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.

A watershed moment in my lifetime of treating cancer patients

Miranda Fielding, MD

Physician

July 26, 2013

I have had patients and their families do strange things during a consultation. Patients taking notes and recording what the doctor says are pretty commonplace these days, as are answering a cell phone and arguing with a spouse over what really happened while giving a history.

Some patients go to great lengths to disconnect from the process, filing their nails, or flipping through a magazine. I’ve watched babies’ diapers being changed, …

The Supreme Court on Myriad: Will it stifle innovation?

Nicole D. Kling, PhD

Medications

July 26, 2013

brca-box-1

The recent ruling by the U.S. Supreme Court brought Association for Molecular Pathology v. Myriad Genetics back to the headlines, with interest being stoked by Angelina Jolie’s recent disclosure of her double mastectomy.

The lawsuit revolved around patents owned by Myriad related to its BRACAnalysis test, which assesses the likelihood that a person will develop certain cancers, including breast cancer, by searching the DNA for disease-causing …

Discovering medicine’s unrehearsed harmony

Ron Li

Medical Education

July 24, 2013

There is something deeply satisfying about hitting the right note on the violin. On the rare occasion when my left hand is perfectly positioned and my bow arm is applying the perfect amount of pressure on the violin string, the resulting note that resonates from the wooden belly of the instrument is, for lack of a better word, perfect.

My favorite piece that …

A guide to giving bad news to patients

James C. Salwitz, MD

Physician

July 22, 2013

The massive magnets of the MRI radiate fields through her brain, scanning veins, arteries and every millimeter of cortex. Grey and white matter, containing all she is and all she ever will be, identified, cataloged, mapped. Two centimeters under the front of her skull, just to the left of center, there is an abnormality; a one centimeter mass surrounded by swelling. The lung cancer has spread, metastasized. Really bad news.

A …

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A guide to giving bad news to patients

News on cancer breakthroughs: Curb your enthusiasm

Christopher Johnson, MD

Medications

July 20, 2013

Hardly a day goes by when some news outlet does not report, often breathlessly, some new breakthrough in cancer research. We need to turn a skeptical eye on most of these reports, particularly those that contain information about very preliminary research findings. The always astute Gary Schweitzer gives a good perspective on this in his HealthNewsReview.org; it’s a good site to bookmark if you follow the medical news.

Three tumors, two breasts, one very difficult decision

Jan Gurley, MD

Conditions and Diseases

July 19, 2013

The more complex and high stakes a health care decision is, like with genetic testing and mastectomies, the more difficult it can be to find your way. There are no “right” answers, only guideposts to help you choose a path that is best for you.

Decision-making alone. When my kids went to camp in the fifth grade, they got to experience something called the Solo Hike. Counselors took them up into the …

Radiation exposure is related to the rise of a lawsuit culture

Dr. Charles

Physician

July 15, 2013

A study published in the British Medical Journal highlights the importance of carefully choosing which children should receive diagnostic CT scans. As a diagnostic test, CT scans utilize ionizing radiation that can cause cellular DNA damage, increasing the risk of cancer. Children who received a CT scan were 25% more likely to develop a cancer in 10 years after radiation exposure, according to a study of 11 …

I need to take my role as historian very seriously

Bruce Campbell, MD

Physician

July 12, 2013

Historians are left forever chasing shadows, painfully aware of their inability to ever reconstruct a dead world in its completeness.
-Simon Schama

“Tell me about your prior cancer treatment,” I say. “When did you have the surgery and radiation?”

“It wasn’t a surgery,” He tells me emphatically. “It was a biopsy.”

“But the doctor SAID it was a surgery!” chimes in his wife.

“Yes, Dad. You have a long scar on your neck,” adds his …

Firing your doctor carries emotional weight

Jessie Gruman, PhD

Patient

July 10, 2013

Last week, a friend told me that her mother had been fired as a patient by her primary care physician in a letter she received in the mail. “Our philosophies of care are too different,” was the explanation.

Last week, I fired my oncologist by email. “I have transferred my care to ___ ___.” I gave no explanation, although the note was polite and appreciative.

My friend and I spent some time …

How Katie Couric continues to influence the colonoscopy debate

Sophie M. Balzora, MD

Conditions and Diseases

July 8, 2013

In 2003, the Archives of Internal Medicine published an observational study assessing the impact of Katie Couric’s March 2000 Today Show colorectal cancer awareness campaign, including the well-known colonoscopy she underwent live on air. The data was compelling, showing a sizeable spike in colonoscopy rates across the U.S. of more than 20%, thanks to this very likeable, personable, and …

I failed to appease pain during her life, so she died terribly

James C. Salwitz, MD

Physician

July 8, 2013

Ellen died a clockwork machine, restrained by Versed, fed by nasal tube, secretions in bags, and as her blood pressure dropped intravenous pressors accelerated in dose until blood squeezed from her extremities left fingertips dry and black as coal. Death occurred on the 41st hospital day, after 27 minutes of scripted, six rib fracturing, 360-joule electric shock CPR. A brutal case by any measure, worse because advanced cancer …

When the weight of illness suddenly descends on an individual

Miranda Fielding, MD

Physician

July 7, 2013

The sudden illness of a colleague is always a shocking surprise. As physicians, we are trained from an early age to ignore our own infirmities in the service of others. Apart from my three C-sections, I have been extremely fortunate in terms of my own health—I can count the number of sick days I’ve taken in the last thirty years on one hand and I am thankful every day for …

Should insurers pay for the Oncotype DX prostate cancer test?

Peter Ubel, MD

Conditions and Diseases

July 4, 2013

Recently, the makers of the Oncotype DX prostate cancer test presented results of a large study demonstrating that their test can help men decide whether their prostate cancer carries a low enough risk of progression to forgo surgical or radiation therapy, two treatments that typically eradicate prostate cancers but also cause most men to experience impotence and incontinence.

Lacking such a test, many men have felt compelled to …

Directing cancer resources in a limited resource world

J. Leonard Lichtenfeld, MD

Health Policy

July 3, 2013

As we walk the halls and sit in the lectures at the annual meeting of the American Society of Clinical Oncology, there’s an elephant in the room. It is right there in front of us, but not many of us seem willing to talk about it. Fewer still are making any commitments to do something about it.

So what is …

The tension between oncology and palliative care

James C. Salwitz, MD

Physician

July 1, 2013

One of the benefits of being an oncologist is that, as a rule, people appreciate our work. That does not mean they want to hear about our day, and the response when someone learns my vocation is rarely, “Hey, that’s sounds like fun!”

Nonetheless, at least there is a modicum of respect. However, I found a group of people with major questions about the work of cancer docs or at least …

Genomics and personalized medicine: Is it really different this time?

J. Leonard Lichtenfeld, MD

Medications

June 24, 2013

Another year and another annual meeting for the American Society of Clinical Oncology in Chicago. This is a meeting that regularly attracts many thousands of doctors, researchers, pharmaceutical folks and others interested in the science and business of cancer from around the globe to learn, to discuss, to persuade, to educate on the progress being made in clinical cancer …

The medicine that kept her alive was not in a bottle

James C. Salwitz, MD

Conditions and Diseases

June 24, 2013

Sue wondered if all doctors subscribe to the same magazines, buy the same cheap furniture, post the same worthless insurance information. She wanted to throw it all through the receptionist window. The second opinion was a waste of time and she had little of that. She was there to make her family happy, but was upset they could not cope, that they were not ready to face the truth, and …

The problem with a negative BRCA test

Jan Gurley, MD

Conditions and Diseases

June 19, 2013

There is nothing so horrifying as when your doctor is too nice to you. During my first mammogram at Kaiser Permanente, I knew I had cancer before they even told me because of the hushed voices, the pats on my shoulder, and the way, suddenly, no one cared how much time was being spent on my visit. When that happens to you before the diagnosis is official, there is nothing …

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The problem with a negative BRCA test

Numbers fail to answer that one vital question

James C. Salwitz, MD

Physician

June 16, 2013

When I visited Allan in the hospital yesterday, I told him to get up and stroll the hall. However, when I checked in on him this afternoon, the nurses informed me that he refused to get up, even to the chair. When I asked why, Allan told me he could not walk. I was concerned, but when I examined him, I found his vital signs were fine, he had no …

The racial disparity of cancer screening and preventive medicine

Sindhura Kodali

Conditions and Diseases

June 13, 2013

Like many other Millenials who grew up in the age of Lara Croft and Brangelina, I greeted Angelina Jolie’s announcement that she had undergone a preventative mastectomy and reconstruction last month with sadness for her loss and admiration for her heroic decision and very public disclosure. I hope her story will lead other women to undergo screening and potentially save lives, but real improvement in women’s health outcomes requires …

Oncology and Hematology

Oncology and Hematology

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