How much survival is enough?

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Yesterday, the FDA approved a new breast cancer chemotherapy called Halaven (eribulin). It was tested in women with metastatic disease that had several courses of chemotherapy already. This is a pretty hard-to-treat patient population, and Halaven extended survival by a median of 2.5 months.When we published yesterday's blog on the drug approval (New drug approved for breast cancer) we got a few comments on our facebook page about it (www.facebook.com/curemagazine).Comment: Just two and a half months? I pray to God my BC does not come back if that's the best they can do. :-(It is a scary thought. All the excitement about a new drug that does extend life, and then we hear it's only about 3 months. Without the drug, the median survival was about 10.6 months, with it, 13.1 months. Not something you want to hear if you have metastatic breast cancer. You want a cure, and rightfully so.But ... it's only the median. There are women who lived longer than the 13 months, but then some women did not live as long. It's also a trade-off with the side effects.It's also extra time. I think it's ironic that we ran Suzanne Lindley's blog about living with metastatic colorectal cancer (Three months of life...is it worth it?) a couple of weeks before a drug was approved that extended life about three months. Suzanne talked about hearing an oncologist at a medical meeting say, "Three months - why bother?" She responded by explaining that in late 2004 she was planning her funeral, but then she discovered a new treatment option that has worked for her. She's "hitchhiked" on various treatments over the years that have given her a month here, a year there, and has streatched it out for more than a decade. Of course, Suzanne's story isn't typical, but it does give us hope. Hope that three months may mean another milestone or another memory. It could also mean that it buys a patient time until a new clinical trial comes along or another drug approval.

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For patients with cancer, the ongoing chemotherapy shortage may cause some anxiety as they wonder how they will receive their drugs. However, measuring drugs “down to the minutiae of the milligrams” helped patients receive the drugs they needed, said Alison Tray. Tray is an advanced oncology certified nurse practitioner and current vice president of ambulatory operations at Rutgers Cancer Institute in New Jersey.  If patients are concerned about getting their cancer drugs, Tray noted that having “an open conversation” between patients and providers is key.  “As a provider and a nurse myself, having that conversation, that reassurance and sharing the information is a two-way conversation,” she said. “So just knowing that we're taking care of you, we're going to make sure that you receive the care that you need is the key takeaway.” In June 2023, many patients were unable to receive certain chemotherapy drugs, such as carboplatin and cisplatin because of an ongoing shortage. By October 2023, experts saw an improvement, although the “ongoing crisis” remained.  READ MORE: Patients With Lung Cancer Face Unmet Needs During Drug Shortages “We’re really proud of the work that we could do and achieve that through a critical drug shortage,” Tray said. “None of our patients missed a dose of chemotherapy and we were able to provide that for them.” Tray sat down with CURE® during the 49th Annual Oncology Nursing Society Annual Congress to discuss the ongoing chemo shortage and how patients and care teams approached these challenges. Transcript: Particularly at Hartford HealthCare, when we established this infrastructure, our goal was to make sure that every patient would get the treatment that they need and require, utilizing the data that we have from ASCO guidelines to ensure that we're getting the optimal high-quality standard of care in a timely fashion that we didn't have to delay therapies. So, we were able to do that by going down to the minutiae of the milligrams on hand, particularly when we had a lot of critical drug shortages. So it was really creating that process to really ensure that every patient would get the treatment that they needed. For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.
Yuliya P.L Linhares, MD, an expert on CLL
Yuliya P.L Linhares, MD, and Josie Montegaard, MSN, AGPCNP-BC, experts on CLL
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