Oncology and hematology

2,498 articles · Since 2004

Articles, page 46

At the end of life, medicine truly becomes an art

January 8, 2016Jan 8, 20163

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, …

Physician voices

Doctors are not in control. Perhaps this is our greatest challenge.

James C. Salwitz, MD

January 4, 2016Jan 4, 2016

There are times, as a healer, I feel helpless. These are not just the moments when cancer consumes. I understand that the dread disease has yet been conquered, and there is still terrible loss. This not when I refer a patient elsewhere; I know my limits. Rather, these are the times when I am trapped, ignored, and the result is needless suffering.

In his classic, often quoted, 1942 short story, Runaround, …

Physician voices

I’m not worried about colon cancer. I’m worried about the potential colonoscopy.

Justin Reno, MD

January 2, 2016Jan 2, 201612

“Don’t forget to bring that stool card back in, OK?” As he walked out of the room, carrying his portable oxygen, he turned back, with the nasal cannula in his nose, and replied, “I’ll get it back to you soon.…

“Don’t forget to bring that stool card back in, OK?”

As he walked out of the room, carrying his portable oxygen, he turned back, with the nasal cannula in his nose, and replied, “I’ll get it back to you soon. I’d hate to have colon cancer.”

At this point, I’d hate for him to have a positive occult blood card. I could really care less about colon cancer. Colon cancer isn’t going …

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Physician voices

Fear, anger, and loss should have burned me out. But it hasn’t.

James C. Salwitz, MD

December 31, 2015Dec 31, 2015

Three decades at cancer’s bedside has taught me about fear. I have seen denial postpone critical diagnosis. I have watched mistrust and anger yield poor choice. I have fought against terror that spreads malignancy by delaying treatment. I have shared…

After so many thousands of patients, so many wasted lives, you would think I would have given …

Physician voices

How the meat industry is acting like big tobacco

Shivam Joshi, MD

December 26, 2015Dec 26, 201510

Recently, the World Health Organization (WHO) released its report condemning processed meat as a group 1 human carcinogen -- a classification that includes such notorious companions as tobacco smoking, smokeless tobacco, and second-hand smoke. This is not surprising considering that…

Recently, the World Health Organization (WHO) released its report condemning processed meat as a group 1 human carcinogen — a classification that includes such notorious companions as tobacco smoking, smokeless tobacco, and second-hand smoke. This is not surprising considering that processed meat contains many of the same known or probable carcinogens as cigarette smoke, like heterocyclic amines and N-nitrosamines.

Red meat was labeled in the runner-up category as …

Physician voices

For each cancer patient, there is one perfect path

James C. Salwitz, MD

December 16, 2015Dec 16, 2015

There is only one correct, perfect, absolute approach to life and decisions near its end. This truth relieves the doctor of final decision. The right way lifts the burden of anxiety, confrontation or guilt. The perfect path makes giving care at a very hard time, much easier. That correct course, the only way to treat every patient and every family, is exactly what the patient and family say it is.

This …

Physician voices

This is why a computer algorithm cannot ever fully replace a doctor’s judgment

Nathan A. Pennell, MD, PhD

December 15, 2015Dec 15, 2015

The past year had been a tremendously exciting time to be an oncologist, and to be a lung cancer oncologist in particular. It seems we hardly have time to get used to one newly approved agent before another one becomes available. In 2015, we have seen gefitinib (don’t I know you from somewhere?), afatinib, nivolumab (twice), pembrolizumab, necitumumab, and osimertinib all …

Conditions and diseases

When an advocate goes too far in the exam room

Anne Katz, RN, PhD

December 10, 2015Dec 10, 20156

When is an advocate not an advocate? When should a spouse step back and let the husband make a treatment decision? When should an adult child of a man with prostate cancer let their father decide what is best for him? These are questions that, fortunately, I don’t have to ask all that often. Most men I see for prostate cancer …

Conditions and diseases

MKSAP: 65-year-old man is evaluated after a recent colonoscopy

mksap

November 28, 2015Nov 28, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 65-year-old man is evaluated after a recent colonoscopy, which disclosed a 2.5-cm pedunculated polyp in the sigmoid colon. The polyp was removed in…

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

A 65-year-old man is evaluated after a recent colonoscopy, which disclosed a 2.5-cm pedunculated polyp in the sigmoid colon. The polyp was removed in its entirety in a single piece. Biopsy results showed a well-differentiated adenocarcinoma confined to the submucosa without evidence of lymphovascular involvement and a 1-mm margin. There is no family history of …

Conditions and diseases

The problem of expert fallacy in cancer screening guidelines

Paul Marantz, MD, MPH

November 23, 2015Nov 23, 20157

The American Cancer Society (ACS), an advocacy organization that has fairly recently (and very positively) taken a more appropriate, evidence-based approach to cancer screening, recently revised its mammography recommendations. While it still recommends more mammograms than the U.S. Preventive Services Task Force (which doesn’t recommend starting until age 50, and then screening only every other year), it has raised the starting age from 40 …

Physician voices

Advances in cancer treatment are built on those of have suffered in the past

James C. Salwitz, MD

November 16, 2015Nov 16, 20153

To cope with loss, oncologists simply forget. Perhaps, “forget” is not the right word. “Compartmentalize,” “separate” or simply “contain,” may be better. We put all those wonderful people who have died, all that suffering, all those lives, in a corner…

Perhaps. However, all those memories remain; they are part of me. Quietly, they change how I practice medicine, what I …

Conditions and diseases

Asking patients about suicide sometimes feels out of place

Anne Katz, RN, PhD

November 16, 2015Nov 16, 20157

We have all seen patients whose distress is off the charts, or off the Distress Thermometer (NCCN). They sit in our offices, dazed and seemingly so depressed that we ask the mandatory question: “Are you thinking of hurting yourself?” Some patients just shake their head, not making eye contact, and even though they say they aren’t going to hurt themselves, we …

Conditions and diseases

Processed meats and cancer: How much is too much?

Albert Fuchs, MD

November 15, 2015Nov 15, 2015

Recently, a group of researchers in the World Health Organization (WHO) released a study that caused a bit of a kerfuffle. The group, the International Agency for Research on Cancer (IARC), published a paper classifying processed meat as a carcinogen. What’s processed meat? According to the authors, it’s “meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavor or improve preservation.” That includes …

Drugs and prescribing

The FDA’s epic regulatory failure

Brian Klepper, PhD

November 9, 2015Nov 9, 2015

A new study in JAMA Internal Medicine finds that two-thirds of cancer drugs considered by the U.S. Food and Drug Administration (FDA) over the past five years were approved without evidence that they improve health outcomes or length of life. (This study closely corroborates and acknowledges the findings published last year by John Fauber of the Milwaukee Journal Sentinel and Elbert Chu of MedPage Today.)

Follow-up …

Read more…

The FDA’s epic regulatory failure

Physician voices

Smoking is the ultimate thief of time

Samuel M. Chen, MD

November 8, 2015Nov 8, 2015

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. …

Read more…

Smoking is the ultimate thief of time

Physician voices

The patient experience: 4 observations from a physician

Thomas D. Guastavino, MD

November 8, 2015Nov 8, 201589

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…

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 …

Conditions and diseases

The new mammogram guidelines emphasize that screening is a personal decision

John Schumann, MD

November 3, 2015Nov 3, 201513

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”…

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 …

Conditions and diseases

A cancer patient who had bad luck with clinical trials

Nathan A. Pennell, MD, PhD

October 30, 2015Oct 30, 20154

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 …

Conditions and diseases

It’s time to rethink pink during Breast Cancer Awareness Month

Kathryn A. Hughes, MD

October 30, 2015Oct 30, 2015

“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…

“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 …

Drugs and prescribing

Why reform needs to start at cancer care

Brian Klepper, PhD

October 29, 2015Oct 29, 20152

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…

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 …

Oncology and hematology

Articles, page 46

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