Tag: blood cancer

Kevin McCarthy’s Brief Speakership Meets Its End

Kevin McCarthy began his 269th day as House speaker by recounting all the times he proved his doubters wrong. In January, after a series of humiliating defeats, the California Republican hung on to become speaker of the House. In the months since, he reminisced, he has narrowly averted the twin crises of a national-debt default and, this past weekend, a government shutdown. “I just don’t give up,” McCarthy told reporters after making one more plea to his party to keep him in his post.

Today, McCarthy’s streak of defying his skeptics came to an end as a group of his GOP critics joined Democrats to vote him out of the speakership after fewer than nine months in office. The unprecedented move could paralyze the House for days or even weeks, as Congress faces a November 17 deadline for funding the federal government.

Whether McCarthy is done for good as speaker remains unclear. The vote to remove him will trigger a new election, and McCarthy was coy with reporters earlier in the day about whether he’d try to reclaim the gavel. Assuming he doesn’t, his tenure atop the House—the briefest in nearly 150 years—was as historic as it was short-lived: He won the office after fighting through more ballots than any speaker in a century, and he was the first to be removed in the middle of a term by a vote of the House.

Few of McCarthy’s 54 predecessors had assumed the speakership with lower expectations. His years rising through the GOP leadership had left him with a reputation as a glad-handing lightweight with few convictions. And his majority seemed ungovernable from the start. He had just a five-vote margin over the Democrats, and was surrounded by hard-liners who demanded confrontation over compromise. McCarthy traded away much of his power as speaker during the marathon series of votes that ended, after 15 rounds, with his election. As part of the horse trade, McCarthy handed his Republican foes the means of his own destruction: the ability for a single member to call, at any time, a vote on whether to remove the speaker.

“From day one, he knew and everyone knew that he was living on borrowed time,” Representative Gerry Connolly of Virginia told me recently.

McCarthy’s most ardent Republican critic, Representative Matt Gaetz of Florida, had made the speaker’s ouster his singular mission even before McCarthy made a surprise reversal on Saturday to avert a government shutdown. Gaetz ultimately persuaded seven Republicans to join him in voting to remove McCarthy via a procedural maneuver known as a motion to vacate the chair.

Read: Kevin McCarthy finally defies the right

Democrats faced their own conundrum: Was the speaker they knew a safer bet than a replacement they didn’t? Whichever Republican succeeds McCarthy is likely to be just as conservative and just as beholden to the hard-line faction that deposed him—if not more so. Yet Democrats ultimately decided that McCarthy was not worth rescuing; all 208 in attendance today voted to remove him.

The speaker had lurched to the right far more often than he governed from the center; he had joined the bulk of the GOP in forgiving former President Donald Trump for his role in fomenting the Capitol insurrection on January 6, 2021, and just a month ago buckled to conservative demands to launch an impeachment inquiry into President Joe Biden. “It is now the responsibility of the Republican members to end the House Republican Civil War,” the House minority leader, Representative Hakeem Jeffries of New York, declared after a lengthy Democratic Party conference this morning, urging members to support McCarthy’s removal as speaker.

In the end, McCarthy almost survived only because Democrats struggled to get their members to the Capitol in time for the crucial votes. McCarthy, however, had suffered too many Republican defections for it to matter. The process began with a vote on a motion to table Gaetz’s motion to vacate the chair. Eleven Republicans voted with the entire Democratic caucus to clear the way for McCarthy’s ouster, more than twice as many members as the speaker could afford to lose within his own party. “The office of speaker of the House of the United States House of Representatives is hereby declared vacant,” Representative Steve Womack of Arkansas, presiding over the vote, said after the 216–210 roll call concluded.

No obvious successor has emerged. McCarthy’s top lieutenant, Majority Leader Steve Scalise, is popular with conservatives but is now undergoing treatment for blood cancer. Majority Whip Tom Emmer or GOP Conference Chair Elise Stefanik could also emerge as alternatives, but neither has been openly campaigning for the job.

Ever the optimist in public, McCarthy seemed to sense before the votes that the run of good fortune and political survival that had taken him to the nation’s third-highest office would not last much longer. He had struck a defiant tone, defending to the end his decision to keep the government open even if it cost him his job. “If you throw out a speaker” for averting a government shutdown, he warned reporters and, implicitly, his Republican colleagues, “then I think we’re in a really bad place.”

Russell Berman

Source link

October 3, 2023
Newest Treatments for RRMM

Newest Treatments for Relapsed/Refractory Multiple Myeloma

091e9c5e820faac4091e9c5e820faac4FED-Footermodule_FED-Footer_091e9c5e820faac4.xmlwbmd_pb_templatemodule0144002/02/2021 01:57:340HTML

Source link

September 29, 2023
What to Know About Multiple Myeloma

If you or a loved one has just learned they have multiple myeloma, the diagnosis may come as a surprise. Chances are that you don’t know much — if anything — about this type of cancer, so you’ll likely have a lot of questions for your doctor as you take in the news and begin to make decisions about your treatment.

“The majority of patients have never heard of multiple myeloma,” says Krina Patel, MD, a myeloma specialist at MD Anderson Cancer Center. “They’ve all heard of melanoma [skin cancer]. The first thing we tell them is that multiple myeloma is a blood cancer.”

This lack of familiarity often makes a multiple myeloma diagnosis more difficult emotionally than other cancers. “This is a rare cancer and most patients have never heard of it before their diagnosis,” says Urvi Shah, MD, a myeloma specialist at Memorial Sloan Kettering Cancer Center. “It is more anxiety and stress because you don’t know what to expect.”

“Patients come in and ask, ‘What is my stage?’ They want to know if it’s early or late and what is going on,” Shah said. “But with myeloma and many blood cancers, it’s different. It’s not like solid tumors, and this causes confusion for patients.”

Because myeloma is a blood cancer, doctors don’t stage it in the same way they do with solid cancers like breast or prostate cancer. Blood cancers are in the blood and are therefore everywhere in the body. But that doesn’t necessarily mean that your cancer is worse or harder to treat. In the case of multiple myeloma, Patel says, “there’s not really a metastatic version.”

Doctors do use a staging system that’s based on blood test results and other things to tell them if the cancer is high risk or not. Those test results can help you and your doctors understand what to expect and how to best treat the myeloma. No matter the stage, multiple myeloma is considered a lasting (chronic) condition.

“Multiple myeloma is considered incurable and a long-term issue,” Shah said. “Now with the latest therapies, we are curing a small subset but not the majority. We still tell patients it is most likely incurable. I hope that will change in the near future. We’re coming close, but we’re not there yet.”

Even though multiple myeloma is almost always a lifelong condition today, there has been lots of progress in treating multiple myeloma in recent years. A person diagnosed with multiple myeloma will have lots of good treatment options.

“Sometimes patients know it’s not curable and get depressed,” Patel said. “They don’t realize at this point it is very treatable. We can’t cure the majority. But we can prolong life for years to decades with therapy that’s tolerable. They’ll be on therapy for the rest of their lives, but treatment doesn’t only prolong life. Quality [of life] is just as important.”

Myeloma treatment typically involves a combination of drugs. Patients newly diagnosed with multiple myeloma are often in pain and tired as a result of anemia, bone lesions, or other complications of the disease. Treatment doesn’t just fight the cancer, but it will often make you feel better, too.

“Most people, when they think of chemo, think of hair loss, nausea, staying in bed all the time,” Patel said. In multiple myeloma, it isn’t like that. “Treatment is really a way to improve quality of life.”

When people first come in, Shah says, “They may have had a delayed diagnosis. They may come in in a wheelchair.” Once treatment is started and the cancer responds as it usually does, she says, those same patients often are up and walking again.

When you have a new diagnosis of multiple myeloma, it’s a good idea to get to a specialist early on, says Jason Valent, MD, a myeloma specialist at the Cleveland Clinic.

“It’s a little easier for somebody like me because I only take care of myeloma patients,” Valent said.

Given many treatment options, new drug approvals, and ongoing clinical trials, it helps to have a specialist who’s on top of new developments as they come. A community doctor may see only a few myeloma patients per year compared to hundreds at a larger cancer center with myeloma specialists. While a doctor close to home can oversee day-to-day care when a larger center isn’t nearby, a specialist on your team can help guide treatment and consider all the options from afar, including new treatments.

“Even if you can’t see a specialist every month, it’s a good idea to have them in the background, especially at points of treatment decisions,” Patel said.

While multiple myeloma is unique, in some ways it’s similar to other cancers. Anytime there’s a new cancer diagnosis, there’s a lot to take in, learn, and consider. In addition to decisions about the cancer and its treatment, you’ll have personal choices to make, including who you want to tell about your diagnosis and when. There will be practical considerations, too, including learning what your insurance will cover and what it won’t.

“Any cancer diagnosis is a life-changing experience,” Valent said. “The emotions that go along with that can be some of most difficult things to deal with.”

Ask if your care team includes or can recommend counselors, psychologists, social workers, pain specialists, or others who can help you with various aspects of the disease and its care. As you face a new diagnosis of multiple myeloma, Shah recommends finding other things to focus on outside of the cancer and its treatment.

“Those who keep up a job or hobby and don’t let the disease define them seem to better manage,” Shah says. “It’s a marathon. Those who fixate and focus on the disease can suffer lots of anxiety and stress.”

“You’re going to be on some form of treatment for the rest of your life,” Valent said. While that’s different from many other cancers, “we treat myeloma in some ways like diabetes. You may take a pill or a shot for the rest of your life, but it’s reasonable to expect to keep the disease controlled, hopefully for long periods of time.”

Source link

July 27, 2023
Race, Income Can Determine Blood Cancer Outcomes, Studies Show

By Ernie Mundell

HealthDay Reporter

MONDAY, Dec. 12, 2022 (HealthDay News) — If someone is stricken with a blood cancer or life-threatening clot, they’ll probably fare better if they are white and wealthy, three new studies show.

The ongoing impact of patient race and income to medical outcomes was in the spotlight Saturday in New Orleans at the annual meeting of the American Society of Hematology (ASH).

In one study, a team led by Dr. Matthew Maurer, of the Mayo Clinic in Rochester, Minn., looked at who got enrolled (or didn’t) in clinical trials for new treatments against a blood cancer known as diffuse large B-cell lymphoma (DLBCL).

It’s the most common form of lymphoma in the United States. According to ASH, existing therapies help cure about 60% of patients, but another 40% may not be helped.

So, enrollment in clinical trials can be crucial for some patients. The Mayo study examined data on enrollment in DLBCL trials from eight large academic medical centers across America.

It found that 76% of enrollees were white.

Results from lab tests were key to getting accepted into the trials, but Black or Hispanic Americans were much less likely to meet those lab-based criteria than were whites, the research showed.

That means trial organizers may need to take a closer look at lab-based eligibility criteria to help level the playing field for entry into future clinical trials. “These exclusion criteria are not impacting everyone equally – they’re impacting minorities more than white non-Hispanic patients,” Maurer said in an ASH news release.

Stem cell transplant disparities

Another study looked at stem cell transplants that in many cases can cure a blood cancer. The procedures necessitate finding a donor (often a family member) with the same blood antigen proteins as the patient.

If such a donor can’t be found, doctors can still perform the transplant, but it often uses cells that are “half-matched” and come from either umbilical cord blood or less-than-ideally matched family members or others. These transplants leave patients more vulnerable to dangerous immune reactions and require more intense follow-up care.

The study was led by Dr. Warren Fingrut, of the Cord Blood Transplantation Program at Memorial Sloan Kettering Cancer Center in New York City. Looking at records from 372 people who underwent stem cell transplants at the center between 2020 and 2022, his team found that while only about one-quarter (24%) of patients with European (typically white) ancestry had to undergo the less well-matched form of transplant, that number rose to 58% among patients who were not of European descent.

The likelihood of a more complex stem cell transplant being needed rose even higher if the minority patient also came from a low-income household, the investigators found.

“Our transplant program is very committed to extending transplant access to minority populations, but our study highlights that many of these patients are both receiving the most complex transplants and facing significant socioeconomic challenges,” Fingrut said in the ASH news release. “Our findings show that addressing financial hardship will be critical to extend transplant access, especially to patients from minority groups.”

Advanced treatments for a dangerous clot

In a third study, researchers found that race and income seemed to matter when U.S. patients were hit by potentially life-threatening clots in the lungs known as pulmonary embolisms.

Non-white and poorer patients were “significantly less likely to receive the most advanced therapies and more likely to die after suffering a pulmonary embolism,” the ASH news release noted.

The study involved data on more than 1 million U.S. patients hospitalized with a dangerous clot in the lungs between 2016 and 2018. Over 66,000 had the most severe, life-threatening form of pulmonary embolism.

Compared to white patients, Asian patients were 24% less likely to receive advanced therapies when hit by a severe form of pulmonary embolism, and they were 50% more likely to die, reported a team led by Dr. Mary Cushman, of the Larner College of Medicine at the University of Vermont.

Likewise, Black patients in the same situation were 13% less likely to get the best treatments compared to white patients, and were 11% more likely to die. Hispanic patients were also 10% more likely to die from their embolism than white people were, the investigators found.

Money and insurance also mattered: Folks insured via Medicaid or Medicare were 30% less likely to get an advanced therapy compared to the privately insured, the study found. And people who placed in the lowest one-quarter with regards to income were 9% more likely to die from their clot compared to folks placing in the top quarter of income.

“Many people die of pulmonary embolism every year,” Cushman noted in the ASH news release. “It’s preventable and it’s certainly treatable. We need to think about what we can do in hospitals to make sure that care is equitable.”

“I hope that clinicians will think about these findings in terms of how they take care of patients every day, and try their best to recognize their unconscious biases,” she added. “Clinicians need to look at the patient in front of them and remember that regardless of their social class or the color of their skin, they should be treated the same as everybody else.”

Experts note that studies presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

More information

Find out more about blood cancers at the American Cancer Society.

SOURCE: American Society of Hematology, news release, Dec. 10, 2022

Source link

December 12, 2022
Rebirth: Cancer Reshapes Nurse’s Life, Outlook, and Career

Oct. 20, 2022 — Tawny Roeder was 23 years old and 3 months away from getting her nursing degree at Briar Cliff University in Sioux City, IA, when she got a job as a training nurse. She was ready to take on the world, but first she had to clear an obstacle: She felt she lacked empathy for the patients in the oncology unit where she worked.

“I knew no one with cancer at the time,” she says. “It hadn’t really impacted my life too much, so it was daunting to have to work with those patients.”

In one word, she felt “oblivious” about the struggles these patients experience. “I felt like I didn’t have the words to care for these people. It was something that scared me.”

She was also oblivious to something far scarier that lurked in her young life. She was on the dance team at Briar Cliff, and “I should have been in the best shape of my life,” but she found her energy and wind spent too easily.

At home during the 2008 spring break, her mom noticed her breathing difficulty. She also began having back pain that woke her up at night.

An X-ray showed a huge mass on her lung. Roeder got the results of a subsequent biopsy – lymphoma — over the phone, “which was awful. I was alone in my apartment.”

Just 2 weeks after starting to care for cancer patients in her hospital, Roeder became one. She studied for her nursing exams while undergoing chemotherapy with the help of her workmates.

Roeder’s journey was just beginning, though. She was diagnosed with an aggressive form of diffuse large B-cell lymphoma, a life-threatening blood cancer.

“There are several patients exactly like Tawny who are on their way to living when they are hit with this deal-breaker,” says Manali Kamdar, MD, clinical director of lymphoma services for University of Colorado Medicine. The diagnosis creates “a huge break in what happens in living a normal life.”

Roeder is one of 80,000 Americans diagnosed yearly with non-Hodgkin’s lymphoma, the most common form of lymphoma.

Kamdar says Roeder’s is one of 85 different subtypes, and she emphasizes that“it is absolutely important that patients get that subtype.” Sometimes it takes several tests, she says, but it is important to establish the subtype as this may influence management of the disease.

Kamdar also says there are now many different treatment options. Chemotherapy with the addition of medications has been a backbone of therapy, but now there are also chemo-free treatment options as well as approaches that involve genetically modifying a patient’s own immune cells, she says.

“The last 3 years have seen a sea change with the number of treatments that have been approved for patients with lymphoma. What I had in my toolkit 5 years ago is nothing compared to what I have today,” she says.

Roeder learned quickly that her cancer was so aggressive that she would need a stem cell transplant, during whichher healthy cells werecollected and stored while she underwent high-dose chemo, and would then be put back into her body intravenously.

However, thistreatment was not available in Sioux City. The closest center was in Omaha, NE, about a 90-minute drive away.

“I was absolutely terrified,” Roeder says. She and her then-boyfriend, Cody, decided to uproot from Sioux City and move to Nebraska. “We thought it might as well be a good place for us to get jobs.”

After a monthlong stay in the hospital while she underwent intensive treatment involving chemo and stem cell therapy, she eventually returned home. She now marks Sept. 11, 2008, as her “rebirth” after the treatment.

The night she returned, Cory proposed to her. “That was a very great coming-home surprise,” she says. “I had tubes hanging out of me. I was bald. I’m not sure it was the most romantic moment.”

The couple married the following May. Meanwhile, Roeder had started her nursing career in pediatrics, but “every time I would go to my oncology checkup, the doctor would say, ‘Come work for our team.’”

In 2011, she took her oncologist up on the offer and began working as a staff nurse in the oncology unit at the University of Nebraska Medical Center.

“It just kind of clicked,” she says. “This is probably why I’m still here. You sometimes have that survivor’s guilt as to why some survive and others don’t.”

Roeder’s treatment left her unable to bear children, so she and Cody have adopted a boy and a girl.

Now 37, in addition to working with lymphoma patients, she also volunteers for the Lymphoma Research Foundation to raise awareness and funding to fight the disease. “I have gained a lot of friendships — people I’ve been in contact with just because of their transplants,” she says.

Roeder, who has been cancer-free since, is now the case manager for lymphoma patients undergoing transplants. She inspires her new patients, especially those who feel alone in their disease journey. “Most are very shocked” when they hear her story, she says. “It’s really shocking for people to see that I look healthy. One hundred percent of the time it is well-received and very much appreciated.”

Source link

October 20, 2022