive the treatment have been known to develop a late-life version of Type I diabetes, requiring daily administration of insulin.  In one clinical trial, five health individuals who received the immunotherapy drug died.

The risk is greater for patients outside major urban medical research centers.  Doctors in these areas are unlikely to have seen the side effects from these drugs and may misdiagnose or delay treatment — and that can be life threatening.  Because some of the symptoms resemble flu, it can be easy for inexperienced doctors to fail to recognize either the urgency or the required treatment.  (Inexperienced in this can can refer to veteran doctors who simply have limited or no experience with these drugs and their side effects.)

Bottom line:

  1. With any cancer therapy, the patient needs to understand that there may be impacts on quality of life and make a conscious choice as to how much risk/impact he or she is willing to accept.
  2. The best course of action is behavioral change and early detection.  That means looking at diet and exercise and learning the early warning signs and how to self-examine.
    • One oncologist I know swears by a concoction that he drinks once per day made up of 2 cups of kale or spinach, a one-inch slice of pineapple and one green apple (e.g., granny smith).  There are other docs with other suggestions.
    • Pets have been known to sense cancer in owners.  If you pet changes behavior, and starts nuzzling part of your body, it’s worth exploring why.
    • Regular doctor visits and screenings.

Anything can be relatively quick and easy to beat at Stage 1.  The length of treatment, cost, and potential for a bad outcome rise with each Stage.

If you’re not going to take care of yourself, then make sure you have your will done.  No reason to create problems for your heirs.


Sources:

  1. Dana Farber Cancer Center, “What Are the Side Effects of Immunotherapy?”, 8 March 2016.  http://blog.dana-farber.org/insight/2016/02/what-are-the-side-effects-of-immunotherapy/
  2. Hackethal, Veronica, MD, “How to Treat Side Effects of New Cancer Immunotherapies”, Medscape, 6 May 2015.  http://www.medscape.com/viewarticle/844264
  3. National Cancer Institute, “Immunotherapy”.  https://www.cancer.gov/about-cancer/treatment/types/immunotherapy
  4. Richtel, Matt, “Immune System, Unleashed by Cancer Therapies, Can Attack Organs”, The New York Times, 3 December 2016.  http://www.nytimes.com/2016/12/03/health/immunotherapy-cancer.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0
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