Taxotears Turns Ten

Later this year will be a bittersweet celebration for myself and many ladies from around the world. Bitter because it marks the anniversary of the birth of a highly successful support group that I have been involved with from the first day.

Ten years ago I found myself in a situation that not only shook me to my core, but also left me with the need to track down others that had been disfigured like myself. What was this disfiguration? The year before I had been given a chemotherapy drug, Taxotere, as part of my treatment for breast cancer. Instead of my hair growing back, as I was told it would, I remained looking like an orangutan—an ugly freak. My doctor told me that the drug company, Sanofi-Aventis, had informed him I was only the third or fourth person in the world that this has happened to! So there must be two or three others out there somewhere, and I vowed to track them down. I hadn’t banked on it being so easy.

The first lady I found was Pam, from Oklahoma, and we decided to find others and create a support group. Cynthia then joined us and she created a website for our group of monk look-a-likes. Little did we know in those early days, how successful the group would become in finding so many ladies. We are now a large, thriving global group, with a constant stream of new members. It’s a group none of use wanted to join and it comes with a lifetime membership.

Now on to the sweet bit.

This group is a safe place for all members, there’s nobody to judge us and accuse us of not being grateful for being alive, which happens to us constantly. These people hear us but do NOT listen to us. They don’t want to understand our message. So we know that when we lend a shoulder to cry on, sometimes just listen, tell our stories and share tips that nobody ‘gets it’ more than we do. What would we have done without this support group? I have no idea, but I do know it’s been an incredible help to us all. We might not be happy to be in this situation but we are sure as hell happy to have each other.

This week I was invited to be interviewed for a radio podcast show for “inspirational authors’ so I asked our members what the group meant to them. I would like to share some of their comments with you.

“This group has given me strength and courage.” — Pam

“This group means I’m not alone.” — Chrissy

“Ladies understand how I feel when no one else does.” — Susan

“I’m not a freak.” — Erica

“This group has taken me from a place of isolation and despair to a place of understanding, validation and most of all hope.” — Suzanne

These are just a few of the comments I received.

I will end this blog on that sweet note, not only sweet because of how we feel about our support group but because it’s a good excuse to have another slice of cake!
Happy birthday to the amazing ‘Taxotears’ group!

My Hair or My Life?

Choice

Ever since a story in The Globe and Mail linked the chemotherapy drug Taxotere to irreversible hair loss, some have tried to turn it into a “my-hair-or-my-life” debate. This is just hair-raising hyperbole and a blatant disregard for the facts.

Why are we splitting hairs with a bunch of bald ladies? After nearly a year of surgery, chemotherapy and radiation, they just want to return to some kind of normal. Instead, they’re diagnosed with the boobie prize of side effects: alopecia, or long-term hair loss, a medical condition in its own right. And all because no one bothered to tell them that Taxotere can cause irreversible hair loss in 3 to 6.3% of patients administered the drug.

None of these women’s lives were in imminent danger. They were all given a positive prognosis and every reason to believe that their lives would return to some kind of normal. This, in large part, is due to more advanced diagnostics, treatment and medications. Along with this, it stands to reason, should come more information about their treatment options.

Let’s keep our eye on the real issue. This is not about vanity. It’s about a patient’s right to make informed choices about their treatment, it’s about a drug that has raised a red flag at the Food and Drug Administration (FDA) and it’s about a drug company that has a history of obscuring the facts.

In April 2009, the FDA issued a warning letter to Sanofi-Aventis, one of the largest pharmaceutical companies in the world, for a reprint carrier citing a study in the Journal of Oncology. The study compared the efficacy of Taxotere and Taxol, the trade name for paclitaxel, in treating locally advanced and metastatic breast cancer.

According to the FDA, the reprint was “false or misleading because it presents unsubstantiated superiority claims and overstates the efficacy of Taxotere.”

In its warning, the FDA stated that it is “not aware of substantial evidence or substantial clinical experience to support the claims made in the carrier regarding Taxotere’s level of efficacy or superiority to paclitaxel.”

Indeed, a study in the New England Journal of Medicine compared the efficacy of the two drugs. It concluded that women who received Taxotere every three weeks had “better disease-free survival,” but women who received Taxol each week “lived longer overall.” Taxotere/Taxol. Tomato/Tomato. Except for that hair thing no one wants to mention.

This is not the first time that Sanofi-Aventis has gotten a slap on the wrist. In 2007, Aventis paid more than $190 million to the U.S. Government to settle drug pricing fraud. The drug manufacturer agreed to settle False Claims Act allegations concerning its pricing and marketing of Anzemet, an antiemetic drug used primarily in conjunction with oncology and radiation treatment to prevent nausea and vomiting.

The government alleged that the pharmaceutical company engaged in a scheme to set and maintain fraudulent and inflated prices for Anzemet knowing that federal health care programs established reimbursement rates based on those prices.

“Marketing drugs to doctors based on potential profits undermines confidence in the integrity of our health care system because it treats beneficiaries like commodities instead of patients,” said Assistant Attorney General Peter D. Keisler.

Once again, with Taxotere, patients feel like they are being treated like a commodity. In this case, a group of breast cancer patients who feel like they are unwitting guinea pigs in a science experiment gone wrong.

“Everything has been loss,” one woman wrote A Head of Our Time. A lost breast, sleep, memory. The friends who flee when they hear the word “cancer”. And then the final insult: hair.

Then there’s all the things you gain: painful scar tissue and lymphedema—swelling in the arm or hand caused by lymph fluid buildup—, a compromised immune system, weight. But they’re lucky to be alive say detractors.

No one can understand the hair-or-my life dilemma better than my friend Jem: she has Stage IV breast cancer. As the mother of two small children, she wanted to know all the side effects of her cancer drugs before she began treatment. After all, she has to answer questions like “Mommy, why are you bald? Mommy, why are you so tired?”

Told it was Temporary

Jem and I did our homework and neither of us found anything in any consumer literature or cancer website indicating that hair loss could be permanent. Just the reassuring word “temporary”. MacMillan Cancer Support, which bills itself as a source of support and a force for change in all things cancer, states on its website that hair loss is “temporary and all your hair will grow again once treatment ends”.

The Taxotere product monograph states that “Hair loss may happen shortly after treatment has begun. However, your hair should grow back once you’ve finished treatment.” “Should”—a little word to gloss over the truth. And one that can be easily overlooked in the shock of diagnosis and the myriad decisions to make.

Despite the daunting list of possible side effects, we made a decision to trust the drugs our oncologist prescribed and took the leap of faith. The last thing the chemo nurse said to me before plunging the IV needle into my hand for my first treatment was “Chemo drugs are stupid. They kill everything, not just the cancer.”

This spoken by a man wearing full biohazard armour to prevent third-degree burns from administering the potentially lethal drugs.

He plunged. Then I waited. Two weeks later, my hair fell out, right on schedule. I did my best to Own the Chrome, throwing a head-shaving party and wearing wacky wigs. After all, I was told, it was just temporary.

“I wasn’t freaked out when I lost my hair because I was told it would grow back,” another woman wrote. “I was ready for the adventure of seeing how it would be. I wasn’t prepared for looking like the “Crypt Keeper” for life. It’s more than just being bald, it’s a constant reminder of cancer.”

She’s not alone.

“The one side effect possibly most dreaded by the patient is alopecia,” wrote Dr. Scot Sedlacek, an oncologist at the Rocky Mountain Cancer Center in Denver, Colorado. “Yet, we have always told our female patients don’t worry, [hair] will always come back. This last statement may not be true,” he writes.

His landmark study on the effects of Taxotere and irreversible hair loss found that 6.3% of study participants experienced Persistent Significant Alopecia—hair re-growth less than 50% of the pre-chemotherapy amount—up to seven years after Taxotere was administered in combination with Adriamycin (doxorubicin) and Cyclophosphamide.

“Such an emotionally devastating long-term toxicity… must be taken into account when deciding on adjuvant chemotherapy programs in women who likely will be cured of their breast cancer,” it recommends.

My Hair or My Quality of Life?

French oncologist Hugues Bourgeois took it into account, presenting research on 82 patients with long-term persistent alopecia to the prestigious 2009 San Antonio Breast Cancer Symposium in December. In his medical practice, Bourgeois gives his patients a choice of Taxol, an equally effective option to Taxotere, but with no known risk of irreversible hair loss.

Perhaps the question would be better phrased, my hair or my quality of life?

If the emotional toll of hair loss seems trivial, how about the financial cost of wearing wigs, painting on eyebrows and gluing on eyelashes for life? There are financial aide programs to offset the cost of temporary chemo-induced hair loss. None for permanent. That cost, too, must be borne by the patient for life.

How about the loss of income due to lost image and lost self-esteem? I work in advertising and I can tell you that no agency wants a bald lady to spearhead their shampoo or hair colour campaign or a lashless lady to hock their long lash mascara. In this biz, you don’t just need to dress for success—you need to tress for success.

All this hair loss, psychological devastation and chemotherapy might not even be necessary. A new molecular test, recently reported by the Associated Press, analyzes 21 genes to help predict whether a woman really needs chemotherapy and whether a cancer is likely to return within the next decade. This could save health care systems untold amounts in “unnecessary treatment and save patients such gruelling side effects as nausea, nerve damage and hair loss,” it stated.

After the unexpected side effect of permanent hair loss, it’s surprisingly difficult to go forward. “Are you cured?” everyone asks, long after the end of my treatment. My bald head and absent brows and lashes give me an unsettling “terminal” look, like having a scarlet “C” stamped on my forehead.

No doctor dares use the other C-word: cured. Who knows what rogue cancer cells are at work? The reality is that many women are living to have breast cancer multiple times, making it more like a chronic disease. A very profitable one.

“Cancer is big business,” my pharmacist said when I commented on the cost of my cancer drugs. “And they’re not in any hurry to find a cure.”

In Breast Cancer: Poisons, Profits and Preventions, a report on the big business of breast cancer, investigative journalist Liane Clorfene-Casten concludes that as a result of a focus on cure, rather than prevention, the population has been brainwashed and businesses have quite literally gotten away with murder.

“Those who will profit,” Clorfene-Casten states, “include chemical companies that make not only the cancer-causing pesticides but also the chemotherapy drugs used to fight cancer. Others are major cancer research centers whose well-connected directors shape the national dialogue on cancer.”

According to Breast Cancer Action Montreal, more than 95% of funds raised by big events like the Run For The Cure are used to build, equip or update cancer treatment centers, leaving a pittance for research into the causes of breast cancer. Ironically, Sanofi-Aventis is a sponsor of this event, entitling them to lots of pink PR and some nice tax breaks.

One thing is for sure: a bunch of bald ladies aren’t good for their corporate image… or their bottom line. In this chirpy era of the corporatization of breast cancer and the cult of pink kitsch, it’s time to take off the rose-coloured glasses before we lace up our sneakers. If these breast cancer patients are being dismissed as vain, this does not bode well for health care consumers in general.

The Canadian Cancer Society trumpets on its website that “We believe that people with cancer must make treatment decisions with the best available information, including knowledge of what the treatment can do and what the side effects may be”.

Even if those side effects seem superficial. Cancer, after all, is not just a flesh wound and the long-term impact of treatment metastasizes throughout a so-called survivor’s life. A woman’s flowing locks are not just a celebrated sign of femininity, hair is a multi-billion dollar industry. So, how many women would choose Taxotere if they knew the facts?

Should these women just smile sweetly so more patients can be subject to the unwitting risk of irreversible hair loss? What about other patients with other undisclosed side effects? Should they take their medicine with a spoon full of sugar?

It’s cruel and unusual to split hairs with a bunch of bald ladies who just want to get on with their lives after breast cancer treatment. This is about much more than a bad hair day. It’s about health care consumers who must hold companies accountable for their actions.

To ignore it would not be vain. It would be dumb.

Photo: openhandweb.org

Shirley and Sanofi-Aventis: Facing off on Facebook

As part of my campaign to make patients aware that the chemotherapy drug, Taxotere, has been linked to permanent baldness–and that it might not just be temporary as I was told–I started writing letters to Sanofi-Aventis, the manufacturer of the drug. I wanted to see if they would cover the costs of my wigs for life. They said they were sorry, but they weren’t going to do anything. Then they didn’t reply to any more of my letters. So I posted photos of my ugly bald head on their Facebook page. Still no answer. So I kept posting. Then they shut down their page. Still no word.

But word travels fast in this digital age. Now the bloggers are abuzz and the Tweets are aTwitter. The rest, as they say, is history:

Pharma Social Media for Dummies
The Balding Blog: Permanent Hair Loss from Cancer Drug Taxotere
Bnet.com: Sanofi’s Latest Challenge
Bnet.com: Sanofi, European Regulators to Bald Breast Cancer Patients: Drop Dead
Pharma Marketing Blog: Patient Unadvocate Lays Siege to Sanofi
Pharma Marketing Blog: Disgruntled Patients Shuts Down Sanofi-Aventis Facebook Page
MedAdNews Insider: Sanofi-Aventis Social Media Mess
Siren Song: Online Reputation is Essential: Sanofi-Aventis Fake Facebook Page Has 3,783 Fans
Trusted MD: Sanofi-Aventis Feels the Social Media Pain
Mark Blevis: Sanofi-Aventis Missed its Tylenol Moment
Extrovertic

Shirley: The Taxoterrorist

I was a healthy 47-year-old woman… or so I thought. I had never been overweight, always ate healthy and swam four times a week. I didn’t smoke. No cancer in the family. How could I possibly get breast cancer?!

Finding the lump in my breast was a massive shock—it moved around and hurt. In cases like that, they often tell you it’s not cancer. Well mine was! I had a lumpectomy, chemo FEC X 3, followed by Taxotere X 3. Then radiotherapy and Tamoxifen.

Each time I went for follow-up appointments with my doctors, I’d pull my scarf off my head and ask “It’s not growing very fast is it?” My questions were always answered with puzzled looks.

At my six-month check-up they delivered the final blow. “We’ve contacted Sanofi-Aventis, the manufacturer of Taxotere,” they said. “I’m sorry to say that your hair will never return. Your hair loss is permanent.”

I didn’t believe them. I was in shock. This can’t be, I thought. I was told my hair would return. Four years later I can say they were right.

For the past three years, I’ve worked tirelessly to be heard: by my doctors, by health regulatory bodies and by Sanofi-Aventis. I soon realized that I wasn’t the only one… or the third… or fourth person in the world with this bizarre side effect.

I have e-mailed my medical team every week for information and support. After all, they gave the drug, so the least they can do is to help me get to the bottom of this.

I wrote to Sanofi-Aventis. They said they were sorry, then to add insult to injury, said that it’s very rare for Taxotere to make patients permanently bald. From that day forward, my life mission has been to find out how rare persistent chemo-induced alopecia actually is.

The dismissals and cover-ups that have emerged have only spurred me on. I was denied the chance to make my own risk assessment. It was my right as a patient to understand my treatment and to agree to it or not.

I am fearless in my quest to ensure that every woman is offered a choice when they are offered Taxotere as part of her chemotherapy regimen. I won’t stop until every woman knows the truth… and every woman has a choice—the choice I was denied.