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Tuesday, January 1, 2019

Patients now living a median 6.8 years after stage IV ALK+ lung cancer diagnosis


According to the National Cancer Institute, patients diagnosed with non-small cell lung cancer (NSCLC) between the years 1995 and 2001 had 15 percent chance of being alive 5 years later. For patients with stage IV disease, describing cancer that has spread to distant sites beyond the original tumor, that statistic drops to 2 percent. Now a University of Colorado Cancer Center study published in the Journal of Thoracic Oncology tells a much more optimistic story. For stage IV NSCLC patients whose tumors test positive for rearrangements of the gene ALK (ALK+ NSCLC), treated at UCHealth University of Colorado Hospital between 2009 and 2017, median overall survival was 6.8 years. This means that in this population, instead of only 2 percent of patients being alive 5 years after diagnosis, 50 percent of patients were alive 6.8 years after diagnosis.
“What this shows is that with the development of good targeted therapies for ALK-positive lung , even  with stage IV disease can do well for many, many years,” says Jose Pacheco, MD, investigator at CU Cancer Center and the study’s first author.
Of the 110 patients on the current study, 83 percent were never-smokers, and had a median age of 53 years. Almost all of these patients were initially treated with the drug crizotinib, which earned FDA approval in August 2011 to treat ALK+ NSCLC, but had previously been available in Colorado and other academic medical centers in the setting of clinical trials. Importantly, after treatment with crizotinib, when patients on the current study showed evidence of worsening disease, 78 percent were transitioned to another ALK-inhibitor, commonly brigatinib, alectinib or ceritinib.
“Many studies have reported shorter overall survival for patients with stage IV ALK+ NSCLC treated with crizotinib. These studies had lower survival outcomes in large part because of a lower percentage of patients receiving next-gen ALK inhibitors after progressing on crizotinib. Patients here were getting next-gen ALK inhibitors in phase 1 and 2 clinical trials before many other centers had access to them,” Pacheco says.
Another factor that influenced survival was the use of pemetrexed-based chemotherapies in ALK+ lung cancer. Often, in addition to targeted therapy with ALK inhibitors, patients will undergo chemotherapy (and sometimes radiation). However, there are many chemotherapies to choose from, and it is often unclear which specific chemotherapies are most successful with specific cancers, stages, and patient characteristics. A 2011 study by CU Cancer Center investigator D. Ross Camidge, MD, Ph.D., who is also senior author of the current study, suggested that pemetrexed works especially well against the ALK+ form of the disease.
“We try to use mainly pemetrexed-based chemotherapies in ALK+ lung cancer,” Pacheco says, “It is possible shorter survival in other studies may be associated with use of non-pemetrexed based chemotherapies.”
Interestingly, the existence of brain metastases at time of diagnosis did not predict shorter survival.
“A lot of the new ALK inhibitors that were developed after crizotinib get into the brain very well, and they work similarly in the brain when compared to outside the brain. And we’re doing more careful surveillance of patients to see when they develop brain mets—instead of waiting for symptoms and then treating, we’re monitoring for the development of metastases with imaging of the brain and if we see something new, we sometimes treat it before it causes symptoms,” Pacheco says.
The most predictive factor of shorter survival was the number of organs that were found to carry cancer at the time of diagnosis.
“At this point, 6.8 years one of longest median survivals ever reported for a NSCLC subpopulation with stage IV disease,” Pacheco says. “It shows the benefit of targeted therapy and how it’s changing survival for a lot of patients. And I think it suggests that for some types of NSCLC, it may become much more of a chronic condition rather than a terminal disease.”
 Explore further: ALEX trial results show alectinib further outpacing crizotinib in ALK+ NSCLC
More information: J.M. Pacheco et al, Natural history and factors associated with overall survival in stage IV ALK rearranged non-small-cell lung cancer, Journal of Thoracic Oncology (2018). DOI: 10.1016/j.jtho.2018.12.014
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Help cancer patients benefit from social media and avoid the pitfalls


Oncologists should help cancer patients be savvy about social media, a recent review argued.
Judicious patient use of social media can improve health outcomes, according to an earlier survey. However, benefits of social media for cancer patients, such as psychosocial support and patient engagement, can be offset by drawbacks including misinformation and privacy violations.
With social media’s potential for both benefits and harms for cancer patients, oncologists and other healthcare providers have an obligation to help patients use social media wisely, researchers wrote this month in Journal of Oncology Practice.
“Oncology professionals are encouraged to speak with their patients about social media and to suggest best practices to enjoy the positive and circumvent the negative aspects of social media. As social media platforms continue to modify the social landscape, the oncology community must recognize and act on their influence on patients with cancer,” the researchers wrote.
The researchers highlighted five benefits for cancer patients from social media:
1. Promotes patient engagement and empowerment
The researchers reviewed 170 studies of patients using information technology, which showed 89% of the studies found positive impacts on health, such as weight loss. In addition, 83% of the studies found enhanced patient engagement, such as text messaging for diabetes patients to access clinical data.
The researchers also found social media can help empower patients by giving them an opportunity to mentally process their cancer experience. Earlier research has shown empowered patients are more likely to attend checkups and screenings.
2. Provides psychosocial support
Earlier research has associated social support with better physical and mental health. Social media communities can help cancer patients who do not have in-person social support by reducing social isolation. Social media can also help cancer patients have conversations about emotional, spiritual, and physical treatment barriers.
3. Offers informational support
Social media can help cancer patients find oncology information. Social media can also spark incidental learning, such as hashtag searches on Twitter that inadvertently connect cancer patients with online support communities. Video platforms like YouTube can overcome healthcare literacy barriers.
4. Enhances the physician-patient relationship
Cancer patients should not use social media to interact with their physicians, but accessing oncology information through social media can increase confidence in relationships with physicians. Experiencing physicians sharing oncology information on social media can improve patients’ perceptions of medical professionals in general and improve relationships with their healthcare providers.
5. Find clinical trials and cancer research education
Social media can help cancer patients find clinical trials for particularly isolated populations who can be reached through social media advertising. Patients with rare forms of cancer can join social media groups targeted at their diagnosis, where they can connect with trial recruiters and other research opportunities.
The researchers also highlighted five social media drawbacks for cancer patients:
1. Substitute for in-person support
“Social support from social media ranges from infrequent and unstructured to regularly scheduled formal online support groups,” the researchers wrote. Behavior on social media can interfere with in-person assessment and treatment. Social media use can become impulsive, which could impede in-person interactions.
2. Misinformation
Online health information is often unreliable compared to information from healthcare providers. Online research should form building blocks for conversations with caregivers. Cancer patients should also keep a vigilant eye on conflicts of interests, such as healthcare professionals not disclosing their ties to medical supply and pharmaceutical companies, then promoting them on social media. With the untrustworthy nature of information online, cancer patients should be skeptical of information gathered through social media and fact check it with healthcare providers.
3. Financial exploitation
For cancer patients, financial perils on social media include unproven cancer cure claims, such as vitamins and special diets. Another risk is medical ads on social media that promote unnecessary procedures and treatments.
4. Information overload
Cancer patients who have internet access can be overwhelmed with medical information. Earlier research has linked information overload with anxiety over the inability to comprehend the avalanche of information and harness it for decision-making.
5. Compromised privacy
Social media users face privacy risks. Social media are public forums, so cancer patients should avoid posting private information. Patients should avoid sharing information that could be identifiable, including age, disease type, sex, and location.
How Physicians Can Help
There are three primary ways healthcare providers can help cancer patients navigate social media safely and effectively, according to the Journal of Oncology Practiceresearchers.
  • Experience cancer-related social media, including exposure to content that patients are viewing.
  • Help patients navigate the benefits and drawbacks of social media, such as by gauging the social media sophistication of a patient or cautioning patients to be skeptical about information found through social media.
  • To limit privacy risks, physicians should not offer medical advice via social media or interact with their own patients via social media.

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Cadila Healthcare gains as USFDA grants approval for Acne Gel


Shares of Cadila Healthcare were trading 1% higher on Monday as the company received approval from the USFDA to market Clindamycin Phosphate and Benzoyl Peroxide Gel.
The combination medication is used to treat a certain type of acne (inflammatory acne vulgaris), the company said in a press note to the exchanges on Saturday. Cadila will manufacture this gel at the groups topical manufacturing facility at Ahmedabad.
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Amazon com D.C.-Area HQ2 a New Beachhead in Battle for Tech-Savvy Vets


Amazon.com Inc.’s planned regional headquarters in the heart of the U.S. military establishment is creating a new potential battleground for veterans. This time, the fight is for them.
Amazon says it wants to hire 25,000 staff for its planned facility near Washington, D.C. over the next several years. That would be almost a sixth of the existing private-sector workforce for defense contractors and government IT specialists in the area.
Defense companies including Lockheed Martin Corp. and Booz Allen Hamilton Holdings Corp. are already tackling a shortage of skilled tech workers in a tight labor market. Contractors working through a two-year uptick in Pentagon spending on projects including cybersecurity and cloud-computing capabilities say they worry Amazon’s arrival will exacerbate a local talent crunch.
“Amazon does put stress on the system,” said Mac Curtis, CEO of Perspecta Inc. a government IT specialist with 14,000 staff that counts the Pentagon and the CIA among its clients.
Amazon wouldn’t say what kind of workers it plans to hire and has yet to post any job listings for the office complex in the National Landing neighborhood of Arlington, Va. The company plans to add another 25,000 workers over the next decade in New York City, the site of its other new second headquarters, or “HQ2.” While less of a magnet for government work, those offices will also require software engineers and cloud experts.
Amazon already employs more than 18,000 U.S. veterans and their spouses, about 3% of its global workforce. The company has said it wants to hire 25,000 more over the next three years. Earlier this year Amazon announced a partnership with the Labor Department to train 1,000 veterans in cloud computing. Some who have completed the program are now working for Amazon Web Services.
That unit is Amazon’s fastest growing, with sales up 48% annually in the nine months to Sept. 30. The company is pursuing more government contracts, including with the Pentagon. Many analysts view Amazon as the front-runner for a deal worth up to $10 billion to shift more Defense Department data to the cloud.
Some of the most prized new hires for defense contractors, and potentially for Amazon, are the roughly 250,000 people who leave active-duty military service each year, said companies and recruitment specialists. Big government-services companies such as Leidos Inc., which is remapping the Pentagon’s health care system, draw a third or more of their staff from people leaving the military.
“Veterans are clearly going to be a target,” said John Barney, a senior consultant at recruitment specialist Korn Ferry.
The Washington area is home to almost 210,000 employment-age veterans, the biggest metropolitan concentration nationwide, according to northern Virginia’s successful pitch for the new Amazon site.
The most sought-after are those with security clearances, a requirement for around 15% of the private-sector government IT and defense jobs advertised in the Arlington area that includes National Landing on recruitment site Glassdoor. The Pentagon is working through a backlog of 275,000 first-time applications for clearance, pushing wait times to more than a year.
The military is considering ways to ease the cleared-worker shortage, including by possibly allowing active-duty members to move more smoothly between civilian jobs and the armed services, said Navy Secretary Richard V. Spencer.
There should be enough talent for Amazon and other defense contractors, he said, adding that he doesn’t expect a competition.
However, recent changes to the military’s retirement plans could make it easier for veterans to enter the private sector. In 2018 the Pentagon created retirement accounts, much like 401(k) plans, that offer veterans benefits even if they serve only a few years. The new system frees them from a pension system that had required members to serve 20 years to qualify for benefits.
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Monday, December 31, 2018

‘Stop Robocalling Me!’; ‘I Didn’t!’


Jeffrey Lewis Knapp saves the four to six telephone numbers his caller ID logs each day. At night he seeks his revenge, calling back the people he thinks are illegal robocallers. “How can I help you?” the Arizona-based retiree says he asks the people who answer.
The problem with Mr. Knapp’s approach: He sometimes calls people who didn’t, in fact, call him first. Instead, the individuals he calls are themselves victims of a phone-related crime called malicious number spoofing, in which callers falsify their number to disguise their identities.
“A lot of times they don’t know that their number was used,” said Mr. Knapp, 66. “I had one guy get a little irritated and hung up, but most are pretty positive.”
Americans’ growing battle against illegal robocallers has reached a boiling point, with victims of one form of phone-related malfeasance now lashing out at those impacted by a different form of it.
Hiya, one of many mobile phone applications with call-blocking features, estimates that there were 8 billion robocalls to U.S. cellphones in the final quarter of 2018, up from about 5 billion in the first quarter.

Many illegal robocalls use number spoofing to obscure their identities. The practice allows bad actors to display to recipients numbers that aren’t actually the ones they are calling from.
Meir Cohen, chief executive of TelTech Systems Inc., which sells an unwanted-call blocking app called RoboKiller, said phone numbers are often misused when robocallers deliberately generate numbers that appear to be in the same area code as the recipient. It is meant to lead victims to believe the call is legitimate and answer their phone.
Web-based calling technology makes it easy for robocallers to display a randomly generated number. The phone numbers spoofed, however, may belong to a real person or business that is unaware that the number is being used that way.
There is no fail-safe way for consumers to keep their numbers from being spoofed and even changing numbers won’t guarantee that the problem will go away, robocall prevention specialists say.
The Federal Communications Commission has said that combating illegal robocalls and malicious phone-number spoofing is its top consumer protection priority and that consumers and businesses impacted by the problem can file a complaint with the agency or record a voice-mail message that says they don’t make marketing calls.
But clamping down on spoofing is difficult.
“A lot of spoofing can happen overseas and when it happens from overseas it can be very difficult to trace the origins of a call,” said Christine Reilly, a partner at Manatt, Phelps & Phillips, LLP, who works with companies on compliance with consumer protection laws.
There are also legitimate uses of spoofing, which makes an outright ban on such technology problematic.
A doctor who wants to call patients back from her cellphone may want to spoof her office number to avoid giving out personal contact information. A domestic violence shelter, where privacy is paramount, may similarly wish to disguise its number when it calls the home of a client.
The FCC has so far handed hefty penalties to bad actors and allowed carriers to block calls from fake area codes as well as numbers that aren’t used for outbound calls.
The agency in September proposed a $37.5 million fine against a Tucson-based company for maliciously spoofing numbers in millions of telemarketing calls over a period of 14 months starting in 2016. In that case, at least one person in Arizona received more than five calls a day from people complaining that she had called them when in fact the company had used her number.
The telecommunications industry, meanwhile, is working on a call-certifying protocol (known as STIR) as well as guidelines for implementing it (known as SHAKEN) in the coming years. Under that system, carriers on the originating end of a phone call would check to make sure that the caller has the right to use a given number while the carrier on the receiving end would certify that nothing had changed as the call was routed and received.
Consumers will eventually see an indicator on their phone signaling whether a call has been verified. If a bad actor spoofed a number, that verification would not occur.
Efforts to stop phone-number abuse such as spoofing have had a limited impact so far, with some victims of angry calls fearful for their safety or finding themselves taking heat from strangers.
Angela Santiago changed her phone number of 20 years after receiving an angry call from a woman accusing her of robocalling. After doing so, however, the same thing happened with her new number.
“It’s a violation and a huge inconvenience,” Ms. Santiago said.
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Digital wellness, brought to you by Big Tech


IN EARLY FEBRUARY, the technologist Tristan Harris stood in front of a crowd at a tech conference and held up his iPhonelike Martin Luther presenting his Ninety-five Theses. He was there to warn of the plain and common dangers of our phones, which he has compared to slot machines and to cults, while announcing a coalition called the Center for Humane Technology to liberate us.
Harris had begun this crusade several years prior, as a Google employee who noticed how tech companies designed products to keep us locked on our devices for their own profit. This represented, to him, a crisis in attention. Now, Harris was hoping to wake the rest of us up—and maybe even convince our tech overlords to do something about it. He even gave his radical movement a name: Time Well Spent.
Nearly a year later, Harris’s cause no longer seems fringe. It’s downright mainstream. Apple wants to free you from the sticky trap of your iPhone. Google wants you to feel JOMO, the “joy of missing out” from your screen. Even Facebook has its own suite of tools to help you manage your screen time, and Mark Zuckerberg called “time well spent” his personal goal for the year, cribbing the language directly from Harris’s movement. The consensus in Silicon Valley is that you should spend less time on your phone.
But don’t be deceived. While it looks like the revolution is won, this is just the beginning of a war to colonize your phone screen. Google, Apple, and Facebook seem like they’ve handed over the keys to unshackle us from our attention-splintering devices, but in doing so, they’ve accomplished something more significant. Tech companies have co-opted the movement, turning “digital wellness” into a Goopified trend that functions as marketing.
“It has been a big year for the movement, but it has also illustrated how much work lies ahead,” says Fred Stutzman, the CEO of Freedom, which helps people manage their time on-screen by blocking apps and websites. “We’re at this uncomfortable stage of digital well-being as marketing, where the tools created by corporations seem like a way to improve their brand image and atone for their past sins.”
The low-hanging fruit of humane technology—turning off notifications, minimizing the number of times your screen lights up and asks you to pay attention to it—has been picked up by Google and Apple. On both iOS and Android, it’s now easier to keep track of how many hours you spend on certain apps, and even set app time limits. But neither company has done much to address the persuasive design of those apps, or help people move beyond what was already possible to do by manually changing a few settings in your phone.
In other words, Google and Apple used the banner of “digital wellness” to re-package tools that already existed, without changing much of anything about your phone.
“Time Well Spent was never about giving users features to set time limits on their phones, it was about changing the game from which companies compete,” says Harris. “The problem is that everyone misunderstood what ‘time well spent’ was about by anchoring on the word ‘time.’ As if lost time was the biggest harm coming from technology. The original TED talk makes clear that the root problem is the race-to-the-bottom of the brain stem to manipulate human nature—hijack our minds—because of the business model to capture people’s time.”
In January, Zuckerberg wrote that his “personal challenge”for the year was to make sure “that time spent on Facebook is time well spent.” It was meant to assuage Facebook’s investors, after a quarter that saw a drop in the amount of time users were spending on the platform. Later in the year, Facebook and Instagram each rolled out their own time-management tools, which include a bar graph that shows how much time you spend on the app and an option to mute push notifications for up to eight hours.
Nothing else has changed. You can now track how much time you spend on Facebook, but you still have to dodge the constant notifications (“11 friends are interested in events happening tomorrow”) and thousands of features designed to keep you scrolling. Instagram is still a FOMO factory, which added features this year like an “online now” indicator and a platform for longform video. It’s hard to see how any of this was designed with “time well spent” in mind, rather than the intent to keep you opening the app and keeping it open longer.
“We need to move away from just human-centered design to human-protection design,” Aza Raskin, a co-founder of the Center for Humane Technology, wrote in a tweet earlier this year. “From: Have a problem? It’s your responsibility to use it differently. To: It’s our responsibility to design technology in a way that protects people.” (Razkin could not be reached for this story; he is currently practicing “time well spent” by studying forest elephant communication in the Central African Republic.)
If anything, Big Tech’s buy-in has validated the difficulty people feel in putting their phones down. Alanna Harvey, the co-founder and CMO of Flipd, an app that nudges users to spend less time on their phones, called 2018 “a turning point.” But other app developers say the year has been damaging for start-ups in the space. Andrew Dunn, who makes a minimalist and distraction-free Android launcher called Siempo, says fundraising has become more challenging this year because “a perception exists that Apple and Google will fully serve consumer needs.”
Both Dunn and Stutzman think the native tools recently added to iOS and Android are overly simplistic. They also point out that neither Apple nor Google has created APIs for their screen time products, which means third-party developers can’t build on them. And worse, some in the industry believe the big companies are actively pushing developers out of the space. Last month, a group of “digital wellness” apps were abruptly removed from the App Store, a move that some took as Apple way of forcing people to only use internal iOS tools.
“If ‘time well spent’ products are purely the domain of the large Silicon Valley players, any control we gain over tech will be illusory, and we’d do a great disservice to all the people who could benefit from these tools,” Stutzman says.
That’s not to discount the gains of the movement this year. In name-checking “digital wellness,” Apple, Google, and the like brought a grassroots campaign to the forefront of conversation and made it possible for more people to understand the magnitude of the tech addiction problem. But don’t be fooled. Your phone is still a battleground for your attention, and Big Tech is still finding new ways to capture yours.
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Rampant migrant illnesses force U.S. Border Patrol to change procedures


Hundreds of migrants and their children seeking to enter the U.S. from Mexico are arriving with illnesses, forcing U.S. Customs and Border Protection to seek additional medical assistance and boost medical screenings, the agency disclosed Monday.
Between Dec. 22 and Sunday, the agency reported 451 cases referred to doctors or other providers, including 259 children. Among the children, half of the cases involved kids under the age of 5.
The ill migrants have been arriving with all kinds of ailments, many with flu or pneumonia that can be particularly pervasive and dangerous this time of year. Seventeen migrants have been hospitalized, including six children, according to the agency..
“The U.S. Border Patrol is doing everything in its power to handle this crisis,” said Commissioner Kevin K. McAleenan in a statement. But he added, “The status quo is not acceptable” given the wave of immigrants arriving.
Secretary of Homeland Security Kirstjen Nielsen said in a statement last week that the Border Patrol has detailed 139,817 migrants on the Southwest border in the past two months. That compares to 74,946 for the same period last year. These include 68,510 family members and 13,981 unaccompanied children.
Making matters worse, McAleenan said central American refugees are now arriving directly by bus, not just by foot, and that a “robust smuggling cycle continues.”
Disclosure of the numbers of sick migrants come amid heightened concern about the medical condition of children in U.S. custody. Previously, the agency disclosed an 8-year-old boy from Guatemala died in custody on Christmas Eve, the second immigrant child to pass away in detention this month.
The boy, Felipe Gomez Alonzo, had been treated and released for cold and fever symptoms during nearly a week in U.S. custody, the agency said.
The Border Patrol has been receiving assistance from the Coast Guard, which has sent medical teams to the border in the Yuma and Tucson, Arizona, and Rio Grande Valley sectors of the border. The Public Health Service also said it will deploy teams to help.
The Border Patrol is also changing procedures to enhance medical evaluations of children. Parents are being interviewed about their children’s medical condition and history and kids’ blood pressure, pulse and temperature are among the vitals being checked by assessment teams, McAleenan told reporters in a conference call.
“We have always had an agent review the condition of the children,” McAleenan said. “What we are providing now is a medical professional” for the evaluations.
He said he said the cases being referred involve illnesses believe to have been contracted in transit to the U.S., not while in U.S. custody. “Many were ill before they departed their homes,” he said.
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