Spencer, Assistant Editor of CURE®, has been with MJH Life Sciences since 2024. A graduate of Rowan University with a bachelor's degree in health communication, Spencer enjoys spending time with family and friends, hiking, playing guitar and rock climbing.

Spencer Feldman

After a mistaken fall risk label, a patient with multiple myeloma showed that self-advocacy is essential for both quality care and emotional well-being.

After I was diagnosed with multiple myeloma, I was fortunate to have many outstanding professional caregivers. That included my oncologist at our local cancer center, the nurses who administered my weekly chemo, and the medical team at a larger hospital, two hours away, where I received my stem cell transplant. They were upbeat and encouraging and clearly explained complicated information about my treatment options.

But I had a negative experience with one caregiver — a physical therapist who assessed my condition prior to the stem cell transplant — that underscored the importance of self-advocacy. Her assessment was one of a few dozen tests required by insurance to ensure I was healthy enough for the expensive, risky procedure. Other tests considered my heart, lungs, kidneys, bone marrow as well as overall physical and cognitive health.

The November day I met with the physical therapist (PT) had been grueling. I’d driven from my home two hours away on icy highways and navigated my way to several different exams across the medical complex. The 5 p.m. PT appointment was last on the list, and I was running late due to delays throughout the day.

I expected the PT meeting to be a simple, check-the-box event. Every doctor I’d met with up to this point described my physical condition as excellent for a sixty-year-old woman. I walked five miles a day, jogged, biked, kayaked, gardened and did yoga and strength training. Doctors typically said that my physical strength would help me recover quickly. I expected to breeze right through the PT meeting.

The PT led me to a tiny conference room crowded with furniture. She had an ambitious agenda and warned that our appointment would take at least a full hour. She opened her laptop and launched what was clearly a structured questionnaire. I described my long list of physical activities, completed several cognitive exams, and balanced on each leg for ten seconds, as she requested. During a fifteen-minute timed walking exercise, I trudged up and down the hall in my clunky winter boots. She said I’d walked 1.2 miles at a nearly five-mile per hour pace, well above the norm.

But, at the end of the appointment, she said I was a fall risk and would be confined to my hospital bed for the full two-week hospitalization. I would have to summon a nurse anytime I needed to go to the bathroom. Her diagnosis confused me, but I was tired and certain I must have misheard her. She was eager to end the appointment, and I was eager to get home. When I examined her notes on my patient portal a few days later, I noticed that she’d cited gait and balance issues and listed “occasional yoga” as the only physical activity I’d reported.

I was stunned. Every other member of my oncology team had stressed the importance of staying active throughout treatment. The prospect of being confined to a hospital bed for two weeks seemed worse than the idea of the stem cell transplant itself.

I speculated about what the PT was thinking. She seemed young; maybe this was her first job. Maybe she was paranoid about liability or distracted because she had to stay late. Or maybe she really did see something concerning. But her discouraging diagnosis was completely at odds with my self-perception and with feedback from other caregivers.

I expressed my rage to my husband. In my darkest moment, I thought, “Fine, if they want me to be weak, I’ll show them just how weak I can be.” I was on the precipice of what psychologists would call learned helplessness. I was perilously close to giving up, to surrendering to what seemed like her inordinate power over my options.

Then I came to my senses. I knew I had to take an active role. I had to self-advocate. I recorded my frustration on the follow-up survey and talked with the PT’s supervisor and with my physician assistant. I was polite but direct about my feelings. They reluctantly retracted her fall risk assessment.

When I had the stem cell transplant a few months later, the nurses promptly identified me as a “fast tracker,” a highly independent patient who needed minimal direction. I did yoga in my room, rode a stationary bike in the workout room, and walked two miles a day in laps. The fall risk assessment was completely unfounded.

I learned an essential lesson about self-advocacy. As patients with cancer, we see so many professionals who make important judgments about our care. Some spend a lot of time with us, others just a few minutes. We must be vigilant and speak up if we don’t agree or aren’t comfortable with a recommendation. Being an active participant not only helps ensure appropriate medical care; it is also vital to our emotional self-care.

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Articles

A patient's experience with multiple myeloma treatment highlights the critical role of self-advocacy in healthcare. Despite having a supportive medical team, a negative encounter with a physical therapist led to an inaccurate fall risk assessment, contradicting the patient's active lifestyle and other caregivers' feedback. This experience underscored the importance of patients actively participating in their care, questioning decisions, and ensuring their voices are heard. Self-advocacy not only influences medical outcomes but also supports emotional well-being during challenging treatments.

I challenged a mistaken fall risk label before my transplant and proved that self-advocacy is crucial to both quality care and emotional well-being.

My Health, My Voice: Why Self-Advocacy Is Important

Personalized treatment for older adults with breast cancer should consider functional status, comorbidities and support systems — not just chronological age.

When treating older patients with breast cancer, it is important to understand that there are many unique aspects that should inform personalized treatment decision-making for this population, according to Dr. Hyman B. Muss, who went on to say that chronological age as it stands by itself is not an adequate measure of health status for these individuals.

Factors to consider when treating these patients can include functional capacity, social support, comorbidities and molecular biomarkers, among others. It is these individualized considerations that make up the patient on a more individual level which will best inform their care.

To further discuss this topic, Muss sat down for an interview with CURE where he discussed treatment considerations, as well as how to understand the life expectancy of older adults with breast cancer, among other important topics.

Muss serves as the Mary Jones Hudson Distinguished Professor of Geriatric Oncology and the director of the Geriatric Oncology Program the University of North Carolina (UNC), UNC-Chapel Hill Lineberger Comprehensive Cancer Center.

CURE: What are some treatment considerations required when treating breast cancer in older patients? How did treatment plans differ from those of younger patients?

: The challenge with older adults is that using age alone doesn't account for the great variability in their health status. If your clinic has 40-year-old women, they will generally be very healthy, and you might intuitively think, "Oh, this is a healthy group." However, in the United States, when someone is 75, there's an intrinsic age bias, a perception that older people are not as fit or able to tolerate things well. Yet, there's great variability.

There are older women, I'm sure you've met, who can play tennis three days a week and move quicker than you or I. Then there are people who are very disabled, and a large middle ground where, when you see them in the clinic, you're just not sure. So, the challenge with older women is not to rely on their chronological age but to actually have an idea of their life expectancy.

How do you approach understanding the life expectancy of older adults with cancer, and what factors beyond the diagnosis do you consider when planning treatment?

Fortunately, there are some wonderful tools for doctors and health professionals, built on the vast datasets the United States has collected on our population over the years, that allow us to accurately predict life expectancy. So, when ‘Mary Smith’ comes in, and you do a geriatric assessment, you find out not just her diagnosis and treatment, but also how functional she is.

Can she take care of herself? Can she do all the activities needed to live independently, use the phone, etc.? Does she have good social support, which, by the way, is related to life expectancy? People who are lonely and don't have many friends, irrespective of their diseases, do worse than a matched person with a similar health status who has friends and is very active. You also look at their medications and other illnesses. You need to put all that information together, which you can, to derive an accurate life expectancy…

That will shape how you talk to the patient, what options you discuss, and what values you want to elicit from the patient concerning their treatments. The challenge is putting all that together in a medical environment that demands high throughput and doesn't frequently allow doctors, nurses, and navigators to do that.

How does aging at the molecular level influence a patient's response to something like chemotherapy?

When we say molecular aging, what does that mean? It refers to the changes we can measure at a cellular level that correlate with the aging process, even if individuals are the same chronological age. For example, you can measure what we call senescent cells in their bodies. As we age, all our organs decline in function. We can't take in as much oxygen through our lungs, our neurons don't fire as quickly, we lose cells and strength in our heart, and our muscles decline.

Why does this happen? As we get older, there are changes in our DNA and proteins. Many cells in our body, in all organs — from the brain and blood to your muscles — become less active. These cells are unable to divide and make new cells, but they don't die. Instead, they can secrete a lot of chemicals, inflammatory factors, and these chemicals can accelerate all types of diseases of aging, including cancer and atherosclerosis. So, when we talk about biologic aging, we measure things like the [number] of senescent cells in your blood or body, the proteins in your blood, and your metabolites. We can then determine that a 50-year-old might biologically be 40 or 80.

What are some biomarkers of aging, and how might they provide a more accurate picture of a patient’s functional status than chronological age?

You can also look at things that we [as a society] don't typically think of as biomarkers of aging, like your oxygen extraction efficiency. For instance, if you take a group of women who are 50 and put them on a bicycle, having them breathe oxygen, they will extract a certain amount of oxygen at a very high level of activity. But if you take those same women and give them all chemotherapy at 50, they will not be able to extract as much oxygen. Chemotherapy has really biologically aged them, because as we get older, you can plot a very clear curve showing that the older we get, the less oxygen we can extract from our blood. So, oxygen extraction efficiency is a biomarker of aging.

If you have two 75-year-olds and know the normal population level, you might see one woman who can't extract much oxygen from her blood, and that will frequently reflect how far she can walk, whether she can push a chair across the room, drive, get out of the house, or carry groceries up the elevator.

A biomarker of aging is something we measure that correlates with your functional status but may be very different from your chronological age, which is your birthday. It's a fascinating area, and people are conducting all kinds of tests and studies to find markers. You can even measure your telomere length. Telomeres are small portions of your DNA that shorten as we age, and when they shorten, they don't allow the DNA to work as well.

You can pay around $1,000 to send your blood out, and they'll tell you your telomere length and estimate how many years you have left. I wouldn't recommend it; I think the tests are inaccurate and not worth the money. However, telomeres do, in a way, reflect your age, but it's very crude and was very popular a few years ago.

I think everyone wants to know how long they'll live, and there's really no good way to do that, especially if you're not wearing seat belts and smoking.

Personalized treatment for older breast cancer patients requires considering factors beyond chronological age, such as functional capacity, social support, and comorbidities. Tools exist to predict life expectancy, aiding in treatment planning. Molecular aging, including senescent cells and biomarkers like oxygen extraction efficiency, influences treatment response and provides a more accurate picture of a patient's health than age alone. Understanding these factors helps tailor treatment discussions and decisions, despite the challenges of high-throughput medical environments.

Dr. Hyman B. Muss discusses the unique facets of care that should inform personalized treatment decision-making for older patients with breast cancer.

Personalized Breast Cancer Care for Older Adults Goes Beyond Age

For Melanoma Awareness Month, Dr. Douglas Johnson explains how stage and features of the disease can guide treatment decisions after diagnosis.

Expert Shares Key Insights During Melanoma Awareness Month

In recognition of Melanoma Awareness Month, CURE spoke with Dr. Douglas Johnson about what people need to know after a melanoma diagnosis, including how the disease is staged and treated. Understanding the depth and features of the melanoma — such as whether it’s ulcerated — is key to determining whether surgery alone is enough or if additional treatment is needed.

Johnson is a physician-scientist and professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee, where he leads the melanoma clinical research program. He explained that for patients with very early-stage melanoma — often defined as tumors less than 0.75 or 1 millimeter deep — treatment may involve only a wide local excision, typically performed by a surgeon or dermatologist.

If the melanoma is deeper or presents with more concerning features, patients may require further evaluation to assess lymph node involvement. This could lead to additional surgery, and in some cases, further therapy based on the surgical findings.

CURE: For patients newly diagnosed with melanoma, what are the most important things to know about the disease and its treatment options today?

: It certainly depends on a number of factors, and certainly the staging of the melanoma is important to think about. [This is] because it affects where patients need to go, as far as their next step. Usually a biopsy is done, and that's how a patient would know that they might have melanoma. It really depends how deep them the melanoma is. That's probably the first consideration that we think about when figuring out what the next steps are and whether the melanoma has what's called an ulceration on the top of it, and those factors would potentially determine what the next steps are.

If a patient has a very early-stage melanoma — defined as is less than 0.75 or less than one millimeter — then they would just have surgery alone. Usually something like a wide local excision and then that would be it. Patients may have that with surgery [and have checks with their dermatologist].

If [the cancer is] a little bit deeper than they would need to see a surgeon and then understand whether they have any lymph node involvement as well and have a bit bigger of an operation. Depending on what's found at those operations, then we need to think about any sort of additional treatment after that.

Transcript has been edited for clarity and conciseness.

Videos

Elraglusib plus gemcitabine and nab-paclitaxel significantly improved survival as a first-line treatment for metastatic pancreatic cancer in a global phase 2 trial.

Eraglusib in combination with gemcitabine and nab-paclitaxel achieved statistical significance in the first-line treatment of metastatic pancreatic ductal adenocarcinoma, according to data from the part 3B phase 2 Actuate-1801 trial which were shared in a news release from Actuate Therapeutics, Inc.

These topline results showed a statistically significant improvement in overall survival with the eraglusib combination compared with gemcitabine and nab-paclitaxel alone. Moreover, these data also highlight a substantial improvement in the median overall survival benefit for patients receiving the investigate treatment compared with previous results which were shared in December of 2024.

“Pancreatic cancer is one of the most aggressive and difficult-to-treat malignancies, where patients urgently need new therapeutic options,” said Daniel Schmitt, president and CEO of Actuate. “There have been no major advances in improving survival in first-line treatment of metastatic pancreatic cancer in over a decade. Demonstrating statistically significant increases in both median overall survival and percent of patients reaching one-year survival and beyond, along with a favorable risk-benefit profile in this phase 2 trial, further demonstrates elraglusib’s potential to shift the treatment paradigm in metastatic pancreatic ductal adenocarcinoma.

“We are incredibly excited to present the topline data at [the 2025 ASCO Meeting]. Based on the significant improvement in survival we have seen to date in the combination arm, we look forward to working with United States and European Union regulators in the second half of this year to map out the path to advancing elraglusib to new drug application and registration and making the drug available to patients as expeditiously as possible,” Schmitt continued.

The news release goes on to share that these data meet the primary end point of overall survival in the phase 2 trial study and confirmed a significant one-year survival rate. Moreover, the combination of elraglusib with gemcitabine and nab-paclitaxel also demonstrated a favorable risk-benefit profile (balance between efficacy and safety).

Key findings from the study will be shared in an oral presentation at the upcoming Annual Meeting of the American Society of Clinical Oncology (ASCO). The company has announced its intent to engage with regulatory authorities to advance the development of elraglusib and expedite its path toward potential approval.

The presentation is entitled "Preliminary results from the randomized phase 2 study (1801 part 3B) of elraglusib in combination with gemcitabine/nab-paclitaxel (GnP) versus GnP alone in patients (pts) with previously untreated metastatic pancreatic ductal adenocarcinoma (mPDAC)" and will be shared on Saturday, May 31, 2025, at 4:48 PM Central Daylight time. Dr. Devalingam Mahalingam will be presenting these data.

More Information on the Actuate-1801 Part 3B study

The Actuate-1801 Part 3B study is a randomized, controlled phase 2 clinical trial designed to evaluate the efficacy and safety of elraglusib in combination with gemcitabine and nab-paclitaxel compared with gemcitabine and nab-paclitaxel alone for the first-line treatment of metastatic pancreatic ductal adenocarcinoma. A total of 286 patients with previously untreated metastatic disease were enrolled and randomized to receive either the elraglusib combination or gemcitabine and nab-paclitaxel alone. Patients treated with the combination received elraglusib at a dose of 9.3 milligrams per kilogram on day 1 of each week within a 28-day treatment cycle.

In addition to the primary end point of median overall survival, key secondary end points include disease control rate, objective response rate, progression-free survival, and incidence of side effects.

Importantly, elraglusib functions as an inhibitor of glycogen synthase kinase-3 beta (GSK-3β), a protein involved in cancer progression. Inhibition of GSK-3β has the ability to inhibit tumor growth and improve survival. This is done through several mechanisms which include enhancement of chemotherapy activity, activation of innate anti-tumor immunity and regulation of gene expression.

The combination of eraglusib with gemcitabine and nab-paclitaxel has shown statistically significant improvements in overall survival for patients with metastatic pancreatic ductal adenocarcinoma, according to the Actuate-1801 phase 2 trial. This combination therapy demonstrated a favorable risk-benefit profile and a significant one-year survival rate, marking a potential shift in the treatment paradigm for this aggressive cancer. Actuate Therapeutics plans to present these findings at the 2025 ASCO Meeting and engage with regulatory authorities to expedite the drug's approval process.

Eraglusib with gemcitabine and nab-paclitaxel achieved statistical significance in the first-line treatment of metastatic pancreatic ductal adenocarcinoma.

Spencer Feldman

My Health, My Voice: Why Self-Advocacy Is Important

Personalized Breast Cancer Care for Older Adults Goes Beyond Age

Expert Shares Key Insights During Melanoma Awareness Month

Eraglusib Combo Improves Survival in Metastatic Pancreatic Cancer

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