VISION, MARCH / APRIL 2011

MARCH / APRIL 2011

Free Joburg Cancer

Resource List
The Johannesburg branch of People Living
With Cancer and the CanSurvive Cancer
Support Group have published a brochure
giving contact details for organisations in
and around Johannesburg who are there to
help cancer patients.
The brochure is freely available in hospitals
and doctors rooms, but should you have Shavathon, Sandton City style
difficulty getting one, please call us on 073
Three young men doing their bit to help raise funds for
975 1452 or email us at jhb@plwc.org.za.
CANSA at the annual Shavathon.
The brochure was sponsored by Bristol-
More pictures from Sandton City Shavathon on page 3.
Myers Squibb Oncology.

JB Express conquerors the Argus

The JB Express was formed to ride the Argus in memory of Justin Bessler
and to raise funds for one of CHOC’s projects – The Cape Cows initiative to
purchase a 15-Seater Quantum Bus to transport the children from the
CHOC House in Plumstead to Groote Schuur as well as the Red Cross
Children’s Hospital for daily chemotherapy.
JB, or Justin Bessler, had only just reached his 21st birthday when he suc-
cumbed to cancer in August last year.
Although the JB Express originally consisted of the friends and family of
Justin Bessler they were joined by a whole bunch of sympathetic individu-
als who simply came to ride for a cause.
Pictured below are Justin’s brother, Warren Bessler, and Mark Forssman and
on the right are the “Princesses from Simonstown” and a wonderful group
of supporters and riders from the Cape who joined the JB Express.
There were 117 riders in the start pens and about 40 official supporters, all
in JB shirts. The race was a fantastic success, the support and interest in the
cause was phenomenal.

The JB Express has to date raised R254 000 and

the Cape Cows have raised R66 000. If another
R80 000 can be raised, the bus will become a
reality.
Donations can be made on the following website
http://www.backabuddy.co.za/noel-bessler
“This was Justin’s dream we just rode it real.”
1
 VISION, MARCH / APRIL 2011

Why a Support Group for New prostate studies

men with Prostate Cancer? New studies on the screening and treatment of genitourinary
cancers were highlighted at the 4th annual GU Cancers meeting
by Lenny Hirsch sponsored by ASCO. A brief report which looks at three of those
studies can be found at:.
One man in six may be diagnosed with Prostate Cancer. If caught in
time, most men can be cured of the disease. Less than 3% of men http://www.ecancermedicalscience.com/news-insider-
diagnosed with the disease will die of the disease. So why the need news.asp?itemId=1578
of support groups?
sion lasts for an hour. We have a short break and the guest lecturer
Firstly, we need to look at the reasons for men who attend support
will make his/her presentation and answer questions. We encourage
groups:
men to bring their wives or partners to the meetings.
1. The Newly Diagnosed Man. In most cases he is told by his doc-
Lenny Hirsch is the chairman of The Living with Prostate Cancer
tor that he must decide on what treatment he should choose.
Foundation in Israel. After being hospitalised 14 years ago and
The doctor may or may not explain the side effects of the treat-
having his prostate removed he approached the Israeli Cancer
ments available to him. In our society the word cancer is consid-
Association to help establish a support group in Haifa where he
ered a death sentence. The newly diagnosed man and his family
was then staying. This group is still in existence nine years later.
are in a state of shock. On many occasions I have had couples
attending a support group meeting for the first time and asking Six years ago he established a website; www. Shalomprostate.co.il
me in wonderment whether these men in the group have and has been involved in having medications included in the bas-
prostate cancer as they are behaving in such a relaxed way. This ket of approved medicines as well as promoting prostate cancer
exposure to others in a similar position means that he is not awareness.
alone and he will soon realise that prostate cancer is not a death
Two years ago, together with a few fellow travelers who had
sentence. He will also hear firsthand about the various treat-
experienced prostate cancer, he established The Living with
ments and the possible side effects. Here, at a support group
Prostate Cancer Foundation. The Foundation is run by people
meeting, he will hear about the doctors with the most experi-
with prostate cancer for others with the disease and now have
ence and the best results.
80 members.
2. The Man after Primary Treatment. In most cases, after primary
Lenny recently visited South Africa and spoke to a group of
treatment, there are side effects that affect one’s quality of life.
prostate patients in an effort to get CanSurvive’s Prostate
The most common side effects are as follows:
Support Group up and running..
1. Erectile Dysfunction. Very few men after treatment will tell

C a n S u r v i v e
you that their erections are as good as they were before the
treatment. In many cases this problem has a profound effect
on the man especially in the relationship with his partner.
Today there are many aids for Erectile Dysfunction and doc- CANCER SUPPORT GROUP
tors who have specialized in treating this problem. From dis-
The Group is run by members of the
cussions within the group one hears how others have
Johannesburg Branch of People Living
learned to cope.
With Cancer in association with the
2. Urinary Problems. In most cases this type of problem Wits Donald Gordon Medical Centre
resolves itself within a short period of time. Many men do and is open to any patient or caregiver.
not know that total lack of urinary control can be rectified
by minor surgery. I have come across cases of men wearing Meetings are held on the second
diapers for a number of years because they did not know
that something could be done about the problem.
Saturday of each month at 9h00 at
3. Rising PSA. The result of the PSA test after primary treat- 18 Eton Road, Parktown
ment should be almost zero. When the PSA starts rising this (opposite Wits Donald Gordon
is an indication that not all the cancer has been destroyed or Medical Centre main entrance)
removed and further treatment will be necessary. Here
again, there can be unpleasant side effects that the patient All patients and caregivers are
will have to cope with. First -hand knowledge from others
who have experienced these side effects is invaluable. welcome
3. The Need to Help Others. I have found, in many cases, men
come to support group meetings to help others and are inter- No charge is made
ested in any new developments in the field of treating prostate Enquiries:
cancer.
Our groups work as follows: For the first part of the meeting men
073 975 1452
are encouraged to talk amongst themselves, asking questions and email: jhb@plwc.org.za
passing on information. Newly diagnosed men are especially website: www.plwc.org.za
encouraged to state their situation and ask questions. This first ses-
2
 VISION, MARCH / APRIL 2011

2011 Shavathon
Scenes from
Sandton City

While broadcasting from Sandton City Shavathon, Mark Pilgrim,

received a cheque for R100 000 from the CEO of Kia South Africa,
Ray Levin. Upon announcing this donation, Ray Levin expressed his
hope that other corporates in South Africa would match and even
better his donation so that more resources could be made available
to those who dedicate themselves to improving the quality of life to
those affected by cancer.

Faces of Hope Fundraiser

The Bluebird Shopping Centre on the corner of Athol Oaklands and Fort Street, Johannesburg will host an evening event
on 2nd April when biodegradable lanterns will be released. The lanterns are available for sale at R60 each and can be
written on. This provides an opportunity to dedicate your lantern to a cancer patient, a survivor or to the memory of
someone who lost their battle - or simply to write a message of hope.
The Faces of Hope Foundation provides financial assistance and support for individuals suffering with life-
threatening illness - specifically cancer. The cost of oncology treatment being as high as they are, the
Foundation aims to relieve some of the financial burden.
Join us at 19h30 on thr 2nd April at the Bluebird Shopping Centre, Ground floor - and make a
difference! Lanterns can be bought before the event - contact Eileen on 079 894 2896 or Tricia on
082 453 8474.

3

THE VIEW FROM THE OTHER SIDE -
Cancer and
self-image
Cancer and its treatment cause big
changes in how patients look. Sometimes a
tumour is visible and directly alters the
patient’s appearance. Some cancer surgeries are disfiguring.
Chemotherapy causes hair loss. Chronic steroid use can change the
way a patient’s face looks. Cyclosporine, used to prevent and treat
graft-versus-host disease, causes hair growth in unusual places.
These changes can be even more profound when the patient is a
child. Radiation causes bones to stop growing, so as the rest of the
child grows, the irradiated bones do not, and scoliosis or other
changes can develop. Chronic steroid use impairs growth. Bone mar-
row transplantation and brain radiation cause significant hormonal
changes whose importance is magnified in the developing child or
adolescent.
Adolescence is a time when appearance is terribly important and
often central to a person’s developing self-image. Imagine, then,
CAPE TOWN BUDDIES ARE ON THE GO -
Argus Cycle Tour
PLWC had a team riding in the Argus Cycle Tour on Sunday 13th
March in support of Cancer Buddies SA. Sponsorships were over
R31000 in our favour and a team of staff and Cancer Buddies
were out early on Sunday morning on Suikerbossie hill to cheer
them on.
At Suikerbossie we were part of a larger group of people from
other Cancer Care organisations which were all cheering too, to
draw attention to and in support of people living with cancer and
cancer prevention.
London
Marathon
Carl Liebenberg, Co-Founder and
Director of People Living With
Cancer, had Lymphoma 13 years
ago.
He will be running the London
Marathon on the 17th April this
year in support of all people living
with cancer in our country. He
has registered with "doit4charity"
a fund generating interface, which
we have used before, and is a secure site. The link below will take
you to his site on there where we would like to invite interested
people to sponsor Carl for R10 per km ... or more if possible.
http://www.doit4charity.org.za/fundraising/carl.liebenberg
4
VISION, MARCH / APRIL 2011
What was your vision
of cancer?
The Faces of Hope Foundation is looking for cancer patients and
survivors to help them with an unusual project.
They want to hear from patients who experienced their diagnosis
of cancer in a visual way. For instance, did you see it as a ship-
wreck or perhaps as the world disintegrating?
They will select a number of “visions” and a South African artist
will interpret them in paintings which will be auctioned in New
York later this year.
The proceeds will be used to assist patients with life-threatening
diseases - particularly cancer - with the cost of the treatment
they could otherwise not afford.
If you are interested in helping, please contact us at
jhb@plwc.co.za or phone 083 640 4949.
how hard it can be to be diagnosed with cancer and then be treated
for it when you’re that age – when all you want to do is fit in!
What can be done about this? One important source of help is peo-
ple who have been through it before. One woman, Marianne Kelly,
started a program in Baltimore called Image Recovery Centers. Ms.
Kelly was diagnosed with a brain tumour in 1987, and that experi-
ence, along with the experience of losing a sibling to leukemia and
having a daughter diagnosed with leukemia, led her to work with
cancer patients to help them maintain a positive self-image despite
the changes caused by their diagnosis and the treatments they
need. I send my patients to the Image Recovery Center at our hospi-
tal as often as I can.
Another source of support can be the stories of patients who cope
particularly well with the effects of their cancer treatment. My
patient M, for example, dyed her hair purple (and sometimes pink or
blue) as it grew back after she lost it during chemotherapy.
My favorite story, though, is about Warren (not his real name).
Warren was 9 when he was diagnosed with retinoblastoma, cancer
arising in the back of the eye. Most retinoblastoma patients are
infants, and Warren is the oldest retinoblastoma patient I have ever
cared for. When he was diagnosed, his tumour was so advanced that
there was no hope of saving the vision in his right eye, so it was
removed, a procedure known as “enucleation.” After healing from
the surgery, Warren received a prosthetic eye. The prosthesis was so
real looking, that one of my colleagues had to ask Warren which eye
he had lost!
But the best part of the story is not the quality of his glass eye, but
what Warren did with it. The first summer he had the eye, he spent
a lot of time swimming in his pool. While other kids in the neighbor-
hood would toss a penny into the pool to dive after it, what did
Warren and his friends dive for? You guessed it – his eye!
How’s THAT for making the best of what life gives you?
”Dr David Loeb is Assistant Professor of Oncology and Pediatrics, Director,
Musculoskeletal Tumour Programme, and Co-Director, Sarcoma Centre at
Johns Hopkins, Baltimore, USA. You can subscribe to Doctor David’s very
readable blog at
http://doctordavidsblog.blogspot.comReadingRoom/HealthBlogs/Reflecti
ons.htm

News from
around the world
Change in PSA level does not predict
prostate cancer
Researchers at Memorial Sloan-Kettering Cancer Center have found
that change in PSA levels over time — known as PSA velocity — is
a poor predictor of prostate cancer and may lead to many unneces-
sary biopsies. This study of more than 5,000 men was published
online February 24 in the Journal of the National Cancer Institute.
Andrew Vickers, PhD, Associate Attending Research Methodologist in
the Department of Epidemiology and Biostatistics and lead author
said, "We have found no evidence to support the recommendation
that men with a high PSA velocity should be biopsied in the
absence of other indications. In other words, if a man's PSA has risen
rapidly in recent years, there is no cause for concern if his total PSA
level is still low and his clinical exam is normal."
While PSA screening is widely used for the early detection of
prostate cancer, it is also associated with a high rate of overdiagno-
sis, which can lead to unnecessary treatment and anxiety. Currently,
early detection guidelines of several organisations recommend that
men with a rapid rise in PSA — or a high PSA velocity — have a
surgical biopsy for prostate cancer, even if there are no other indica-
tors that cancer may exist. Those indicators could be an elevated
baseline PSA or a positive digital rectal exam (DRE).
This study's population came from the Prostate Cancer Prevention
Trial. Five thousand five hundred and nineteen men aged 55 years
and older with no previous prostate cancer diagnosis, normal DRE,
and a baseline PSA of 3.0 ng/mL or less were randomly assigned to
finasteride — a drug commonly used to treat enlargement of the
prostate gland, more commonly referred to as BPH, or benign pro-
static hypertrophy — or placebo for seven years. This particular
study focused on the men in the placebo group. The men were fol-
lowed with yearly PSA tests, with biopsy recommended for men
with a PSA higher than 4.0 ng/mL. After seven years, all men who
were not diagnosed with prostate cancer were asked to consent to
an end-of-study biopsy.
Dr. Vickers and colleagues found no important association between
PSA velocity and biopsy outcome after adjusting for risk factors
such as age, race, and PSA levels. PSA alone was a much better pre-
dictor of biopsy outcome than PSA velocity.
Researcher instigates cancer cell suicide
A Wayne State University School of Medicine physician-researcher
has developed a personalised therapy to treat a wide range of can-
cers. The treatment is based on a naturally occurring human
enzyme that has been genetically modified to fool cancer cells into
killing themselves.
The unique concept, patented by Wayne State University, was suc-
cessfully demonstrated on melanoma cells that are resistant to rou-
tine treatments such as chemotherapy or radiotherapy. Melanoma
is a perfect model for testing this new therapy because it is consid-
ered the most aggressive form of human cancer due to its many
defence mechanisms against available treatments. The success of
5
VISION, MARCH / APRIL 2011
Cancer Coping Kit
The multi-lingual Cancer Coping Kit helps cancer patients cope
with their journey to recovery, thanks to a grant from the
National Lottery Distribution Trust Fund (NLDTF).
The Cancer Coping Kit is available in English, Afrikaans, isiZulu
and seSotho. It provides knowledge and understanding for peo-
ple diagnosed with cancer. The kit also provides family members
and caregivers with information and coping techniques. Patients
or caregivers can obtain the kit from:
Bev du Toit: 073 235 1571
People Living With Cancer: 073 975 1452
The Breast Health Foundation: 076 479 0400
CANSA: 011 648 2340
the therapy in killing melanoma suggests a similar outcome in
treating other cancers.
The method was developed by Karli Rosner, M.D., Ph.D., assistant
professor and director of Research in the Department of
Dermatology who explains "If you imagine the cell's nucleus as a
computer and DNA in the nucleus as computer software, then the
altered, hacked DNA program corresponds to a computer virus."
"To further understand this anti-cancer technology," he continued,
"recollect the plot from the movie, Independence Day. In this movie,
a computer virus is introduced into an alien ship to neutralise its
defences and make it vulnerable to external weapons. We do some-
thing similar but much better by introducing the altered genetic
code of DNase1 into the DNA of cancer cells alien to the healthy
body." The cancer cell, unaware of the destructive potential of the
modified code, translates it into a protein that evades the cell's
defence mechanisms and enters the nucleus. In the nucleus, the
protein damages DNA by chopping it into fragments without the
need for external weaponry, i.e., other medications. Following dam-
age to DNA, the cell's organelles disintegrate and the cancer cell
dies. In this way, Dr. Rosner's technology leads cancer cells into
committing suicide because he fools them into generating the pro-
tein that will cause their own death.
"Although this has been tested on melanoma cell lines, Dr. Rosner's
approach can be tailored to other types of tumours," said Darius
Mehregan, M.D., the Hermann Pinkus Chair of the Department of
Dermatology. "I think it is important for other researchers in the
Wayne State University system to be aware of possibilities to col-
laborate, and for the pharmaceutical industry to be aware of the
economic potential of this novel technology."
Source: Julie O'Connor, Wayne State University - Office of the Vice
President for Research
Morphine and other pain relief drugs used
in cancer surgery may spur return of
malignancy
An article in Scientific American asks if the anaesthesia and
painkillers used to make operations and recovery bearable also
influence the risk that cancer will return?
As Morphine is often described as a cancer patient's best friend it
came as a shock when researchers at the University of Minnesota
 VISION, MARCH / APRIL 2011

published a study showing that doses of morphine similar to those

used to ease pain actually spurred the growth of human breast can-
cer cells grafted into mice. "These results indicate that clinical use of
morphine could potentially be harmful" in some cancer patients, the
Dates to remember
scientists wrote in 2002 in Cancer Research. 9 April Cancer Support Group, Parktown 0900
The findings went relatively unnoticed, despite the study's poten- 13 April R4R General meeting/Support 13h30
tially apple cart–toppling conclusion. Nearly a decade later, howev- 18 April Cape Town PLWC Support Group
er, mounting evidence seems to suggest that the group was onto 7 May Bosom Buddies meeting
something as a series of studies in laboratory animals, molecular 14 May Cancer Support Group, Parktown 0900
models and cancer patients suggest that pain drugs given during
21 May R4R General meeting/Support 10h00
and after cancer surgery stimulate the growth and spread of certain
tumours. 28 May Bosom Buddies Pink Pyjama Party
30 May Cape Town PLWC Support Group
Cancer seems to thrive on exposure to opioids, particularly mor-
11 June Cancer Support Group, Parktown 0900
phine, the most widely used narcotic for relief of surgical pain. In the
presence of these drugs tumours grow faster and develop more 11 June Bosom Buddies 6th birthday bash
extensive networks of the blood vessels they rely on to feed their 27 June Cape Town PLWC Support Group
expansion—a process called angiogenesis, says Jonathan Moss, an 29 June R4R General meeting/Support 14h00
anesthesiologist at the University of Chicago (U. of C.) Medical 9 July Cancer Support Group, Parktown 0900
Center. 25 July Cape Town PLWC Support Group
Still, Moss admits that more data in people are needed. "You can 30 July Bosom Buddies meeting
cure a lot of cancers in mice," he says, "and not necessarily have any 13 August Cancer Support Group, Parktown 0900
effect in humans." 13 August R4R Volunteers update 10h00
A similar link to a risk for returning cancer is cropping up in studies 14 August Bosom Buddies Spinathon / Boxathon
of the form of anaesthesia provided during cancer surgeries. 29 August Cape Town PLWC Support Group
Patients who undergo general anaesthesia typically require more 3 September Bosom Buddies Mad Hatters Tea Party
opioid painkillers after surgery than those who receive general anes-
7 September R4R General meeting/Support 14h00
thetics—which keep patients asleep but do not deaden nerves—
plus injections of local anesthetic to block the nerves at or near the 10 September Cancer Support Group, Parktown 0900
site of surgery. 26 September Cape Town PLWC Support Group
The human data so far are retrospective—scientists cannot isolate 1 October Bosom Buddies meeting
the potential effect of anaesthesia from the effects of other factors 1 October R4R General meeting/Support 10h00
such as blood transfusion, temperature regulation and statin admin- 2 October Livestrong Day
istration during surgery. "The retrospective data are very intriguing 8 October Cancer Support Group, Parktown 0900
and we have a good physiological rationale for why it may be hap- 31 October Cape Town PLWC Support Group
pening," says Durieux, co-author of a review article on the sur-
2–4 November R4R Volunteer Training
gery–cancer connection in the June 2010 issue of Anaesthesia &
Analgesia. "On the other hand, this may go away once we do well- 12 November Cancer Support Group, Parktown 0900
controlled clinical trials." 16 November R4R General meeting/Support 10h00
26 November Bosom Buddies year end function 0900
http://www.scientificamerican.com/article.cfm?id=cancer-surgery-pain
28 November Cape Town PLWC Support Group
Financial worries top psychosocial 3 December R4R Year End Gathering 10h00
10 December Cancer Support Group, Parktown 0900
concern of cancer patients
CONTACT DETAILS :
Highlighting shifting priorities after the recession, nearly half (49%)
People Living With Cancer, Johannesburg: 073 975 1452,
of all recent psychosocial consultations with patients at a leading
plwc@icon.co.za
cancer center involved financial worries, rather than adjustment
issues or other pressing mental health concerns. These included a People Living With Cancer,Cape Town: 076 775 6099,
lack of adequate health insurance, inability to afford medications, info@plwc.org.za, www.plwc.org.za
housing crises, and/or difficulties in meeting basic financial obliga- Bosom Buddies: 0860 283 343, www.bosombuddies.org.za
tions during cancer treatment. Campaign for Cancer: www.campaign4cancer.co.za
Among patients' presenting concerns were losses of benefits from CANSA Johannesburg Central: 011 648 2340, 19 St John Road,
layoffs, high premiums, and housing foreclosures, with these chal- Houghton, www.cansa.org.za
lenges often taking precedence over the more existential struggles Reach for Recovery (R4R) : Johannesburg, Antoinette Reis,
faced by patients facing life-altering or life-threatening cancer diag- 011 648 0990 or 072 849 2901
noses.
Reach for Recovery: Harare, Zimbabwe contact 707659.
Mental health distress - including coping challenges, adjustment to Cancer Centre - Harare: 60 Livingstone Avenue, Harare
the diagnosis or treatment, and acute risk assessment for suicidality Tel: 707673 / 705522 / 707444 Fax: 732676 E-mail:
- constituted 37% of social work consultations, followed by other cancer@mweb.co.zw www.cancerhre.co.zw
issues, including coordination of family meetings to discuss goals of

6

care or decision making (5%), and domestic or family violence (2%).
The "devastation of financial recession" has not only jolted the pri-
orities of cancer patients, but also has taxed the institutional and
external philanthropic assistance programmes that once addressed
such needs.
http://www.oncologystat.com/news/Financial_Worries_Top_Psycho
social_Concern_of_Cancer_Patients_US.html
Telemedicine planned for Kenya
An Indian medical tourism company is hoping to introduce
telemedicine to Kenya, after already implemented in Canada and
Britain. According to Chandigarh-based Doctor Z India Healthcare
Ltd., the company is hoping the effort will bring more development
in the medical sector to the African country.
“The company has been entrusted by Mohali-based Center for
Development of Advanced Computing, a scientific society under the
Ministry of Communications and Information Technology, the gov-
ernment of India, to provide technology to launch the project,”
according to a statement made recently.
The company said it would be the first such effort to enter Kenya.
Doctor Z India Managing Director Zora Singh, in comments to the
Business Standard, said “We are planning to launch telemedicine
project in Kenya in association with C-DAC Mohali as a technology
partner.”
She went on to say that C-DAC was chosen as a partner because
“they have past experience in this field. Besides, we are also plan-
ning to run OPD’s camp in Kenya, Ethiopia and East of Africa.”
C-DAC’s first major project in Kenay, ironically, was a telemedicine
enterprise begun in 1999 and was successfully completed in 2003.
http://bikyamasr.com/wordpress/?p=29578
Anti-tumour effect of rapamycin increased
by red wine compound
Researchers from Cleveland Clinic's Lerner Research Institute have
discovered that resveratrol - a compound found in red wine - when
combined with rapamycin can have a tumour-suppressing effect on
breast cancer cells that are resistant to rapamycin alone.
Recently published research in Cancer Letters - also indicates that
the PTEN tumour-suppressing gene contributes to resveratrol's anti-
tumour effects in this treatment combination.
Charis Eng, MD, Ph.D., Chair of the Genomic Medicine Institute of
Cleveland Clinic's Lerner Research Institute, led her team to study
the effect of combining resveratrol, a chemopreventive drug found
in many natural compounds, with rapamycin on breast cancer cells.
The research demonstrates an additive effect between these two
drugs on breast cancer cell signaling and growth.
"Rapamycin has been used in clinical trials as a cancer treatment.
Unfortunately, after a while, the cancer cells develop resistance to
CONTRIBUTIONS FOR PUBLICATION IN
“VISION” NEWSLETTER
Articles and letters submitted for publication
in VISION are welcomed and can be sent to:
cansurvive@icon.co.za
7
VISION, MARCH / APRIL 2011
PLWC Cape Town
Have you, a friend or a family member been diag-
nosed with cancer? Do you have any questions or
concerns? Do you feel the need to talk to others
who have been in the same position?
You are invited to join us at our Cancer Support
Group held at Vincent Pallotti Hospital in the GVI
Oncology unit
Time: 18h00 – 19h30
See the calendar on page 6 for dates
or contact the PLWC helpline on 076 775 6099
WE LOOK FORWARD TO MEETING YOU
rapamycin," Eng said. "Our findings show that resveratrol seems to
mitigate rapamycin-induced drug resistance in breast cancers, at
least in the laboratory. If these observations hold true in the clinic
setting, then enjoying a glass of red wine or eating a bowl of boiled
peanuts - which has a higher resveratrol content than red wine -
before rapamycin treatment for cancer might be a prudent
approach."
Article URL:
http://www.medicalnewstoday.com/articles/216480.php
Smartphone can SMS, check email, and now
detect cancer
Transforming smartphones into medical marvels is a hot trend in
scientific research. And now, a new smartphone-controlled device
could help doctors diagnose cancer in a simple, in-office procedure -
with results in a matter of minutes.
Researchers at Massachusetts General Hospital in Boston have
developed a new system that can detect tumours by analyzing a
tiny sampling of cells (a speck of tissue), sparing patients from the
larger biopsies currently used.
Announced in the journal Science on February 23, the handheld
device, operated by a smartphone app, has at its core a micro
nuclear magnetic resonance chip, or a simplified version of the tech-
nology found in magnetic resonance imaging (MRI) scanners. "It
works by using magnetic nanoparticles to measure protein levels,
looking for specific markers that indicate the presence of cancer,"
reports New Scientist magazine on the technology.
In a trial of 50 patients, researchers reported that the device cor-
rectly detected cancer in 96 percent of the cases. Even better, a sec-
ond trial of 20 patients scored total accuracy (New Scientist says
current methods for detecting cancer are only 84 percent accurate).
Plus the results are fast compared to waiting days for a biopsy
result, which can be agonizing for patients.
Researchers say don't expect to see these smartphone apps in doc-
tors' offices anytime soon. They report some problems with the fact
that protein markers aren't always present in cancer cells, which
could result in misdiagnoses, so more work needs to be done.
Read more about the cancer-detecting smartphone app:
http://stm.sciencemag.org/content/3/71/71ra16

Patient rights in the medical
schemes environment
By Elsabé Klinck
The most basic rights that medical scheme beneficiaries have are
the prescribed minimum benefits (PMBs). Currently the PMBs
include:
Ë 270 Treatment and Diagnostic Pairs (DTPs), such as so-called
“treatable cancers”.
Ë Treatment for all emergency conditions defined as “the sud-
den and, at the time, unexpected onset of a health condition
that requires immediate medical or surgical treatment, where
failure to provide medical or surgical treatment would result
in serious impairment to bodily functions or serious dysfunc-
tion of a bodily organ or part, or would place the person’s life
in serious jeopardy”.
Ë 25 chronic conditions, including epilepsy, COPD, hypertension
and diabetes.
PMBs must, in terms of regulation 8(1) to the Medical
Schemes Act, be funded “in full and without co-payment”. The
correct classification of a diagnosis as part of the PMBs is
therefore imperative. Schemes are, however, entitled to use
the following mechanisms to manage the costs associated
with funding the PMBs, i.e.:
Ë The appointment of designated service providers (DSPs) with
whom certain agreements have been reached in terms of the
manner and cost of treating medical scheme beneficiaries;
and/or
Ë The application of treatment algorithms, formularies and/or
pre-authorisation, aimed at improving the effectiveness and
efficiency of healthcare provision.
The law places criteria on how medical scheme should apply formu-
laries, treatment algorithms or disease limitations to the PMBs.
These limitations should be set on the basis of evidence-based
medicine, i.e. the current best evidence, whereby individual clinical
experience is integrated with the best available external clinical evi-
dence from systematic research. The principles of clinical appropri-
ateness and evidence-based medicine are also found in the HPCSA’s
ethical rules (in particular rule 23 on the relationship between the
pharmaceutical industry and medical practitioners) and Undesirable
Business Practices Policy.
Formularies and protocols may consider cost-effectiveness and
affordability. Cost-effectiveness is not defined in the law, but should,
on a plain language interpretation, go beyond price or cost alone. It
is interesting that the HPCSA’s new Ethical Rule 23 also refer to
cost-effectiveness as an acceptable way of distinguishing between
DISCLAIMER: This newsletter is for information purposes only and
is not intended to replace the advice of a medical professional.
Please consult your doctor for personal medical advice before
taking any action that may impact on your health.
The views expressed are not necessarily those of People Living With
Cancer or those of the Editor.
8
VISION, MARCH / APRIL 2011
Elsabé Klinck is a B.Iuris, LL.B graduate, who also completed a
degree in Psychology for Applied Professional Contexts and an
Honours Degree in German.
Elsabé has been working in the health sector since 2001, gaining
valuable experience dealing with medical practitioners and phar-
maceutical issues, as well being a key contributor to a prominent
health care consulting company.
She has extensive knowledge and practical experience in health
care/medical practice issues, medical schemes, medicines, medical
devices and patient rights and a background in constitutional/
human rights law.
medicines or devices. However, the application of what is cost-
effective should not override what would be clinically appropriate
for a particular patient. This principle is also entrenched in the law
through a stipulation that, if a patient is, or would not be, treated on
a formulary medicine or in terms of a scheme protocol, the patient
is entitled to alternative treatment without being required to make
a co-payment.
The law, as does the HPCSA’s ethical rules, protects the choices of
patients. Regulation 8(5) states that a patient may decline a clini-
cally effective product that a scheme will fund in favour of another
product, subject to a co-payment. The HPCSA’s Undesirable
Business Practices Policy states that “choice should be optimized as
it enhances competition”, but that choice may be restricted, provid-
ed that “quality of care is not sacrificed”.
Mobiles reduce errors say
71% of oncologists
More than 71 percent of the oncologists said mobile resources—
including Skyscape’s drug-dosing calculator—helped them reduce
medical errors.
“Responding to a survey by Skyscape, oncologists said the use of
mobile technology helps reduce medical errors and increases the
amount of patients they can see during the day,” a Skyscape com-
pany statement says.
Actually, the results are interesting. About 33 percent of respon-
dents said that mobile devices “create efficiencies in their weekly
workflow that allows them to increase patient volumes,” accord-
ing to Skyscape.
“Skyscape evolved as kind of an Amazon of medical resources,”
says Brett Miller, president of parent company Physicians
Interactive Holdings’ Healthcare Professional Division. It took
well-known medical texts and reference books and repackaged
them in digital form for PDAs and, later, smartphones.
Miller, who joined the company in February 2010, says it’s fair to
call Skyscape and the Healthcare Professionals Division the
mobile arm of Physicians Interactive for now, but expect that to
change in the future. “It probably will evolve into more than that,”
Miller says. “We own some proprietary resources to help physi-
cians with their workflow,” he explains.
And mobile is the right way to reach them, according to a survey
of oncologists that Skyscape to release recently.
http://mobihealthnews.com/10468/survey-45-percent-of-oncol-
ogists-say-mobiles-reduce-errors/

KIDNEY CANCER ROUNDUP
Highlights from ASCO’s
Genitourinary Symposium
By Jay Bitkower
Unfortunately, there were no reports of any major breakthroughs in
therapies for metastatic renal cell carcinoma (mRCCC) this year. No
applications have been made to the FDA since October 2009 when
pazopanib (Votrient) was approved for kidney cancer treatment. The
next two drugs in the pipeline for approval are two more tyrosine
kinase inhibitors (TKIs), tivozanib and axitinib. Both drugs are now in
Phase III trials comparing their efficacy to that of sorafenib
(Nexavar), which is the new placebo.It is expected that the results of
these trials will be presented at this summer's ASCO Meeting and
FDA approval will most likely be given in 2012.
There were 100 abstracts presented at the Symposium, with 18% of
them relating to sunitinib (Sutent). Researchers already know
enough about the response to sunitinib so they are focusing more
on the specifics of treatment such as risk of congestive heart failure
in patients treated with the drug. The largest category of presenta-
tions by far, 25% of the abstracts, dealt with what I would call prog-
nostic and predictive factors for outcome of patients with metasta-
tic kidney cancer. Researchers know very little about what factors
are predictive of survival, perhaps indicating why there is a plethora
of studies.
Axitinib and tivozanib are expected to provide improved results over
the other TKIs (Nexavar, Sutent, and Votrient), but they will not be
the home run we are looking for, insofar as they are unlikely to gen-
erate a complete or durable response. As Dr. David McDermott from
the Dana Farber Cancer Institute, pointed out in his overview of cur-
rent therapies, in addition to not producing a complete response,
these agents must be taken continuously in order to maintain effi-
cacy, resistance usually develops within a year of initiating treat-
ment, and there may not be room for much more improvement of
these VEGF pathway inhibitors. Combinations of these drugs have
been tried with little success due to high toxicity. A few of combina-
tions were reported on at the Symposium. For example, a Phase I
trial combining everolimus (Afinitor) and sunitinib reported toxici-
ties requiring reductions in the recommended dosages of both
drugs. Similarly, the combination of sunitinib and bevacizumab
(Avastin) did not yield positive results. However, a Phase I trial of
tivozanib and temsirolimus (Torisel) exhibited no dose reducing tox-
icities, and 29% of patients had a partial response.
Dr. McDermott also said that new evidence suggests that taking a
break in therapy may not reduce eventual effectiveness of the tar-
geted therapies (this if course depends on the aggressiveness of the
disease), and re-challenging' patients with the same drug has shown
benefit. However, he calls for new agents and novel trial design. Dr.
McDermott promoted immunotherapy both as a combination with
targeted therapies and as monotherapies - see below for more on
that. For example, a Phase III trial is underway combining AGS-003,
a dendritic cell therapy, with sunitinib.
Dr. Robert Motzer of MSKCC reported on a Phase II trial comparing
sunitinib (Sutent) on a 4 week on/2 week off, 50 mg dosing sched-
ule versus continuous 37.5 mg dosing. There was no statistically sig-
nificant difference between the two in terms of efficacy or adverse
events, however, there was a slight trend favoring the 4/2 version in
terms of efficacy. They evaluated quality of life (QOL), as reported
by the patients, and a plot overlaying the two results showed no dif-
9
VISION, MARCH / APRIL 2011
ference overall, but, what was interesting, was that the continuous
dosing protocol yielded a smooth line representing QOL issues but
the 4/2 protocol's plot was jagged, as expected, where QOL
descended while on the drug and ascended while off of it.
Dr. Brian Rini of the Cleveland Clinic, in an oral presentation, report-
ed on the results of a Phase II trial of AMG386 in combination with
sorafenib. AMG 386 is an angiopoietin inhibitor. Angiopoietins are
circulating proteins that promote blood vessel stabilization. It is
hypothesized that blocking angiopoietin in combination with a
VEGFR inhibitor would further depress angiogenesis. AMG 386 had
anti-tumour activity in pre-clinical studies. This was a three-arm
trial in which AMG 386 was given in two different doses in combi-
nation with sorafenib and the third arm, sorafenib, was used as a
monotherapy. Unfortunately, the combination showed no improve-
ment over sorafenib alone in progression-free survival. There was a
difference in response rate for the higher dose arm of AMG 386.
Toxicity was equivalent for the three arms. This drug is being further
tested in mRCC patients in combination with sunitinib with AMG
386 being given only at the higher dose.
Dr. David McDermott also reported on an update to the MDX-1106
trial. MDX-1106, an immunotherapy, is an anti-PD-1 agent, where
PD-1 itself suppresses T-cell activity. In a subset of a larger trial of
solid tumours, MDX-1106 is being tested in 16 renal cell patients. As
reported at last year's ASCO Meeting by Dr. Mario Sznol of Yale
University in a Phase I trial, MDX-1106 therapy resulted in a
response rate of 31% with low toxicity. The response rate has since
improved to 43%.
Finally, Dr. Michael Atkins of Dana Farber, reported on non-clear cell
malignancies. Although 90% of mRCC patients have clear cell his-
tology, when non-clear cell tumours turn metastatic, they are usu-
ally more aggressive than clear cell and there is little treatment
available. Dr. Atkins said that there is some evidence that collecting
duct tumours respond to chemotherapies that are useful for transi-
tional cell carcinomas. Tumours with sarcomatoid features, which
can be any histology, have also responded, in a small study, to a
combination of sunitnib and gemcitabine, and a larger trial conduct-
ed by Dr. Naomi Haas will soon open using these agents. He noted
that there aren't many trials for non-clear cell mRCC patients so
data are not readily available analyzing efficacy. In the expanded
access trial for sunitinib, there was an 11% response rate for non-
clear cell patients. In the seminal Phase III trial for temsirolimus,
non-clear cell patients fared even better than clear cell patients,
however this was a small subset of the trial.
Further work is necessary with mTOR inhibitors. Papillary Type I car-
cinoma, which may be caused by a mutation or up-regulation of
the c-Met gene, has shown some response to c-Met inhibitors.
There is currently a trial of GSK089 (foretinib), a dual c-Met and
VEGFR2 inhibitor in papillary patients.
The trial is stratified by those having c-Met mutation or up-regula-
tion and those with no activity of c-Met. A majority of patients had
tumour shrinkage with those having mutations or up-regulation
having more frequent shrinkage.
For chromophobe tumours, there is an up-regulation of the mTOR
pathway implying that an mTOR inhibitor might be effective.
Mostly what's needed are more clinical trials for non-clear cell
patients.
Jay Bitkower, a seven year survivor of kidney cancer, is
president of the Action to Cure Kidney Cancer (ackc.org)
whose primary mission is to specifically advocate for kidney
cancer research.