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Small-Scale Question Sunday for January 12, 2025

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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I handle a lot of cases involving mesothelioma due to asbestos exposure and, though this is completely anecdotal, immunotherapy seems to be working wonders on that front. It seems like a few years ago meso was a death sentence, and now there are people who, while not exactly cured, seem to be living with it for years. One case involved a 60 year old woman who had a resection and subsequent immunotherapy after being symptomatic for over a year before doctors even figured out the correct diagnosis, and she was judged to be completely cancer free, which is something I thought impossible. There are of course plenty of people who respond poorly to it, but these are usually people in their 80s who were probably close to death anyway. Some of these cases are surprisingly sad, though, beyond the fact that any cancer case is sad. One that I'm working on now involved an 87 year old man who was walking miles every day over challenging terrain without any problem and slipped on ice when out on one of his walks. He hurt his ribs and went to the hospital for a CT scan, which uncovered pleural effusions and was suspicious for meso, which a biopsy confirmed. I honestly wonder for a guy his age who wasn't having any problems if the treatment is worse than just living with the disease until he needs palliative care, considering that he was otherwise active but was wiped out by the cancer treatments.

I handle a lot of cases involving mesothelioma due to asbestos exposure and, though this is completely anecdotal, immunotherapy seems to be working wonders on that front. It seems like a few years ago meso was a death sentence, and now there are people who, while not exactly cured, seem to be living with it for years

I don't know mesothelioma because it's relatively rare, and I don't see patients - just lines on a graph. That being said, it seems like a pretty similar story with 2 year survival rates of 41% versus 27%. Don't get me wrong, if I get cancer I'll take the pembro, but we're laughably far from curing cancer or LEV.

If you get diagnosed with a solid tumor (i.e. not a leukemia), basically you're either lucky and we caught it early enough to remove it entirely by surgery or you're going to die from it with vanishingly rare exceptions.

One case involved a 60 year old woman who had a resection and subsequent immunotherapy after being symptomatic for over a year before doctors even figured out the correct diagnosis, and she was judged to be completely cancer free, which is something I thought impossible.

I imagine that's bad for your bottom line. Or she lived long enough for you to collect?

I honestly wonder for a guy his age who wasn't having any problems if the treatment is worse than just living with the disease until he needs palliative care, considering that he was otherwise active but was wiped out by the cancer treatments.

Yeah. That's the choice to be made. Hopefully he was of sound mind and deciding for himself.