On the day we cure cancer I will rise in morning dark. I will stand in last night cold, and watch stars fade. The light will come and a following breeze blow. On that incredible dawn, there will be brilliance. I will make sunrise rounds on the day we cure cancer.
I will stay late and breakfast with my wife. We will talk about flowers, kids and books. I will stand …
I recently talked about wondering how those I had met through my own patients were doing, especially after my patients had passed on. I wondered if they were all right and whether they were able to move on. Well, I’ve been thinking about it again, though this time in the context of cancer survivorship.
The Office of Cancer Survivorship of …
When do I stop being someone’s oncologist?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old woman has a 3-month history of increasing fatigue. She has no other medical problems and does not take any medications.
On physical examination, temperature is normal, blood pressure is 130/80 mm Hg, pulse rate is 72/min, and respiration rate is 16/min. The patient appears pale. …
MKSAP: 78-year-old woman with increasing fatigue
The U.S. spends far more on cancer care than 10 European countries, but according to a new study, it may be “worth it” as “the value of the survival gains greatly outweighed the costs.”
The study, published this week in Health Affairs, found that U.S. spending on cancer care, in 2010 dollars, increased by 49% from 1983 through 1999, from $47,000 per cancer case to $70,000 per case. Meanwhile, in …
Is our high cost of cancer care worth it?
Austin Frakt, health economics blogger at The Incidental Economist, has a post up commenting on Kenny Lin’s post about shared decision-making and PSA testing. The following is an edited comment I posted on that article.
I have to disagree with Kenny on this one, despite having written an article in the New York Times Magazine that strongly supported Kenny’s work at the US Preventive Services Task Force, which found …
Don’t discard shared decision making on the basis of PSA testing
In January, when my close friend’s lymph node biopsy came back as a rare form of T-cell lymphoma, I scoured the scientific literature. What was his prognosis?He was 56, a little overweight but otherwise healthy. He had helped us move into our home more than a decade ago, and I was like an uncle to his son and daughter.
In the literature I found jagged graphs plunging downward, indicating that my …
When doctors are incorrect in their prognosis of terminal illness
There was no mistake, but a bad thing has happened. Despite the best efforts of the doctors, Bob’s wife is very sick. Due to a rare side effect of treatment, her liver is failing. Bob believes this could have been prevented. He is very mad.
“When we go to see the doctor, he stares at the computer,” says Bob. “He does not look at us. Most of the time, the doctor …
The computer had stopped the doctor from communicating
“So, the doctor told me I have breast cancer. I just wanted to let you know. I’m doing fine right now, but I have some decisions to make regarding my treatment options. I’ll keep you posted.”
This may be a typical email sent to family and friends after receiving a breast cancer diagnosis. Sending emails seems more practical at this point. With so many friends and family to update, unless a …
What to say to a newly diagnosed cancer patient
Will we – you and me and our parents and neighbors – be a significant force in quelling the tide of over-testing for the early detection of disease?
When you have had cancer as many times as I have, you become suspicious that there are more cancer cells inside you waiting for some obscure signal to make them leap into action and start multiplying out of control. So you develop a …
Have cancer screening tests been oversold?
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …
End stage colon cancer becomes even more tragic without hospice
I have a confession to make.
As soon as I finished reading the Annual Report to the Nation recently, I got up from my desk and took a walk for 20 minutes.
What, might you ask, compelled me to do this?
The answer is what made me take a walk is the same reason I am writing this follow-up commentary. Sitting …
Lower your cancer risk and take a walk
In my first week of the 3rd year surgery clerkship, I was introduced to some of the “Rules of Surgery.” For example, “All bleeding stops eventually,” or, “Everyone doesn’t need to die with an incision,” and even “The enemy of good is better.”
Boarded for this particular afternoon was a pancreaticoduodenectomy (the Whipple procedure), which for students is known to be a must-see operation if given the opportunity. However, the night …
Why do bad things happen to good people?
Pain is the result of a physiological series of electrical and chemical events that occur in the body. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”
Pain receptors are bare nerve endings that are widely distributed throughout the body in the skin and mucous membranes. When pain receptors are …
Cancer pain is often undertreated
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A Miami Herald story, heralds “Prostate cancer hits younger men.” You know right away how this one is going to play out.
The story begins by profiling a 48-year old man with prostate cancer. It says his “doctor ordered the test as a routine practice for his male patients.” There isn’t any discussion about how such ordering as a routine practice doesn’t demonstrate the kind of shared decision-making model that the …
Cancer screening stories need to report on the uncertainties
Last week was tough. I had to refer several patients to hospice, and a few more received bad news regarding their disease. This has always been the toughest part of my job, but it’s also the part patients need me to handle best. I have to remind myself that no matter how hard it is for me to give bad news, the patient and their families are the ones receiving …
Doctors need to be better trained to deliver bad news
As a veteran of World War II, my grandfather was a GI Bill success story, the first man to go to college from his impoverished neighborhood in Jersey City thanks to government at its finest. A card-carrying member of the state teachers’ union, and a politically active Democrat for most of his life, it came as something of a shock to me when, after a few decades of observing big …
A radiologist disagrees with the breast cancer screening guidelines
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Colorectal cancer is the second leading cause of cancer-related deaths for men and women in the United States. Although the effectiveness of colorectal cancer screening in reducing deaths is supported by the available evidence, only about 60 percent of American adults aged 50 and older get screened.
A new …
ACP reminds physicians to assess risk, screen for colorectal cancer
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
Seven years ago, a 45-year-old man was diagnosed with a biopsy-proven mediastinal germ cell tumor. The patient was treated with combination chemotherapy (bleomycin, etoposide, and cisplatin) and had a complete radiographic response. He has been disease-free since completing therapy, and follow-up serum tumor marker measurements, chest …
MKSAP: 45-year-old man with a mediastinal germ cell tumor
I met Burt the Monday before Labor Day. As I walked into the room, he stood up–a sturdy, fifty-three-year-old guy with a direct, sky-blue gaze. Although he was a little etched around the eyes, he mostly looked the picture of health.
Two years before, he’d had a cancer. It was treated and thought to be gone. But for several weeks now, he’d been having excruciating low-back pain; he rated it a …
When words are worthless in the cancer clinic
After my recent blog posts, I was inundated with questions regarding how I would change the way I interact with my cancer patients if I return to work. I’ve tried to chronicle my experiences – from diagnosis to death – in hopes that you will learn how you can interact with your patients more effectively.
Diagnosis
There was an undeniable shock that disrupted all of the carefully-constructed systems and routines with …
When it comes to cancer, do not just focus on survival
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