Michael D. Becker discusses the impact of oral and pharyngeal cancers, highlighting that approximately 43,371 new cases occur yearly with a significant mortality rate, largely influenced by HPV infection. He shares insights from his personal journey as a cancer patient, emphasizing the importance of health literacy and awareness around treatment options and potential side effects. The document underlines the necessity for improved patient education to navigate the complexities of cancer treatment and clinical trials.

1. A “Talk” with Purpose
Michael D. Becker
McKesson
Manufacturer Networking Evening
Thursday, May 31, 2018

2. My Unique Perspective…
Wall Street
Biotechnology Industry Executive
Industry Consultant

3. …and, Cancer Patient

4. About Oral Cancer
• 43,371 people get cancers of
the oral cavity and pharynx
annually*
o ~70% men, ~30% women
o 9,404 people expected to die annually
• Key risk factors include using
tobacco and/or drinking alcohol
* U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2014 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human
Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2017. Available at: http://www.cdc.gov/uscs.
Chicago’s Wrigley Field currently seats 41,159
Source: SB Nation “A Day In Wrigley Field History: May 18, 1947”
https://www.bleedcubbieblue.com/2013/12/8/5185458/wrigley-field-history-may-18-1947

5. HPV and Cancer
• Studies show that ~70% of oropharyngeal cancers may
be caused by human papillomavirus (HPV)*
• According to the CDC, HPV is very common:
o Nearly 80 million people—about one in four—are currently
infected in the U.S.
o About 14 million people, including teens, become infected
with HPV each year
• In most cases, HPV goes away on its own and does not
cause any health problems
• Persistent HPV infection can cause health problems like
genital warts and cancer
Image credit: What is human papillomavirus (HPV)?
By Lori Smith BSN MSN CRNP | https://www.medicalnewstoday.com/articles/246670.php
* Centers for Disease Control and Prevention - HPV and Oropharyngeal Cancer. Available at: https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm

6. My “Talk” with Purpose
Prevention Screening
Primary
Care
Diagnostic,
Imaging, &
Pathology
Treatment
Experience Across the Patient Spectrum…

7. Prevention:
The Best and Worst of Times

8. Screening:
Cervical Cancer Example
Encounter with
HPV-infected
partner
Acquisition of
“high-risk” HPV
Preinvasive
cervical lesion
Invasive cervical
cancer
Need to vaccinate before
virus exposure
Can take 20-30 years
cytology and yearly exams

9. Primary Care:
My First Sign of Disease
• Symptoms of head/neck cancers*:
oLump or a sore that does not heal
oSore throat that does not go away
oDifficulty in swallowing
oChange or hoarseness in the voice
• But symptoms may be caused by
other, less serious conditions
* U.S. Department of Health and Human Services | National Institutes of Health | National Cancer Institute. Available at: https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet
~3 cm

10. Diagnostic, Imaging and Pathology:
Two Months from Discovery to Treatment
Find lump;
GP appt
Initial ENT
appt
CT scan
Second
ENT appt;
biopsy
Pathology
report; SCC
PET scan to
find primary
1st opinion
oncologist
2nd opinion
oncologist
Surgical
consult
Rad Onc
consult
Oncologist
consult
First day of
treatment
11/25/15 12/01/15 12/02/15 12/03/15
12/10/1512/17/15 12/11/1512/24/15
12/30/15 01/04/16 01/07/16 01/18/16

11. My Treatment Journey (so far)
Line of
Therapy
Description Timing Intent/Outcome
1st
Approved treatment:
7-weeks of chemoradiation
(cisplatin and daily radiation)
Q1 2006
• Curative intent
• No evidence of disease on June
2016 PET scan
• Recurrence (distant metastases)
on December 2016 PET scan
2nd
Experimental treatment:
Immunotherapy (bispecific mAb
inhibiting PD-L1 and TGF-β)
H1 2017
• Evidence of activated T cells
in vicinity of the tumor
• Progressive disease
• Taken off study
3rd
Approved treatment:
Chemotherapy combo
(carboplatin & paclitaxel)
H2 2017/
Q1 2018
• Palliative intent
• Reductions in tumor size on
several CT scans; no new sites
• 9-mo of treatment/cycles ended
3/6/18

12. My Image Examples
First PET scan – 12/17/15
PET scans – Jun 2016 vs. Dec 2016
3D CT image – July 2017

13. My Side Effects
Editorial Cartoon by Mike Keefe, InToon.com
Plus, opioid addiction!

14. Side Effect Examples

15. Side Effect Examples (cont’d)
Photo from November 2017
Image source:
http://www.labworld.co.uk/replacement-fetus-model.html

16. What I’ve Learned
Patients need to know more about We need to improve health literacy**
• Where to go for treatment (community setting, teaching
center, for-profit, etc.) and benefit of seeking a second
opinion
o And where potential conflicts of interest exist…
• What to really expect in terms of side-effects from
treatment
o Balanced so that patient is scared away from pursuing
• Clinical trial options
o Only 3% of adult cancer patients participate in clinical trials*
• FDA’s Expanded Access Program
o FDA receives ~1,000 applications annually for expanded
access to treat patients with investigational drugs
• Only 12% of U.S. adults have proficient health literacy
o Using a table, calculate an employee's share of health
insurance costs for a year
• Only 53% have intermediate health literacy
o Read instructions on a prescription label, and determine
what time a person can take the medication
• Only 21% have basic health literacy
o Read a pamphlet, and give two reasons a person with no
symptoms should be tested for a disease
• 14% have below basic health literacy
o Read a set of short instructions, and identify what is
permissible to drink before a medical test
* Institute of Medicine (US) Forum on Drug Discovery, Development, and Translation. Washington (DC): National Academies Press (US); 2010.
** U.S. Department of Health & Human Services “America's Health Literacy: Why We Need Accessible Health Information.”
Web: https://health.gov/communication/literacy/issuebrief/

17. Thank you! Thank You!
michael@mdbllc.com
awalkwithpurpose.com