In the June 10 edition of the British Journal of Cancer, researchers announced that a combination of two treatments resulted in effective palliative care for elderly mesothelioma patients.  Following studies on the drug Alimta, Italian researchers issued a blend of Alimta and the drug Paraplatin to 178 patients with malignant pleural mesothelioma.  Overall, the one-year survival rate was 64% and the disease control rate was 76%.

The subjects of the study were also examined according to age.  Forty-eight of the patients were over 70 years old; in this group, the disease control rate was 60%, compared to a 67% rate in the younger group.  Time to disease progression was 7.2 months versus 7.5 months, and median survival was 10.7 versus 13.9 months for the older age group versus the younger age group, respectively.

Because these data were not significantly different, the treatment regimen was determined to be equally effective among elderly and younger mesothelioma patients.  These findings indicate that age should not restrict the use of the Alimta/Paraplatin combination in mesothelioma patients.

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In June, I blogged about a California bill addressing end-of-life rights for patients. A similar bill is currently stuck in committee in Vermont and a proposition for a federal bill is being brought to the Senate's attention. It would be the first act of its kind to gain national passage.

The California bill requires doctors to teach terminal patients about end-of-life options such as hospice homes and palliative care, so that the patients know they are not obligated to continue aggressive treatment regiments. Under the bill, doctors must give this straight talk to patients who are expected to survive less than a year.

This bill puts the patient in power of decision-making. Without this provision, physicians control how much patients knows. This bill ensures that the patient is fully informed and can make educated and knowledgeable choices regarding their health, treatment, and end-of-life environment.

Physicians are obligated to present options to patients, but not endorse any. Nevertheless, the bill has garnered opposition from politicians who believe that it is setting the stage for assisted suicide cases. While palliative care aims only to comfort a patient in their last days, it has been known hasten the process of dying.

California's measure is known as the "Terminal Patients' Right to Know End-of-Life Options Act." Under the bill, physicians who do not comply with the terminal patient's wishes must refer the person to a new doctor who will carry out his or her intentions.

Many doctors fear that compliance with the bill will be hard to guarantee, as it is often difficult to predict a patient's likelihood of surviving a year. To this point, some oncologists believe that discussing end-of-life options too early can cause the patient harm. Though this point was essentially debunked in a recent study, physicians struggle to find a balance between informing their patients and overwhelming them. Some doctors warn against divulging details too soon: "What most people want to know about are hospice and palliative care. They may not be asking about last-resort options like palliative sedation and stopping eating and drinking," said Dr. Quill, director of the University of Rochester Medical Center's palliative care program in New York.

Thomas J. Smith, MD, an oncologist and co-author of a Journal of the American Medical Association article on poor communication between cancer patients and doctors, said the California law "is something that could be tested in one state, and if it works, then it could potentially be applied to other states. It certainly raises awareness of the issues."

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