Oncology and hematology

When going “by the book” hurts patients

Thomas D. Guastavino, MD

December 19, 2014Dec 19, 20144

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 …

When going “by the book” hurts patients

After prostate cancer treatment: What about intimacy for men?

December 16, 2014Dec 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 …

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

Kenneth Lin, MD

December 4, 2014Dec 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

December 4, 2014Dec 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

November 30, 2014Nov 30, 20149

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 …

Health policy

We waste a lot of dollars on unnecessary medical care

Peter Ubel, MD

November 26, 2014Nov 26, 201425

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…

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

November 26, 2014Nov 26, 20142

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…

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 …

J. Leonard Lichtenfeld, MD

We need to start skin cancer prevention with our children

November 25, 2014Nov 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…

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

November 24, 2014Nov 24, 20142

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…

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

November 23, 2014Nov 23, 20143

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 …

(Dis)comfort measures

More resources are needed for pediatric cancer research

David A. Williams, MD

November 20, 2014Nov 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

November 20, 2014Nov 20, 20143

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 …

Why cancer still evokes fear

What Mayor Thomas Menino taught us about cancer

James C. Salwitz, MD

November 20, 2014Nov 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 …

Medical education

Gynecologic cancer: Being a part of these women’s stories

Sharlay Butler

November 19, 2014Nov 19, 2014

Mrs. C was used to my quiet knock every morning at 6 a.m. She smiled as I turned on the overhead lights, but began to grimace when she realized that today was dressing-change day. The rustling packages of bandages in my overstuffed coat pockets had given it away. Mrs. C had stage four metastatic endometrial cancer; a malignancy of her uterus that was not responding well to chemotherapy and had …

What does a good death mean to you?

November 19, 2014Nov 19, 2014

In July 1991, I was beginning my first year of medical school in Rochester, New York. I was filled with excitement and anxiety on beginning a journey in medicine as I started on the road to becoming a doctor. At…

At that time, Rochester was in the national spotlight because of the actions of one of our faculty members, Timothy Quill. …

What does a good death mean to you?

Walk in the shoes of a cancer patient

Hannah Breit

November 17, 2014Nov 17, 20143

We sit, we listen, we attempt to focus and absorb what we are required to know. We learn how to give bad news, even using one another as makeshift “standardized” patients. How does one “standardize” a patient anyway? Who knows,…

But what happens when you stop pretending? When you wake up one morning …

Walk in the shoes of a cancer patient

Oncologists have one of the lowest burnout rates. Why?

James C. Salwitz, MD

November 14, 2014Nov 14, 20142

The alarm clock’s blast brings hours of work, running from task to task, always pushing toward the next turn. In moments of failure, the waves of complexity and anxiety batter and you question each stroke. Then you fly downhill, easy breeze in your face, as success urges you on. After the finish, the parking lot empties, the lights go out, and …

When patients seek a second opinion: It’s not about you

November 12, 2014Nov 12, 201411

I remember when I first started in oncology; I had joined the faculty at Brown three years after fellowship and was seeing a patient* with newly diagnosed breast cancer. She was in her 40s, an advertising executive, married, with two small kids. The diagnosis was unexpected (as it usually is), with a lump found while showering. She had come …