Taking Charge of Your Treatment
For mesothelioma patients, the crux of the crisis is how to buy more time. How can we as lawyers help, if at all? Medical, logistical, and philosophical questions abound: how bad is the tumor? What treatment options are there? Are they any good? How much do they cost? Is one form of surgery better than another? Is surgery even necessary? If my client gets radical treatments, can he still endure a grueling two-week deposition? Can he make it to trial? Can he still play golf, hike, bike, or putter with his grandkids? What's his quality of life going to be? How long has he got More...
Questions for you Doctor - No Quick Fixes (2/7/08)
"MPM does not have one widely accepted treatment modality since none reliably results in cure." (Ismail-Khan R, Robinson L, Id.) This is the bottom line for mesothelioma science today: no cure. At the same time, there are certainly some slow fixes. Since few doctors have experience with the disease, one five-year survivor summed up the first step in a sound treatment plan as, "Get thee to an expert. And when you're done with him, get thee to another." More...
Talc Pleurodesis - Stem the Effusions (2/7/08)
Though talc pleurodesis (TP) is not always recognized as a "treatment" for malignant mesothelioma, some researchers have shown that unselected survival data is comparable to highly selected surgical series of combined pneumonectomy, radiation, and chemotherapy. More...
Surgery - Radical Surgery: Keep the Lung? Or Let it Go? (2/7/08)
Why surgery? Surgery designed to remove all possible tumor-invaded or contaminated tissue is radical surgery. Because mesothelioma is a diffuse tumor, and because surgery itself can spread the cancer cells, in order to eradicate all tumor the surgeon would have to cut out the ribs and intercostal muscles, the pleura, lung, trachea, pericardium, diaphragm, esophagus, superior vena cava, aorta, subclavian artery and vein, nerves, and vertebral bodies.( Aelony Y. ) Essentially, whack out everything below the neck and above the gut, and you'll be "cancer free." More...
Doctor Survey - Do Surgeons Rate? (2/7/08)
Even with decent data, many patients will still base their treatment decisions on intangibles, such as the doctor's bedside manner, the doctor's enthusiasm, location of the hospital, the hospital's reputation, and scuttlebutt found on Internet chat rooms. "Harry saw Dr. X and he's been alive now going on 5 years," may be more convincing to a patient than a stack of peer-reviewed randomized clinical trials. More...
Chemotherapy: The Standard of Care? (2/7/08)
In 2004, the FDA approved Alimta for the treatment of mesothelioma. Before that, there was no drug that had been approved specifically for meso, and most patients were steered to multi-modal therapy protocols that included radical surgery. Oncologists and Eli Lilly touted Alimta/Cisplatin as the new "standard of care." A large randomized trial showed that the Alimta/Cisplatin regimen offered about 12.1 months of life rather than Cisplatin alone, which offered about nine. Since then, many surgeons have commented that they are seeing fewer patients, as primary care doctors have begun to bypass surgeons and refer their patients directly to the town oncologist. More...
iMedicine: The Quest for Good, Solid Data (2/7/08)
The mesothelioma client's first step is to hop on the Internet, where his beleaguered boat is quite often capsized by a monster wave of information, pseudo-information, and misinformation. His first task is to begin ruling out bad options like the unregulated nostrums in the Bahamas and Tijuana. More...
Alternative Therapies: Keeping the Beast at Bay (2/7/08)
A few leading surgeons have taken steps to experiment with new compounds designed to delay tumor recurrence and manage it at tolerable levels. These doctors recognize that eradication may be the ideal, but until then it's best to try to tame the beast. Dr. Robert Cameron at UCLA has achieved promising results by having his patients take a daily injection of low dose interferon-alpha after surgery and radiation. In an unpublished study, he reported median survival of greater than 36 months for this particular multi-modal therapy. More...
Multimodal Therapy: The Kitchen Sink Approach (2/7/08)
Multimodal therapy based on surgery appeals to common sense and to the approach with other cancers: extract the monster from the chest, and then blast all remaining traces with radiation or drugs. It also appeals to thoracic surgeons, who make their living cutting. Just when it seems like the lifeboat choice is getting clearer, though-at least we know we need surgery - new issues arise, buffeting the boat harder than ever. More...