Month: June 2017

One question I wanted to ask Dr. Evan Lipson today at Robert’s follow-up appointment at the new Sidney Kimmel Cancer Center at Sibley Hospital was, what does it mean for a melanoma patient to reach the five-year milestone after apparently successful resection of his cancer?

Looking back wistfully at the days when I had “general knowledge” about cancer with no personal connection, I still consider five years as a time to breathe a deep sigh of relief. I haven’t been sitting around worrying about the potential for Robert to have a recurrence, but one thing I’ve acknowledged since we passed the five-year mark on June 18 is that it won’t surprise me if it happens.

My question for Dr. Lipson was based on anecdotes I remember from a few years ago, when I was still monitoring the Melanoma Research Foundation’s Melanoma Patients Information Page regularly. I remember reading about several survivors whose cancer came back after seven to ten years with no evidence of disease (N.E.D.), and I wanted to know if melanoma is different from other kinds of cancer in this respect. Does it recur after five years more frequently than other cancers?

Dr. Lipson said yes, melanoma comes back after five years. However, he explained that five years is not necessarily considered a milestone for the chance of the cancer returning. Instead, it marks a point at which some follow-up testing, like xrays, CT scans and MRIs, is ordered less frequently in N.E.D. patients because the risk of continuing exposure to radiation outweighs the benefits of earlier diagnosis. That doesn’t mean the chance of a recurrence or finding a new lesion suddenly drops off; it continues to decline gradually, as it has been doing thus far.

A sigh of relief for Robert, perhaps – he will be glad not to drink “milkshakes” with isotopes in them as often and will have less fear of beginning to glow in the dark. One more six-month interval, which will bring him to the end of the five-year follow-up study since he completed the GVAX clinical trial at Hopkins after his melanoma was resected. Then the frequency of follow-up scans will most likely reduce to nine months, and eventually to one year.

Robert’s question for Dr. Lipson was about the research he participated in. He asked whether the new studies and treatments have eclipsed the research the Hopkins team and other melanoma specialists were doing with vaccines in N.E.D. patients five years ago. The answer: cancer vaccine research has advanced, including for therapies that can be given to patients with tumors that can’t be fully resected. For example, the Food and Drug Administration has approved Phase 3 research into the TVAX vaccine for treating brain and kidney cancers, and the research has entered Phase 2 for melanoma and seven other cancers.

One important thing about this research for melanoma patients is that this vaccine may have a longer-lasting effect than the recently approved adjuvant therapies, with fewer risks and side effects. With the vaccine therapy, some cells from the patient’s tumor are combined with an immunotherapy agent and injected back into the patient to generate an immune response against that tumor. Some of the cancer-fighting cells the body creates in the immune response are removed, made to reproduce in the lab and then infused back into the patient to immunize him/her against recurrence if the cancer has not been completely removed or has already metastasized.

Whew! Hope I got that all right! In case it’s still too complicated, I’ll give you this simpler explanation, the one that persuaded us not to go with a chemotherapy treatment when Robert enrolled in the GVAX trial in 2012. Chemotherapy is nasty; better to prevent recurrence with a vaccine if possible. Little risk from trying, so why not?

OK. I’m ready to move away from melanoma again for a few months. Let me know if you have questions – I’ll try to answer!

High on my wish list for news and feature editors advertising for freelance journalists is to tell us how we fit into their publishing plans. All too often, it’s difficult to tell from the ad or call for pitches whether this opportunity fits into our work plans.
If content providers would say what they mean and mean what they say in their postings, we could save a lot of time – ours and theirs – by not applying for unsuitable gigs. Here are various scenarios gleaned from recent postings seeking freelance journalists:
Their business model includes regular contributions from independent journalists, perhaps because they want to air features and reports from a variety of voices.
They need coverage in an area (geographic or subject matter) where they don’t have staff reporters and are looking for top-quality freelancers with knowledge and connections to provide it.
They are contracting work to a freelancer while determining whether a new product or area of coverage will work.
They use freelancers to fill in for employees on leave or to cover occasional shifts.
They post the job status as freelance so they don’t have to put someone on the payroll.
I say “yea” to the first two, “ok” to the third if it’s fully disclosed in the notice, but “no” to posting freelance jobs to fill staff positions without hiring. It doesn’t matter whether the gigs or shifts are full- or part-time, regular hours or on-call. These days it may not even matter whether the work is done in-house or remotely.
All too often we find ads like “Senior Digital Producer – Full-Time freelance with the opportunity to turn into a permanent position” or “full-time freelancer with health benefits to work on features and front-of-book/back-of-book.” Or this one for a sports copy editor, clearly a newsroom job under supervision of a higher-ranking editor: “Enter data into website. Provide assistance with editing process. Answer phone calls, help compile roundups, and edit stories.” These are clearly staff, not freelance, positions and should be advertised as such.
Many media companies post for freelancers because employees cost more. Like all employers, publishers and broadcasters must withhold and match employee payments for Social Security and Medicare in addition to paying for state and federal unemployment insurance. These workers also generally are covered by wage and hour laws and workers’ compensation insurance. These “benefits” cost employers not only money but also time for compliance. Hiring freelancers is one way to get around that. As a result, journalism is among the industries that frequently don’t comply with the state and federal worker classification rules.
Independent journalists with years of experience say there are other reasons media companies prefer to post freelance gigs. Here are a few:
They can get quality work done cheaply by laid off and early-career journalists.
They don’t care about the quality of the work – they are just looking for cheap content.
They have no intention of paying and are less likely to face a meddlesome collection action from an independent worker, particularly one working remotely.
Some readers might discount the intentional abuse the latter reason connotes, but many long-time freelancers are convinced this problem is more widespread than we know. As for the lack of care about quality, we have the option to say “no” to cheap work that wastes our time, and shame on us if we agree to do it and then complain. But shame on them if they take advantage of our colleagues’ unintended employment situations.
Classifying a worker as an employee vs. independent contractor is important to companies for tax and legal reasons – specifically relating to employment tax and labor laws. The classification depends not on how much money a business has in its budget, whether the work is done in a certain place, or even how much value the business places on the work. In the U.S., according to the Internal Revenue Service, it relates solely to whether the person or company doing the hiring has control over what work will be done and how. Some states go further, with presumptions that workers are employees if they perform substantially similar functions as employees.
To media companies that look at experienced professional journalists as a source of cheap labor, whatever their circumstances, I say “shame on all of you.” You contribute to the smog surrounding our profession today. You need to clean up your act and help us all get to a better place for journalists to fulfill our role as watchdogs, educators and providers of information to the public.