	In metastatic colorectal cancer (mCRC), mutations in the BRAF gene are emerging as prognostic indicators of worse outcomes. The latest evidence comes from an updated analysis of the CRYSTAL study, in which patients who had wild-type (normal) KRAS gene status but mutations in BRAF had a poor prognosis in spite of treatment with cetuximab, reported Eric Van Cutsem, MD, of University Hospital Gasthuisberg, Leuven, Belgium, at the ASCO 2010 Gastrointestinal (GI) Cancers Symposium. Patients with wild-type KRAS typically respond to inhibitors of epidermal growth factor receptor (EGFR).

	At the 2009 ESMO/ECCO meeting, Dr Van Cutsem presented the main results of the phase III CRYSTAL trial of 1198 patients with mCRC, in which treatment with cetuximab and FOLFIRI was associated with a 30% reduction in progression (P = .0012) and a 20% reduction in mortality (P = .0093), versus FOLFIRI alone, in the KRAS wild-type population.

	At the GI Cancers Symposium, Dr Van Cutsem presented updated data on the wild-type KRAS cohort, 83% of whom had tissue samples tested for BRAF status. Of these, 6% showed mutations. The BRAF mutation was present in 9% of all patients with KRAS wild-type tumors. Overall survival in the KRAS wild-type population of 666 patients was dependent upon BRAF status, Dr Van Cutsem reported.

	In the FOLFIRI plus cetuximab arm, median overall survival was 23.5 months for all KRAS wild-type patients and 25.1 months for KRAS wild-type/BRAF wild-type patients, but just 14.1 months for KRAS wild-type/BRAF mutation patients. PFS was, respectively, 9.9 months, 10.9 months, and 8.0 months.

	In patients with the BRAF mutation, cetuximab had no benefit over FOLFIRI alone, as the differences between the experimental and control arms in this wild-type population were not statistically significant. “This final analysis confirms KRAS tumor mutation status

	to be a predictive factor across all efficacy endpoints examined for cetuximab in combination with FOLFIRI,” Dr Van Cutsem said. “And it suggests that BRAF tumor mutations are a poor prognostic factor in first-line metastatic colorectal cancer.” 

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In metastatic colorectal cancer (mCRC), mutations in the BRAF gene are emerging as prognostic indicators of worse outcomes.

BRAF Mutation Emerging as Prognostic in KRAS Wild-Type mCRC Patients

	A study presented at the Molecular Origins of Lung Cancer Conference found that three tumor microRNAs appear to predict when first-line chemotherapy will fail in some patients with small cell lung cancer, a problem affecting approximately 6500 patients annually. “For patients with small cell lung cancer, there are really only about two [platinum- based] chemotherapy options. We need to be more precise with our treatments and identify earlier who is going to be resistant in order to design better clinical trials that will identify effective therapies for these at-risk patients,” said Glen J. Weiss, MD, lead investigator of the study and director of thoracic oncology at the Virginia G. Piper Cancer Center at Scottsdale Healthcare and co-head of the Lung Cancer Unit at the Translational Genomics Research Institute (TGen), in a press statement.

	The study included 34 patients (median age, 69.1 years) with small cell lung cancer in various stages. Following systemic chemotherapy, there were two complete responses and 13 partial responses. Two patients had stable disease and four had progressive disease. Weiss and colleagues conducted microRNA assessments to understand chemoresistance in these patients. MicroRNAs were chosen because they regulate gene expression similar to messenger RNA, but are smaller and more stable across a variety of fluid and tissue types.

	The initial assessment found 16 microRNAs associated with progressive disease, and further testing identified three microRNAs linked to chemoresistance, including miR-92a-2 (P = .010), miR-147 (P = .018), and miR-574-5p (P = .039). These findings were validated by quantitative real-time polymerase chain reaction. Weiss noted that although 47% of patients had hypertension and 32% had emphysema or chronic obstructive pulmonary disease, these comorbidities were not linked to chemoresistance.

	The microRNA biomarkers identified by Weiss and colleagues will have to be evaluated in an independent cohort of small cell lung cancer patients before any patient will be denied chemotherapy based on these findings, noted Tyler Jacks, PhD, president of the AACR, during the media briefing. Thereafter, studies will need to be conducted to determine what therapies may be effective in patients with chemoresistance. The hope is that this fi nding will help personalize treatment in patients with small cell lung cancer, a disease that has not seen any real treatment advances in well over a decade.

Three Biomarkers May Predict Treatment Response in Small Cell Lung Cancer

	Gefitinib, an epidermal growth factor receptor—tyrosine kinase inhibitor (EGFR-TKI), is commonly used as a treatment for non–small cell lung cancer (NSCLC). Typically, patients are switched to another treatment once disease progression occurs on gefitinib; however, a study presented by In-Jae Oh, MD, PhD, assistant professor, Chonnam National University Hwasun Hospital in the Republic of Korea, at the Conference on Molecular Origins in Lung Cancer, suggests that there may be value in attempting a second regimen of gefi tinib after observing progressive disease with at least one cytotoxic treatment.

	In Oh’s study, patients with NSCLC were put on gefitinib treatment until their disease progressed. They were then given at least one cycle of chemotherapy before reinitiating treatment with gefi tinib. Out of six patients who had partial responses to initial treatment with gefitinib, two had partial responses to the second treatment and three had stable disease. Among the nine patients who had stable disease after the first treatment with gefi tinib, two had partial responses and five had stable disease again after the second treatment. The overall disease control rate with the second treatment of gefi tinib was 80%.

	Oh noted that a number of factors were possible indicators for a patient’s likelihood of responding to a second treatment of gefitinib, including activation of a mutation of the epidermal growth factor receptor (EGFR) gene, good response to initial EGFR-TKI for more than 3 months, and the adenocarcinoma’s histology. Being a female never-smoker also seemed to be a significant factor, as 10 of the 12 patients who had favorable responses fit this profile.

	“After failure with gefi tinib and subsequent chemotherapy, we can try gefitinib again, especially for the patients who had previously responded to gefitinib,” said Oh. “This strategy will keep some patients from the toxicities of chemotherapy and help maintain the quality of life for several months,” he noted. According to Oh, if patients do not respond well to another round of gefitinib, treatment can always be switched. 

Gefitinib, an epidermal growth factor receptorâ€“tyrosine kinase inhibitor (EGFR-TKI), is commonly used as a treatment for nonâ€“small cell lung cancer (NSCLC).

Second round of gefitinib shows promise in non-small cell lung cancer

, touting it as “a revolutionary device for browsing the Web, reading and sending email, enjoying photos, watching videos, listening to music, playing games, reading e-books, and much more.” Anticipation ran high, but at the end of the press briefing, many were disappointed, and some mockingly referred to the iPad as the “iTampon” on Twitter. Yet even if the iPad’s moniker were not vulnerable to such crude comparisons, a single letter sets its name apart from Apple’s own iPod, and paired with its features, this left some dismissing it as simply an “iPod Touch on steroids.”

	Despite its generally lukewarm reception, there is no denying that the iPad is a slick device that has the potential to carve a niche in the tech sector. According to Steve Jobs, Apple’s CEO, “iPad creates and defines an entirely new category of devices that will connect users with their apps and content in a much more intimate, intuitive, and fun way than ever before.” The iPad thoughtfully combines features of a smartphone, notebook, and tablet, and according to Colin Crawford, founder & CEO of Media 7 Consultancy, who attended the press briefing and blogged about it on 

, “The magic in Apple’s iPad is just how seamlessly it appears to work. It’s going to be a while before Apple’s competitors can match the functionality in a similar form factor, which could give Apple an 18 to 24 month lead.”

	While the iPad has superb functionality, there are several notable omissions and limitations, some of which may affect its adoption by the healthcare sector. Yet despite its inability to meet some consumers’ high expectations, the iPad offers features that are sure to put it on many wish lists, including those of healthcare providers. A recent survey conducted by Epocrates, one of the leading providers of mobile medical reference solutions, found that almost 20% of physicians intend to purchase an iPad within a year and another 38% are seriously considering purchasing one but want more 

 first. Wondering if the iPad is right for you? We take a comprehensive look at this novel device and examine its limitations and potential role in the healthcare sector, allowing you to better decide whether to make the investment.

	While the iPad has been touted as a “revolutionary device” by Apple, several limitations have been noted. Proponents of the iPad say that these seeming flaws are actually meaningful design choices. Regardless, some may be significant enough to impact the iPad’s utility in the healthcare sector, whereas others have workarounds or may pose no issue at all. Let’s examine the major criticisms so that you can decide whether any are indeed deal breakers for you.

	While the device was touted to revolutionize Web surfing, it does not support Adobe’s seemingly ubiquitous Flash video technology, leaving some wondering how good the Web surfing experience can be on the iPad since Flash is heavily employed on the Web and its presence may be growing. According to Adobe, more than 75% of all videos on the Web use Flash, and more than 98% of Internet- connected computers have the Flash player installed on their system. In addition, Adobe is working hard to get Flash 10.1 installed on smartphones. It is estimated that 53% of smartphones will support Flash by 2012, with several popular smartphone models anticipated to adopt it by the end of this year, including the Palm Pre, Motorola Droid, and Google’s Nexus One. The lack of Flash on the iPad may preclude accessibility to certain Websites, including some useful medical resources.

	According to Apple, the reason for the omission is that Flash is “buggy” and that problems with its plug-in software are likely the culprit behind the majority of Mac computer crashes. While Adobe has developed a version of Flash that can run on the iPad, Apple has instead chosen to back HTML5, an emerging rival to Flash that is being developed as the next major revision of HTML. While Apple may eventually adopt Flash, it is unlikely to do so in the near future, but some say that a lack of Flash support on the iPad won’t have a major impact on the Web-browsing experience, partially because an increasing number of Web developers are finding alternatives to Flash content on 

. Further, because most medical apps do not employ Flash, this may not be a deal breaker for physicians.

	Although numerous functions can be performed on the iPad, it appears there will be limited ability to multitask; thus, this device cannot be considered a replacement for a netbook or laptop. For instance, a user cannot listen to Pandora while writing a document, have a Twitter app open at the same time as their browser, or minimize their e-book to look something up on the Web. Some have noted that the lack of multitasking, however, is only restricted to third-party applications, allowing you to perform multiple tasks using some of the iPad’s built-in apps, but not those of third parties. Clinicians are constantly multitasking, and limited ability to do so on the iPad may have some impact on its utility. It is said that the iPad is running the iPhone’s 3.2 operating system (OS), and some speculate that multitasking might be an iPhone (and iPad) OS 4.0 feature.

	The multipurpose iPad has been touted as an e-book reader, and with its launch comes Apple’s new iBookstore. Apple has said that it will adopt Adobe’s EPUB format for its books. The technology has been adopted by libraries and many leading e-book reader manufacturers; however, compatibility issues may arise when Apple adds its own copy-protection scheme to this format, and these books may no longer be compatible with other e-book readers, affecting the ability to transfer books to different devices in the future. Further, the iPad does not feature electronic-ink display, making reading books on it akin to reading them on a computer screen, rather than mimicking print. While the reading experience may not be as comfortable on the eyes as electronic-ink displays, an advantage of using the iPad as an e-book reader is that any images can be viewed in color. Dedicated color e-book readers are in development and slowly being brought to some markets, such as the Fujitsu FLEPia, which was released in Japan in 2009, but the system is costly, sluggish, and its onscreen colors are dull. No electronic-ink displays are able to render images in color, and while viewing pictures in color may not be important if the objective is to read a novel, it can be critical for oncologists and other healthcare providers who need to view pathology, surgical, and other medical images in color.

	Another major criticism of the iPad is that it lacks a camera. Because images and video play a major role in interactivity on the Web, especially when it comes to social networking sites, the lack of a camera hinders the connectivity that the vast majority of people are accustomed to. Further, video chatting using a service like Skype is out of the question because there is also no USB port to allow a Webcam to be attached. This may be inconvenient for healthcare providers who wish to stay in touch with their families while away at a convention or with their office while on vacation. It also limits the ability to use the iPad as a telemedicine platform, an area of medicine that is rapidly expanding, including in oncology.

	Although the iPad is said to provide up to 10 hours of battery life, many are skeptical that it will live up to these claims. Even if it did, the lack of an interchangeable battery could limit its utility in the healthcare sector. As Crawford questions in his HCPLive.com article, even if the 10 hours were a reliable figure, which would cover most of a hospital shift or a private practice workday, “what happens when the iPad gets handed off to the next person? The inability to swap out a dying battery for a fresh one becomes prohibitive to the iPad’s effective use.” However, as one physician notes in a blog post at 

, while some physicians work 12-hour shifts, the iPad “will likely not be in continuous use. If docked into the keyboard it will get a chance to recharge.”

	Although the iPad contains a virtual keyboard, and can be enhanced by a physical keyboard option, including a keyboard dock that also serves as a charging station, the iPad does not appear to support Apple’s Bluetooth mouse. This may limit the utility of the iPad when it comes to some clinical applications.

	In early January, rumors circulated on the Web that Apple executives had visited Cedars-Sinai Hospital in Los Angeles on several occasions to meet with hospital administrators to discuss the utility of Apple’s then-

 tablet device in the medical setting. Whether these meetings actually occurred remains unknown, but following the announcement of the iPad, there have been numerous posts on the Web speculating on how the iPad may serve as a workflow solution to clinicians. In an article on 

, Dana Blankenhorn, a tech journalist, notes that the iPad’s size, price-point, and capabilities make it the “[device that doctors have been] dreaming of ever since the PC revolution began.” He notes that the iPad can transform medical practice by “delivering a solid, easy-to-follow upgrade path directly from paper. Put security on the clinic’s WiFi and HIPAA is happy. A little VOIP and pager software and you can follow the staff wherever they go, which is one reason WiFi is so cool in a hospital setting to begin with.” He also notes that the iPad can be set up to interface with either an in-house EMR system or a SaaS system by running a small clinic’s signals directly through a router at the nurse’s station.

	In the Change Doctor blog, Lyle Berkowitz, MD, says he could see the iPad used for “data retrieval, some ordering, and possibly some basic documentation.” He thinks that the iPad “might make the most sense in the inpatient setting, where there is a lot of movement and a big limiting factor has been not enough computers for all the rooms” versus the outpatient setting, “where one doctor usually works consistently in 2 to 4 rooms” and “having a regular PC type device (or net device) with a large monitor and keyboard still makes the most sense for now.”

	The iPad will also spur the development of more robust healthcare apps geared to physicians and consumers. Although the iPad won’t be available for another month, some companies have already announced developing or tailoring existing apps specifically for this device. Epocrates, for instance, will be tailoring its signature drug reference database for the iPad. In addition, 

 announced that its Voalté One solution—a point-of-care app that enables users to send and receive text messages, make voice calls, and receive critical care alarms on the iPhone, allowing for more prompt responses to patient needs&mdash;will be available on the iPad by the time it is released in late March.

	While the iPad may have some drawbacks, it is likely a product that will develop and gain popularity over time. Even with its current specs, it affords some exciting possibilities, especially in the healthcare sector. Do you think you will buy an iPad? 

 to know what you think of this new platform. Send an e-mail to Christina Loguidice, editor, at 

Feature Articles

ON JANUARY 27, APPLE INTRODUCED THE iPad, touting it as "a revolutionary device for browsing the Web, reading and sending email, enjoying photos, watching videos, listening to music, playing games, reading e-books, and much more." 

iPad Should You Make the Investment?

	The explosion of data available though analyses of genetic information on malignant cell lines, human cancer specimens, and “normal tissue” has revolutionized scientific exploration into the causes of cancer, and has helped us understand tumor aggressiveness and why certain cancers are resistant to treatment while others are sensitive to a wide spectrum of anti-neoplastic drug regimens. Further, rapidly evolving data demonstrate in a number of settings that specific molecular profi les of individual tumors can be quite useful in selecting a particular management approach (eg, HER2 over-expression in breast cancer predicting for the utility of trastuzumab) or in deciding whether to administer a class of agents (eg, documented presence of a KRAS mutation in metastatic colon cancer revealing the absence of biological and clinical activity for inhibitors of the epidermal growth factor receptor [EGFR]).

	Increasingly complex genomic and proteomic patterns within individual cancers are being examined, and highly intricate and remarkably sophisticated bioinformatics strategies are being employed to defi ne specific molecular “signatures” that can be used for prognostic purposes or to select specific treatment regimens predicted by these profiles to be of genuine clinical value. But how can clinicians realistically be expected to understand these extremely elaborate analyses? One might even ask how equipped are regulatory agencies to evaluate in detail the claims (for marketing purposes) that a particular genomic pattern is acceptably reproducible and predictive of a well- characterized event or clinical outcome?

	Assistance in dealing with these highly relevant issues appears to be on the horizon. A new term, “forensic bioinformatics,” has been coined to describe the activities of a small group of experts in the extremely complicated and rapidly evolving field of bioinformatics who have elected to serve as independent reviewers of reports of clinical associations involving analyses of molecular 

	This effort has been substantially assisted by the voluntary and sometimes obligatory submission of the original raw data used in these reports into Web-based repositories, permitting subsequent re-analysis by the independent bioinformaticians. Similarly, justifi cations for disagreement with the original report, or re-interpretation of the findings with alternative explanations provided,are openly displayed online for anyone with an understanding of the issues to review.

	 This innovative form of scientifi c interchange and debate is a truly exciting and most welcome development. Importantly, there should be no inherent assumption in this exercise that the original report and analysis is wrong, seriously fl awed, or that the investigators were sloppy in their work if a negative critique of the research is provided. Conversely, it would appear to be inappropriate for any group reporting these associations between clinical outcomes and complex biological processes that may 

	ultimately affect patient welfare to challenge either the wisdom of the concept of truly independent data review or the associated statement that even genuinely excellent investigative efforts can be improved.

	We should be grateful to the individuals and groups with expertise in the area of bioinformatics for their important contribution to ensure the quality of clinically relevant cancer research and the safety of our patients.

Maurie Markman, MD, is editor-in-chief of Oncology Net Guide and vice president of clinical research for University of Texas MD Anderson Cancer Center in Houston, Texas.

ONCNG Oncology

The explosion of data available though analyses of genetic information on malignant cell lines, human cancer specimens, and Ã¢ï¿½ï¿½normal tissueÃ¢ï¿½ï¿½ has revolutionized scientific exploration into the causes of cancer, and has helped us understand tumor aggressiveness and why certain cancers are resistant to treatment while others are sensitive to a wide spectrum of anti-neoplastic drug regimens. 

Forensic bioinformatics: A novel and important use of the Web

	Tired of all those eco-unfriendly memo pads, sketchbooks, and sticky notes? The 

pushes paper one step closer to extinction. This electronic notepad—essentially a small, high-tech whiteboard&mdash;allows you to write a quick note, sketch, doodle, and more. Oncologists may fi nd the device useful for jotting down a research or patient note. The Boogie Board’s writing surface utilizes a highly responsive, pressure-sensitive, plastic LCD that smoothly recreates the pen-to-paper experience. Users simply write or draw on the LCD with the included stylus or any suitable instrument&mdash;even a fingernail. Applying different degrees of pressure varies line thickness and pushing a button erases the screen. Generating and retaining images requires no power, while erasing consumes a tiny amount. A small battery allows over 50,000 uses, so the cost per erasure is significantly less than the per-sheet paper cost of a comparable notepad. The Boogie Board measures 8.8 by 5.6 inches, which is smaller than a regular spiral notebook. It retails for $29.97 and at 0.2 inches thick and 4.2 ounces, is easy to transport. Early feedback has been positive, but users hope updated versions can save individual screens for future access. 

	The Fitbit Tracker is a useful health data monitoring tool oncologists can recommend to patients. Much more than a basic pedometer, the $99 device also records caloric data and tracks sleep patterns. The latter might particularly benefit patients with cancer, who experience higher insomnia rates than the general population. Users clip the ultra-compact device, which resembles a black money clip, to any article of clothing (including undergarments) or carry it in their pocket. The Fitibit uses a 3D motion sensor similar to the Nintendo Wii’s to automatically track calories burned, steps taken, and distance traveled. At night, users attach the Fitbit to their wrist with an included strap and it records how long they take to fall asleep, the number of times they wake up, the amount of time they are actually sleeping, and more. Walking within 15 ft of the included base station syncs the data to the user’s fitbit.com account. Users then log in to their free lifetime accounts to access charts and graphs analyzing their data and goals. The Website also allows users to enter dietary and activity information to obtain a complete health analysis. To check progress instantly, the 

 has a display screen that cycles through steps, calories, distance, and an avatar measuring goal progress.

	Looking for a way to “Go Green” while keeping some green in your wallet? By harnessing energy from interior lighting, the IllumiCharger USB wall outlet charges your electronic devices without charging you a penny. The IllumiCharger recycles ambient light in a process similar to the powering of solar classroom calculators. It reduces your power grid consumption and consequently, lowers your monthly energy tab. The ubiquitous USB charging connection is starting to come standard with most electronic devices. The IllumiCharger helps you “keep up with the Jobses” with two USB inputs for your recharging needs. You can place 

in multiple rooms and eliminate bulky adapters. The device also scores Green points with completely recyclable packaging and a shell made from recycled and corn-based plastic. This grid-less electricity source is one of 18 finalists in the Greener Gadgets Design Competition. 

Gadget Watch

	Dating can be a terrifying and frustrating endeavor, especially if you are shy or socially awkward. It may seem impossible to even meet someone when you find yourself struggling to muster up the courage to initiate a conversation. Now imagine you are struggling with or have just overcome a major health issue such as cancer. Not only do you have to deal with all the usual dating obstacles, but you have to determine when to disclose this to a potential love interest. If the disease is communicable, such as HIV, there are disclosure laws in place that can put an individual at risk of criminal prosecution if not followed. For those with non-communicable diseases such as cancer, there are no laws outlining when disclosure must occur. Regardless of the illness and laws, disclosure is one of the greatest challenges faced by individuals battling a disease or disability. The fear of rejection can be paralyzing, and there is a fine line between telling someone too soon or waiting too long and risking becoming emotionally vested.

	The Internet has made dating a little easier, and while online dating had some stigma attached to it in the past, it has become more commonplace and acceptable. A benefit of online dating is that it bypasses issues of social awkwardness or shyness and allows you to determine whether you may be compatible with someone before you meet them; however, if you have an illness, determining when to reveal this to a potential mate you’ve met online is still a struggle. Do you tell them before you meet? Can you handle potential rejection if you tell them after you meet? This is precisely the dilemma that a new genre of dating sites geared specifically for individuals with illnesses are seeking to eliminate.

 had the opportunity to interview the founders of two of these sites: 

. The first site has over 8000 members and provides a social network to people with various conditions, ranging from cancer and HIV to obesity and alcoholism, whereas the second has about 1600 members with cancer. In speaking with the founders, it became clear that because these sites allow users to be upfront with their illness, they can concentrate on developing meaningful relationships without the fear of being rejected because of their illness.

	While an oncologist’s role is not necessarily to play matchmaker, helping with complex emotional issues can go a long way toward putting a patient on the road to recovery. This may be especially important for patients facing disfiguring surgeries such as mastectomy, which may leave them feeling unattractive and undesirable. As noted by Jan Gurley, MD, an internist physician practicing in San Francisco, in her Dating Post Diagnosis: 6 Practical Tips 

 post, “for many patients, when it’s time to face recovery, and the battle for survival has receded a bit, self-doubt is a disease that is epidemic, and virulent. Left unchecked, it can mutate into self-loathing, and then leave permanent emotional scars that can disable.” She notes that physicians can prevent this by focusing on the whole patient, which may entail venturing into uncomfortable territory and talking with patients about intimate matters, including dating. Websites such as Prescription4Love.com and cisforcupid.com may serve as a resource for helping some patients develop meaningful relationships and restore normalcy to their lives following a devastating diagnosis.

 was founded in February 2006 by Ricky Durham as a dedication to his brother, Keith, who had suffered from Crohn’s disease, which had caused Keith’s weight to drop to as low as 75 pounds at times and resulted in him wearing a colostomy bag. A major issue for Keith was disclosing his illness to others. “Deciding when to tell someone you have a colostomy bag is incredibly difficult,” Ricky told 

. “I thought if Keith had a chance to meet someone with a similar condition, there would be no need to have to disclose anything. This is when 

 became a vision,” he added. Although the Website was still in its developmental stages when Keith passed away in July 2004, he liked the idea.

	The Website started with 11 conditions and a simple design, and has grown considerably over the 4 years it has been in existence. Currently, the site has over 8000 users worldwide and over 40 conditions listed, including communicable and non- communicable illnesses; genetic, cognitive, and metabolic disorders; and disfigurement from burns or amputation. It includes “men looking for women, women looking for men, women looking for women, and men looking for men,” said Ricky, who also noted that new members are signing up daily, with many willing to date outside of their illness. This expands the options considerably because some people do not want to date someone with the same illness, and these sites have few members compared with major online dating outlets like eHarmony and Match.com, which have millions of users.

	Prescription4Love was initially supported by Ricky’s father, but they recently started charging a fee of $9.95 to help pay for expansion of the Website’s features. Members now have the ability to contact each other through e-mail, instant messaging, or via a new blogging feature that is set up similar to Facebook. Registration takes just a few minutes, and once users complete and submit their registration form, they can start searching for potential matches. “All private information and e-mails are kept confidential,” assures Ricky.

	While some users have been asked to be removed from the site because they have found love, Ricky notes that many who make love connections opt to stay on because the site is also a friendship site. This is similar to CisforCupid.com, another emerging site, but one that is focused on cancer. 

) was launched in 2007 by Lesley Topping, a breast cancer survivor and film editor living in Brooklyn. The site “serves as an alternative online dating service for people whose lives have been affected by cancer,” Topping told 

 She noted that while it may not appeal to everyone since cancer is stressful and raises many concerns, it nevertheless serves as a useful resource to others, “allowing them to connect in a direct, open, and supportive setting with others who can relate.”

	While some have equated online dating with entering a meat market, CIFC instead evokes a feeling of peace and community as one is greeted with a tapestry showing red-crowned cranes on the home page and other images subtly representing love when perusing other sections of the site. Lesley chose the cranes to represent CIFC because they are symbols of longevity and love in some parts of the world, and she found their picture comforting during her treatments. She hopes the cranes will bring others comfort as well, noting that many use the site as they are undergoing treatment. This finding surprised her, because she envisioned it mostly being used by those who have completed treatments.

	CIFC operates similar to other dating sites. First users submit their e-mail address for verification. “E-mail and other personal information is never sold or given to outside sources,” noted Lesley. Once the address is verified, users can create a personal profile, sharing their information and describing what kind of relationship they are looking for. “Users are not required to discuss their cancer in their profile,” said Lesley. Once a profile is approved, the ability to search profiles and communicate with others via a private mailbox is enabled. In the coming months, CIFC is looking to add the ability to blog.

	As of January 2010, the site had over 1600 users. Although women largely outnumber the men, the demographics are changing as more users are becoming aware of the site and registering, which is free. The site is currently supported through donations and its online shop on 

, which features items such as coasters and canvas bags adorned with CIFC’s signature cranes.

A Personal Account of Dating Despite Cancer 

 had the opportunity to discuss online dating with Jeanne Sather, who had generated a media frenzy in 2007 after placing a personals ad on her blog, The 

, looking for a Canadian husband. The ad read, in part, “Assertive, adventurous 52-year-old woman, living with incurable cancer, would like to meet a marriage-minded Canadian gent who is a cancer survivor or living with the disease. ... You: Age 45 to about 57. Canadian citizen living in Vancouver, B.C., or willing to relocate there. Cancer patient or survivor. Open-minded. Bit of a risk taker. Warm hearted but not clinging. Bald OK.” She received quite a few offers, mainly from men in their 70s, but also one from a beautiful, healthy, young, heterosexual, black woman living in Ontario who was willing to help Jeanne out. “[The ad] was more a political statement about the lousy state of health insurance coverage in this country than it was a serious search for a man, but I did meet a few men,” Jeanne said. 

	Jeanne is an outspoken advocate for cancer patients whose breast cancer journey started in 1998 when she was 43 years old. She underwent a mastectomy followed by 12 weeks of chemotherapy. During this time, she was dating a man, but it did not work out. “I ended the relationship immediately. He was not someone who could cope with any of this, and he made that clear early on by putting demands on me—he needed me to take care of him, and I was the one with cancer!,” she said. “I was also working full- time as a journalist, and I had two young children. My sons were 13 and 8. With the demands of cancer treatment on top of everything else, I think I felt that there wasn’t time or energy for dating. And it seemed so superficial, worrying about impressing some guy, when I was facing life and death issues.”

	In 2001, Jeanne learned that the cancer had metastasized to her bones, and she has been receiving almost continuous treatment since then. In 2008, she wrote in her blog “having gotten my cancer beaten back, yet again—I feel like looking around,” and so she posted a profile on CIFC, but never received a response, noting that part of the problem is that women largely outnumber the men on these types of sites. “I think women in general are much more willing to take care of a partner who has cancer, and are more willing to enter into a new relationship with someone who either has cancer or has a cancer history, than men are,” she notes. This astute observation was recently confirmed in a 

 that revealed a much higher incidence of separation or divorce following a cancer or multiple sclerosis diagnosis in women than in men, with a divorce rate of 20.8% versus 2.9%, respectively.

	In April 2009, Jeanne discovered a new dating site, geared specifically for the terminally ill, called Till-Death-Do-Us-Part.com. She posted a profile, but could not contact the handful of people who were registered on the site, and even sent an e-mail to the founder to no avail. The story behind that Website is unclear, and it is no longer in operation. Jeanne is now spending time with “Car Guy,” as he is referred to in her blog. He is the mechanic who fixed her 1964 Corvair, and they have cultivated a deep friendship, which can be complicated at times because of her cancer.

	Based on her experience, Jeanne recommends that the first place those with cancer should search for someone to spend time with, and potentially their life with, is in the real world, through night classes, support groups, and volunteering. According to Jeanne, this allows people “to get to know you and become friends before you look at them as potential partners.” She notes that while this approach takes more time, it is more likely to be successful. As a second option, she suggests going to Websites geared specifically for people with cancer or other health problems.

	Individuals facing cancer or those who have completed treatment may want to start dating, but the thought of jumping in may be overwhelming. Disease-focused Websites like Prescription4Love and CIFC provide these individuals with another alternative, while eliminating the potential dilemma of when to share one’s medical history with a potential love interest. Although these sites currently have relatively few members, they are growing daily and expanding their features, which may draw in even more people. As the sites grow, so will their potential for making love connections.

Cover Story

Dating can be a terrifying and frustrating endeavor, especially if you are shy or socially awkward. It may seem impossible to even meet someone when you find yourself struggling to muster up the courage to initiate a conversation.

February 2010