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.

How to talk to a patient with terminal cancer? Not like this.

Allen Frances, MD

Physician

October 6, 2014

A friend of mine has been living well with lung cancer for five years — working, running several miles a day, traveling, doing good stuff with his family, and generally enjoying the pleasures of everyday life. He knows the cancer will eventually kill him, but has been making the most of every remaining minute.

Then, a month ago, things suddenly turned dramatically south. Severe shortness of breath, constant coughing, sleeplessness, fatigue, …

There’s a part of us that’s unafflictable

Kenneth D. Bishop, MD, PhD

Physician

October 2, 2014

We’re born into our bodies, and we take that for granted.

Our first job is to take a breath, something we’ll hopefully do many millions of times and never think about. That first breath changes everything: Our blood starts to flow through our heart and lungs in a different way and for the first time we taste a new world.

Before we’re born, all our needs are met via an artery and …

Estrogen therapy and breast cancer: The pharmacist said no

Anne Katz, RN, PhD

Medications

September 28, 2014

It’s not often that I find myself speechless. I have heard all sorts of stories in my office — as a sexuality counselor, I am often humbled by the trust that people place in me and how much they disclose about their private lives. But one conversation I had with a patient literally made my jaw drop.

The patient is a …

Exploring the Angelina Jolie effect in breast cancer screening

Alan Cassels

Conditions and Diseases

September 26, 2014

Up to this point, it had only been a hypothesis: That celebrity firepower can definitively drive consumer health behavior in a certain direction. The case here concerns whether women wish to embark on a genetic hunting expedition to see if they are at high risk of developing a particular disease such as breast cancer, and the motivator in this case is Angelina Jolie.

The actress underwent genetic testing for mutations related …

MKSAP: 69-year-old woman with a lump under her arm

mksap

Conditions and Diseases

September 21, 2014

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

A 69-year-old woman is evaluated for a lump under her arm found on self-examination. She is otherwise healthy and has no other symptoms. Medical and family histories are unremarkable, and she takes no medications.

On physical examination, temperature is 37.4 °C (99.3 °F), blood pressure is 110/70 mm Hg, pulse rate is 72/min, …

Two women, two cancers, two different pathways

Don S. Dizon, MD

Physician

September 19, 2014

I sometimes wonder what I would do if I was told I had cancer. How much would I subject myself to in order to survive, or to achieve remission? As a parent, I can answer only that I would likely go through hell and back if it meant being there for my kids — to watch them grow up, graduate …

The death certificate didn’t say enough

James C. Salwitz, MD

Physician

September 17, 2014

August 17, 2010. Maris is a 57-year-old woman in excellent health. She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law. A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge.

It is 10:11 a.m. when Maris presents to the emergency room. Three hours earlier, her legs became wobbly while …

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The death certificate didn’t say enough

Sex or death: The difficult decisions of prostate cancer treatment

Anne Katz, RN, PhD

Conditions and Diseases

September 12, 2014

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As part of my role as a clinical nurse specialist in a busy prostate clinic, I see men (with their partner) as part of their decision-making process for active treatment for prostate cancer. The purpose of the appointment is for me to explain the results of their prostate biopsy, dispel any …

What’s it like to be an oncologist? This is just one day.

James C. Salwitz, MD

Physician

September 10, 2014

7:00 a.m. Lights on.

Coffee, black and a banana. Paperwork. 27 patient visits, 3 emergencies, 35 phone calls. Lots of computer time. Some laughs and a few tears. Paperwork. Last family meeting. Coffee, black. In between: Thursday.

Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range …

A physician is now biased towards over-testing. Here’s why.

Val Jones, MD

Conditions and Diseases

September 5, 2014

Health screening is part of good preventive care, though over-screening can lead to increased costs, and potential patient harm. Health care professional societies have recently developed excellent public service announcements describing the dangers of over-testing, and new research suggests that though additional medical interventions are associated with increased patient satisfaction, they also lead (ironically) to higher mortality rates.

And so, in a system attempting to shift to a “less is more” …

Does owning cancer equipment change treatment patterns?

Robert Pearl, MD

Physician

September 4, 2014

Today’s article follows the money trail to expose a different form of bias: the kind that takes place when doctors own their own diagnostic and therapeutic equipment.

For people living with cancer, this kind of bias can have a particularly painful impact.

Radiation therapy brings out medical bias

In the United States, cancer is the second most common cause of death, killing nearly 600,000 Americans …

A bystander to the evolution of plastic surgery

Miranda Fielding, MD

Physician

September 2, 2014

I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights. The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop. The tagline is as they say, priceless: “Modern medicine had to start somewhere.”

On the third episode, last Friday …

Cancer screening in the elderly: Don’t be stupid

Kenneth Lin, MD

Conditions and Diseases

September 1, 2014

The electronic medical record that my office uses features a clinical protocol button that we are encouraged to click during patient visits to remind us about potentially indicated preventive services, such as obesity and tobacco counseling and cancer screenings. I once tried it out while seeing a 90-year-old with four chronic health problems. The computer suggested breast cancer, colorectal cancer, and cervical cancer screenings: three totally inappropriate tests for the …

My new practice saves lives

Rob Lamberts, MD

Physician

August 26, 2014

Oh yeah. Hot dang. All right. Groovy.

Boom goes the dynamite.

I had a very great day yesterday.

I saw three patients who had recent diagnoses of cancer. Yeah, those two statements seem to contradict. They don’t. Each person I saw gave me a clear view of how the practice I’ve been building over the past 18 months is making a difference. A big, big difference.

The first patient was a guy who is …

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My new practice saves lives

Delivering bad news: Don’t pass the buck

Don S. Dizon, MD

Physician

August 22, 2014

When I was a fellow, part of our training involved doing consults for patients, most of whom had just learned they had cancer or recurrence of disease. These consults were never easy, but the importance of sitting with someone who had just learned of their diagnosis was an integral part of learning the medicine and art of oncology.

Even after many …

Missed opportunities give leverage to cancer

Kenneth D. Bishop, MD, PhD

Conditions and Diseases

August 21, 2014

Last week a patient said to me, “You live your whole life thinking you’re going to have time to enjoy life later on, and then this happens.” Then he started to cry because we had just reviewed his recent CT scans and some of his lab results and he had a new diagnosis of a type and stage of cancer that meant he likely had about eight months to live. …

How we cope with a cancer diagnosis starts in childhood

James C. Salwitz, MD

Physician

August 21, 2014

A baby’s smile reflects the purity in their heart. An infant’s world is a marvelous place of possibility and love. Children see themselves as special, capable, even omnipotent. Time teaches failure, loss, and mortality. How much we lose of that original perfection, that first excitement, that natural confidence, determines how we face the challenges and tragedies of life; whether we will be happy. It may even determine how we cope …

Oncologist pay and chemotherapy: Buy and bill needs to stop

Robert Pearl, MD

Physician

August 19, 2014

Today’s article highlights the lingering problem of physicians buying and selling prescription medications to patients — at a profit.

The medical profession has struggled with this controversial practice for more than 150 years.

In George Eliot’s 1874 novel “Middlemarch,” an idealistic young doctor named Tertius Lydgate questions the ethics of fellow physicians who make handsome profits prescribing and dispensing their own remedies to the townsfolk. His medical colleagues shun him for it.

Around …

I am so sorry I didn’t make this different for you

Merry Jennifer Markham, MD

Physician

August 9, 2014

The telephone message arrived in my EMR’s inbox. A patient’s daughter had called and wanted to ask some questions about her mother. Her mother, Louise (name changed), had died about two weeks before.

I hesitated before calling her, recalling her mother’s cancer course.

Louise had been diagnosed with cancer at a relatively young age, in her late 40s. She received curative chemotherapy …

Cutting the wrong test at the wrong time

Harry E. Sarles Jr., MD, John I. Allen, MD, MBA, and Colleen M. Schmitt, MD

Conditions and Diseases

August 8, 2014

At the critical time when our nation has made meaningful and measurable progress against colorectal cancer incidence, threats to reimbursement for colonoscopy screening for Medicare beneficiaries are looming, which may jeopardize the effectiveness of public health strategies to increase screening and prevention of colorectal cancer in the U.S.

New data from the American Cancer Society indicate that colorectal cancer has declined by 30% in just the last decade among those aged 50 …