PAGE 24 / FEBRUARY 25, 2007 SCRIPTDOCTOR: MEDICINE IN THE MEDIA How an ER Storyline Helped Pass the Patient Navigator Act By Andrew Holtz, MPH picked up on the importance of patient Andrew Holtz, MPH, is a former CNN Medical Correspondent navigation and if even they have, then t’s a happy picture: President and the author of “The Medical Science of House, M.D.” This you’ve got to know that there’s rele- Bush beaming, flanked by smil- column examines mass media programs, particularly vance for this. So it was another way of ing members of Congress, as he entertainment TV, for insight into popular perceptions, so that stimulating the people who were work- signs the Patient Navigator Out- ing on it.” I rather than merely wincing at distortions or reach and Chronic Disease Prevention DoCanto notes that members of oversimplifications in the portrayals of medicine on these Act of 2005. It was one of the few Congress are besieged by pleas for shows, health care professionals can learn something from pieces of health care-related pieces of action…so anything that can cut legislation to reach his desk during media professionals about the way that medical and health through the clutter is useful. “They are the last session. topics are presented. Send questions to him about how the real people, too. They watch these pro- “For a bill that, in the scheme of media treat medical topics or suggestions for future columns grams. I think they do have an impact.” things, was small, for it to rise to the to [email protected] DoCanto got the video from Dr. level where the President invites the Freeman, who had worked with ER members of Congress who were in- writers to create the storyline. volved in this effort to the White House Dr. Freeman, now a Senior Adviser and they have a signing ceremony in move a bill funding more patient navi- and-true technique of bringing a to the Director of the NCI on cancer dis- the Oval Office, with photographs and gator programs. Hollywood celebrity to Washington to parities and Medical Director of the such; that’s pretty amazing,” says Licy But they also got an assist from open doors and perhaps win some Ralph Lauren Center for Cancer Care DoCanto, who was with the American some unusual “testimony:” votes. and Prevention in New York City, says Cancer Society’s Government Relations In the ER hallway, Dr. Ray Barnett the collaboration began with a briefing Office at the time. and Dr. Gregory Pratt look back ‘Refusal of Care’ Episode set up by the Hollywood, Health & For reasons I’ll explain shortly, I at a cancer patient and another Society program at USC Annenberg’s took a personal interest in the recollec- woman talking inside Trauma In the episode titled “Refusal of Care,” Norman Lear Center. He told the ER tions of DoCanto and other supporters Room One. doctors were trying to persuade a reluc- writers about patients who resisted of patient navigator programs, such as Barnett: “Where’d you find her?” tant patient to accept treatment for the surgery because they had the mistaken former Harlem Hospital Cancer Chief Pratt: “There’s a cancer support advanced cancer they had stumbled on belief that if air touches a tumor, the Harold Freeman, MD. They have group upstairs. They have patient while treating her for a bone fracture. cancer will spread. pushed for many years to expand the navigators to help people get The woman blocked out the pleas of use of these trained lay people, who through the system.” white-coated physicians, but opened up help guide patients through treatment Clips of an episode of ER featuring to a cancer survivor. and bridge the gulf between the worlds a patient navigator were played for leg- “I brought it to them,” says Do- “Members of Congress of patients and physicians. They used islators and key staffers in what could Canto. “Here we took a very popular all the standard lobbying techniques to be thought of as a twist on the tried- program and we said, ‘Even ER has are besieged by pleas for action, so anything that can cut through the clutter M. D. Anderson using thalidomide, an therapy, as is the Src oncogene inhibitor Osseous-Epithelial agent that is active in disrupting the dasatinib. And researchers will soon be is useful. They are real continued from page 22 interaction between a primary prostate using insulin-like growth factor-1 people, too. They watch cancer tumor and the bone stroma. blocking pathways in combination with prostate cancer progression and may Thalidomide is not an ideal drug for chemotherapy, he said. these programs. They do account for how prostate cancer pre- this purpose because of its adverse have an impact.” sents in the clinic, he said. The clinical effects, he noted, but there are new ‘Cutting Edge’ implication is that those pathways agents in development that do possess become further targets to consider in many of the properties of thalidomide Another speaker at the meeting, inhibiting the disease. without the toxicity. Gregory R. Mundy, MD, the John A. Dr. Freeman, a member of OT’s Dr. Logothetis said researchers saw Oates Chair in Translational Medicine Editorial Board, said he suspects the Combination Key a disruption of the stromal-epithelial and Director of the Vanderbilt Univer- myth may spring from stories of people interaction with thalidomide adminis- sity Center for Bone Biology, spoke who did not appear to be seriously ill As with many other newly developed tration, but importantly this was seen about this osseous-epithelial interaction until after they were treated. targeted therapies, treatments targeting prior to any evidence of an effect on the in an interview at the meeting. “The community translates the case the stromal-epithelial connection would epithelial compartments. “That’s just been characterized in into, I believe: ‘John walked into the have to be used as part of a combina- This validated the principle of tar- the last several years, and it’s clearly emergency room. He was strong tion regimen, Dr. Logothetis said. geting the host component in metastatic going to be very important for metasta- enough to walk in. They operated on Blocking the bone stroma alone would disease as a therapeutic approach. sis and maybe for the dormant state of him. He seemed to tolerate the surgery not be curative, although it could be a He mentioned some of the new some tumor cells,” Dr. Mundy said. okay; he was discharged in 10 days. strategy to prolong survival. agents in ongoing experiments that “That’s cutting-edge stuff.” And then he died.’ So the translation is: “Therapies blocking the stroma might interfere with this interaction: He said other speakers had de- ‘The air touched the cancer and caused plus cytotoxic therapies is how we Atrasentan, a selective endothelin-A scribed how cells now being identified the cancer to spread,’” Dr. Freeman envision it,” he said. receptor antagonist, was the first to in the bone marrow actually prepare said. enter major trials and is now being test- the metastatic site of the tumor cells to The pervasiveness of this belief Early Clinical Research ed in combination with chemotherapy. later settle down and grow. These are was documented in a 2003 survey by with Thalidomide Sunitinib, an inhibitor targeting several also in the bone marrow, he said, but Mitchell L. Margolis, MD, and col- receptor tyrosine kinases, is also being presumably the whole process is direct- leagues at the Philadelphia VA Medical O He described early clinical research at studied in combination with chemo- ed by the primary tumor cells. T (continued on page 25) ® and was severe in 1%. In patients with advanced colorectal cancer, acneform rash was reported in 89% ERBITUX (Cetuximab) (686/774) of all treated patients, and was severe in 11% (84/774). Subsequent to the development of severe dermatologic toxicities, complications including S. aureus sepsis and abscesses requiring incision and For intravenous use only. drainage were reported. Brief Summary of Prescribing Information. For complete prescribing information please consult official Patients developing dermatologic toxicities while receiving ERBITUX (Cetuximab) should be monitored package circular. for the development of inflammatory or infectious sequelae, and appropriate treatment of these symp- toms initiated. Dose modifications of any future ERBITUX infusions should be instituted in case of severe WARNING acneform rash (see DOSAGE AND ADMINISTRATION, Table 3). Treatment with topical and/or oral antibi- Infusion Reactions: Severe infusion reactions occurred with the administration of ERBITUX in approx- otics should be considered; topical corticosteroids are not recommended. imately 3% of patients, rarely with fatal outcome (<1 in 1000). Approximately 90% of severe infusion Use of ERBITUX in Combination With Radiation and Cisplatin reactions were associated with the first infusion of ERBITUX. Severe infusion reactions are character- The safety of ERBITUX in combination with radiation therapy and cisplatin has not been established. ized by rapid onset of airway obstruction (bronchospasm, stridor, hoarseness), urticaria, hypotension Death and serious cardiotoxicity were observed in a single-arm trial with ERBITUX, delayed, accelerated and/or cardiac arrest (see WARNINGS and ADVERSE REACTIONS). Severe infusion reactions require (concomitant boost) fractionation radiation therapy, and cisplatin (100 mg/m2) conducted in patients with immediate interruption of the ERBITUX infusion and permanent discontinuation from further treatment. locally advanced squamous cell carcinoma of the head and neck. Two of 21 patients died, one as a (See WARNINGS: Infusion Reactions and DOSAGE AND ADMINISTRATION: Dose Modifications.) result of pneumonia and one of an unknown cause. Four patients discontinued treatment due to adverse Cardiopulmonary Arrest: Cardiopulmonary arrest and/or sudden death occurred in 2% (4/208) of events.