Cancer screening in those with metastatic disease“Your cancer has come back.” These are words no one treated for cancer wants to hear, yet they are words I have said far too often in my own career. In this case, I had said this to a patient I had cared for ever since her initial diagnosis. At that time, she had stage III breast cancer. After her surgery, ...

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Cancer care for international patientsThe world is a big place and here in the U.S., we are fortunate to live in a part of it where we have access to technology and advanced medical care, clinical trials, and new therapies, even before they are approved by the Food and Drug Administration. Indeed, even new agents approved for one indication can be prescribed off-label in ...

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Treating cancer should not be paved in our patients financial despairMartha (name changed) had recurred yet again -- her third in as many years. Despite our best attempts, remission proved fleeting. Fortunately, she had few (if any) symptoms of the cancer in her abdomen; no bloating, no nausea, no difficulty moving her bowels. Her concerns were more psychological -- anxiety and frustration because her cancer refused to go away, and indeed, ...

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Can narrative medicine inform quality of care? As characterized by Dr. Rita Charon in her JAMA article almost 15 years ago, narrative medicine is “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” It is the recognition that scientific knowledge alone is not enough -- not enough for our patients, for ourselves, and for society. It stresses the importance of not only hearing what our ...

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When patients ignore the evidence: Try to understand their valuesI still remember being taken aback by how young she was. “She” was Mary -- a 28-year-old woman who had completed chemotherapy for stage II breast cancer. She was treated elsewhere and had moved cities when her husband got a promotion. “I’m still getting used to this area, but I am happy my hair came back before we had to move. I ...

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Are physicians ready for the e patient movement?I gave a talk recently to a group of my peers about addressing the needs of patients after a diagnosis of cancer, emphasizing points where transitions occur -- from treatment, to end of therapy, surveillance, recurrence, and extending all the way up to the end of life -- and how important it is to consider the entire journey of a person ...

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Twitter and cancer patients: What to make of the outrage?On one afternoon last week, I sat at my desk working on a paper when my iPhone buzzed, telling me I had a new message. This message, forwarded from my Twitter account, alerted me to an editorial published in the Guardian (which has since been removed because it was “inconsistent with the Guardian editorial code). Entitled, “Forget funeral selfies. What are the ethics of tweeting ...

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The desire to have a baby in the face of metastatic cancerShe came to see me, alongside her husband. She was 26-years-old, diagnosed with metastatic myeloma involving her bones, which had presented when she fractured her hip while jogging. Her disease had progressed on treatment and she was to start a clinical trial. Despite being pale, she looked well. I imagined she often heard, “Wow -- you look too good to have ...

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Valuable lessons I have learned as an oncologist come from patientsEvery once in a while, something unexpected occurs that shakes me to my core -- where I question the point of life, ask why we even bother; when in the end, it all just ends. This time, it happened on a Sunday morning. I woke up in a good enough mood -- the sun was shining through my windows, and my cat, ...

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There can be hope at the end of lifeI remember when Susan*, a close friend of mine with breast cancer (who had been living with metastatic disease for about a year before), was told she was  terminal. Beyond the shock and fear, Susan felt grief and anguish that her life would end so much sooner than she (or any of us) had expected. Suddenly, Susan had so many big ...

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