Ads for Drugs to Treat Cancer-Related Fatigue.. comment?

[Guest guest]

This is about an article I found online y/day via a press

release from a medical media company. I found myself questioning

the study's methods so I put the press release in my blog and

" answered " it based on my reading of the original articl, which

the p-r provides a link to (it'sin .pdf format). If I

have time I might do more hands on reporting about it, but for

what's it's worth --

http://tinyurl.com/c9tay

or go to www.psa-rising/blog/ and scroll down.

The p-r says in part:

" Direct-to-consumer advertising promoting the use of

erythropoietin to alleviate cancer-related fatigue fails to

point out that the drug is only effective against fatigue caused

by anemia. However, anemia is not a significant cause of fatigue

in most cancer patients, according to a study in the December

issue (Volume 8, Number 6) of Journal of Palliative Medicine, a

peer-reviewed publication of Ann Liebert, Inc. "

<snip>

" Recently, however, drug companies have begun marketing drugs

directly to consumers on television and in newspaper

advertisements, touting the drugs’ ability to improve quality of

life for cancer patients. Unfortunately, these ads invariably

imply that a drug can help anyone.

" 'This data will help physicians resist the patient and family

pressure to use erythropoietin because they saw it on

television,' says F. von Gunten, M.D., Ph.D., Editor-in-

Chief of Journal of Palliative Medicine. 'There are different

things that can be done to relieve fatigue. Erythropoietin is

ineffective in relieving fatigue if anemia is not the cause. It

is an expensive placebo.' "

While the opinion is refreshing, I suppose, I don't see

enough evidence for their hypothesis in this study, which never

addressed causes of fatigue in " most cancer patients " in the

first place -- but might end up being applied to most. I feel

the press release overstates the study, which looked only at

advanced patients in palliative care (no active tx) and looked

only at paper trail, analysing charts of some 177 pts. I don't

see they even tried or asked if a fatigued patient actually

feels better or the same before and after epo or transfusion

(regardless of where blood numbers say it's needed). And looks

like they made no distinction between levels for a man and a

woman.

Even so, if it is true that for advanced cancer patients

fatigue is independent of red blood counts, we need to know why,

what else is going on, so as look for better ways of dealing

with this fatigue-- which all the study patients, no matter how

high or low their counts, said was their worst quality of life

affecting symptom. The authors do see a correlation between

fatigue and depress, feeling of well bning, and albumin level (a

marker which Norman's oncologist told him was key in late

stages).

(For a bit on albumin see here:

http://www.transweb.org/qa/qa_txp/faq_albumin.html

In advanced cancer pts albumin level may be helped some by IV

hydration or drinking plenty of fluids, possibly by fish oil:

http://www.nutrition.org/cgi/content/full/129/6/1120

Low albumin is independent marker, really, of decline.

Anyway, I wrote my blog " reply " late at night in a state of

fog/fatigue. If anyone has clearer insight I'd appreciate

hearing. Does anyone have experiences with being helped or not

helped by taking epo/transfusion for fatigue while coping with

advanced prostate cancer? My recollection when Norman was on

chemo at an advanced stage of his PCa was that getting a

transfusion was like proverbial blood from stone. At some large

cancer hospitals they want to wait till numbers are " in the

basement, " 7.5 g/dL and below. From what I read this varies: " A

recent systematic review of the literature indicated that

hemoglobin transfusion triggers currently vary between 70 g/L

and 100 g/L (equivalent to 7.0 g/dL and 10.0 g/dL), and are most

often between 80 g/L and 90g/L. "

http://tinyurl.com/ddqva

In a large cancer hospital, with many seriously ill cancer

patients in waiting rooms and corridors, fatigue and anemia look

almost normal. For busy outpatient clinics may be an

inconvenience to have patients occupying chairs or

stretchers for hours - the length of time it takes to get type

and screen followed by transfusion - in addition to their

chemo. And (crude thought) onclologists get virtually NO payoff

from patient use of self-injectible Epo/Procrit, which now can

be bought at cutprice online pharmacies. You depend on the

oncology nurse and the oncologist to take in good faith - as

Norman's did - this need for blood support. Norman was visibly

and kinetically healthier after a transfusion or home injected

Epo. Without supportive meds for red and white counts he would

not have been able to maintain consistently the chemo he wanted.

If taking transfusion or Epo had not helped pull him out of

energy slumps I don't believe he would gone through the serious

hassle of getting the prescriptions through his insurance.

If we'd had to battle with doctors who outright told us he was

asking for Epo because of ads on TV (when we never even watched

TV), I would have thrown up.

Your comments?

best

Jacquie