I sit at my desk in a cubicle with high ceilings and an open entryway. It is dark except for the somewhat eerie glow of light emitted by CRT monitors. With concentration and some sense of urgency, I methodically plow through the queue of studies to be interpreted. Some are marked STAT, some not. I address the former first.
Our ER is a busy one. Many cases come from that department. …
Smoking is the ultimate thief of time
Last year, I retired from full-time practice and moved to a new area. At about the same time, my wife was diagnosed with breast cancer, and because she was in good health prior, she had relatively little contact with the health care system as a patient.
Before our move she worked as a part-time school nurse, so we were able to share provider horror stories from different perspectives. Since we moved …
The patient experience: 4 observations from a physician
The big story recently is that the American Cancer Society issued an updated guideline recommending that women undergo mammography less frequently than before.
This announcement was denounced on both “sides” of the perennial debate. Those in the “mammograms save lives” camp are outraged that a scientific society dedicated to cancer prevention and treatment would issue a proclamation that seems to run counter to the notion that “early detection saves lives.”
Those …
The new mammogram guidelines emphasize that screening is a personal decision
I am superstitious, and I freely admit it. I don’t use the word “cure” with patients until the 5-year scan has come and gone cleanly. I don’t celebrate the scans showing tumor response until I see them myself and make sure I am not mixing up the new scan with the old. And one of my most closely held superstitions …
A cancer patient who had bad luck with clinical trials
“Isn’t she … isn’t she pretty in pink?”
– Psychedelic Furs, Pretty in Pink
October in New England. The sky is a brilliant blue, the leaves on the trees are turning impossible shades of orange, yellow, and red.
October is Breast Cancer Awareness Month, so in addition to the brilliant fall colors all around, people are wearing pink clothing and pink ribbons, and products on …
It’s time to rethink pink during Breast Cancer Awareness Month
Recently, the clinically positive results from the CLEOPATRA oncology trial were released, showing that pertuzumab, when added to docetaxel and trastuzumab as first-line chemotherapy, produces an average survival benefit of 15.7 months in HER2 positive breast cancer patients.
That good news notwithstanding, the authors calculated that Genentech’s price for adding pertuzumab to gain one quality adjusted life year is a breathtaking $713,219. In …
Why reform needs to start at cancer care
In the past year, the CHEST Foundation, the foundation of the American College of Chest Physicians, has created public service announcements and surveyed fans at sporting events such as the Daytona 500, Green Bay Packers football games, and the Indy 500. We’ve asked them questions about lung cancer, and the answers we’ve received aren’t too surprising.
When asked, “What is the …
Why we need to pay attention to lung cancer
Diagnostic tests such as CT scans are not perfect. A test can make two errors. It can call a diseased person healthy: a false negative. This is like acquitting a person guilty of a crime. Or a test can falsely call a healthy person disease: a false positive. This is like convicting an innocent person of a crime that she did not commit. There is a trade-off between false …
Doctors are thanked by the false positives but sued by the false negatives
Evey: “You did this to me? You cut my hair, you tortured me … you tortured me!”
V: “You said you wanted to live without fear. I wish there was an easier way, but there wasn’t.”
– V For Vendetta
A month ago I logged into my medical record to check the results of a PET scan part of a neurologic workup my oncologist ordered. I had called his office about the results, but as the end …
So I am still here. I live to fight another day.
Cancer drugs have become increasingly expensive in recent years. No one blinks anymore when a new lung cancer or colon cancer treatment comes to market priced at more than $100,000 per patient. In part, we don’t blink because we have simply gotten used to such prices — the shock has worn off.
Moreover, many of these new treatments are targeted therapies that only work for patients whose cancers express specific mutations, …
Are new cancer drugs really worth their price?
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
Even though I have had health insurance continuously since finishing training, I found the costs of illness significant. So that the costs of care cancelled my income for working nearly half a year. No wonder so many people have gone bankrupt due to health care expenditures. This was a major impetus for health care reform and the Affordable Care Act.
Fortunately for me, my savings and those left me by my …
Why cancer outcomes to vary by socioeconomic status
I have written about the support that a partner/spouse provides to someone living with cancer — with prostate cancer and for young adults with cancer — and I always include the partner in discussions about treatment choice or sexual difficulties.
But a number of my older patients are single, and their experiences …
Who said that the older years are golden? They seem pretty grey to me.
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On the business side of health care, doctors are at a disadvantage. Because of their training, or lack therein, and native personality, they often fail to understand the realities of the market place, take confrontation personally and are suckers for an aggressive sales pitch. They feel that their motives are pure and because they sacrifice themselves and their families, over many years, they should receive respect and success. “I build …
For doctors to survive today, they need emotional intelligence
What is not to like about medical marijuana? It treats pain, vomiting, fatigue, anxiety, depression, insomnia, seizures, muscle spasms, Crohn’s disease and allows many cancer patients to resume remarkably normal lives. It is not addictive. It does not interact with other medicines. It acts quickly and is easy to adjust. It can be consumed in numerous ways. It is safer than essentially any other drug: 1,500 Tylenol deaths in the …
Legalize medical marijuana? See how a decision can affect this cancer patient.
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
The recent announcement by a California company offering DNA blood tests (also known as “liquid biopsies“) for the early detection of cancer takes us to a place most of us expected we would get to, but much earlier than we are prepared for. Simply stated, our technology and rush to get new tests to market — even before we have a basic understanding of how to use those …
A liquid biopsy for cancer: Too good to be true?
There are two, old, particularly nasty rumors, about cash and cancer. The first, which seems to be fading, is that scientists cured the disease long ago, but the pharmaceutical industry suppresses the cure so they can get rich selling worthless therapies. This never made sense to me, since the company or person that cures cancer will be rich beyond anyone’s wildest dreams. In addition, I have personally known several thousand …
It is time for an honest conversation about money and cancer
The 20th century saw striking advances in curing childhood cancer, primarily as a result of the discovery that broadly toxic chemotherapy agents could kill malignant cells. As a result, pediatric cancer, once a virtually incurable disease, now enjoys an overall long-term survival rate that tops 80 percent. In the 21st century, attention is turning to newer agents that promise to open additional, less toxic avenues to cure. As we mark Childhood …
4 things on the horizon in childhood cancer
From her vantage point, cost had nothing to do with money. On most days, she struggled to her feet when I entered the room, greeted me effusively, and escorted me to her bedside chair, all the while chattering about the inadequacy of our hospital’s slushies, the beauty of the day outside, and the latest update on her children’s accomplishments at school. Despite her debilitating malignant small bowel obstruction from ovarian …
How a head CT changed everything for this patient
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