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.
To have cancer is to change forever. It is a devastating declaration. Each of us copes with the diagnosis differently. How people adjust and move on with their lives are lessons in humanity.
I take care of a patient who explained to me how he deals with incurable cancer. Stan is active and able to enjoy grandchildren, friends and hobbies. He describes himself as happy, despite his terminal diagnosis. The key …
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To survive with cancer, you need to accept that you are going to die
When one partner has cancer, both partners are affected, as is their relationship. Although cancer is a health crisis that can wreak havoc on any relationship, many marriages survive, and even flourish, after cancer. Approaching cancer as “our problem” and finding opportunities to continue to connect as a couple can help to minimize both partners’ emotional distress. It is possible to fight the battle against cancer together and to strengthen …
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How cancer can strengthen your relationship
From age six through high school, I played baseball. Playing baseball ended, rather abruptly it seemed, when I went to college, but the lure of the game has always remained. To my colleagues, it must seem that I can hardly understand the world without the comfort of baseball analogies. I was thrilled when my son Ryan, age 12, saw the …
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The analogy between baseball hierarchy and medical systems
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently, breast cancer has certainly gotten a lot of play in the media as of late.
Every major news outlet in America covered the breast cancer study released by JAMA which said that nearly half of the women who had second surgeries for breast cancer may not have needed the …
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Reading between the lines of breast cancer treatment studies
I was jogging one day while on a business trip in LA and collapsed during the run. Within hours, I was at the hospital at UCLA Medical Center on a gurney headed for a CT scan of my abdominal cavity. I remember telling the ER physicians that I was a doctor and recommending my own course of action. As my advice to the ER doctors went largely ignored, I realized, …
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A diagnosis of stomach cancer profoundly changes an oncologist
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm sandy beach vacation, new bigger home and grand Thanksgiving dinner love. Not even baby’s first words love. I mean power passion that gets us through the hard times, type of love.
Edna and Ken are 90, married and both have active cancer. They have been partners for 62 years. …
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In love there is a life giving force
Julie Gralow, an oncologist at the Fred Hutchinson Cancer Center in Seattle, recently prescribed an exciting new therapy for a 60-year-old woman with metastatic breast cancer. Three-and-a-half years into her battle against the disease, the patient had already exhausted three different anti-estrogen therapies, each of which only put a temporary check on the spreading tumors.
The newly prescribed drug, Novartis’ Afinitor, is one of the recently approved targeted therapies that have …
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A look behind the growing cost of cancer drugs
Ovarian cancer screening clearly touches a nerve.
No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease is at an advanced stage. Tests to look for the disease, such as the transvaginal ultrasound or the CA-125 blood test, are not specific enough. That leads to false positive tests that necessitate more studies that may not be …
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How I approach ovarian cancer screening with patients
I found a recent Associated Press article on an aspect of the new health care law that many of us may have overlooked. It requires consumer-friendly summaries of what insurance plans cover, a provision that now seems to be at risk. The insurance industry is up in arms about implementation costs and added regulatory burdens. (There’s a good story at NPR, which includes a link to an example of what …
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Why we need to go from e-patient to i-patient
It’s been five years since she was told she was cancer free. Today she was told it was back, and the future was quite grim.
My job was to make sure she understood how to properly take the medication that would reduce the swelling around the tumor so radiation could start as soon as possible.
That was my job. Clinically speaking it wasn’t the most challenging or difficult issue of the day as I …
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Experiencing an uninvited gift
What could be so simple as a blood test?
A quick prick with a needle, a wait of a day or two for results and a discussion with the doctor about those results. In the words of our vaunted politicians, it would be an “up or down vote” on whether there was anything to deal with.
That was the thinking of my wife’s physician when she ordered a test called the “CA-125.” …
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How the CA-125 became a $50,000 blood test
When I relocated my radiation oncology practice from Jacksonville to Tampa, Florida, I had to figure out how to compete against urologists in a market that was radically different from the one I had left. Unlike their peers in Jacksonville, Tampa urologists owned their own radiation centers, guaranteeing I wouldn’t receive referrals from them.
To break the referral pattern, I updated and posted my physician profile for free on an online …
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How a doctor uses Google to market and recruit patients
EHRs are not ready for prime time. EHR benefits are questionable and there are documented instances where patients’ deaths were directly attributed to an EHR. EHRs are cumbersome and slow. They are unnecessarily complex and built on very old technology. The people who build EHRs have no concern for the end user and therefore EHR usability is pretty abysmal. And EHRs are expensive to buy and expensive to maintain, not …
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How adopting an EHR is like treating cancer
At the end of the year, I find myself thinking about patients usually—and especially those that have passed away. I wonder how their families are coping, how their children are, and whether each day has gotten easier. I think about how my patients died—and whether or not I did enough to ensure that they did not suffer.
It’s an odd thing …
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The sense of loss extends beyond the death of a patient
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 …
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Our society expends huge sums on futile care
When I finished my book on famous patients, the most common question I received was “Are the stories of sick celebrities really relevant to other patients?” My answer was that yes, with some caveats, these experiences are well-worth knowing.
The same can be said for the story of Patrick Swayze’s terminal pancreatic cancer, which has now been told by his widow, actress Lisa Niemi Swayze, in a new book, “Worth Fighting …
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How Patrick Swayze died: Why we should care
The fact that the term “cancer survivorship” is now part of our vocabulary is a testimony to advances made in management of these diseases. Most cancer survivors, however, are not unscathed by the experience. As I tell my patients, they won’t be entirely as they were before treatment. How these issues are dealt with varies from person to person. But, awareness that chronic problems may persist long after treatments end …
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Incorporating 12-step program concepts into cancer survivorship
Test your medicine knowledge with the MKSAP challenge, in partnership with the 
