I just finished reading George’s recent post on Evelyn Lauder, who recently passed away from ovarian cancer, and am still stirred by the passing of Patrick Swayze from pancreatic cancer and Elizabeth Edwards from metastatic breast cancer. There’s a reason I am a surgeon, and not a medical oncologist. Death has this bleak sadness about it, that eternal optimists ...
Posts tagged Cancer
A look behind the growing cost of cancer drugs
Julie Gralow, an oncologist at the Fred Hutchinson Cancer Center in Seattle, recently prescribed an exciting new therapy for a 60-year-old woman with metastatic breast cancer. Three-and-a-half years into her battle against the disease, the patient had already exhausted three different anti-estrogen therapies, each of which only put a temporary check on the spreading tumors.The newly prescribed drug, Novartis’ Afinitor, is one of the recently approved targeted therapies that have ...
How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve.No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease is at an advanced stage. Tests to look for the disease, such as the transvaginal ultrasound or the CA-125 blood test, are not specific enough. That leads to false positive tests that necessitate more studies that may not ...
Why we need to go from e-patient to i-patient
I found a recent Associated Press article on an aspect of the new health care law that many of us may have overlooked. It requires consumer-friendly summaries of what insurance plans cover, a provision that now seems to be at risk. The insurance industry is up in arms about implementation costs and added regulatory burdens. (There’s a good story at NPR, which includes a link to an example of ...
Experiencing an uninvited gift
It's been five years since she was told she was cancer free. Today she was told it was back, and the future was quite grim.My job was to make sure she understood how to properly take the medication that would reduce the swelling around the tumor so radiation could start as soon as possible.That was my job. Clinically speaking it wasn't the most challenging or difficult issue of the day as I ...
How the CA-125 became a $50,000 blood test
What could be so simple as a blood test?A quick prick with a needle, a wait of a day or two for results and a discussion with the doctor about those results. In the words of our vaunted politicians, it would be an “up or down vote” on whether there was anything to deal with.That was the thinking of my wife’s physician when she ordered a test called the "CA-125." ...
How a doctor uses Google to market and recruit patients
When I relocated my radiation oncology practice from Jacksonville to Tampa, Florida, I had to figure out how to compete against urologists in a market that was radically different from the one I had left. Unlike their peers in Jacksonville, Tampa urologists owned their own radiation centers, guaranteeing I wouldn’t receive referrals from them.To break the referral pattern, I updated and posted my physician profile for free on an online ...
A reminder that families suffer together
There are two in the solitary sick room. Between covers, attached to the IV, connected to the monitor, is the woman. Cancer assaults her body and she lies trapped. Constant at bedside is her son. Whether day or night, weekend or day, he is there. Always with the question, the concern, the anger.Through weeks of tests, pain and treatment, he is never satisfied. There is always something we are doing ...
How adopting an EHR is like treating cancer
EHRs are not ready for prime time. EHR benefits are questionable and there are documented instances where patients’ deaths were directly attributed to an EHR. EHRs are cumbersome and slow. They are unnecessarily complex and built on very old technology. The people who build EHRs have no concern for the end user and therefore EHR usability is pretty abysmal. And EHRs are expensive to buy and expensive to maintain, not ...
The sense of loss extends beyond the death of a patient
At the end of the year, I find myself thinking about patients usually—and especially those that have passed away. I wonder how their families are coping, how their children are, and whether each day has gotten easier. I think about how my patients died—and whether or not I did enough to ensure that they did not suffer.It's an odd thing ...
MKSAP: 58-year-old woman with acute left-sided flank pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 58-year-old woman is hospitalized for acute left-sided flank pain. She has had fever and night sweats for 1 month and a 9.1-kg (20-lb) weight loss over 6 months.On physical examination, temperature is 37.7 °C (99.8 °F), blood pressure is 135/88 mm Hg, pulse is ...
Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. "There's a cancer ...
How Patrick Swayze died: Why we should care
When I finished my book on famous patients, the most common question I received was “Are the stories of sick celebrities really relevant to other patients?” My answer was that yes, with some caveats, these experiences are well-worth knowing.The same can be said for the story of Patrick Swayze’s terminal pancreatic cancer, which has now been told by his widow, actress Lisa Niemi Swayze, in a new book, “Worth Fighting ...
Incorporating 12-step program concepts into cancer survivorship
The fact that the term “cancer survivorship” is now part of our vocabulary is a testimony to advances made in management of these diseases. Most cancer survivors, however, are not unscathed by the experience. As I tell my patients, they won’t be entirely as they were before treatment. How these issues are dealt with varies from person to person. But, awareness that chronic problems may persist long after treatments end ...
Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy and eventually turned out to be a great writer and speaker. Unfortunately he only does so in German, which is why it doesn’t make much sense to post a video of him here.In a recent talk he gave (German only), he talks about whether a connected and ...
Stories help the public make sense of evidence
Recently, I presented Family Medicine Grand Rounds at Georgetown University School of Medicine on resolving conflicts between screening guidelines. During the question and answer session, Department Chair James Welsh, MD asked how evidence from carefully conducted clinical trials can possibly overcome powerful emotional stories of "saved lives."I answered that evidence-based medicine's supporters must fight anecdotes with anecdotes. For every person who believes his or her life was extended by a ...
The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella?“Join my Medicare Advantage plan and get free membership to a local health club, free glasses and dental care.” This time of year, during Medicare Advantage Annual Enrollment period, the only TV commercials that annoy us more often are for lawyers who want to help us if we were injured at work or in a ...
Why palliative care and hospice is the ultimate gift
Dear Doctors:I am writing no less than 45 days after my mother died from a GI bleed from ovarian cancer. Not once did my mother's team of doctors mention palliative care. It was not until days and even hours before her death that hospice was discussed and implemented. Our family was blindsided by this.While no one likes to talk about the topic of death, it is important to remember that ...
An oncologist’s deal with fate
Recently, a very dear friend learned that her breast cancer (diagnosed in 2010) had spread to her brain. Despite my many years as an oncologist, having faced questions from my own patients about "Why me?", "What did I do to deserve this?"—questions I am fully aware have no answer—I found myself asking the same questions, expressing the same anguish: "Why ...
Why mammography is an imperfect test
It is a scenario familiar to all breast imaging practices.A patient feels a lump in her breast and calls her doctor. The doctor examines her, agrees that a lump is present, and refers the patient to a breast imaging facility for a diagnostic mammogram and breast ultrasound (also known as a sonogram). At her mammogram appointment, a little sticker is placed on the lump felt by the patient, and mammogram ...
