Update on Mesothelioma: A CancerCare Teleconference

CancerCare Update on MesotheliomaOn Monday, June 30 from 4:30-5:30PM Eastern Time, CancerCare is hosting a free mesothelioma teleconference workshop. The teleconference, titled Update on Mesothelioma, will feature a panel of experts to discuss numerous topics related to the disease. Registrants will be able to listen in on the phone or through a live stream online.

The Update on Mesothelioma teleconference will cover topics including mesothelioma treatment choices; the role of clinical trials; managing side effects, discomfort and pain; communicating with your health care team; quality of life and life style concerns; and physical activity and nutrition issues and tips. Questions for the panel of experts will also be accepted.

The panel of experts consists of four individuals: Richard J. Gralla, MD, FACP, Professor of Medicine, Albert Einstein College of Medicine; Lee M. Krug, MD, Director of the Mesothelioma Program, Associate Attending Physician, Division of Thoracic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center; Mary Hesdorffer, MS, APRN-BC, Nurse Practitioner, Executive Director, Mesothelioma Applied Research Foundation; and Winfield Boerckel, MSW, MBA, Director of Social Service – Long Island, Lung Cancer Program Coordinator, CancerCare.

Mary Hesdorffer, MS, APRN-BC, is an expert nurse practitioner with over 16 years of experience in mesothelioma treatment and dozens of published articles in a variety of scientific journals. She is the executive director of the Meso Foundation and the first line of help for patients and caregivers faced with a mesothelioma diagnosis.

Lee M. Krug, MD, is an Associate Attending Physician in the Division of Thoracic Oncology, Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York, New York, where he completed a fellowship and chief fellowship in medical oncology. Dr. Krug is the Director of the Mesothelioma Program at Memorial Sloan-Kettering Cancer Center. He is also the chair of the board of directors of the Meso Foundation.

To register for the free Update on Mesothelioma teleconference workshop, visit CancerCare.org.

Looking for Inspiration

Running on treadmillby Mary Hesdorffer, NP, Executive Director of the Meso Foundation

I found myself on the treadmill looking for inspiration to go the extra mile. Two miles into it and I am running out of steam. I am not an ESPN fan, which means that I have to take inspiration from another source. Into my mind pops up the image of Joe Friedberg, MD.

Of course, I wonder, who else would channel Joe Friedberg while on a treadmill? Am I losing it?

As you know, Joe is a champion in the field of mesothelioma, toughing it out in the operating room with a grueling procedure, which has recently reported some promising results. I recalled a conversation with Joe when he suggested that to complete a pleurectomy decortication, one has to be totally committed to going the extra mile (as these operations last up to 8 hours) and one has to be willing to persevere through fatigue, and physical and mental challenges.

There has been much debate about surgery – extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (PD) vs. those who believe that surgery should not be offered to patients with mesothelioma, and advocate for palliative care only.

I think about Joe in these debates, and his honesty and lack of bravado when he simply states that “we don’t know what is the best surgical option to offer patients and that all surgery in this disease is experimental.” Though the uncertainty is unsettling, the honesty is refreshing.

Recently, Dr. Friedberg and his team at UPENN have launched a new clinical trial that will randomize patients to either a pleurectomy decortication or a pleurectomy decortication coupled with photodynamic therapy. Joe has spent many years championing photodynamic therapy as an adjuvant therapy to his pleurectomy decortication surgery, making this clinical trial a one-of-a-kind move to get closer to the truth.

Doing 3 miles on a treadmill no longer seems daunting.

Here is why Joe’s courage is so important and why I hope others follow in his footsteps. It is well-known among researchers that most surgical studies have an inherent bias to them. In other words, a surgeon’s excellent numbers may be produced not only by their skill, but also by choosing to operate on patients who have the best chance to tolerate the surgery and do well after. The fact is, surgery often results in a surgical remission, but unfortunately, in mesothelioma, the cancer generally returns after a certain period of time. To extend the remission, surgeons use specific adjuvant therapies to lengthen the time to progression and, of course, create the best case scenario to prevent the return of disease. This is the crux of the discussion about what will kill the cells that are waiting like seeds in a garden ready to sprout into recurrent disease.

I am appalled to hear so many surgeons in this disease state quite frankly that their approach works and there is no need to do a randomized trial which will eliminate bias from their results. Worse yet are those surgeons who boast that their patients do better in their hands, with their procedure yet when I scour the literature there are no published reports in scientific journals. In academic medicine there is a phrase “If it isn’t published, it never happened.” In other words it is expected that you submit your results to a peer reviewed journal to demonstrate that your outcomes are accepted by your peers and your data has been analyzed by, and scrutinized by unbiased reviewers who are experts in the field of surgery. There is no room for arrogance when we are losing patients in these procedures. We need to know what is the true statistical difference. The gold standard is to compare a new hypothesis and test it against the standard to see if this really is a significant improvement.

Dr. Friedberg has reported some impressive results with his combination of pleurectomy decortication combined with photodynamic therapy, and now he’s willing to take a step further to understand if there is a difference between patients undergoing pleurectomy decortication alone from those getting both the surgery and the adjuvant therapy.

This is what the mesothelioma community needs – “proof of the pudding.” We truly do not know what is better so we need to strip back the notion of “my treatment works, and I don’t need to prove it.” Randomized clinical trials can help us find a gold standard of treatment for mesothelioma.

I guess, what that means is that I, too, should be going the extra mile on this treadmill. Mile 4, here I come.

A Look at the Advancing Breakthrough Therapies for Patients Act

Dr. Mary Hesdorffer, NP, Executive Director, Mesothelioma Applied Research Foundation takes a look at the Advancing Breakthrough Therapies for Patients Act.by Mary Hesdorffer, NP, Executive Director, Mesothelioma Applied Research Foundation

The Advancing Breakthrough Therapies for Patients Act was first introduced in the Senate by Senators Bennet ( D-CO), Hatch (R-UT) and Burr (R-NC). Two months later, Congresswoman DeGette (D-CO) and Congressman Bilbray (R-CA) introduced the act in the House of Representatives. The bills, which received bipartisan support, were included as an amendment to the Food and Drug Administration’s Safety and Innovation Act (FDASIA), the latest iteration of the Prescription Drug User Fee bill, and in July of 2012, the breakthrough therapy designation was signed into law.

As a result of this law, a new drug may be designated as a breakthrough therapy if it is intended to treat a serious or life-threatening disease, and if preliminary clinical evidence suggests it provides a substantial improvement over existing therapies. Once a breakthrough therapy designation is granted, the FDA and drug sponsor work together to determine the most efficient path forward. In just two years, 178 requests for breakthrough designation have been submitted, 44 designations have been granted, and 6 drugs have been approved within the program.

On May 6 of this year, Mary Hesdorffer, the executive director of the Meso Foundation, and Melinda Kotzian, its chief executive officer, attended the congressional briefing titled Friends of Cancer Research, which focused on evaluating the progress of this program.

The panel agreed that the next task will be to streamline the process. This will eliminate applications that absolutely do not meet the criteria for breakthrough designation.

Janet Woodcock, MD, director, of the Center for Drug Evaluation and Research within Food and Drug Administration, stated that they “are not planning on moving drugs through this process that offer only incremental progress, but those that demonstrate a substantial benefit.”

Two representatives of the pharmaceutical industry shared their companies’ experience in gaining the first designation under this act. They noted that the time and commitment of all parties involved made this process work.

Dr. Woodcock cautioned that sequestration had an impact on the financing of this program. It will take more funding to continue operating the Breakthrough Therapies program at the present level, but she hopes that streamlining the process will allow for a more drugs to reach the patients in need.

Caregiver Burnout: The Unspoken Suffering of the Caregiver

Caregiverby Mary Hesdorffer, NP, Executive Director of the Meso Foundation

Speak to any caregiver and they will share with you the rewards of caring for a loved one when tragedy strikes. In the beginning, the tasks are met and the list items ticked off one by one. It feels good to be unselfish; the endorphins are sending us messages that we have become the noble self that we had hoped one day to become.

Months go by and the caregiver looks up and thinks ‘Oh my God, will this ever end? Where am I in this process and how did I lose my way?’ The caregiver is not a machine. No human being is programmed to be on high alert 24/7, ready to handle any emergent situation that arises. The caregiver is the unselfish, ever giving angel of mercy residing in the home of a cancer patient. Friends and family can see the signs of burn out, but the caregiver wears this as a badge of pride often until “something gives.” It may manifest as an emotional outburst or extreme exhaustion may take over, and all of a sudden, the world of the caregiver has crumbled.

If you are caregiving for a spouse, stop what you are doing now and sit down with your loved one and tell each other why you came together and why you have stayed together. Yes, caregiving may be somewhere on the list, but my hunch is that it is not one of the top reasons why you are together. Despite the diagnosis of cancer, a patient and a caregiver can still find joy in their relationship and, yes, even a laugh or two. Come back into the 20th century, spend a dollar and get Amazon Prime or Netflix, and look for those comedies that will make you both laugh out loud. Laughter is the best medicine, both for the caregiver and for the patient. Walking into the home of a cancer patient should not feel like walking into a church or a museum, but a place where a living, breathing human resides.

Caregivers, take 30 minutes each day for you. Do this early in the journey. In academics, we call it protected time. Whatever activity you choose should be strictly for your benefit. If you can take a bit more, join friends for lunch, or better yet, go to an exercise class. Invite them for dinner so you both can enjoy socialization and stimulating conversation that does not revolve around “when the next treatment is scheduled” or “have you taken your medicine yet?”

Let’s get the conversation going. Please let us know what works or has worked for you during this stressful time. Caring for the caregiver should be a priority, as few realize that the caregiver is also suffering during this cancer journey.

Thank You from Mary Hesdorffer

Mary Hesdorfferby Mary Hesdorffer, NP, Executive Director of the Meso Foundation

It feels like a time warp as we move from project to project, one day blending into the next. We are deeply immersed in planning three regional conferences before this year ends, and projecting what is in store for us in 2015.

I would like to take this opportunity to personally thank all of those who participated in our 2014 Symposium, which took place in early March. It is so important that we gather together to address the individual and global needs of the mesothelioma community. Weren’t our doctors amazing? I was so grateful that they came out in large numbers to support us and to impart valuable knowledge and support to those in need.

I would also like to thank the individual members of the staff who made the conference appear so effortless.

Erin Maas was responsible for the site location and all of the logistics that go along with running a conference. Thank you, Erin, for a job well done.

Maja Belamaric and Beth Posocco were in charge of communications and marketing the conference, work that is not always visible to the public. The live stream attracted nearly 600 viewers thanks to their tireless efforts to ensure that it was properly managed and advertised.

Erica Ruble was the unofficial hostess of the event making sure that everyone was welcomed and warmly introduced to others. Her fundraising knowledge and encouragement to others has helped us to grow exponentially.

Dana Purcell was responsible for planning many of the supportive care and fundraising sessions. I think we can all testify to a job well done and we look forward to her continued work on community events and individual fundraisers over the upcoming year.

Last but not least is our government affairs director, Jessica Barker. Jessica is well-known on the hill championing our causes and making valuable connections with politicians and government entities to provide our community with a strong voice in Washington. You will see Jessica making her rounds to many political events and she is a sage advisor to both Melinda and me. If you are planning to attend the ADAO conference taking place in Washington, DC in April, please introduce yourself to Jessica as she will be representing the Foundation at this asbestos-focused event. Unfortunately, I will be unable to attend, but I wish Linda Reinstein a successful conference.

Finally, our CEO Melinda is really owed a debt of gratitude for managing the business side of the Foundation and ensuring our financial health so we can remain strong in achieving the goals of our mission. It is a pleasure to work closely with Melinda as she brings her impressive non-profit background into the discussion and helps me to advance the scientific agenda of the Foundation, proving continuously that two heads are better than one!

Keep in close touch with me and let me know your thoughts on how we are doing. Also, we will soon be announcing the date and time for another telephonic town-hall meeting to discuss the future and current state of the Foundation.