An Asprin a Day Keeps Bladder Cancer Away? - March 25, 2009

My health, stamina, and well-being have improved slowly over the past three weeks. I am not getting tired in mid-afternoon early in the week, and the effect is decreased even later in the week. The 5 days in California were awesome - weather, food, wine, everything. We even got a cool rental car - a Saturn Sky, pictured here (click to enlarge). It's a real eye-catcher in red, which is my favorite color, and it drew a lot of attention from folks and their cellphone cameras. I have slowly been adding reviews to my restaurant review site, which has taken time from updates over here. In other news, our church is attempting to buy our first building and property from another church, and it's been grueling for me working that on top of the day job. The worst is over, for now, as others will be helping out a lot when (if) we go forward.

Today's topic is courtesy of Robert S. in New York, an active member of our little Bladder Cancer fraternity. Robert can use your prayers and good will as he goes in for TURBT #2 tomorrow. Memorial Sloan-Kettering prefers to do 2 TURs all the time, the second done after 6 BCGs to verify grade and staging. Oddly, they don't routinely do the chemo bake post-TUR, which is a very effective treatment with ample supporting recent evidence. So maybe having that big reputation that MS-K has isn't "all that" after all... In any event Robert is dreading that his cancer T1 might be upgraded, so let's pray that won't be the case. He passed on this news article on how a small dose of aspirin daily can not only improve your heart health and reduce heart attack risk, it also strongly correlates with increased success rates for BCG treatments. Read on for details...

NEW YORK (Reuters Health) - The use of aspirin as a cardioprotective agent significantly reduces recurrence among patients being treated for high-grade, non-muscle-invasive bladder cancer, the results of a small case-control study suggest.

The subgroup of patients with carcinoma in situ and high-grade papillary bladder cancer has a "high risk of tumour recurrence and progression and thus represents an ideal cohort for evaluating chemopreventive agents," the research team, led by Dr. Jason R. Gee at the University of Wisconsin-Madison, comments in the March issue of BJU International.

Their study cohort comprised 43 such patients treated with intravesical bacille Calmette-Guerin. Twenty were taking aspirin (81 or 325 mg/day) for cardioprotection.

The 5-year recurrence-free survival rate was 64.3% among those taking aspirin versus 26.9% among those not taking aspirin (p = 0.03). After adjusting for multiple confounders, aspirin correlated with a significant effect on recurrence rate (hazard ratio 0.179, p = 0.001).

Other independent predictors were maintenance treatment with intravesical bacille Calmette-Guerin (HR 0.233, p = 0.02) and smoking history (HR 3.199, p = 0.05).

"The results of the present study support the further investigation of aspirin and other NSAIDs as preventive agents in patients being treated for non-muscle-invasive bladder cancer," Dr. Gee and associates conclude.
My statistics training tells me that the low p values are very significant for correlation (though casuation is still speculative). For instance the p value of 0.001 implies that there is less than one tenth of a percent chance that the difference between the samples is random. Pretty good analysis here, cheap and easy to implement, with benefits for your heart as well as your Bladder Cancer treatments!

How People React to Your Cancer - March 17, 2009

Two weeks from today I will "celebrate" the one-year anniversary of my bladder cancer diagnosis. Despite the feeling that it's only been a few weeks since then, nearly EVERYTHING has changed about me and my life in the last 50 weeks. There was the initial shock, two quick surgeries, the stress of awaiting lab results, BCG series, and judgment days. There was a re-ordering of priorities, physical and spiritual. There was the complete and total change in diet starting August 1. There was the addition of vitamins and supplements. There was trying to work and act like it was all no big deal. And lastly I have added (and hated) exercise. It's been a whirlwind of change. Trying to figure out when (or if) there was time to go play in between medical events, and a new appreciation that life is, indeed, very short was another new experience.

One thing that's struck me is how others react to (and have reacted to) the news of my cancer diagnosis. In reality, there are only two frames of reference that folks have available to them based on their indoctrination and experience.

1) You are going to die. It is only a matter of how soon and how awful the process.

OR

2) You are fine because the cancer has been removed and killed off, and it won't come back. Really the whole thing is over and can be forgotten about as an unpleasant episode.

What people need to know (and are afraid to ask) is whether you are in the first or second category. They desperately hope you are in the second group, so they will "fish" for you to say things that suggest that's the case. Even if you don't intend to, they will interpret anything you say to put you in category two.

Bladder Cancer is unusual in that it's hard to say you are in either category. For high grade cancer like mine, the odds are uncomfortably high for mortality. With early detection and treatment, the prognosis is improved, but not to the degree that any doctor will declare you out of the woods - ever. For low grade bladder cancer the odds are much better. But the reality of bladder cancer is this - you are NEVER going to be in the second category. I will have annual cystoscopies FOR LIFE. Because you can't ever tell people it's finished, they become very uncomfortable with the only other alternative they know - painful, ugly death.

How do people deal with the two scenarios? If they believe you to be in the first category they fell really awful. Because it is bad news, and especially because there is nothing at all that they can do to make any of it better. Seeing you just reinforces that feeling, so you become a pariah, and they will try avoid you, even though they are truly sympathetic.

On the other hand, if they believe you are in category 2, they are truly happy for you. Truth be told, they are equally happy for themselves not to have to be bothered about it. And they will treat you as they normally would, rarely if ever mentioning it.

How do I know this? Because that's exactly how I responded to people with cancer diagnoses. So rude but so true.
Having been there myself less than a year ago, I can recognize it in others. Folks deal with me the very same way. Sort of a "please tell me you're in category 2, and we can get on with things..." attitude. Because of bladder cancer's long road before we know if we are ahead of the game (not quite category 2), true status of your situation makes nearly everyone unhappy and uncomfortable. And there is still nothing they can do for me outside of sympathy and prayer.

What I spend a lot of time doing is reassuring others. Since it's not over with to be forgotten about, they are fearful that I must be in a long, unpleasant Category 1 process. Frequent reassurances that things are going well are required. It turns out that dealing with my cancer is even harder on loved ones and friends than it is on me. As it turns out, there are a few resources for them. Anne Orchard wrote a book called Their Cancer - Your Journey. She left a very encouraging comment on David F.'s blog when he was wrestling with this very issue. She also referred him to a support website: http://familiesfacingcancer.org/

Anne made the point is that there's also nothing you can do to guide others through their journey of dealing with your cancer, other than to be strong and set an example. So don't even worry about it. This means reassuring when you can, and not being bothered when some avoid you. While my situation is not a secret in the workplace, some don't even know, and I don't mention it unless there's a need. Others have convinced themselves that I'm OK, others are still worried that I will be dying soon, and some work hard to avoid me altogether. I try to take it all in stride.

One last word: narcissism. While all of us are self-centered to some degree, having cancer and what you go through and how you adapt IS all about you. Dealing with your having it and what you go through and how you adapt is not about you at all - it's about them. These are two entirely different problems requiring different paths to solution. I would argue that now I have cancer, it really IS all about me. But that fact in no way makes me more interesting.