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.

Stemming the flood of memories that threatened to drown her

Jordan Grumet, MD

Physician

January 6, 2015

Julie was lost in thought.

Her right pointer finger slowly traced the edges of the metallic trinket. It was tucked far enough into her pant pocket that only the longest digit could reach. Back and forth, her hand moved caressingly, pausing from time to time to inspect any irregularity, any imperfection. In such a manner Julie built a mental image of the old forgotten piece of jewelry. Her hands visually occupied …

The hardest and often worst part of medicine: The waiting

Sarah Mongiello Bernstein, MD

Conditions and Diseases

January 5, 2015

My brother wears a scar around his neck. It represents his second surgery for papillary thyroid cancer. The first started off the same way. Ugly, red and angry. Curving like an ominous smile around his neck, like a noose. That’s how it felt too — the lump in his throat growing as he sat quietly, alone in a doctor’s office. It’s interesting how physical scars are a visual manifestation of …

MKSAP: 66-year-old man with vague abdominal pain

mksap

Conditions and Diseases

January 3, 2015

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

A 66-year-old man is evaluated for vague abdominal pain of several months’ duration and a 10-kg (22-lb) weight loss. He drinks alcohol socially but does not smoke. The patient is otherwise well, has good performance status, and takes no medications.

On physical examination, vital signs are normal. No lymphadenopathy is noted. Cardiopulmonary examination …

Being a patient made me a better doctor and physician leader

Craig Mittleman, MD

Conditions and Diseases

January 1, 2015

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It was last summer in July when I became sick. It was a range of not unusual upper respiratory symptoms, but as time progressed and my symptoms didn’t respond to the usual combination of steroids and antibiotics, I became concerned. I’d developed a more distinct pain in my chest and became increasingly mindful about those bad things we see from time …

The people who will cure cancer are the patients

Kenneth D. Bishop, MD, PhD

Conditions and Diseases

December 25, 2014

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Sometimes I tell people I’m learning how to treat cancer, and their first question is ‘why haven’t we cured cancer yet?’

We will. It’s coming.

In medicine, we’re much better at treating infections than cancer, but it wasn’t always that way:

We didn’t know washing your hands before delivering a baby was safer for women until 1847.
The concept of a germ was proposed in 1870.
The first Read more…

The people who will cure cancer are the patients

When discussing cancer treatment, the approach matters

Michael Carbine

Patient

December 20, 2014

Dr. Peterson, the radiation oncologist, gets right to the point.

“The medical center’s tumor board has concluded that your cancer is inoperable, incurable and untreatable,” he says flatly. “Any chemotherapy or radiation treatments would be palliative in nature.”

He begins explaining the reasons behind the board’s verdict, but everything he’s saying washes out. My mind stopped working as soon as I heard the words “incurable” and “palliative.” I am sliding into shock.

Dr. …

What is value in cancer care? It depends.

J. Leonard Lichtenfeld, MD

Conditions and Diseases

December 19, 2014

Value.

A simple word with lots of meanings, all of which depend on the context of the moment. Value in health care — especially in cancer care — is certainly no exception. What is undeniable is that we are seeing an increasing clamor about value in cancer treatment. And one person’s value is clearly another person’s concern.

At the crux …

When going “by the book” hurts patients

Thomas D. Guastavino, MD

Physician

December 19, 2014

I find myself in a unique position. I recently retired as an orthopedic surgeon and my wife and I moved out of my practice area. At the same time, my wife was diagnosed and started treatment for breast cancer. So I got opportunity to interact with the health care system both as a provider and as a family member of a patient receiving long-term care first from providers I knew …

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When going “by the book” hurts patients

After prostate cancer treatment: What about intimacy for men?

Don S. Dizon, MD

Conditions and Diseases

December 16, 2014

I had just started the sexual health clinic at Massachusetts General Hospital (MGH) when I was approached to meet with a group of prostate cancer survivors. I was hesitant at first — my interests were in female cancer survivors who had experienced sexual dysfunction. This was partly because I had assumed men had an easier time accessing information on …

Lung cancer screening and shared decision making: Will it happen?

Kenneth Lin, MD

Conditions and Diseases

December 4, 2014

Recently, the Centers for Medicare & Medicaid Services (CMS) officially proposed coverage for annual low-dose computed tomography (LDCT) screening for lung cancer in current or former smokers age 55 to 74 years with at least a 30 pack-year history. In doing so, CMS followed the lead of the U.S. Preventive Services Task Force, which had previously given a “B” grade recommendation for screening in a similar population through age 80 years.

In the …

A walk in Central Park: Contemplating physician burnout

Bernadette Sheridan, MD

Physician

December 4, 2014

There are times when who you are and what you do are inseparable. A photographer views a scene from the camera’s point-of-view even when the camera is not in hand. A police officer assesses situations with an “on duty” reaction, even when off-duty. And a health care professional rarely turn off the knee-jerk reaction to assist when someone requires help.

That immediate …

Trivializing the significance of losing one’s hair during cancer treatment

Don S. Dizon, MD

Physician

November 30, 2014

Even after so many years, I take the process of starting someone on anticancer treatment very seriously. The drugs we use can cause damage, and that damage can persist long after the end of the last planned treatment. Platinum salts can cause neuro- and nephrotoxicity. Taxanes can cause neuropathy. Angiogenesis inhibitors can result in hypertension. The lists of potential …

We waste a lot of dollars on unnecessary medical care

Peter Ubel, MD

Health Policy

November 26, 2014

It is well known that Medicare expenditures threaten the financial solvency of the U.S. government. And it is pretty well agreed upon that some of our Medicare spending goes towards wasteful medical care.

But which medical care is wasteful and how much is such care costing us? A study in JAMA Internal Medicine provides a sneak peek at answers to these important questions. The research, led by Aaron Schwartz, a graduate student …

Even if no life was saved, an ER physician makes a difference

BirdStrike, MD

Physician

November 26, 2014

I walk out of the patient room. My eyes stare at the computer screen. I’m behind, way behind. I roll my head on my neck. My neck feels tense, and I have a headache. It’s been a long week. I need a vacation. Hurry up, click-click-click this computer, I think to myself. Dammit, is this EMR really freezing up again?

I look …

We need to start skin cancer prevention with our children

J. Leonard Lichtenfeld, MD

Conditions and Diseases

November 25, 2014

The numbers about skin cancer incidence and costs in the United States are worse than anyone expected.

That’s the message that comes from a report published recently in the American Journal of Preventive Medicine on research from the Centers For Disease Control and Prevention, the Agency for Healthcare Research and Quality and the National Cancer Institute.

The researchers took a look at the number of skin cancers …

The costs of fertility preservation in cancer treatment

Anne Katz, RN, PhD

Conditions and Diseases

November 24, 2014

I have fertility on my mind — and it’s definitely not personal. And it’s really fertility preservation that has me thinking. I recently completed the manuscript of my 10th book — a text for oncology care providers about the provision of psychosocial care to young adults with cancer

Writing the book was at times frustrating due to the paucity of research and …

(Dis)comfort measures

Jay Baruch, MD

Physician

November 23, 2014

Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that’s more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now …

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(Dis)comfort measures

More resources are needed for pediatric cancer research

David A. Williams, MD

Conditions and Diseases

November 20, 2014

The fact that childhood cancer is, thankfully, a rare disease belies the fact that it is the leading cause of disease-related death in U.S. children, age 1 to 19. The fact that it is a rare disease also belies the fact the number of people with a direct stake in expanding research into pediatric cancer is quite large and extends well beyond the small number of children with cancer and …

Why cancer still evokes fear

Elizabeth Horn, MD

Conditions and Diseases

November 20, 2014

Nobody, it seems, is comfortable with death. In Haiti, where death and life are fluid concepts, where voodoo curses and ghosts are spoken of as fact rather than fiction, death is comfortably present. The dead are buried in mass graves throughout the country, victims of political crime, violence, malnourishment and infectious disease. There, life can be drained from a healthy person in a matter of hours for lack of clean …

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Why cancer still evokes fear

What Mayor Thomas Menino taught us about cancer

James C. Salwitz, MD

Conditions and Diseases

November 20, 2014

Beloved and deeply respected Boston mayor Thomas M. Menino died on hospice in Brigham and Women’s Hospital recently. Menino developed advanced cancer of unknown primary (CUP) in the spring of this year, and after six months of chemotherapy, he elected to stop active treatment. Reportedly he was comfortable, and surrounded by friends and family at the time of his death. The press, the …

Oncology and Hematology

Oncology and Hematology

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