Oncology and Hematology

Physicians writing on KevinMD about cancer: the screening argument that has run since 2009, how a diagnosis is delivered, what treatment costs patients, life after treatment, and what the work does to oncologists. Four maintained records draw on this archive: Cancer: what physicians say, in their own words, End of life: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Opioids: what physicians and pain patients say, in their own words.

When colon cancer is diagnosed, it’s also a difficult day for the gastroenterologist

Michael Kirsch, MD

Conditions and Diseases

July 15, 2019

Exercising good judgment can mean the difference between life or death. Life can be unforgiving of the choices we make. As we all know, many life events are beyond our control and understanding. But, there is much we can do to shape our paths to a brighter destination.

Consider some of the choices listed below that many folks make every day. Are any of them familiar to you?

Texting while driving.

…

The line between family member and personal doctor

Brian Vukelic, MD

Physician

July 12, 2019

I, like many physicians, am the only doctor in my extended family. To say that they are proud is probably an understatement. I’ve been a practicing physician for seven years now and yet my grandmother each time I see her greets me with, “There’s my doctor grandson.” I have worked quite hard to get to where I am, and I enjoy what I do. I, too, am proud to be the …

How can data analytics to improve the care and outcomes of cancer patients?

J. Leonard Lichtenfeld, MD

Health Technology

July 11, 2019

I want to share some thoughts about artificial intelligence, or as I prefer to call it “data analytics.” Fundamentally: How can we capture the capability of analytics to improve the care and outcomes of cancer patients? And more importantly: How can we harness this technology to help bring back the human touch in cancer care?

Admittedly that’s a large focus covering lots of opportunities. Speak to one expert, and you will …

A physician family’s enraging experiences with the U.S. health care system

Judith Graham

Physician

July 9, 2019

Dr. Hasan Shanawani was overcome by frustration. So, last week he picked up his cellphone and began sharing on Twitter his family’s enraging experiences with the U.S. health care system.

It was an act of defiance — and desperation. Like millions of people who are sick or old and the families who care for them, this physician was disheartened by the health care system’s complexity and its all-too-frequent absence of caring …

After cancer treatment: It’s time to reconsider the ringing of the bell

Anne Katz, RN, PhD

Conditions and Diseases

July 8, 2019

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. …

Take a break from all the bad news, and praise hope

J. Leonard Lichtenfeld, MD

Physician

July 6, 2019

Reading the headlines in the morning newspaper lately can downright depressing. It was with that feeling that I recalled three conversations I had recently with people who have various cancers. And I realized that despite all the chaos around us, maybe it’s time to say something in praise of hope.

Hope is very real, especially when you or a loved one or someone you know is diagnosed and treated for cancer. Hope …

Cancer care costs everyone too much. What can we do about it?

Andrew Hertler, MD

Health Policy

June 24, 2019

Today’s fee-for-service oncology business model misaligns incentives by rewarding practices for keeping margins and service volumes high — even when it’s wasteful — rather than for optimizing patient outcomes.

While discussions of drug pricing dominate the cost control conversation, we, as practitioners, have been abdicating responsibility and missing the opportunity to address cancer’s financial toxicity. We can do better. The practice-level assumption of financial risk for patient care — or the …

What should a cure for cancer look like?

J. Leonard Lichtenfeld, MD

Conditions and Diseases

June 23, 2019

Words have meaning. And when it comes to cancer, especially advanced cancer, there aren’t many words that have more meaning than the word “cure.” It is that very word and concept that is top of mind for some of us these days.

We clinicians are guilty as charged when it comes to reluctance declaring those who have had a remarkable response to treatments for advanced cancer “cured.” Experience has taught us …

When medical science becomes fake news

Brian C. Joondeph, MD

Physician

June 22, 2019

Every week there is another health pronouncement saying what is now good for you and what is going to kill you. Unfortunately, the “what” is often interchangeable — what was supposed to kill you last week is now suddenly good for you or vice versa.

Foods, supplements, and activities, all studied extensively and determined to be either good or bad, then subject to a new study, with the opposite conclusion. How …

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When medical science becomes fake news

MKSAP: 62-year-old woman with ovarian cancer

mksap

Conditions and Diseases

June 22, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 62-year-old woman is evaluated during a follow-up visit for recently diagnosed stage IIIA high-grade serous ovarian cancer. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and completed six cycles of chemotherapy with cisplatin and paclitaxel. The patient’s paternal aunt was diagnosed with breast cancer at age 52 years. …

The Trebek effect: the benefits of well wishes

Richard Gunderman, MD, PhD

Physician

June 21, 2019

Long-time “Jeopardy!” host Alex Trebek announced in March that he had been diagnosed with stage 4 pancreatic cancer. Within days, he offered thanks to “the hundreds of thousands of people who have sent emails, texts, tweets, and cards wishing me well regarded my health.” Then last month, Trebek reported that his cancer was in “near remission,” saying that his doctors “hadn’t seen this kind …

How is Alex Trebek doing with his pancreatic cancer treatment?

Michele R. Berman, MD and Mark S. Boguski, MD, PhD

Conditions and Diseases

June 20, 2019

In a recent People article, Jeopardy! host Alex Trebek shared some good news. Diagnosed with stage 4 pancreatic cancer in March, Trebek said he was told that he has been responding very well to his chemotherapy regimen, and that he’s in “near remission.”

He went on to say, “It’s kind of mind-boggling. … The doctors said they hadn’t seen this kind of positive …

Why so many doctors won’t break bad news to patients

JoNel Aleccia

Conditions and Diseases

June 12, 2019

After nearly 40 years as an internist, Dr. Ron Naito knew what the sky-high results of his blood test meant. And it wasn’t good.

But when he turned to his doctors last summer to confirm the dire diagnosis — stage 4 pancreatic cancer — he learned the news in a way no patient should.

The first physician, a specialist Naito had known for 10 years, refused to acknowledge the results of the …

A physician diagnosed with cancer, and the importance of mentorship

Heather Thompson Buum, MD

Physician

June 3, 2019

An excerpt from Mirth is God’s Medicine: Coping with Cancer as a Physician.

“As iron sharpens iron, so one person sharpens another.”
– Proverbs 27:17

In the coming weeks, after the biopsy returns positive for cancer — and after the initial shock wears off — I am trying to plan ahead, and …

When constipation pain was worse than cancer pain

Robert Centor, MD

Conditions and Diseases

May 30, 2019

Coming in to meet the students, house staff, and patients for the first day on service always excites me. This Monday was no exception. What awaited me? How many patients would I need to see? What lessons could I impart?

When I arrived, we had 11 patients, two new, and nine had arrived previously. Going through the list, while routine, always stimulated questions and teaching opportunities. Sometimes the team had questions …

MRI safety in breast cancer screening

January Lopez, MD

Conditions and Diseases

May 23, 2019

The numbers are scary: The average woman has a 12 percent risk of developing breast cancer at some point in her life. For women with certain genetic mutations or risk factors, lifetime risk can climb to 85 percent.

Even more terrifying than the numbers, however, are the rumors; rumors that the contrast dye used in MRIs for breast cancer screenings is harmful; rumors that are driving women away from an adjunctive …

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MRI safety in breast cancer screening

How this physician does her job while grieving

Dr. Caroline Macari

Physician

May 23, 2019

Two years ago, something happened that — not to be overly dramatic — changed my life, including my everyday experience of my job as an emergency specialist.

My older brother, Martin died of a rare and aggressive form of non-Hodgkin’s lymphoma that spread despite every treatment that was thrown at it.

When he was dying, I managed to unleash in myself a raging anxiety, which caught me by surprise. In the year …

Celebrities are bringing a myriad of health conditions into the public consciousness

Joshua Mansour, MD

Physician

May 21, 2019

It seems now as if every day and every month is associated with a “national day” or an “awareness month.” Some such as “national taco day” may be less important than others, well depending on one’s priorities. Although many illnesses now also have a dedicated day or month, many of these diseases will go unnoticed. They will rarely be discussed — that is until a celebrity or someone in the …

This story happens every week in clinics like mine and it’s got to stop

Hans Duvefelt, MD

Physician

May 17, 2019

Jeanette Brown had lost twenty pounds, and she was worried.

“I’m not trying,” she told me at her regular diabetes visit as I pored over her lab results. What I saw sent a chill down my spine:

A normal weight, diet controlled diabetic for many years, her glycosylated hemoglobin had jumped from 6.9 to 9.3 in three months while losing that much weight.

That is exactly what happened to my mother some years …

The simplest and most important question to ask in the exam room

Michael L. Millenson

Conditions and Diseases

May 16, 2019

It was the first time the young woman had come to the health center in a suburb just north of Chicago. When the 26 year old walked into the exam room back in 2008. There was no paper chart or electronic health record (EHR) accompanying her, no background information — nothing to indicate anything but a routine annual gynecological exam.

She and her husband were about to try to have their …