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.
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.
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.
Understanding the earliest drivers of cancer formation can lead to less toxic and more effective treatments.
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.
Average life expectancy had been no better than 18 months for people diagnosed with advanced gastrointestinal stromal tumors, or GISTs.
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.
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.
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.