Sunday, September 11, 2011

Awareness is Good; Treatment is Essential

President Obama proclaimed that September is Ovarian Cancer Awareness Month.  He acknowledged that ovarian cancer is still one of our deadliest diseases saying:

Ovarian cancer continues to have one of the highest mortality rates of any cancer, and it is a leading cause of cancer deaths among women in the United States. This month, we remember the mothers, sisters, and daughters we have lost to ovarian cancer, and we extend our support to those living with this disease. We also reaffirm our commitment to raising awareness about ovarian cancer, and to advancing our screening and treatment capabilities for the thousands of American women who will be diagnosed this year.
For those of us living (and hopefully not dying) with ovarian cancer, the lack of recognition for this disease is all too palpable and manifests itself in subtle ways.  For example, the current drug shortages seem to affect ovarian cancer disproportionately.  Not only is Doxil, a key treatment for recurrence of ovarian cancer, currently not available for most women who need it, the mainstay chemotherapies for ovarian cancer--cisplatin, carboplatin and taxol (placitaxel) are also in shortage.  See also the FDA report on shortages here. Some of these drugs are also used to treat breast cancer, also a woman's disease.

I cannot emphasize how important these three mainstay drugs are for ovarian cancer.  They pushed me into a year long remission after I was treated with them for five months in early 2010.  I am only getting carboplatin now to treat a recurrence and it seems to be working so far given that my CA125 numbers have dropped significantly.  I would not be exaggerating to say that I would likely be dead  if those drugs were not available to me in 2010.  It is amazing to me that shortages of such critical drugs are not being addressed at the same time the President is calling for "advancing . . . treatment capabilities" for ovarian cancer.  Yes, we need research for new drugs but we also need access to the drugs that work now to put ovarian cancer into remission.

There have been several good press reports about the drug shortages but unfortunately everyone of them focused on men with cancer rather than the impact of these shortages on women's cancers.  Gardiner Harris' New York Times article  was the best of the bunch by discussing both an ovarian cancer patient who could not get Doxil and a breast cancer patient concerned about the Taxol shortage.  However, the person who was shown in the picture accompanying the article was a man with colorectal cancer.  To the Point interviewed Gardiner Harris, a representative of the generic drug trade association and Senator Klobucher but included as the "cancer patient" experiencing problems with shortages a man with cancer in remission!  And the PBS News Hour coverage of the drug shortage also featured a 55 year old man with acute myeloid leukemia who luckily was in remission despite the shortage of the drug used to treat his type of cancer.

Is it a coincidence that the drug shortage story is told in the press by chronicling its effects on men?  My own view is that the story is more compelling when it affects men than when it is shown to be disproportionally affecting women's cancers--particularly cancer affecting mostly older women who are beyond child bearing age.  The men in these stories are all professionals whose careers are interrupted.  The women are shown as crying about the situation.  It is bad enough that we women have to suffer these shortages but to also be shortchanged by mainstream media in what appears to be not so subtle sexism is beyond comprehension.

The public needs to be made more aware that the drug shortages exist and affect women's cancers in a significant way.  One suggestion I have is to contact the White House to make them aware during this month of ovarian cancer awareness that treatments for ovarian cancer are in critical shortage.  You can write to the White House here with the message that while awareness of ovarian cancer is good, it is essential that these drug shortages end so that women with ovarian cancer can get the critical chemotherapy drugs used for mainline treatment.

ADDENDUM (9/14/11):  I have just learned after some research that cervical cancer is also disproportionately affected by these shortages.  The common drugs used to treat cervical cancer are cisplatin, carboplatin, taxol (placitaxel) and fluorouracil, 5-FU  which are all in shortage.  Fluorouracil is also used to treat colorectal cancer and pancreatic cancer, which are obviously gender neutral cancers.  And do not forget that Taxol is one of the mainstay treatments for breast cancer which is diagnosed in about 230,000 women per year in the U.S. with 2.5 million survivors.

ADDENDUM 2 (9/15/11)  Endometrial cancer is also disproportionately affected by the shortages because its mainline chemo treatments are carboplatin, Taxol, doxorubicin and cisplatin, all of which are in short supply.  Unfortunately, another cancer whose treatment is seriously affected is testicular cancer, for which 3 of 4 mainline chemo treatments (Bleomycin, Etoposide, and Cisplatin) have shortages.  Prostate cancer, on the other hand, (the most common men's cancer) is typically not treated by chemo and when it is, fortunately for those patients, the chemos used (e.g. docetaxel) do not seem to be in shortage.  Here are links to contact Congress about pending legislation re the drug shortages.

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