Dr. Anthony L. Back, Seattle Cancer Care Alliance
“I feel that my calling is to be a healer in this world,” he says.
“And in my research, there is a little piece of culture change that I’d
like to make happen in oncology: Really good communication—the kind
that would make patients feel heard and respected and informed—because
it is one of the ways that physicians can be healers.”
My good friend Suze just happened to meet Dr. Back yesterday in a chance encounter at the hospital where we work. He's in town to teach physicians how to better communicate with their patients and Suze was instantly impressed with this extraordinary young doctor. And she knew I would be interested in learning about him.
Here's what Debra Jarvis, a staff chaplain at Seattle Cancer Care Alliance says about Dr. Back:
To read what Dr. Back has to say about, "Having Difficult Conversations About Cancer" click here.
To read about Back in the Seattle Times article, "Discovering the Power of Goodbye" by Carol M. Ostrom, click here.
Dr. Back has written over 40 articles about doctor-patient communication, on the order of: "An approach to understanding the interaction of hope and desire for explicit prognostic information among individuals with severe chronic obstructive pulmonary disease or advanced cancer." This doctor "gets it"!
For a listing of his articles in PubMed click here.
What Does Dr. Back Have To Do With "The War on Cancer"?
I worked late last night and when I got home I hit the internet to see what has been written about Anthony L. Back--not his research articles--but the non-medical interesting in-depth articles about him.
And where did this search lead me?
Smack dab to Sharon Begley's brilliant September 15, 2008 Newsweek article called: (I subscribe to Newsweek--how had I missed this article?)
We Fought Cancer...And Cancer Won. After billions on research and decades of hit-or-miss treatments, it's time to rethink the war on cancer. Click here for the complete article.
Read it if either you or someone you love has been touched by cancer. I read it after just learning that my mother-in-law wasn't going to win her personal war on cancer. It explained a lot.
Here is just a small excerpt--the five paragraphs that jumped out at me. The quote by Dr. Anthony L. Back comes at the end & to me it speaks of hope and empowerment--a new way to look at "The War on Cancer".
Food for Thought From Previous Posts:
Archives of Internal Medicine Study Asks: Can Cancer Disappear Naturally? Lessons to Learn - Diet & Exercise May Help
Prevent and Control Cancer with the Anti-Cancer Way of Life--Dr. David Servan-Schreiber
Dr. Servan-Schreiber's People's Pharmacy Interview: The Top 5 Reasons for the Increase in Cancer Today
Women With Breast Cancer Recurrence Have Higher Estrogen Blood Levels - Exercise & Diet Can Help
My good friend Suze just happened to meet Dr. Back yesterday in a chance encounter at the hospital where we work. He's in town to teach physicians how to better communicate with their patients and Suze was instantly impressed with this extraordinary young doctor. And she knew I would be interested in learning about him.
Here's what Debra Jarvis, a staff chaplain at Seattle Cancer Care Alliance says about Dr. Back:
“I've been with
Tony as he's given difficult news and here is what impressed me: If
it's clear that a patient does not understand or is not realizing what
he is saying, he will say it a thousand different ways to make sure
that he or she is hearing it.
“He is always very gentle, and he listens way more than he talks. Paradoxically, he is also not afraid to laugh in a situation like this. I've heard patients make jokes about their prognosis, and he'll respond to the joke and then very gently steer the conversation back to what he was saying."
She adds that Dr. Back has “a deep appreciation for spirituality, knowing that medicine is not simply about drugs and surgery and cures.”
“He is always very gentle, and he listens way more than he talks. Paradoxically, he is also not afraid to laugh in a situation like this. I've heard patients make jokes about their prognosis, and he'll respond to the joke and then very gently steer the conversation back to what he was saying."
She adds that Dr. Back has “a deep appreciation for spirituality, knowing that medicine is not simply about drugs and surgery and cures.”
To read what Dr. Back has to say about, "Having Difficult Conversations About Cancer" click here.
To read about Back in the Seattle Times article, "Discovering the Power of Goodbye" by Carol M. Ostrom, click here.
Dr. Back has written over 40 articles about doctor-patient communication, on the order of: "An approach to understanding the interaction of hope and desire for explicit prognostic information among individuals with severe chronic obstructive pulmonary disease or advanced cancer." This doctor "gets it"!
For a listing of his articles in PubMed click here.
What Does Dr. Back Have To Do With "The War on Cancer"?
I worked late last night and when I got home I hit the internet to see what has been written about Anthony L. Back--not his research articles--but the non-medical interesting in-depth articles about him.
And where did this search lead me?
Smack dab to Sharon Begley's brilliant September 15, 2008 Newsweek article called: (I subscribe to Newsweek--how had I missed this article?)
We Fought Cancer...And Cancer Won. After billions on research and decades of hit-or-miss treatments, it's time to rethink the war on cancer. Click here for the complete article.
Read it if either you or someone you love has been touched by cancer. I read it after just learning that my mother-in-law wasn't going to win her personal war on cancer. It explained a lot.
Here is just a small excerpt--the five paragraphs that jumped out at me. The quote by Dr. Anthony L. Back comes at the end & to me it speaks of hope and empowerment--a new way to look at "The War on Cancer".
"We tell you about Robert Mayberry because his case sheds light on why cancer is on track to kill 565,650 people in the United States this year—more than 1,500 a day, equivalent to three jumbo jets crashing and killing everyone aboard 365 days a year. First, it shows the disconnect between the bench and the bedside, between what science has discovered about cancer and how doctors treat it. Biologists have known for at least two decades that it is the rare cancer that can be completely cured through surgery. Nevertheless, countless proud surgeons keep assuring countless anxious patients that they "got it all."
[Instead of the new rock-star therapies that precisely target a molecule we're going to] tell you about Robert Mayberry. In 2002 a routine physical found a lesion on his lung, which turned out to be cancer. Surgeons removed the malignancy, which had not spread, and told Mayberry he was cured. "That's how it works with lung cancer," says oncologist Edward Kim of the University of Texas M. D. Anderson Cancer Center in Houston, who treated Mayberry. "We take it out and say, 'You're all set, enjoy the rest of your life,' because really, what else can we do until it comes back?" Two years later it did. The cancerous cells in Mayberry's lung had metastasized to his brain—either after the surgery, since such operations rarely excise every single microscopic cancer cell, or long before, since in some cancers rogue cells break away from the primary tumor as soon as it forms and make their insidious way to distant organs. It's impossible to know. Radiation therapy shrank but did not eliminate the brain tumors. "With that level of metastasis," says Kim, "it's not about cure. It's about just controlling the disease." When new tumors showed up in Mayberry's bones, Kim prescribed Tarceva, one of the new targeted therapies that block a molecule called epidermal growth factor receptor (EGFR) that acts like the antenna from hell: it grabs growth-promoting signals out of the goop surrounding a cancer cell and uses them to stimulate proliferation. Within six months—it was now the autumn of 2005—the tumors receded, and Mayberry, who had been unable to walk when the cancer infiltrated his brainstem and bones, was playing golf again. "I have no idea why Tarceva worked on him," says Kim. "We've given the same drug to patients in the same boat, and had no luck." But the luck ran out. The cancer came back, spreading to Mayberry's bones and liver. He lost his battle last summer.
In Mayberry's case, says Kim, "my gut feeling is that [cells from the original lung tumor] were smoldering in other places the whole time, at levels so low not even a whole-body scan would have revealed them." Yet after surgery and, for some cancers, radiation or chemotherapy, patients are still sent back into the world with no regimen to keep those smoldering cells from igniting into a full-blown metastatic cancer or recurrence of the original cancer. Mayberry's story also shows the limits of "targeted" cancer drugs such as Tarceva, products of the golden age of cancer genetics and molecular biology. As scientists have learned in just the few years since the drugs' introduction, cancer cells are like brilliant military tacticians: when their original route to proliferation and invasion is blocked, they switch to an alternate, marching cruelly through the body without resistance.
We also tell you about Mayberry because of something Boston oncologist (and cancer survivor) Therese Mulvey told us. She has seen real progress in her 19 years in practice, but the upbeat focus on cancer survivors, cancer breakthroughs and miracle drugs bothers her. "The metaphor of fighting cancer implies the possibility of winning," she said after seeing the last of that day's patients one afternoon. "But some people are just not going to be cured. We've made tremendous strides against some cancers, but on others we're stuck, and even our successes buy some people only a little more time before they die of cancer anyway." She pauses, musing on how the uplifting stories and statistics—death rates from female breast cancer have fallen steadily since 1990; fecal occult blood testing and colonoscopy have helped avert some 80,000 deaths from colorectal cancer since 1990—can send the wrong message. "With cancer," says Mulvey, "sometimes death is not optional."
Both presidential candidates have vowed to support cancer research, which makes this a propitious time to consider the missed opportunities of the first 37 years of the war on cancer. Surely the greatest is prevention. Nixon never used the word; he exhorted scientists only to find a cure. Partly as a result, the huge majority of funding for cancer has gone into the search for ways to eradicate malignant cells rather than to keep normal cells from becoming malignant in the first place. "The funding people are interested in the magic-bullet research because that's what brings the dollars in," says oncologist Anthony Back, of the Hutch. "It's not as sexy to look at whether broccoli sprouts prevent colon cancer. A reviewer looks at that and asks, 'How would you ever get that to work?' " And besides, broccoli can't be patented, so without the potential payoff of a billion-dollar drug there is less incentive to discover how cancer can be prevented."
[Instead of the new rock-star therapies that precisely target a molecule we're going to] tell you about Robert Mayberry. In 2002 a routine physical found a lesion on his lung, which turned out to be cancer. Surgeons removed the malignancy, which had not spread, and told Mayberry he was cured. "That's how it works with lung cancer," says oncologist Edward Kim of the University of Texas M. D. Anderson Cancer Center in Houston, who treated Mayberry. "We take it out and say, 'You're all set, enjoy the rest of your life,' because really, what else can we do until it comes back?" Two years later it did. The cancerous cells in Mayberry's lung had metastasized to his brain—either after the surgery, since such operations rarely excise every single microscopic cancer cell, or long before, since in some cancers rogue cells break away from the primary tumor as soon as it forms and make their insidious way to distant organs. It's impossible to know. Radiation therapy shrank but did not eliminate the brain tumors. "With that level of metastasis," says Kim, "it's not about cure. It's about just controlling the disease." When new tumors showed up in Mayberry's bones, Kim prescribed Tarceva, one of the new targeted therapies that block a molecule called epidermal growth factor receptor (EGFR) that acts like the antenna from hell: it grabs growth-promoting signals out of the goop surrounding a cancer cell and uses them to stimulate proliferation. Within six months—it was now the autumn of 2005—the tumors receded, and Mayberry, who had been unable to walk when the cancer infiltrated his brainstem and bones, was playing golf again. "I have no idea why Tarceva worked on him," says Kim. "We've given the same drug to patients in the same boat, and had no luck." But the luck ran out. The cancer came back, spreading to Mayberry's bones and liver. He lost his battle last summer.
In Mayberry's case, says Kim, "my gut feeling is that [cells from the original lung tumor] were smoldering in other places the whole time, at levels so low not even a whole-body scan would have revealed them." Yet after surgery and, for some cancers, radiation or chemotherapy, patients are still sent back into the world with no regimen to keep those smoldering cells from igniting into a full-blown metastatic cancer or recurrence of the original cancer. Mayberry's story also shows the limits of "targeted" cancer drugs such as Tarceva, products of the golden age of cancer genetics and molecular biology. As scientists have learned in just the few years since the drugs' introduction, cancer cells are like brilliant military tacticians: when their original route to proliferation and invasion is blocked, they switch to an alternate, marching cruelly through the body without resistance.
We also tell you about Mayberry because of something Boston oncologist (and cancer survivor) Therese Mulvey told us. She has seen real progress in her 19 years in practice, but the upbeat focus on cancer survivors, cancer breakthroughs and miracle drugs bothers her. "The metaphor of fighting cancer implies the possibility of winning," she said after seeing the last of that day's patients one afternoon. "But some people are just not going to be cured. We've made tremendous strides against some cancers, but on others we're stuck, and even our successes buy some people only a little more time before they die of cancer anyway." She pauses, musing on how the uplifting stories and statistics—death rates from female breast cancer have fallen steadily since 1990; fecal occult blood testing and colonoscopy have helped avert some 80,000 deaths from colorectal cancer since 1990—can send the wrong message. "With cancer," says Mulvey, "sometimes death is not optional."
And Finally, the Dr. Anthony L. Back Connection to the War on Cancer
Both presidential candidates have vowed to support cancer research, which makes this a propitious time to consider the missed opportunities of the first 37 years of the war on cancer. Surely the greatest is prevention. Nixon never used the word; he exhorted scientists only to find a cure. Partly as a result, the huge majority of funding for cancer has gone into the search for ways to eradicate malignant cells rather than to keep normal cells from becoming malignant in the first place. "The funding people are interested in the magic-bullet research because that's what brings the dollars in," says oncologist Anthony Back, of the Hutch. "It's not as sexy to look at whether broccoli sprouts prevent colon cancer. A reviewer looks at that and asks, 'How would you ever get that to work?' " And besides, broccoli can't be patented, so without the potential payoff of a billion-dollar drug there is less incentive to discover how cancer can be prevented."
I leave today for two trips. First to NYC to visit my son & daughter-in-law who are expecting their first child at the end of May. Then on to Florida to visit with my mother-in-law. She is now home from the hospital. The euphoria we felt after her successful surgery on November 4 is gone. We naively thought "they got it all and that any remaining malignant cells could be chemically eliminated & zapped away." Hospice has now arrived.
I think Dr. Back and Sharon Begley have it right and I hope someone is listening.
Can't we also look at prevention?
Do we always have to wait until it's too late to get better--when our only options are surgery, chemo or radiation?
Why can't our best & brightest scientists seriously look at how we can keep our cells healthy and our immune systems in tip-top shape?
Does prevention always have to be the step-child of research, relegated to "out there", "wacky" & "alternative"?
"If we don't tell people that the science shows how they can protect themselves from disease with their own choices and what they can decide to take into their own hands, we are giving them false hopelessness.
Cancer lies dormant in all of us. Like all living organisms, our bodies are making defective cells all the time. That's how tumors are born. But our bodies are also equipped with a number of mechanisms which detect and keep such cells in check. In the West one person in four will die of cancer--but three in four will not: THEIR DEFENSE MECHANISMS WILL HOLD OUT."
I think Dr. Back and Sharon Begley have it right and I hope someone is listening.
Can't we also look at prevention?
Do we always have to wait until it's too late to get better--when our only options are surgery, chemo or radiation?
Why can't our best & brightest scientists seriously look at how we can keep our cells healthy and our immune systems in tip-top shape?
Does prevention always have to be the step-child of research, relegated to "out there", "wacky" & "alternative"?
"If we don't tell people that the science shows how they can protect themselves from disease with their own choices and what they can decide to take into their own hands, we are giving them false hopelessness.
Cancer lies dormant in all of us. Like all living organisms, our bodies are making defective cells all the time. That's how tumors are born. But our bodies are also equipped with a number of mechanisms which detect and keep such cells in check. In the West one person in four will die of cancer--but three in four will not: THEIR DEFENSE MECHANISMS WILL HOLD OUT."
-Dr. David Servan-Schreiber, Psychiatry Professor, Univ. of Pittsburgh-
Food for Thought From Previous Posts:
Archives of Internal Medicine Study Asks: Can Cancer Disappear Naturally? Lessons to Learn - Diet & Exercise May Help
Prevent and Control Cancer with the Anti-Cancer Way of Life--Dr. David Servan-Schreiber
Dr. Servan-Schreiber's People's Pharmacy Interview: The Top 5 Reasons for the Increase in Cancer Today
Women With Breast Cancer Recurrence Have Higher Estrogen Blood Levels - Exercise & Diet Can Help
It sucked, when at 28, I asked my surgeon how he’d judge if I was in remission? His answer: “There is no remission. That concept is obsolete. We see cancer in you that 20 years ago technology would not have picked up. We would have said to you then ‘you are in remission.’ Now we see it. Technology is just going to get better and better. We will always be able to find some cancer in you and if we cannot, we know it is just waiting there anyway.” Yeah, I cried my eyes out after that appointment, but I was still grateful for the truth.
Blog http://everythingchangesbook.com/
Posted by: Kairol Rosenthal | February 13, 2009 at 06:46 PM