Taylor Walker

In May, Texas Governor Rick Perry signed legislation that requires health insurance providers to cover orally administered chemotherapy drugs in the same manner as intravenous cancer treatments. Nine other states and the District of Columbia have currently passed chemotherapy parity laws. Similar bills have been introduced in approximately 20 other states.

The Texas law has the potential to drastically reduce the economic burden placed upon a growing number of cancer patients who rely on inadequate healthcare plans to purchase their costly oral medications.  

With oncology drug prices continuously escalating (rising 11.5 percent in 2010, according to the 

), patients who can’t manage these high costs are left with few options. Some abandon medication altogether, especially in cases where there is no intravenous substitute. 

A reason for this disparity is intravenous and oral cancer medications are typically filed under different benefit plans. Insurance policies typically cover most, if not all, costs related to intravenously administered chemotherapy. However, oral versions of the same drug are classified as prescription drugs, which requires the patient to pay a much larger copayment, or share of the cost, according to an 

April 2010 Office of Legislative Research report

Both forms of chemotherapy have existed for decades, but oral medications have recently increased in number and indications for usage. In addition to the 40 oral chemotherapy drugs already approved by the Food and Drug Administration, 25 percent of the estimated 400 chemotherapy drugs under development are expected to be created in oral form, according to an 

August 2010 study by the Texas Department of Insurance

. The problem is, only about 28 percent of these oral drugs have intravenous alternatives, forcing many patients to either pay the additional cost of oral medications or go without.

Articles

Texas joins nine other states in requiring health insurance providers to cover oral chemo the same as I.V. treatments.

Another State Gets Chemo Parity

Everyone’s heard the saying, “An apple a day keeps the doctor away.” While this accepted adage takes care of one medical need, new evidence suggests shifting the attention from apples to Zs.

According to a recent study led by investigators at St. Jude Children’s Research Hospital in Memphis, adult survivors of childhood cancer who experience fatigue or trouble sleeping are three to four times more likely to encounter cognitive impairments, such as difficulty with attention, memory and the speed at which they process information, than survivors without sleep problems. These impairments can negatively affect survivors’ abilities to maintain a steady job, further their education or even their capability to live alone.

Survivors of central nervous system tumors were found to have the highest rates of cognitive impairment. Also, adult survivors on antidepressants had higher risk of memory problems and higher risk of impaired task efficiency.

Long-term childhood cancer survivors are already more susceptible to impaired neurocognitive functions due to a direct or indirect result of treatment to their central nervous systems, but this 

, published online in the April 11 edition of 

, was the first to illustrate that difficulties sleeping could be associated with these problems.  The investigators reached this conclusion by examining neurocognitive questionnaires filled out by 1,426 childhood cancer survivors and comparing the results to 384 healthy sibling controls.

This study also raises the possibility that the many psychological effects of cancer and cancer therapies are actually responsible for sleep disorders. Nevertheless, it supports further study of the beneficial effects of improving ones sleep habits, which even with this uncertainty, represents a sound prescription.

Although current treatment options leave future survivors vulnerable to similar cognitive issues, Kevin Krull, PhD, corresponding author and associate member of the St. Jude department of epidemiology and cancer control, says the team is hoping to improve survivors’ outcomes without altering successful treatment methods by focusing on sleep hygiene.

“They need to pay better attention to their sleep quality,” says Krull. “Take the time to get a good night’s sleep. In our society, that’s not always an easy thing to do. [But] if you’re at risk for some of these cognitive problems, it’s all the more important.” Need some help getting a good night’s sleep?

If you find that it takes you longer than 30 minutes to fall asleep at night, Krull suggests:

1. Exercise during the day rather than before bed.

2. Make your bedroom more inviting by keeping it dark and cool.

4. Wake up at the same time every day regardless of whether it’s a weekday or weekend.

Study shows adult survivors of childhood cancer may have sleep issues that negatively affect cognitive function.

Sleep Problems Impair Childhood Cancer Survivors

As a person who works in a creative field every day, the concept of setting aside time for personal, non-client driven art and design took me down a path where the written word became a very important outlet for coming to grips with my stage 3 prostate cancer diagnosis. My journal grew rapidly. And yet after surgery, some six weeks post-diagnosis, I abruptly quit writing. Since then, I have often revisited this incredible diary that represented my life's cataclysmic event. Now, nearly two years after radiation and a year after completion of hormone replacement therapy, it is stunning to see the progress of my journey. The writing may not have helped me heal, per se, but the act of writing clearly established a very well-documented "jumping off" point from my past life to my new life as a cancer survivor. More importantly, it has given me the perspective to go forward as a resource to others in my community who are suffering similarly, but without help.

After my surgery for breast cancer in late 2008, I had an overwhelming urge to do something creative. I had always wanted to learn how to make jewelry, so I immersed myself in "beading." I spent hours just sorting through beads and findings of all types and sizes, finding that it calmed me. I started with simple earrings and bracelets and enjoyed experiencing the colors and textures as much as the creative act itself. Becoming so immersed in my beading definitely helped me cope with my chemo and the many side effects that came along with it.

I'm a three-year survivor of small cell lung cancer. Yes, I did art during treatment. I had never done it before. I used colored pens and pencils to make drawings on blank greeting cards and used them for “progress report” notes to friends and family. I surprised myself. Each of them was different, and I must admit, really quite good. I received many compliments and felt honored to be able to pass them along.

I found writing about my feelings during and after my three different cancer journeys brought me a sense of peace. I especially found the writing helpful when I was in isolation for treatment of my metastatic thyroid cancer. I was alone. No family or friends were present, and it was one of the loneliest times of my life. Writing about this experience was very helpful in my healing. I was able to express my deepest fears and only I knew what they were. I didn't have to hold back and worry anyone else. Sometimes when I'm fearful, I look back over my writing to see how far I've come since those dark days of despair. It brings me back to reality. I'm still here!

I always thought if I were ill, I would use the time to write a lot of music, but as a breast cancer patient, chemo and radiation exhausted me. However, I continued to teach private music students as long as I could. Just getting out into the studio, focusing on music with them, and doing the best I could to teach was good medicine. I couldn't help lead the singing anymore at church, but I sat in the pews and sang. Those songs seemed to speak hope and healing right to my heart. I had some favorite CDs too that I would sing to and cry with!

Shortly after my cancer diagnosis and treatment in 2005, when they told me I had only two to three years to live, I began making jewelry. When I started my jewelry, I completely forgot that I had cancer. And when I completed something new and received compliments from friends and relatives, I felt truly blessed and went on to the next piece with exhilaration. Today, almost six and a half years later, I am still making beautiful jewelry which is admired by almost everyone that sees it. Although my cancer treatment also included chemo and brain radiation to keep the cancer from spreading there, I believe that making jewelry helped me zone out the fact that I was supposed to be dying.

I used a journal with my first bout with breast cancer in 2003, but I re-found knitting to really help with my recovery. I needed to find time each day to knit to calm my mind and spirit and really heal. I continued knitting: gifts for family and friends and chemo caps for cancer patients. When I was diagnosed with a second form of breast cancer in 2009, I already had my support team of doctors in place and my knitting for charity to get me through. We have a wonderful group at our senior center I had joined after retiring, and we knit for charity.

After a successful bone marrow transplant for leukemia in 1993, I yearned to tell my story so my odyssey might benefit others. I started with a memoir, but got bogged down in details. What I wanted to share was hope. After years of struggling with prose, I turned to poetry to capture the essence of each phase of my journey: symptoms, diagnosis, treatment, recovery and renewal. It was cathartic to express my experience with the minimalism of poetry. It took a long time, but I finally self published my book, 

, via lulu.com in 2007, and sold a few copies with proceeds going to the Fred Hutchinson Cancer Research Center in Seattle where I was treated. Sharing my story was definitely a strong component of physical and spiritual healing from cancer—it inspired me to remain deeply grateful and to acknowledge a larger purpose to my personal experience.

I’m a professional artist who continued to work during the course of chemotherapy and radiation treatments for my breast cancer. It took my focus off of what I was dealing with and allowed me to consider my cancer in the context of being a life experience that I was going through temporarily. Art can take you outside of yourself, and by continuing my work, I wasn’t fixated on the side effects of treatment because I was more concerned about getting back to my studio to create.

CURE asked readers: Did you use a form of art to help in your healing during and after cancer? Was it visual, written, musical or some other form of artistic expression?

Taylor Walker

Another State Gets Chemo Parity

Sleep Problems Impair Childhood Cancer Survivors

Readers Write: The Healing Power of Art

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