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    The Benefits of Physical Therapy After Cancer

    Getting our bodies back into condition after cancer treatment is an important part of survivorship. Rehabilitation after cancer treatment can help us regain what we thought we might have lost and enjoy an enhanced quality of life.

    Evidence shows that physical therapy after cancer
    treatment is underprescribed. We might only think of physical therapy as being for people who were injured in an accident or who had hip-or-knee replacement surgery.
    You may not realize that physical therapy can help you recover from treatment-related issues including fatigue and quickly tiring, deconditioning and difficulty with your gait and/or balance. Physical therapy can also help us overcome radiation treatment side effects or learn how to cope with lymphedema after breast cancer surgery.
    Studies show that even the most active person before cancer treatment feels older and sicker than they did when they were diagnosed. This is where physical therapy can help us reverse the effects of cancer treatment.
    What kind of problems can physical therapy help?
    PT, as physical therapy is often called, can help restore your energy and zest for life. It can also address specific body functions adversely affected by surgery or radiation treatment.
    Pain. Studies show that about one-third of all cancer patients suffer from pain after treatment. Pain may be a result of damage done by the cancer itself (weakened bones that fracture). Pain can also be a result of treatment. A physical therapist is trained to assess the cause of your pain so that they can effectively treat it. Pain can come from compression fractures, a compressed nerve or peripheral neuropathy caused by chemotherapy. Breast cancer survivors may suffer shoulder pain, caused by range-of-motion issues on the surgery side. Reduced strength on the surgery side may be an issue too.
    Deconditioning. Even the most active person loses strength and mobility during extended treatment. Lung cancer patients who lose lung tissue because of surgery face decreased oxygen capacity. Fatigue from chemotherapy derails patients’ best intentions to keep exercising. Chemo patients often lack the energy to go out for a walk or lift weights in their basement. Survivors, just out of treatment, may resist attempting exercise because of their lack of stamina and fear of failure.
    Physical therapy helps patient get stronger in graduated steps so that patients regain confidence in their ability to resume their favorite activities — like golf, gardening, walking or yoga.

    Fatigue. Fatigue is REAL for people with cancer and survivors. In fact, it’s called “cancer-related fatigue
    (CRF).” The National Comprehensive Cancer Network (NCCN) defines CFT as “distressing persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.’’ Studies show that physical activity is the best way to treat cancer-related fatigue.
    Physical therapists are trained to work with people who have become deconditioned by illness and/or surgery. They can help patients regain their stamina and flexibility.
    Balance/falling. As many of can attest, we, as patients and survivors, are at increased risk for falls. About six months after my last chemo, I fell in the bathroom — the fall knocked me unconscious, and I had a gash above my right eye that required six stitches. There are a number of reasons that we are more prone to falls. These reasons include:
    *Weaker strength in our legs. *Decreased sensations in our feet from peripheral neuropathy. *Declining sense of balance (perhaps from chemotherapy and hormone therapy). *Many cancer patients suffer from decreased bone mineral density. Combine decreased bone strength and a fall — you have a formula for broken bones. *Physical therapy helps patients regain their sense of balance. Weight-bearing exercises help rebuild bone strength. *Peripheral neuropathy. Several chemotherapy drugs, including vincristine, cisplatin, paclitaxel and oxaliplatin, cause peripheral neuropathy. Patients experience tingling and numbness in their hands and feet resulting in dropped objects and falls.

    Physical therapy helps in several different ways: *Improves range of motion. *Strengthens muscles. *Retrains balance skills to help prevent falls. *Use of braces or splints to improve posture. *Teaching patients to be aware of the terrain and its fall risks. *Electrical stimulation therapy benefits many patients too. *Incontinence. Patients may experience urinary or fecal incontinence after cancer treatment. There is no need to feel embarrassed about this problem. It’s a common issue after cancer treatment. Pelvic floor physical therapists can help retain your muscles to help you regain control so that you can live a normal life again. *Difficulty swallowing. Patients who have head and neck cancer may experience difficulty swallowing after surgery and/or radiation. You may have scarring or swelling/shrinking of the esophagus.

    A swallowing specialist teaches patients new ways to swallow and how to avoid gagging or choking. They also help in these areas:
    *Strengthening the muscles in your throat. *Swallowing exercises. *Tongue exercises. *Jaw exercises. *Lymphedema. Not only do breast cancer survivors experience lymphedema, other patients have lymphedema occur in their lower extremities. Lymphedema is caused by removal of lymph nodes during cancer surgery. This causing swelling because the lymphatic tissue can no longer drain. Physical therapists teach manual message, compression sleeves and limb exercises that are done at home on a continuing basis. *Vaginal stenosis. Women diagnosed with cervical, ovarian, uterine, rectal and anal cancers often have pelvic radiation as part of their treatment. One of the side effects is vaginal stenosis, scarring, shortening and narrowing of the vagina. This may make intercourse and pelvic exams very painful or even impossible. A pelvic floor physical therapist utilizes gentle massage and graduated size dilators to help restore the vaginal passage to near normal.
    The Bottom Line …
    It may seem counterintuitive, but exercise helps reduce fatigue. Physical therapy targets specific muscle groups to restore specific bodily functions including swallowing, continence, balance and everyday living tasks liking climbing stairs and getting up and down from chairs. Ask to be referred to physical therapy after treatment to help you fully recover. When referred by your physician, PT is covered by your insurance. If you’ve already met your max-out-of-pocket, there won’t even be a copay involved. Take advantage of the help that physical therapy provides.

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    Tips to Protect Yourself During Cancer Prevention Month

    How to Protect Yourself This Prevention Month

    Cancer is a difficult word to hear, often associated with strenuous battles and unpredictable times ahead. February is Cancer Prevention Month, a time to learn how to treat your body better in hopes to prevent this disease from impacting yourself and your loved ones.
    Many Cancers are carried through genetics or are hereditary. Few have been directly linked to specific causes. Nevertheless, there are a still number of cancers that may be caused by environmental or physical factors, and there are strategies you can implement to lower your risk of diagnosis. This may seem daunting, each step is generally simple and only takes small changes in your daily routine to increase your hopes of a long and healthy life.
    Making small changes in your diet could make a big impact on your overall wellness. These changes aren’t guaranteed to prevent cancer but it may help in reducing your risk. A good way to improve any diet is by including more fruit, vegetables, and whole grains into your nutritional plan. These foods are filled with antioxidants, which assist in fighting free radicals, and can aid in reducing inflammation that is believed to be one cause in the growth of cancer cells. Fortunately, if you are a coffee drinker, you might have unknowingly been helping your fight against this disease, as coffee beans are filled with antioxidants. If you’re looking for new foods to add to your diet here are just a few that may make a big difference down the line:
    Garlic ● Cinnamon ● Leafy greens (ex kale) ● Cruciferous greens (ex. cauliflower, cabbage, bok choy) ● Berries ● Tomatoes ● Apples ● Red Onions

    In general, staying lean by avoiding refined sugars and high caloric foods will help reduce your risk of obesity. There are several studies that believe obesity and cancer may be linked. Of course, it’s important to be mindful of what we eat, but knowing associated benefits include cancer prevention is yet another reason to attempt this lifestyle change.
    There is a large amount of evidence that proves the more physically active you achieve, the more likely you are to have a lower risk of cancer and countless other health implications. Simply put, physical activity is imperative to better health and overall prevention. For instance, research is showing that more physically active women have a lower likelihood of breast cancer.. For example, fitness aids in lowering the amount of hormones, like estrogen, that have been associated with cancer growth. Fitness also lowers the rate of obesity, and can also help decrease inflammation, which have both been linked to cancer cell development. 

    Trying to move your body every day is an important step that shouldn’t be ignored. It seems easy these days to stay in your office chair, or be too tired after work to head to the gym. There are easy ways to get your body moving, like going for a walk with a coworker during lunch or spending some time in the morning on the elliptical while responding to emails.
    If you are still on the smoking bandwagon, it may finally be time to take your health into your own hands and stop. This is the most vital step when it comes to lung health. “Tobacco use is the single largest preventable cause of cancer in the world causing 22% of cancer deaths,” according to dosomething.org. Other than smoking, there are other lesser-known risks when it comes to breathing. Take the time to teach yourself what you may unknowingly be inhaling, and how to prevent this from occurring.
    Completing a home inspection is important when considering your health and the wellbeing of those you live with. There are a number of home materials and products that may put you at risk for cancer. Asbestos is a building material that was heavily used between the 1930s to the 1970s due to its durability and fire resistance. Although it is a known carcinogen and proven to cause cancer of the lungs known as pleural mesothelioma, it is still utilized in some parts of the world and historic uses has this toxin unknowingly hidden across countless buildings and borders. To assist in the cancer prevention process, hire an inspector to check your home for asbestos and always be wary of what could lurk behind closed walls before attempting any remodeling or DIY projects.
    Radon is another threat you may be facing within your home. Around 20,000 lung cancer deaths a year can be associated with exposure to this gas. Radon is naturally occurring and develops through the natural breakdown of uranium, which may be found in rocks, soil, groundwater, and well water. Because radon cannot be seen and is odorless and tasteless it is often difficult to detect and may go unnoticed. This gas may inhabit the air of your home through cracks in walls and flooring, and can only be identified through a radon test which you can conduct yourself. However, if your home tests hire than a 4 it may be time to contact an expert and fix the problem to avoid future complications.

    VOCs, or volatile organic compounds, are important to look out for within your home. This includes anything such as acetone, ethanol, formaldehyde, benzene, and toluene on an ingredient list. VOCs can be found in many home cleaning products and can cause a number of health problems, including cancer. Luckily, getting VOCs out of your home is much simpler than asbestos removal or radon detection. 
    Consider making your own cleaning products, or searching for a safer alternative to positively impact the air quality within your home. Paying attention to what’s in the air you breath is just as important as eating a healthier diet when it comes to cancer prevention. This Cancer Prevention Month, try to implement steps from each of these areas to lower your risk of cancer and create yourself an overall healthier lifestyle.

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    Survivor's Guilt - Do You Have It?

    People on the outside of the World of Cancer believe that those of us who have completed our treatment will be joyous and happy and just jump back into life with both feet and never look back. Unfortunately, that’s not always the case.

    Most of us realize that we’ve changed during treatment. We are more aware of the value of time and the wonder and beauty of life. And we’ve gotten to know other people with cancer; we’ve made in person friends and online friends. And then we will learn that someone has died, and we experience survivor’s guilt.
    Survivor’s guilt
    is defined as “surviving a life-threatening experience when others have not survived.” We hear about it on television – the people who survive an airplane crash, the soldiers who survive an enemy attack or the sole survivor of a horrific automobile crash. Survivors often wonder, “Why me?” They ask themselves why they were “more worthy” of surviving than the people who succumbed to their injuries or illnesses.
    Survivor’s guilt can be debilitating and deprive us of our quality of life. So, we, as cancer survivors have to learn to live with the reality that we have survived while others have not. WhatNexters are not immune from survivor’s guilt. We see it brought up every few months on our questions section.
    What causes cancer patient survivor’s guilt?
    There are several causes for the guilt that cancer patients feel. • Just plain guilt. We just don’t understand why we survived our cancer and our friend, who had the same type of cancer did not survive. These guilt feeling are accompanied by the unfairness and unjustness of the situation. “Why me?” we ask ourselves, “We had the same chemo.” • Guilt because we didn’t do enough. We may feel guilty over the financial costs to our family. We may feel guilty that our caregiver had to juggle too many tasks and still work their regular job. • Guilt over believing that we are not living a full enough life after cancer treatment. Our family, friends, and co-workers may expect us to be giddy with joy and plan trips, travel and create a bucket list of things to do. Yet we find that we need time to adjust to the enormity of what we’ve experienced. We just want “things to seem normal again” – and we feel guilty that we don’t have more grandiose plans.

    Why are there differences in outcomes?
    First of all, recognize that survivor’s guilt is a normal feeling. But for some people, survivor’s guilt becomes all-consuming robbing them of living a full life. Some people fall into a deep depression while other survivors develop anxiety. So what can we do to cope with the reality that not everyone survives a cancer diagnosis? Consider these reasons that influence the outcome of cancer treatment. • Every person’s cancer is different, even with the same diagnosis. Cancer is a complex disease. Breast cancer is not “just breast cancer.” There are genetic differences. Ductal breast cancer is totally different from a large solid tumor. There are differences in the hormonal influences. Most times, we don’t know the exact details of someone else’s cancer – there may have been mitigating circumstances that make their cancer more difficult to treat. • Response to treatment varies among patients. Remember those scans that we had during our treatment? They were to evaluate “response to therapy.” Typically, after 4-to-6 cycles of chemotherapy, patients have an imaging test (CT, PET or MRI) to evaluate their response to therapy. If a patient does not respond to their first chemotherapy drug, their oncologist will change their treatment plan. This is a situation where “luck” plays a role in surviving cancer. The subtle differences of genetics and grade of tumor cells is something that we have no control over. We’re just “lucky” if we don’t have mutations and respond to treatment. • Co-existing health problems. If a cancer patient has diabetes, a heart condition or other serious health problem, these co-existing health issues complicate their treatment. Chemotherapy often has rare, but serious side effects, like heart problems, blood clots or extremely high blood pressure. Surgeons may be reluctant to operate on a person with a serious heart condition or who still smokes (due to slower healing and more surgical complications).
    How do we learn to cope with survivor’s guilt?
    Once we recognize and acknowledge that the development of cancer and its treatment is complicated, we begin to realize that we can’t change our particular diagnosis and our treatment outcome.
    So what next? These tips may help you cope.
    Giving back. Many patients, me included, find that giving back helps us with survivor’s guilt. We may join a support group to offer encouragement to those newly diagnosed. We may knit caps for the local cancer center. We might volunteer at a local soup kitchen. We might even get training to become a “cancer buddy.” All of these altruistic actions help us pay it forward. • Express your feelings. Begin to journal or start a blog to express your feelings. Write poetry or use art to allow your feelings to surface, rather than letting them fester beneath the surface. • A support group or counselor. Free counseling is available through Cancer Care. Just a few sessions may be all you need to cope with your survivor’s guilt. • Spirituality. Talking to your minister, priest or rabbi may help you understand that your surviving cancer should be a source of joy and comfort, not guilt and despair. • Acknowledge your grief and then permit yourself to move on. When a friend, relative or online acquaintance dies, allow yourself some quiet time to acknowledge your grief and reflect on that person’s value – grieving is important. Then, move on mentally.

    The truth about survivor’s guilt is no one should feel guilty for surviving. Everyone’s cancer is different, and their response to treatment is different. We wouldn’t be the compassionate and caring human being that we are if we didn’t feel sad when anyone passes away because of cancer, but we shouldn’t ever feel guilty because we survived.
    Just remember – we survivors bring hope to those who are newly diagnosed.
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    World Cancer Day - Feb. 4th, 2019

    Monday, February 4, 2019, is World Cancer Day – a day designated throughout the world to bring awareness concerning cancer and the importance of early screening and detection. This day also focuses on ways to help prevent cancer, with healthy eating, exercise, smoking cessation, and HPV awareness and vaccination.

    The World and Cancer.

    According to the World Health Organization, about 9.6 million people died worldwide in 2018 from cancer. Translated that means about 1 of every 6 deaths was caused by cancer. Here are some other startling facts.

    70 percent of deaths occur in low-and-middle income countries. That’s not surprising. Residents in the low-income countries often lack access to basic healthcare. Access to more advanced diagnostic tests is limited, and cancer treatment is limited. Only 26 percent of low-income countries even have pathology services available to the public sector.
    One in five of all cancer deaths is caused by one of 6 factors: obesity, lack of exercise, low fruit/vegetable consumption, tobacco use, HPV/hepatitis and alcohol consumption.
    Tobacco alone is responsible for about 22 percent of all cancer deaths worldwide.
    Hepatitis and HPV, both cancer-causing viruses, are responsible for one-quarter of all cancer deaths in low-and-middle income countries.
    Cancer is diagnosed later in low-and-middle income countries, making it more difficult to treat.
    Only 1 in 5 low-and-middle income countries lack the data to develop a cancer policy.

    Cancer, Worldwide, by the Numbers

    We, here at WhatNext, understand how devastating a cancer diagnosis is. We also know the costs associated with diagnosis and treatment. But most of us have access to healthcare. But can you imagine your loved one getting sicker and sicker with no diagnostic tests and no treatment options? The problem is that there is no basic healthcare in small villages and rural areas. Even in larger urban areas, services in many hospitals is antiquated and out-of-date.

    These are the estimated cases diagnosed annually.

    • Lung – 2.09 million

    • Breast – 2.09 million

    • Colorectal – 1.80 million

    • Prostate – 1.28 million

    • Skin cancer (non-melanoma) – 1.04 million

    • Stomach – 1.03 million

    Here are the estimated deaths annually.

    • Lung - 1.76 million deaths

    • Colorectal – 862,000 deaths

    • Stomach – 783,000 deaths

    • Liver – 782,000 deaths

    • Breast – 627,000 deaths

    What Can Be Done?

    Clearly, cancer worldwide is a humanitarian crisis. While we here in the U.S. and other developed countries complain about costs, waiting a few days for scans results and waiting a month before our treatment begins, millions of people go undiagnosed and untreated in a tragedy that is unknown by most people.

    Tobacco accounts for 22 percent of the deaths and HPV/hepatitis causes another 25 percent of the deaths. That’s almost 47 percent of all cancer deaths worldwide. Simple public health awareness campaigns accompanied by smoking cessation programs could prevent thousands of deaths and the suffering of untreated disease. Vaccination against HPV and hepatitis B could prevent 1 million cases of cancer annually.
    Fathers and mothers, still alive and able to care for children, would justify the costs – these children wouldn’t be orphaned and wouldn’t become wards of the state.

    Only when we, in the developed nations, know and acknowledge the tragedy of cancer worldwide will we begin to help prevent cancer in the developing nations. And who better than us, cancer patients and survivors, to help tell this story.

    The Bottom Line …

    This untold story is why World Cancer Day exists – to help raise awareness of the value of ways to help prevent cancer and early screening detection.

    The magnitude of helping prevent lung cancer and virus-caused cancer appears to be beyond what we could reasonably be able to do. But wait – there are two examples of eradication of worldwide disease for us to study.

    Rotary Foundation and Polio. Baby boomers in the U.S. remember polio in the 1950’s. When Dr. Salk developed the polio vaccine, children throughout the United States were vaccinated, first with a shot and then a vaccine in liquid form dropped on a sugar cube. Polio was eliminated in the U.S., then Canada and then in industrialized nations across the globe. In 1979, the Rotary Foundation committed to eradicating polio from the world, in a similar manner to how smallpox was eradiated worldwide. Their efforts have reduced polio cases by 99.9 percent. Just 22 cases were reported in 2017. The efforts continue to penetrate into the few remote areas where polio exists. Some 16 million polio cases have been averted through the Rotary Foundation’s efforts. The Gates Foundation is matching Rotary’s efforts with $2.00 for each dollar Rotary spends to see that polio is eradicated from the world. Once the last case is reported, constant monitoring for three more years is required to ensure that polio is gone for good.

    Jimmy Carter. In 1986, the Carter Foundation began its efforts to eradicate guinea worm disease, a debilitating disease caused by drinking contaminated water. It was common in Africa and Asia and infected more than 3.5 million people when their efforts began over 30 years ago. The Carter Foundation worked with the World Health Organization, UNICEF, the U.S. Center for Disease Control and the various countries suffering from this parasitic disease. Cases are now down to just 28 isolated instances, another reduction of 99.9 percent. Efforts continue in South Sudan, Mali, Chad, and Ethiopia to eliminate these last remaining pockets of the worm. This is another success story similar to the elimination of smallpox.
    If the initiatives of these two organizations have done so much, why is it impossible for similar results to help prevent cancers caused by tobacco use, the HPV virus and the hepatitis virus? Commercially available vaccines already exist. Smoking cessations products like nicotine patches and Chantix exist too. Who will step up next to help eliminate suffering in our world?
    World Cancer Day – February 4, 2019 – it gives us a lot to think about.
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    Alcohol and Cancer - Do They Mix?

    Some studies show that drinking alcohol is a risk factor for developing cancer especially for oral, breast and liver cancers. Other studies show consuming small quantities of alcohol protect against heart disease and type 2 diabetes. Still, other studies show that red wine might prevent cancer.

    So what, as patients and survivors, supposed we to do? First and foremost, talk to your oncologist about your alcohol consumption during treatment. The type of cancer and chemo and the extent of disease are factors in determining whether it is safe for a patient to consume alcohol. (My oncologist asked me during my consultation appointment about my alcohol consumption and said an occasional drink would be OK. Frankly, I never felt “good enough” to drink alcohol and abstained throughout my treatment.)
    Consuming alcohol during treatment.

    Many chemotherapy drugs have specific recommendations to not drink alcohol while taking that particular drug. ChemoCare.com provides specific information regarding the consumption of alcohol for every chemotherapy drug. Unless your oncologist has specifically advised you that it’s OK to drink alcohol, it’s best if you don’t. There are a number of reasons why.

    Alcohol makes mouth sores worse. • Medications that most cancer patients take, such as anti-nausea medicine, painkillers and sleep aids, can cause serious or even fatal reactions when taken while consuming alcohol. • Alcohol can further damage your liver if you have primary liver cancer or metastases in your liver. • Chemo drugs and alcohol are both metabolized in the liver, which has the potential of causing serious side effects. • Consuming alcohol can lead to dehydration – chemo can cause diarrhea and/or vomiting leading to even more dehydration.

    Alcohol consumption in survivorship.
    The water is a little muddy when it comes to alcohol consumption after treatment is over. Some studies are for specific types (and even sub-types) of cancer. For less common types of cancer, few studies exist, and it’s best to have an honest conversation with your oncologist as you go into surveillance after your treatment is completed. According to AICR, alcohol, when combined with smoking, is very detrimental.
    Breast cancer. Breast cancer is one of those cancers linked to alcohol consumption. Yet the results are mixed for consumption afterward. Moderate drinking confers health benefits including lowering the risk of heart disease and high blood pressure. Studies do suggest that postmenopausal patients who have ER+ breast cancer may be more prone to a recurrence if they consume alcohol because alcohol increases the level of estrogen in postmenopausal women. The Fred Hutch Cancer Research Center has conducted the largest study looking at alcohol consumption and mortality for breast cancer patients. Moderate alcohol consumption after treatment did not appear to increase mortality. And a final reminder – many breast cancer patients have to take either Tamoxifen or aromatase inhibitor (anastrozole or letrozole) for five years post-treatment to help prevent recurrences. These patients are advised to limit their alcohol consumption – be sure to speak to your oncologist about your specific situation.

    Colorectal cancer. There are over 1.3 million colorectal cancer survivors in the United States. University of California San Francisco researchers wanted to know if the 2012 American Cancer Society’s “Nutrition and Physical Activity Guidelines for Cancer Survivors” actually improved outcomes. So they studied almost 1000 Stage III colorectal cancer patients for a median time of seven years. These guidelines include weight reduction if obese, exercise and physical activity, eating more fruits and vegetables along with reducing red meats/processed meats. The study asked participants about their alcohol consumption. The study showed that patients with limited alcohol consumption along with a healthy diet and exercise program did not suffer decreased life expectancy or an increase in cancer recurrence.
    Head and neck cancers. Some estimates show that about one-quarter of all head and neck cancers are attributable to alcohol consumption. But again, the jury is still out on alcohol’s effect on whether alcohol consumption decreases life expectancy after treatment. So moderation is recommended.
    The Best Advice …
    Talk to your oncologist. If you enjoy an alcoholic beverage and you are out of treatment, drink in moderation. ASCO (American Society of Clinical Oncology) offers some helpful information about alcohol and cancer. As with everything else in life, MODERATION is the key.

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    Is The High Cost of Revlimid Too High For Multiple Myeloma Patients?

    We all know that cancer care is expensive. We see our individual bills for our type of cancer, and most of us struggle to pay it. But multiple myeloma patients are now facing a financial crisis with the cost of Revlimid, an oral medication used as a maintenance drug after an autologous stem cell transplant or for newly diagnosed patients who are not eligible for an autologous stem cell transplant. 

    Revlimid is very effective, but at what costs to the patient and their family? Financial toxicity for multiple myeloma is prevalent among these patients. With more and more new, more effective treatments becoming available for other types of cancer, including lung and breast cancer, the challenges facing multiple myeloma patients will likely become more common for many more of us.
    Let’s look at the history of Revlimid (lenalidomide).
    Revlimid is related to thalidomide, the anti-nausea medicine used to prevent morning sickness in the late 1950s and early 1960s. Researchers discovered in 2005 the potential that lenalidomide might have for the treatment of multiple myeloma. Celgene, a biotechnology company, began marketing Revlimid in 2006 as a treatment for multiple myeloma. When introduced, Revlimid cost $6,195.00 for 21 tablets, considered a month’s supply.
    By 2010, the price had escalated to about $8,000/month. By April 2016, the price had reached $10, 691. And now for the sticker shock, in March 2017, the price had soared to $16,691. The reason that Celgene keeps raising its price for Revlimid is that it has no competition. Celgene has prevented generic competition through a vast complex of patents and grants of market exclusivity.
    Revlimid brought in a record $8.1 billion, 63 percent of Celgene’s revenue in 2017. This seemingly impossible sales amount is all from a derivative of a 60+-year-old drug that was available over-the-counter in Europe before it was removed from the market because of the serious birth defects it caused.
    So what can multiple myeloma patients do to get this life-saving drug?

    The WhatNext editorial team was just discussing the price increases of Revlimid and how some patients are considering discontinuing it as maintenance and taking their chances with what happens. Just that morning, I had read a short article on CURE Magazine about a patient who has been taking Revlimid for over four years.
    Because Revlimid is an oral chemo, it’s covered differently, albeit, more expensive copays, because it’s covered under your prescription coverage. Regardless of whether you have private insurance, Medicare or Medicare Advantage, getting your pills on a regular basis can be financially and logistically challenging.
    For those of you who have only had infused chemotherapy, oral chemo is covered by your prescription drug coverage. The patient has to pick it up and pay for it at that time. Sometimes, a local pharmacy chain may be able to supply it. But one of your best options is to have your oncologist call it into the pharmacy at the treatment center, aka medically-integrated dispensing. The pharmacists and insurance coordinators already know-how expensive the copays will be for their patients, and they are usually connected with a number of financial aid options. Private insurance patients usually qualify for financial assistance through the manufacturer. Medicare and Medicare Advantage patients usually qualify for a grant through a foundation.
    Another benefit of a medically-integrated dispenser is that you’ll have a real person to talk to and who knows your medical history. They help coordinate the timely delivery of your oral chemotherapy. If your insurance changes, they jump in to help you continue to get your medication filled along with finding financial assistance.
    What if there’s not a medically-integrated dispensing pharmacy available?
    Several organizations offer private copay assistance. We sometimes have to be willing to do some of the legwork to get the medications we need.
    Healthwell Foundation for Medicare recipients.

    Leukemia & Lymphoma Society for patients with household income up to 500 percent of the Federal Poverty Level with private insurance.
    Patient Advocate Foundation for patients with income below 400 percent of the poverty level.
    Patient Access Network Foundation for patients with income below 500 percent of the poverty level and have either private insurance or Medicare/Medicare Advantage.

    As you can see, the income limits are high enough that most patients can receive help. For an individual, one can make up to $48,560-$60,700 and still qualify for help. For a couple, joint income can be from $65,840-$82,300.
    The Bottom Line …

    Don’t throw up your hands in despair when you learn how much Revlimid costs. Don’t think about not taking it. Don’t contemplate stopping taking it after a year of maintenance. The odds are that almost every multiple myeloma patient can find the financial assistance they need to take this effective treatment.