Limits are being placed on profits doctors can make on some cancer drugs, causing oncologists to search for new income. Some fear these physicians may resort to prescribing additional treatments for some patients. Not just any treatments, though -- just the ones with the best reimbursements.

Until 2005, Medicare paid a markup of 20 to 100 percent for many cancer drugs. In 2005, Congress changed the reimbursement system to pay physicians just six percent more than the average price for a given treatment. This decrease has made it difficult for small practices to break even on cancer drug purchases because the purchases are not large enough to receive rebates or discounts from drug manufacturers.

According to a recent New York Times article, some oncologists have attempted to increase profits by performing chemotherapy more often, ordering more diagnostic scans, and by putting pressure on patients to make out-of-pocket drug co-payments.

Say it isn't so.

In a study of 401 cancer specialists in the UK, 102 exhibited possible psychiatric morbidity and more than one in ten showed clinically important levels of depression. The study was published by Professor Chris Todd and his team at the University's School of Nursing, Midwifery and Social Work and Christie Hospital, Manchester in Clinical Medicine in June.

The team surveyed all palliative medicine, clinical oncology and medical oncology specialists in the country. 63% of the specialists responded to the study.

The main concerns for the respondents included being over-stretched, keeping up-to-date with knowledge, fear of making mistakes, talking to distressed relatives and long working hours. For the palliative care group, stress factors included making the right decision as a team and low prestige of specialty.

Todd adds, "Many doctors in various specialties experience high levels of stress during their working lives and are more at risk of depression, alcoholism and suicide than the general population. They also report that it can affect their performance. Cancer clinicians are exposed to high risk of poor mental health and other work has shown that their psychiatric morbidity has increased markedly over recent years."

As far as what can be done to alleviate this problem, Todd suggests tackling workload problems as well as changing the culture to allow these specialists to work through and talk about difficulties without a fear of affecting their career prospects.

Is the cancer in your family inherited? Some families experience large amounts of cancer and whether it is environmental, every day living habits, or genetics are all factors that should be looked into. Genetic testing, usually performed with a blood sample, may provide information about you and an increased risk for cancer because of family genetics.

For instance, nearly everyone born with familial adenomatous polyposis (the genetic predisposition to colon cancer) develops the disease by age 40 if preventive surgery isn't done. Knowing this early can aid in prevention and early detection. Talk with your doctor about genetic counseling. A Genetic Counselor provides individuals and families with information on the nature, inheritance, and implications of genetic disorders to help them make informed medical and personal decisions. Genetic counselors often work in clinics with oncologists or gastroenterologists and focus on cancer risk.

If you've battled cancer in your lifetime (or are battling it now), have you agreed with everything you've been shown and told from your physicians and oncologist? Most likely, you have not -- for various reasons. But, should you?

There is new research showing that cancer patients in an advanced state who disagree with their physicians actually have a higher chance of dying when the subjects of nutrition and physical condition come up. While certain nutrition philosophies are pretty much agreed upon in the cancer prevention field, are these disagreements happening due to denial or some other reason?

Long-term cancer outcomes were found to be affected by patient-doctor agreements, with the a researcher on this study saying that "patients disagreed with their clinicians greater than 50 percent of the time." Why is this? From those who have battled cancer, I'd be very interested to hear reasons why so many disagreements end up happening.

Cancer sent me into a state of depression. And it took more than a year of counseling and treatment with an anti-depressant to bring me back to a balanced and healthy level of functioning.

My type of depression -- the kind that shows up just after a cancer diagnosis -- is not uncommon. And neither is the spillover that depression can leave on the children of moms depressed because of their disease.

A study at the University of Pittsburgh -- the first to examine the relationship between children's concerns and a mother's cancer-related depression -- found children of depressed breast cancer patients were more likely to be concerned or anxious about their mother's cancer and about how the disease affects their families.

It's not surprising that kids worry about their moms during times of illness. What startled researchers, though, is the fact that children's' anxieties extended to concerns about the entire family.

The results of this study, funded by the National Cancer Institute, has clear implications. As a society, we need to think about how depression affects whole family units. Oncologists must learn to spot depression early and must swiftly assist women in finding appropriate treatment. And parents should talk openly about cancer and it's emotional side effects with their children in an effort to protect them from withdrawing, hiding their concerns, and suffering in silence.

Most estimates indicate nearly one quarter of women diagnosed with breast cancer have young children. And about 100,000 kids will be affected by a cancer diagnosis this year alone.

I just heard someone say that time doesn't heal all wounds -- it just makes them worse. I guess it depends on the wound. I imagine losing a child is one wound that never really heals. But I've found that my cancer wounds -- both physical and emotional -- have healed with time. And a trip down memory lane proves it.

Two years ago I wrote about my wounds, fresh and raw and painful, on my Breast Cancer blog.

Confession
Wednesday, February 23rd, 2005

The girls I know at the Young Survival Coalition website have discussions on many topics about the impact of cancer on our lives. Sometimes though someone comes up with an idea to lighten things up. Here are the most popular things we don't want to hear from our doctors...

1. When complaining to my plastic surgeon about the funky shape of my tissue expander, he said "Well, its sort of like a beach toy that is not fully inflated yet".
2. When asked to take part in a clinical trial suitable for stage II cancer I asked my oncologist "So that means I'm stage II then?". He said "Yeah at least!"
3. After taking samples of my tumor, my physician asked "Do you want to see them, they look like little tiny pieces of angel hair pasta?"
4. After discussing plastic surgery for breast cancer my plastic surgeon said "You know they are never going to look real".
5. When discussing with my oncologist about getting my port removed he said " Well, I guess we can put it back in if we need it".
6. Talking to my oncologist he says, "Well everything is fine, for now"
7. My primary oncologist asked me "So, who is your primary oncologist?"
8. My plastic surgeon remarks "I hate making nipples".
9. Arriving to get a mammogram a few years after a breast cancer diagnoses. "Why are you here?".

US Oncology has launched a new program, OncologyRx Care Advantage, that provides a convenient home delivery service of oral cancer medications to cancer patients in Oregon, Washington, Texas and Virginia.

Not only will they be delivering cancer medications to cancer patients at home, oncology-trained pharmacists and nurses will call the patients to see if they have any questions and to monitor side effects, and in turn, patients can call anytime of the day or night to speak with nurses or pharmacists.

The OncologyRx Care Advantage team will report on a regular basis to the physician so that the physician is aware of how their patient is doing at the time cancer medications are delivered to the home. While this service is limited to Oregon, Washington, Texas and Virginia, the company hopes to expand to all 50 states by 2007.

I received a comment today on my Sunday Seven post about how inspiring sentiments help me survive. The comment was from a women who is surviving lung cancer and she asked a question to all readers really -- when will the fear of recurrence ever go away? How do you out there deal with it? So I replied to her private e-mail address and shared my thoughts about fear and recurrence and how I deal with these issues as a cancer survivor. She replied and wrote, your e-mail was so uplifting. I think I just found you on a really bad day and I am thankful that I did. And so I realized that maybe I should not limit my thoughts to just one person when others are surely in her same boat -- my same boat. So here is what I wrote to this one reader who -- like so many others on my journey -- has helped me by allowing me the chance to help her.

Just want to say that I think you are already dealing with the fear-of-recurrence thing because you have been surviving for as long as you have been traveling this bumpy road. So while you survive, you just need to live each day like it's your last and fight for your life at the same time. Someone once told me to think of cancer as a chronic condition -- something we will live with for the rest of your lives. And we just keep treating it, wherever it pops up. And the longer we survive, the more resources there are to help us survive even longer. As for getting through each day, I recommend counseling (I go once per month but at one time I went each week). I also take an anti-depressant (Zoloft) which I do not push on anyone, but for me, it has helped. I went to my oncologist one day and asked him how to live peacefully without worrying constantly that cancer is coming back to haunt me -- he said many cancer patients take anti-depressants to take the edge off so I began the drug and began counseling too. Neither completely take away the fear -- but they help me manage and that's all I can ask for. I also have two little boys who keep me busy and distracted from feeling sorry for myself. And I try to keep busy in other ways too. Helping others with cancer -- or others who just need help -- is healthy too!

Helping others with cancer does help me. It reminds me that I am not alone and that others have fears like me and that collectively, we can all survive better if we lean on one another and borrow from one another and inspire one another.

Strange things have happened to my skin ever since I encountered surgery, chemotherapy, and radiation for breast cancer. I developed an allergic reaction to the Tegaderm tape and latex used during and after my lumpectomy. My entire chest and one underarm were covered in red, itchy, burning, blistery bumps that oozed and then dried up. It took weeks of misery and a bunch of creams, lotions, and drugs to calm my skin and my anxiety too. Then I became allergic to an antibiotic while I was hospitalized for chemo-induced fever and low blood counts. The same horrible skin reaction again covered my chest and this time, my back also. It happened again a few months ago after a trip to the beach and I can only imagine that it was some combination of salt water, sunscreen, and chlorine that prompted this attack. I am still not sure of the cause. But it struck once again recently after a trip to my neighborhood pool. Sunscreen and chlorine were again my possible enemies. So I am staying away from all possible culprits now -- the tape, latex, certain antibiotics, sunscreen, salt water, and chlorine. And of course, the sun too. Perhaps treatment has made my skin even more sensitive than it already was. Perhaps something else is at fault. Regardless, I am now ultra careful about anything I put on my skin. I avoid most everything -- except for Dove soap and sometimes some fruity smelling lotion for my legs -- and I look for anything that is targeted for delicate skin.

So an advertisement in a magazine caught my eye today -- an ad for a hypo-allergenic deodorant that is highly recommended by dermatologists and oncologists. Naturally Fresh Deodorant Crystal Spray Mist and Roll On are both extremely gentle and also very effective. They are 100 percent natural and are fragrance free. They last for up to 24 hours, do not stain, and are good for one year. Like some deodorants that merely mask odor, these actually kill the bacteria that causes odor. Naturally Fresh Deodorant seems like a great find to me -- and it can be found CVS, Target, GNC, Hannaford Bros., A&P, Harmon Stores, Drug Fair, and Kerr Drug in the United States and Shoppers Drug Mart, Jean Coutu, and GNC in Canada.

Someone once told me to think of cancer as a chronic condition -- an illness like diabetes or asthma that may linger for life and may require continual treatment. And while battling cancer, perhaps for life, I should just hope that medical advances occur and new treatments become available. And maybe, just maybe, the science of medicine will decrease by leaps and bounds the number of people who die from cancer.

During my own battle with cancer -- which has been 18 months long -- two new breast cancer drugs have hit the scene with rave reviews from researchers and medical professionals. This is good news for me because my type of breast cancer makes me a candidate for both drugs. Herceptin is one of these drugs -- given to women who are HER-2/neu positive -- that's me -- and over express a protein that makes the tumor aggressive. Herceptin is received over 52 weeks -- and I go every three weeks for a 90-minute infusion of this clear liquid that causes me really no side effects at all. It can be toxic to the heart but monitoring tests have revealed that my heart is not suffering at this time. And with just three more infusions to go -- one this Wednesday -- I will likely encounter no adverse reactions to this potentially life-saving drug.

And now Tykerb is making headlines. Tykerb, suggested for use with advanced breast cancer and manufactured by British-based GlaxoSmithKline PLC, is an experimental drug that delays the growth of tumors nearly twice as long as standard chemotherapy in patients who no longer respond to Herceptin. This finding, reported this past Saturday at a meeting in Atlanta of the American Society of Clinical Oncology, confirms initial findings about the promise of this drug -- that like Herceptin, made by Genentech, precisely targets tumors without killing lots of healthy cells. The difference between the two drugs is that Herceptin blocks the protein on the cell's surface and Tykerb does it inside the cell -- blocking a second abnormal protein too. And while Herceptin is given intravenously, Tykerb is given in pill form -- which may make it cheaper and easier to use.

While now part of an international study, Tykerb may be available to women in the United States later this year. And it perhaps will be offered in conjunction with Herceptin or instead of Herceptin for women with advanced breast cancer.

I hope I do not ever need Tykerb -- and that Herceptin alone will be enough for me -- but it is comforting to know that there is something else out there. Something that if necessary, just might help me live with this potentially chronic condition called cancer.

A fundamental change in how cancer is treated might one day result in the elimination of oncology specialties. There will be no need for breast cancer oncologists, or prostate cancer oncologists, or brain cancer oncologists -- because tumors will not be treated based on location. Washington University School of Medicine in St. Louis researchers are predicting that cancer therapy will be based on how a tumor reacts to anticancer drugs, regardless of the tumor's physical origin.

"We've shown that drug effect is independent of where the tumor came from in the body." states Howard McLeod, Pharm.D., director of the pharmacology core at the Siteman Cancer Center. According to researchers, having a good tumor-drug match will not only improve survival rates, it will be cost-effective. One solution to the ever-increasing costs of cancer drugs. Analyzing a tumor and designing specific and individualized treatment makes much more sense than a one-size-fits-all approach to treating cancerous tumors -- and it does seem like it would be more effective -- leading to greater success rates of treatment.