"There's more to it of course, but I wanted to give the flavor of the choices you can be faced with way before you think you'll need to."

That, my friends, is a message from Curt.  Read it carefully, because it is a message from a young man who is facing a circumstance that none of us ever want to contemplate.  His need to make decisions about his life and death came upon him without warning at a time when no one would have ever expected this to happen.

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If a study in the current issue of the New England Journal of Medicine was a report about a new treatment that extended the lives of patients with advanced lung cancer by almost 3 months, the crowds would be cheering.  But it isn't a study of a new chemotherapy drug, targeted therapy or vaccine.  And I doubt there are lots of cheers in the audience.

It's much simpler than an expensive, complicated new treatment for a devastating disease.  It's about starting palliative care to help patients deal with the symptoms from their disease and its treatment early in the course of that disease leading to a dramatic improvement in survival in a cancer that is almost always fatal.

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There they go again, trying to ruin my day.  The "they" in question are my epidemiology colleagues down the hall at our American Cancer Society offices in Atlanta. 

The topic a couple of weeks ago that got me going was an article they published suggesting that I had a higher chance of premature death because I sit at a desk most of the day.  Today's "offense" was a report published in the Archives of Internal Medicine showing that the larger your waist size-for the most part, with a couple of exceptions-the greater your chance of premature death.  And even if your body mass index (BMI) was normal-which is a measure of your height relative to your weight, and is used to classify people as normal, overweight or obese-you could still have an increased chance of death if your paunch is, uh, oversized.

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1)The son in law came in at 1:35, #11 in his class.

2) The wife came in at around 2:35, but she did finish after walking a portion of the 5k run at the end.  And just finishing was a terrific accomplishment in our eyes.

3) The 19 yo daughter finished around 2:25, running strong at the end. She won 3rd place in her group.  There were only 3 entrants.

4) The real hero was in the 15 yo son. He is in good shape and was doing well until the final run when he developed terrible leg cramps. He had to walk the entire 5k, part of it "straight legged" and the last 1/2 mile limping severely. He made it across the finish line--unassisted--at 2:56, which was 4 minutes before he would have been disqualified. He got a second place award, since there were only two entrants in his age class. He showed incredbile determination.  We are very proud of him.

A lot of experts write and talk about getting more exercise and making the commitment to a healthier lifestyle.  I am one of those folks who think staying active is important, especially as we get older.

But there are many out there who just can't seem to get it done.  One excuse or another, whether it is time, work, travel or other obligations-whatever, we just can't seem to get where we need to be when it comes to our health.

So forgive me while I take a personal moment to share with you my pride and admiration of someone very close to me who has made that commitment for the sake of her health and well-being to do something special, something they never dreamed they would be able to do.

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It's off to the North Georgia mountains to spend some time celebrating family, friends and birthdays (July was a prolific month in our family).  Will be back August 2.

In the meantime, be well and be safe. 

Dr. Len

 Yes, this is me doing what I love to do: barbecuing (my friends picked this picture as one of their favorites).  Maybe we'll throw in a little fishing also.

In early June I appeared on a nationwide news show and in a very brief comment indicated that I thought a new approach to radiation therapy in the treatment of primary breast cancer was "not ready for prime time."  Subsequently, later in the month, I wrote a blog on the treatment-called TARGIT-where I further outlined my concerns.  My primary issue-among some other more technical matters--were that the results of the trial were being promoted to suggest that the treatment was "ready" for moving into clinical use.  I wasn't so certain.

During this period of time, I was contacted by someone affiliated with the company that manufacturers the machine used to deliver the radiation, and offered an opportunity to have a discussion with some of the researchers involved in the clinical trials of TARGIT.  We accepted their offer.

Last week we had our follow-up call, and I think now is a good time to offer some information regarding that discussion.

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Sometimes you just can't get a break...

That's the way I feel after reading an article my colleagues from the American Cancer Society and other experts wrote in today's edition of the American Journal of Epidemiology.  The topic? The relationship between the time you spend sitting during the day and your chances of premature death.

The bottom line? If you sit all day, you are in real trouble even if you exercise regularly.  For those of us who try to exercise regularly, it's possibly one of the most discouraging reports I have read in a long time.

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The news this afternoon that an FDA advisory panel recommended removing approval for bevacizumab (Avastin®) as a treatment for advanced breast cancer is certainly going to be difficult for patients, their families, supporters and doctors alike.

The unfortunate reality is that despite earlier reports that this targeted therapy (which has been successful in treating a number of other cancers and works by inhibiting the growth of new blood vessels that feed cancer tumors) was successful in treating advanced breast cancer didn't hold up when studied in further clinical trials.

Bevacizumab in the treatment of breast cancer has followed a long, somewhat tortuous course beginning as early as 2005 with an announcement by the National Cancer Institute that the drug was successful in a clinical trial where women with advanced breast cancer were treated with the drug.

Following that announcement, it took an additional almost 3 years until the FDA approved bevacizumab as a treatment for breast cancer.  However, that approval was not a "slam dunk", after another FDA advisory panel had recommended against approval on a close vote.  The FDA overrode the panel's recommendation, and gave the drug a conditional approval while further clinical trials were underway.

It was the results of those clinical trials that were presented to the FDA's cancer drug advisory panel today, resulting in an overwhelming (12-1) vote to remove approval of bevacizumab as an effective treatment for advanced breast cancer.

The trials in question used standard chemotherapy with or without bevacizumab, and looked to see how long the treatment(s) delayed the progression of breast cancer (what we call "progression free survival", or PFS) as well as how long the women lived after they received their treatment ("overall survival" or OS).

The reports from a couple of years ago showed the addition of bevacizumab almost doubled progression free survival from 5.8 months to 11.3 months.  However, the data at that time did not show that bevacizumab increased survival, which up to this point in time has been the "gold standard" for approving almost all cancer treatment drugs.  That is one of the reasons the FDA asked for more information.

For some of us, the core question at that time was whether or not women had a better quality of life during that period of extended progression free survival, even if the drug did not increase the length of their days.  The thinking was that even if total survival wasn't improved, at least if they had better function and less pain, it would still be worthy to consider the drug effective.  Unfortunately, the studies were not designed to give an answer to that question.

Now come the two new studies, and the news wasn't particularly impressive that bevacizumab made a real difference in the treatment of the women in the trials.

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How do you know if you or a loved one are getting quality cancer care? 

That's an interesting question, although it isn't a new one.  I have been asked that question on a number of occasions and in several media interviews, and quite frankly it's difficult to answer.  In no small part because like many other things we do in medicine, true quality is difficult to measure with any certainty.

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