A little knowledge

The last of the mini-med seminars finally came and went. We are now unleashed upon the world as mini-doctors, capable of exposing slightly more advanced ignorance in future conversations with medical professionals.

I was looking forward to the oncology lecture, but it was a bit of a letdown. In retrospect, the topic was maybe a little too broad to fit into two hours—or, actually, an hour forty, since we had a mini-graduation ceremony that was cute but completely unnecessary. The oncological basics were pretty much what most of us already know, although the statistics on diagnosis and remission rates were good wonk fodder. The doc skimmed over conventional chemotherapy and wouldn't have talked about radiation at all had it not been for a question from the audience; instead he focused on explaining how antibody therapy and some of the new small-molecule drugs work. I hadn't heard the stats on Gleevec/STI571 before—90+% remission in CML patients, 75% in gastrointestinal stromal tumors (translation: life for the dying, in Novartis' hands lying)—or understood how long drugs and antibodies stay in the system, nor was I familiar with some of the survival data for other novel therapies. It's sobering to hear that progress in the past 25 years means that expected survival time for patients with colon cancer has doubled...to two years. Yikes. But cure rates are improving overall, and most neoplasms aren't as resistant as colon or pancreatic cancers. Oh, and he explained how PET scans work. Radioactive sugar uptake! Truly we live in an age of wonders.

The exciting, for very stats-happy values of the term, news was that the school's cancer center is starting a database of molecular information on every patient they treat. Ultimately, they hope to be able to mine the data to develop targeted regimens that will have the best results at the lowest cost (physically, not fiscally, which is another and slimier kettle of fish) to the patient.

It was also a kick to learn that the school's cancer center is going to join the ranks of facilities offering long-term follow-up care. The follow-up issue has finally gotten some attention in the last 15 years or so, as pediatric patients in particular are generally surviving long enough to have their health concerns tracked on a broader scale. Unfortunately, without a coordinated follow-up program, there's no guarantee that they'll hear about what tests they should be getting or what long-term side effects they should look out for. Even those who do hear the news are often stuck being their own advocates for care, dealing with physicians who may not know the likely ramifications of a drug regimen given 20 years ago. (In these cases, a handful of PubMed abstracts is a very useful thing. Snapping, "It's not my fault that you haven't kept up with this research," when confronted with obstruction, however, will not make friends. Not that I would ever do such a thing and find it so cathartic that I practically needed a cigarette afterward. At least not more than once.) Integrated survivorship programs are more likely to know the long-term nasties, understand what's normal for someone who's had their innards irradiated, and keep all the test results in one place. They're also usually more helpful in coordinating schedules for tests, because it's easier for a customer to spend a day or two getting poked and scanned than it is for him or her to schedule five different appointments with various departments over two weeks, only to find that nobody knows to whom the results have gone. CAT scans are unpleasant enough; there's no reason to erect further barriers to compliance.