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 plan for a long hospital stay

Andrew Griffith

Patient

September 1, 2012

Planning a lengthy hospital stay is like planning any extended vacation or business trip, with the difference that transitioning to hospital life means transitioning to no longer being in control, where choice is limited, and where one is dependent on others.

Given my lengthy hospital stays as part of my stem cell transplants – some planned, some as a result of complications – the following may be helpful should you find …

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How to plan for a long hospital stay

End of life ethics and the importance of doing the right thing

Pramita Kuruvilla, MD

Physician

August 31, 2012

Recently, a former clinic patient was admitted to the hospital. This man and his family had been struggling with his cancers for several years. His first cancer had led to a total voice box removal with tracheal stoma placement years ago, which prevented him from talking. His post-operative condition made communication even harder for this non-English speaker, who then depended upon an English-speaking family member to translate.

Then, two years ago, …

The unspoken sentiment towards patients with advanced cancer

Don S. Dizon, MD

Physician

August 30, 2012

I have been thinking about the cancer experience—what it must be like to be on the receiving end of a cancer diagnosis, to live with cancer, and to experience the treatments; to receive the news that treatment worked or that it didn’t. I also have been thinking about what it must be like to “carry” a diagnosis of cancer around. …

How long do I have? The question of prognosis has no simple answer

James C. Salwitz, MD

Physician

August 28, 2012

“The question” comes in several forms: “Doc, what stage is my cancer?” “What is my prognosis?” “Can it be cured?” “Am I going to die?” “Have long have I got?” These tough honest words require courage. “The question” superficially asks for a simple answer. Time to live. However, in the real world of life and death, these questions and therefore the answers are far more complex and subtle.

Years ago we …

How do I tell my son that I have cancer?

Michael Solomon

Patient

August 24, 2012

An excerpt from Now It’s Funny: How I Survived Cancer, Divorce and Other Looming Disasters.

What am I supposed to tell Luke? When do I even tell him anything? How do I tell him? I remember when I was a kid and my mother was hospitalized with some problem (to this day I’m not quite sure what it was) and she was gone for a few days and then back …

Why we need to suffer the growing pains of electronic health records

Richard Just, MD

Health Technology

August 22, 2012

My group purchased our electronic health records system (EHR) about 5 years ago. We had 4 clinical practice locations (soon to be 5 1/2) with 1 administration office. None of these sites are close to each other. A major reason for purchasing an EHR was, and still is, to collect and analyze all data from our entire practice for the purpose of determining outcomes of our treatments. In other words, …

Why brain tumors are my least favorite cancer

James C. Salwitz, MD

Conditions and Diseases

August 20, 2012

If I had to choose my “least favorite” cancer, it would be brain tumors. This malady is not only challenging to treat, but it attacks in such a personal and disturbing way. It is hard enough to fight a complex disease, but to do it when the ability to focus and understand is disrupted by brain injury is a terrible curse. Still we have learned a lot and therapy is …

My mother couldn’t advocate for herself when she needed it the most

Leana Wen, MD

Physician

August 20, 2012

My mother is my role model and my inspiration for what I do every day. She was diagnosed with breast cancer when she was in her forties, and fought it courageously for seven years until she passed away in 2010.

There are so many stories I can tell about my mother and her battle with cancer. Let me start with just one. Whenever she’d go to her oncologist, she would go …

Don’t accept advice from physicians until they understand your values

Peter Ubel, MD

Physician

August 20, 2012

Facing advanced cancer, who among us wouldn’t look to our oncologist for expert advice on whether another round of chemotherapy makes sense? But do you know what your oncologist cares about, and can you be sure her recommendations map onto your own treatment preferences?

A recent study lead by Michael Kozminski (I was senior author) shows that American oncologists downplay the value of treatments that improve quality of life, …

Googling cancer information: Tips from a cancer survivor

Andrew Griffith

Patient

August 19, 2012

When I got my phone call with the diagnosis of mantle cell lymphoma (MCL), my instinct, like so many of us, was to Google. Today, 3 years later, I have learned about what to look for, what to avoid, and how to manage my natural wish to know as much as possible.

The following are suggestions to help others faced with a cancer diagnosis.

Google wisely. Google (and Wikipedia) are a reflex. …

MKSAP: 62-year-old man with a 2 month history of progressive fatigue

mksap

Conditions and Diseases

August 18, 2012

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

A 62-year-old man is evaluated for a 2-month history of progressive fatigue, dyspnea on exertion, anorexia, and nausea. He has no other medical problems and takes no medications.

On physical examination, temperature is normal, blood pressure is 157/88 mm Hg, pulse rate is 86/min, and respiration rate is 22/min. BMI is 31. The conjunctivae are …

Helping cancer survivors fight neuropathy

Cindy Tofthagen, PhD, ARNP

Conditions and Diseases

August 16, 2012

As an oncology nurse, I see more and more people fighting—and winning—the battle against cancer these days thanks to earlier detection and a variety of new treatment approaches. But, like many healthcare professionals, I also see many cancer survivors struggle with the underappreciated long-term health effects often referred to as the “price of survival.”

Cancer-related neuropathy is a common long-term health effect impacting a third of cancer survivors. It can result …

Hospital discharge planning: Involve the patients

Jessie Gruman, PhD

Patient

August 15, 2012

“Here is a prescription for pain medication. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. Go see your doctor in two weeks. Do you want a flu shot? I can give you one before you leave. If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to …

Should I get a spray tan? A doctor discusses whether it’s safe

Bobby Ghaheri, MD

Conditions and Diseases

August 12, 2012

We all know that the use of baby oils and baking in the sun for hours on end is probably not a good idea. We know that increased sun exposure correlates with increasing skin cancer rates. We know that it can cause accelerated skin damage in the form of pigmentation changes, wrinkles, and increased skin laxity. Don’t believe me? Check out this picture! Truck drivers tend to get increased sun …

An American oncologist looks at health in China

Richard Just, MD

Physician

August 11, 2012

In today’s China, both eastern and western medical philosophies and practices exist relatively harmoniously. Patients with minor, usually self limited problems are treated initially with a seven day course of seven liquid herbal preparations taken each day. If symptoms subside, usually treatment is discontinued. If improved but not resolved, formula may be modified. If worse, regimen can be changed and/or referral to specialists arranged. There are hospitals that practice purely …

Is Susan G. Komen wrong about mammograms?

Charles Bankhead

News

August 3, 2012

The world’s largest breast cancer charity used misleading statistics and deceptive statements about mammography to promote breast cancer awareness and screening, authors of an opinion piece asserted.

In promotional material for the 2011 Breast Cancer Awareness Month, Susan G. Komen for the Cure suggested large differences in breast cancer survival among women who undergo screening mammography and those who do not. …

Genomic medicine: How it can help cancer patients

Brian Klepper, PhD

Patient

August 3, 2012

The news of my wife Elaine’s primary peritoneal cancer 27 months ago began a fevered effort to learn all we could about her disease and our options. Peritoneal cancer, which is close in form and behavior to ovarian, is rooted in the abdominal lining. “Gold standard” treatments notwithstanding, the prognosis isn’t good. After a 12-36 month remission in which tumors are inactive, the disease generally returns, and a high percentage …

Well meaning improvements can hurt critical healing relationships

James C. Salwitz, MD

Physician

August 3, 2012

Steve is lying almost flat in the hospital room, an IV attached to his arm. I am happy to see he is more comfortable, last night’s crisis has passed. He smiles as I enter and walk to his side. I touch his hand as I sit down on the pressed clean blanket. And then … a shrill loud wail breaks the silence … lights flash above his bed … fear …

Many doctors fail to understand the math of cancer prevention

Peter Ubel, MD

Physician

August 2, 2012

All too often the most powerful illusions seduce us through truthful whisperings. Let’s start with an obvious truth: Living a long and happy life after a cancer diagnosis is better than living a short miserable one.

Given a choice between receiving a diagnosis of metastatic cancer—an incurable life-ending-it’s-already-spread-to-your-brain neoplasm—versus the diagnosis of a localized, snip-it-out-and-it’s-done tumor: Who wouldn’t choose the latter?

And yet this simple truth causes doctors to embrace unproven screening …

The circle of support in the critical moments of the cancer journey

Don S. Dizon, MD

Physician

July 29, 2012

On a recent trip to Philadelphia, I caught up with Dan, a friend of mine since college. He is an artist in Philly, where he lives with his wife and daughter. He had asked me about being an oncologist, told me he had read my ASCO blogs.

We spent hours discussing everything—parenthood, careers, and mutual friends, and one in particular. Her …