Oregon’s Death with Dignity Act, 20 years later

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Number of prescriptions and assisted deaths under the Oregon Death with Dignity Act. (Blanke et al. from Oregon Health Authority data)

In 1997, Oregon became the first state to make it legal for terminally ill patients to self-administer a prescription to hasten death.

A review of 991 cases of lethal self-medication through 2015 shows that the law’s impact has remained largely predictable. Three-fourths of the people were dying of cancer, nearly all were white and around 70 percent had attended college. More than 90 percent had health insurance, were receiving hospice care and died at home.

Still, some findings surprised first author Charles Blanke, M.D., a professor of medicine in the OHSU Knight Cancer Institute and chair of the SWOG research consortium.

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A new way to guide cancer immune therapy

Scrutinizing the immune cells infiltrating a tumor may reveal the cancer’s vulnerability or resistance to immune-based therapies.

 

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Lessons from Oregon about end-of-life care

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Deaths among Medicare enrollees in Oregon, Washington, and the rest of the U.S. (Tolle and Teno)

At the end of life, people in Oregon are more likely to have their care wishes honored, less likely to be hospitalized and more likely to use home hospice services compared with people in Washington and the rest of the U.S.

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With foundation help, an Oregon doctor roots out low-value medical practices

Vinay Prasad (OHSU/Kristyna Wentz-Graff)

Vinay Prasad (OHSU/Kristyna Wentz-Graff)

Physicians have started to face up to an uncomfortable truth: their profession has often embraced new treatments that don’t really help patients.

“When you look at the balance of benefit and harm, some therapies provide no net benefit,” says OHSU assistant professor Vinay Prasad, M.D., M.P.H., who has landed a $2 million grant to go after the problem.

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A Native American health focus at the OHSU Knight Cancer Institute

Knight Cancer physician Amanda Bruegl, M.D., is leading an effort to understand health issues among Native American tribes and communities in the Pacific Northwest, with a special focus on gynecologic cancer.

 

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Amanda Bruegl, M.D. (OHSU/Fritz Liedtke)

Throughout medical training, Amanda Bruegl’s commitment to work with Native Americans never faltered. As a member of the Oneida and Stockbridge-Munsee tribes, she is one of two Native American gynecologic oncologists in the United States.

“When I was looking for a job,” she says, “it was really important to me to do something to advocate for Native American women’s health.” She saw a need for that in the Pacific Northwest.

“I was looking for places where there was a significant Native American population and the opportunity to do outreach,” she says.

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The cancer drug that “changed everything”

Understanding the earliest drivers of cancer formation can lead to less toxic and more effective treatments.

 

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Years of life expectancy at age 55 for people diagnosed with CML compared with the general population, from the work of Bower et al. (OHSU/Joe Rojas-Burke)

It transformed the outlook for people diagnosed with chronic myeloid leukemia. A disease with a three- to five-year life expectancy became, for most patients, a chronic, long-term condition managed with a daily pill.

And this week, researchers published the outcomes of people treated for more than 10 years with the drug imatinib (Gleevec), ushered from lab to clinical success by Brian Druker, M.D., director of the OHSU Knight Cancer Institute. The findings stand as a testament to the idea that understanding the earliest drivers of cancer formation can lead to less toxic and more effective treatments.

Estimated overall survival at 10 years was 83 percent among patients receiving first-line imatinib treatment, Druker and co-authors reported in the New England Journal of Medicine. Many of the recorded deaths of people in the imatinib group were unrelated to CML. Among 134 patients with cytogenetic assessments at 10 years, 92 percent had a complete cytogenetic response, that is, they had no measurable sign of the chromosome alteration that causes CML.

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Oncology knows no borders: Unintended impact of the new U.S. travel ban

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Nima Nabavizadeh, M.D.

The travel ban issued by President Donald Trump could bring an unintended consequence for U.S. citizens: the loss of medical care givers serving rural communities and poor neighborhoods. “Immigrants have always done what no one else wants to do – and this includes providing high-quality medical care for underserved patients,”  say OHSU Knight Cancer Institute physicians Nima Nabavizadeh, M.D., and Charles Thomas, Jr., M.D., in a commentary in JAMA Oncology.

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When it’s time to stop a lifesaving cancer drug to find out if you are cured

Gleevec structure - Structure of Gleevec bound to the kinase domain (1)The depth of remission achieved with the targeted therapy imatinib (Gleevec) raises a tough new question for some leukemia patients: is it ever safe to stop taking the breakthrough drug developed at OHSU?

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Improving survival for patients with GIST

Average life expectancy had been no better than 18 months for people diagnosed with advanced gastrointestinal stromal tumors, or GISTs.

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Michael Heinrich, M.D.

The outlook changed dramatically in 2001 with the arrival of the targeted therapy drug imatinib (Gleevec). “Now we’ve learned that some might live a decade or longer. And we’ve come to understand which class of patients benefit the most,” said Michael Heinrich, M.D., first author of a new report on the long-term outcomes of women and men who enrolled in the pivotal clinical trial organized in 2000 by SWOG, the research consortium headquartered at the OHSU Knight Cancer Institute.

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Why breast cancer is more dangerous for new moms

Breast cancers that emerge after a woman gives birth are significantly more deadly. Those diagnosed within five years of childbirth are about three times more likely to spread and give rise to life-threatening metastatic tumors. Researchers now are closing in on the reasons why.

 
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Scientists at OHSU have discovered how the liver – one of the most common sites of breast cancer metastasis – becomes vulnerable to tumor invasion after childbirth. Using rodent models, they’ve shown that as the liver recovers from the demands of pregnancy and lactation it becomes an inviting landing spot for escaping cancer cells to take root and grow.

And the same process appears likely to occur in women. The researchers dug into the details of more than 500 cases of young women’s breast cancer and found a liver-specific increase in metastasis among those diagnosed within five years of giving birth. If confirmed by more direct evidence, the authors say their findings could help physicians choose more effective treatments for young mothers diagnosed with breast cancer. The researchers reported the findings in the February issue of Cancer Discovery.

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The cancer drug that “changed everything”

The cancer drug that “changed everything”

A New England Journal of Medicine report describes outcomes after more than 10 years with imatinib (Gleevec), the targeted therapy drug ushered from lab to clinical success by Brian Druker, director of the OHSU Knight Cancer Institute.