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.

Get rid of the cancer first before considering breast reconstruction

Miranda Fielding, MD

Conditions and Diseases

March 2, 2014

When it comes to surgery for cancer, having a “positive margin” is a bad thing. It means that when the surgeon said he “got it all,” even though he meant it with all of his heart, likely he didn’t. For a woman undergoing a lumpectomy for breast cancer, that positive margin means a re-excision of the lumpectomy site or alternatively, a mastectomy. For a woman who has just had a …

The conspiracy of cancer prognosis

Rick Boulay, MD

Conditions and Diseases

March 1, 2014

It should be easy, right? I mean, I am a professional with what feels like eons of training. So how can an oncologist with years of experience fail at perhaps the most important question a patient can ask, ”How long do I have, Doc?”

It’s not that I want to avoid the question. Well, okay, sometimes I do. It’s not the most pleasant of conversations to have. But really, I don’t …

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The conspiracy of cancer prognosis

How we doubled colorectal cancer screening rates

Theodore R. Levin, MD

Conditions and Diseases

March 1, 2014

March is colorectal cancer (CRC) awareness month, so it’s an appropriate time to reflect on how to increase the number of people who get screened for this cancer that’s largely preventable through screening. Between 2005 and 2012, Kaiser Permanente, Northern California, doubled the percentage of our eligible patients who were screened for CRC.

So how did we do it?

We employ a combined screening model with fecal immunochemical test (FIT) outreach and …

From a mother: What my child’s oncologist should know

Suzanne Leigh

Patient

February 28, 2014

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Please let us know that we’re not alone. We realize that our doctors are not our friends, but telling us that the medical team will be sticking with us during this journey that we were never on board with, is an empowering message when we are at our most powerless.

Show us that you care about our child, too. We know that you identify our …

Chronic conditions don’t have normal business hours

Jessie Gruman, PhD

Patient

February 27, 2014

It looks like an airport lounge without the rolling suitcases. There are about 20 of us cancer survivor-types fiddling with our phones or reading the newspaper. A few of us are sipping delicious contrast fluid in preparation for a scan, but most of us are waiting to meet with our oncologists for follow-up or monitoring visits. All of us are between the ages of 20 and 70 and all of …

To every cancer patient: You give us courage

James C. Salwitz, MD

Conditions and Diseases

February 27, 2014

Hot oil splatters as thick fatty fish slips into the smoking pan, next to boiling rice and simmering garlic greens. Quickly golden, she flips the fillet and turns down the heat. Small feet pound down the stairs, drawn by the crackling aroma, but it’s a mother’s trap; she motions the child to set the table. One by one, the family gathers, as plates and utensils clatter onto the wood and …

Cancer screening comes down to personal preferences

Ira Nash, MD

Conditions and Diseases

February 26, 2014

I have been thinking a lot about cancer screening tests. It seems that there has been a constant stream of articles about screening in both the lay press and professional journals — as well as the inevitable stories in the lay press about the reports in professional journals — but this is more personal. I have had two recent experiences that …

Save mammography or save women? Supporters face a quandary.

Michael Kirsch, MD

Conditions and Diseases

February 25, 2014

Sometimes, we play a little politics on this blog. I am a student of current events and enjoy following the dysfunction and absurdities in American politics. To paraphrase the legendary former British prime minister, “never has so little been done by so many to benefit so few.”

Readers know how skeptical I am about medical dogma. When I was an intern a quarter century ago, I didn’t grasp why routine measurement …

Radiologists on the new mammogram study. Who’s right?

Jennifer Gunter, MD

Conditions and Diseases

February 24, 2014

The BMJ recently published the latest results from the Canadian National Breast Screening Study (CNBSS). A brief summary of the CNBSS: Women were randomly assigned to annual mammography or breast exams and then the outcomes tracked. The results in the BMJ: mammography did not improve survival.

This is a very interesting study and when I first started working on this post I wanted to delve more into the science of …

Are physicians ready for the e-patient movement?

Don S. Dizon, MD

Physician

February 21, 2014

I gave a talk recently to a group of my peers about addressing the needs of patients after a diagnosis of cancer, emphasizing points where transitions occur — from treatment, to end of therapy, surveillance, recurrence, and extending all the way up to the end of life — and how important it is to consider the entire journey of a person …

Defeating cancer is not an armed conflict

James C. Salwitz, MD

Physician

February 20, 2014

On December 23, 1971, President Richard M. Nixon signed the National Cancer Act of 1971, and declared the “war on cancer.” The allusion to combat appealed to the soul of the American people not long after their success in World War II and the humiliation of Vietnam; they intuitively understood the sacrifice, teamwork and massive effort, which is implied in the concept of War and they were ready for another victory. Committing dollars, …

The influence of Janis Babson can be felt by many physicians

Emily Gibson, MD

Physician

February 15, 2014

I was 8-years-old in June 1963 when the Readers’ Digest arrived in the mail inside its little brown paper wrapper. As usual, I sat down in my favorite overstuffed chair with my skinny legs dangling over the side arm and started at the beginning, reading the jokes, the short articles and stories on harrowing adventures and rescues, pets that had been …

A cancer patient return visit after 20 years

Miranda Fielding, MD

Physician

February 13, 2014

A couple of weeks ago my nurse came to me with a request for a consultation. Since our schedule has been packed full lately, she’s been asking me where I can squeeze patients in.

She said, “I’m not sure about this one — he says you treated him twenty years ago and he wants to see you. But there is no new pathology so I don’t know how urgent it is.”

I …

My cancer has been knocked into oblivion

Elana Miller, MD

Conditions and Diseases

February 12, 2014

From the beginning, there were so many signs that my cancer didn’t have a chance.

First, there was the rock-hard lymph node above my collarbone that disappeared with one night of steroids, even before I started chemotherapy.

Then, there was the chest x-ray done only a few days after starting my first round of chemo. It’s not pretty, and you can see that the …

Mammograms: Breast cancer screening as an individual patient decision

Kevin Pho, MD

KevinMD

February 12, 2014

In a major cancer screening development, a study from the British Medical Journal found that an annual screening mammography didn’t result in a mortality benefit:

Women screened annually by mammography for 5 years had had a breast cancer mortality hazard of 1.05 compared with the control group during the screening period. During follow-up for a mean of 22 years, the mammography group …

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Mammograms: Breast cancer screening as an individual patient decision

Everyone should have a pleasant mammogram experience

Abigail Schildcrout, MD

Physician

February 12, 2014

This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it.

In my personal experience, mammograms have ranged from quite uncomfortable to downright painful. And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in …

When medical wishes are respected

Kelly McCutcheon Adams, MSW

Patient

February 11, 2014

In 2005, my husband and I bought a small farmhouse in northern New England next door to Tom and Sally.

They were in their early seventies, married nearly fifty years, with a large family. Tom’s grandfather had built a farmhouse in 1900 on the family’s small pig farm. In the 1970s, Tom and Sally had parceled off the land and built a modern house for themselves, a stone’s throw from the …

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When medical wishes are respected

After a cancer diagnosis: Giving a patient time

Jim deMaine, MD

Physician

February 7, 2014

Ben’s first symptom was coughing up blood. The cancer had been silently growing for months, if not a few years. He had no pain or shortness of breath. The chest x-ray showed a “5cm L hilar mass” and the subsequent CT scan showed enlarged lymph nodes and likely spread to the liver.

“So Doc, what is it? A cancer? How much time do you give me?” All these questions on a …

Did a New York Times column unfairly attack ER doctors?

WhiteCoat, MD

Physician

February 6, 2014

Cardiologists are causing patients to get cancer.

It’s true.

Cardiologists routinely perform angiograms on patients who have no heart disease whatsoever.

As shown in this Harvard newsletter, each angiogram exposes the patients to about 7 mSv of radiation. Add in the myocardial perfusion imaging at another 25 mSv of radiation and you have enough radiation to cause cancer in an otherwise healthy individual.

And cardiologists routinely subject patients with normal …

Grateful for the pennies from heaven

Starla Fitch, MD

Physician

February 5, 2014

A few short years ago, my wonderful father-in-law Bill was diagnosed with an inoperable cancer.

My husband and I traveled to the Midwest to visit Bill and my mother-in-law Betty. We were happy to be able to spend a little time with him, and he knew we were there.

Sadly, he passed away the night before we left.

We believe he held on until my husband arrived; all his other children lived nearby.

Later, …

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Grateful for the pennies from heaven