The patient was well over 6 feet tall and looked like he had recently lost weight. When he took off his winter coat and hung it over the back of the chair, I could see his scapulae like wings under his sweater. He folded himself into the chair and carefully crossed his legs. He sighed softly as he arranged his ...

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asco-logo Mr. G* was diagnosed with advanced prostate cancer two years ago and has been on a succession of medications to control a progressive cancer. His PSA never nadired after surgery, and adjuvant radiation only increased his urinary problems. Androgen deprivation therapy added to his symptoms, and he is now considering taking a second-generation androgen-receptor antagonist. Fortunately, his cancer has not ...

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asco-logo The couple that entered my office on a warm fall day seemed out of sorts. She looked nervous, and he looked irritated. Before he sat down I heard why he felt that way: “I don’t even know why we’re here.“ I explained briefly what my role is but this did not seem to clear up anything. “I just want her to be ...

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asco-logo Do you ever wonder what the staff in hotel conference rooms think about what we talk about in presentations and lectures? I talk about sensitive stuff -- sexuality, fertility, etc. -- and I use words that many people have not said out loud in front of hundreds or thousands of people. I’m used to the words, of course, and they ...

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asco-logo It’s become a common practice in oncology institutions across North America: A patient completes their prescribed course of treatment and they ring a bell. Usually, it's a large bell, like one that used to be rung in schools signaling the end of recess. Or it's a ship's bell, attached to a wall outside the radiation department or the chemotherapy unit. ...

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asco-logo Going through the process of diagnosis, treatment decision making, and often lengthy treatment without a partner can be challenging. While children, friends, and other family members are supportive, for the single individual, there is no one to talk to in the middle of the night when fear and doubt often surface. I often counsel people who have finished treatment for their ...

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asco-logo The woman waiting to see me looked every inch a lawyer or accountant in her black pencil skirt, pink shirt, and a Chanel-style houndstooth jacket. Her ankle boots were reminiscent of those worn by women in Victorian times with a row of small buttons up the side. She had a scarf loosely knotted around her shoulders, and her hair was ...

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asco-logo I recently attended a lunchtime session on the Choosing Wisely initiative. This public and professional awareness endeavor attempts to educate the public and health care providers about procedures that do not benefit patients, and that may ultimately cause harm. It was an interesting educational session and while most of the content was not new to me, one of the statements by ...

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asco-logo It usually starts with a phone call: “Doc, can I come and talk to you about something?” The “something” might be erectile difficulties or other side effect(s) from prostate cancer treatment. It might be confusion or indecision about what treatment to agree to. I always inform the caller that any of these issues are better resolved if their spouse/partner is present and ...

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asco-logoSarah* is a new patient, referred to me because she is having difficulty deciding on treatment for breast cancer. I don’t know much else about her, and a quick review of her electronic medical record tells me that she is 48 years old and has hormone-positive disease in her left breast. There are numerous missed appointments, and it appears that her ...

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asco-logo As the patient talked, I found myself nodding my head. In so many ways, she was just like me. Highly educated, a professional, a woman who had worked hard and long to get where she was. And then cancer took it all away, or at least that’s the way she described it. She was diagnosed with metastatic cancer one year ...

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asco-logo I am in the privileged and humbling position of hearing the stories of patients’ pasts. Sometimes the stories are so horrendous that it takes all my energy to stop myself from crying as they recount the brutality of their experiences. I have heard harrowing descriptions of all manner of abuse done to patients when they were children. The abuse was ...

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asco-logo I see these couples quite often: the man has been prescribed androgen deprivation therapy and his partner is distressed. He no longer has erections, although for some that had been a problem for years. But even then, they tell me, he at least tried occasionally. Now there is nothing. No hugs, no kisses, no hand holding, no touch. The partners are ...

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asco-logoI had never met the man, but from a brief reading of the notes in his medical record, I knew that this was not going to be easy. Thirty years old with stage III kidney cancer, the notes showed a long history of missed appointments and late arrivals. I had been asked to talk to him about sperm banking and so ...

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asco-logoThe couples I see for counseling are not always perfect, not that any couples ever are. But when cancer enters the relationship, for some couples, things get ugly and get ugly fast. I believe that we like to think that cancer makes people “better”; that people rise to the challenge and become the best they can be. I think that we ...

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asco-logo One of the nurses knocked on my door on a quiet Monday morning. “Hey, can you see this patient? I guess it’s not urgent but he’s here now, and I think what the doctor told him just threw him for a loop.” Of course I had time. In my role as clinical nurse specialist in a busy uro-oncology unit, I see men who ...

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asco-logo Many of the couples that I see in my practice grow closer after the diagnosis and treatment of cancer. I describe it as being forged by the searing flames of this dreaded disease. First, comes the terror of the diagnosis and the fear of losing one’s love. I see it in the eyes of the women and men as they sit ...

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asco-logo Ten years ago, I first met this patient, newly diagnosed with intermediate-risk prostate cancer. As I walked into the examination room, I was struck by the juxtaposition of his wife, crumpled in a chair and weeping silently, with the patient himself, pacing the 12'-by-4' room with a look of either anger or frustration. This difference in response between the man and ...

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asco-logo I was sitting in a meeting, listening and participating, but at the same time keeping an eye on my email. I always do this, sometimes to my peril. Email is distracting, and more than once I have been called on to say something and I have no clue where the discussion had gone as I glanced at my inbox. At this ...

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asco-logo We’ve come a long way from the 1940s and 1950s when men didn’t cry — not when they stubbed a toe or came back from the war and certainly not in front of strangers. In the last 20-plus years, we have seen a loosening up of the "stiff upper lip," and we now see men crying in all sorts of places. ...

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