I remember, when I was a kid, that my grandmother would spend time at our breakfast table reading the newspaper. Not cover to cover, mind you — she seemed to always focus her attention on the obituaries. Sometimes she would look up and tell anyone sitting around her about the death of someone near her age …
Let’s stop calling cancer a war
When I was a resident, my colleagues chided me for wanting to be an oncologist. Back then (and it pains me to be old enough to use that phrase, by the way), oncology was thought of as a field of futility. We administered toxic drugs to patients with cancer, and far more often than not, they …
To be an oncologist today is to be a part of a revolution in medicine
One of the questions that I face (and which I am certain many of us do) concerns the use of alternative therapies. Iron chelation therapy, high-dose vitamin C infusions, Chinese herbs — interest in these therapies and others like them are driven by word-of-mouth (“a friend of a friend”), claims on websites and patients curiosity. Cancer is …
Please don’t mix herbal supplements with cancer treatments
One of the privileges of medicine is the chance to meet people from every walk of life — many of whom you might never get a chance to know otherwise. Of course, such meetings are never spontaneous. In medicine, we are brought together by illness, and the people coming to see me are seeking advice on treatment for …
Being an oncologist is a privilege, even if it’s sad
I believe in miracles. That might sound odd coming from an oncologist –especially since our field is driven by the data. Our path forward continues to be built through trials and the collaboration between clinicians and patients, working together to forge a better way to treat cancer. I certainly believe in evidence, but still … I believe in …
An oncologist experiences the joy of being wrong
As an oncologist, I have witnessed patients go home and heard later how they died there, surrounded by family and friends. I have seen others die in a hospital room, comforted by the care of the inpatient team even as they depart this earth. These are the ones that stick with me and what I think about when …
Not all patients share the same views on end of life
Sometimes, I think that many folks see oncology as an acute care specialty: patients get cancer, get sick, and then they die. There’s an impression that we meet patients only for a moment in time before they are gone forever. But speak to any oncology specialist, and you will see nothing is farther from the truth. While …
Saying goodbye to a patient who’s your friend
Milly* was 82 years old and had been diagnosed with a recurrent ovarian stromal tumor — one that is typically seen in much younger women. Surgery was ruled out, and a colleague from outside of Boston sent Milly to me for an opinion about medical treatment. I reviewed her case before I met her: no significant medical problems, …
A doctor thinks a patient is prepared for death. He’s wrong.
She had come to see me in consultation. A professor at a local university, she was well until four years earlier when she developed abdominal bloating and pain — telltale signs of ovarian cancer. Surgery followed, then adjuvant chemotherapy with intraperitoneal treatments. (“Terrible regimen,” she said.) She was fine for two years, until the bloating recurred heralding …
What’s the one word cancer patients never want to hear?
Evidence-based medicine. It is what we all strive to provide. It means employing the most up-to-date knowledge to the approach of medicine, from preventive care to screening to the diagnostic work-up and treatment. Wherever the data point us, that’s what we should do. Yet putting it into practice can sometimes be the most challenging part of being …
Evidence should not be used to enforce mandates
Most times, I feel excited to be an oncologist. Oncology research is accelerating and every week brings more news, whether it be a deeper understanding of tumor genomics, a broader understanding of cancer genetics and risk, and, it seems, more ways to provide precision therapy. Studies are coming out showing gains in survival in many different cancers, and …
A reminder that there are no guarantees with cancer
As an oncologist who also specializes in sexual health, I have realized just how essential it can be. I have seen many grapple with the consequences of cancer and its treatment on their own sexual view of themselves (their sexual self-schema) and how it can impact the relationship between partners. For some, the experience draws them closer; for …
Cancer’s toll on romance and sensuality
I still remember her clearly. She was a wonderfully vibrant 68-year-old woman from Haiti. She was always impeccably dressed, loved to talk, and had an incredibly infectious laugh. Whenever I walked in to the clinic to see her, her eyes always seemed to smile as broadly as she did.
“Nice to see you, Doc!” she would say. I …
We cured her, but the result was unacceptable
Young women get gynecologic cancers, and I have had my share of conversations about ovarian cancers with women in their 20s and 30s. It rarely happens, but when it does, it is devastating. I make it a point to talk with them about their present and their future; although it is something I try to do with all …
A story that showed me how cancer is a social disease
I was at a meeting in 2014, called the REV Forum; its objective was to rethink cancer care delivery by gathering patients, advocates, thought leaders, and entrepreneurs. Even now I am struck by some of the things I learned that day. One that stays in mind is when a woman who looked like she was in her …
Oncologists teach and comfort. Patients need both.
She had been admitted overnight: a previously healthy 62-year-old woman who had been blindsided by acute onset of abdominal bloating and pain 6 months prior. A flurry of tests showed she had pancreatic cancer, and that it was advanced. She had started chemotherapy, but the regimen was so toxic; she suffered from unrelenting nausea and fatigue to …
Compassion on the inpatient oncology service
I like to consider myself an “evolved” clinician — one who believes in the patient’s voice, personally invested in shared decision-making, always ready to support my patient’s decisions, as long as I know it’s informed by the best data I have available, even when it is not the course I would want them to make. Most of …
This is the key to shared decision-making with patients
She had been a patient for several years, and I still remember meeting her that first time: Her breast cancer was stage IV at diagnosis, already established in her bones; she was scared; she was in pain. Surgery was taken off the table, and she was referred for medical therapy. We had discussed prognosis, the incurableness of her cancer, …
At the end of life, medicine truly becomes an art
One afternoon, I was seated in front of my computer working when a ping came through, notifying me of a message delivered on Twitter. I stopped what I was doing and scrolled through Twitter and then checked my message. It was from someone I had never met in real life (“IRL,” in social media), though I felt we had …
Moms after cancer are a new demographic
Jodi (name and descriptors changed to protect patient identity.) had been diagnosed with ovarian cancer several years earlier, had received adjuvant carboplatin and paclitaxel therapy, relapsed three years later, and since then, had been on several forms of therapy — most recently receiving weekly paclitaxel. She was tolerating treatment well, but a CT scan done to re-evaluate her extent …
Not all patients want to be autonomous
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