Great study published in the BMJ
http://www.bmj.com/content/349/bmj.g7262
Sunday 14 December 2014
Saturday 13 December 2014
Friday 28 November 2014
Saying NO to excessive Pharmaceutical Costs
Hospital says NO to excessive Pharmaceutical costings
This story has been doing the rounds for a while, and things seem to be getting slightly clearer now. Great stance for these doctors and the hospital to support them to refuse the massive costs of some medications (for minimal extra advantage). What if everyone took a stance against these costs? Is that feasible? Is it wise?
Worth thinking about.
This story has been doing the rounds for a while, and things seem to be getting slightly clearer now. Great stance for these doctors and the hospital to support them to refuse the massive costs of some medications (for minimal extra advantage). What if everyone took a stance against these costs? Is that feasible? Is it wise?
Worth thinking about.
Sunday 23 November 2014
Single Best Medical Resource
I have found that the single best medical resource that I use is UpToDate.
www.uptodate.com
Full access is expensive, but it is definitely worth the money spent. Online, Desktop and mobile phone access is available.
There is a cheaper version for doctors-in-training or if you buy access in groups.
www.uptodate.com
Full access is expensive, but it is definitely worth the money spent. Online, Desktop and mobile phone access is available.
There is a cheaper version for doctors-in-training or if you buy access in groups.
Wednesday 19 November 2014
Patient data: can we use it better?
Great video about patient data. Innovative ways to making data work better for everyone.
https://www.youtube.com/watch?v=0ED9YSxgB9w
https://www.youtube.com/watch?v=0ED9YSxgB9w
Monday 10 November 2014
Oesophageal Cancer - New Standard of Care
The standard therapy of offering patients Cisplatin with 5Fluorouracil with Radiotherapy has been around for a long time. Has worked well over time, but not well enough.
The recent CROSS study has proven that Carboplatin and Paclitaxel with Radiotherapy (neoadjuvant or definitive) is the new standard of care. It is much more effective for squamous cell cancers as compared to adenocarcinomas (but works well in both conditions).
This regimen is well tolerated and most patients complete therapy. I have now changed my clinical practice and use this regimen as the default.
The recent CROSS study has proven that Carboplatin and Paclitaxel with Radiotherapy (neoadjuvant or definitive) is the new standard of care. It is much more effective for squamous cell cancers as compared to adenocarcinomas (but works well in both conditions).
This regimen is well tolerated and most patients complete therapy. I have now changed my clinical practice and use this regimen as the default.
Sunday 9 November 2014
Some Partners and Cancer Sufferers
What is wrong with some guys? I met with three women with cancer in the past two weeks, who were diagnosed with nasty cancer - and their partners have walked out on them (after diagnosis). This is when these women need the maximum amount of support. This is when their world is falling apart... more of it falls apart :(
Some of these stories are so sad, that it drives us to despair.
This is supposedly delinked from the medical world, but it is absolutely interlinked with our care. If a patient is falling to bits in her/his mind, how can they deal with everything else?
The nurses in the Unit are just amazing and have adopted these women as part of our larger family. All we can do is support them through this incredibly difficult time, the best we can.
Some of these stories are so sad, that it drives us to despair.
This is supposedly delinked from the medical world, but it is absolutely interlinked with our care. If a patient is falling to bits in her/his mind, how can they deal with everything else?
The nurses in the Unit are just amazing and have adopted these women as part of our larger family. All we can do is support them through this incredibly difficult time, the best we can.
Tuesday 14 October 2014
Immunology for Oncology and Others
Recently found an excellent Immunology course in Sydney - Immunology for BPTs (Basic Physician Trainees).
Held once a year, over a weekend. Covers all the stuff needed for most of us.
Immunology is taking over bits of Oncology and thus is vital to understand.
www.immunology4bpts.com
Held once a year, over a weekend. Covers all the stuff needed for most of us.
Immunology is taking over bits of Oncology and thus is vital to understand.
www.immunology4bpts.com
Saturday 11 October 2014
Gestational Trophoblastic Cancer Chemotherapy
Affects younger women in the child bearing age. Monitored by checking HCG levels.
Usually chemotherapy with methotrexate is adequate.
If the hormones levels do not return to normal or keep rising, the patient needs to be switched over to the EMA-CO procotol - Etoposide, Methotrexate, Dactinomycin - Cyclophosphamide, Vincristine (alternating week regimen).
Curable diseases must always be treated.
Usually chemotherapy with methotrexate is adequate.
If the hormones levels do not return to normal or keep rising, the patient needs to be switched over to the EMA-CO procotol - Etoposide, Methotrexate, Dactinomycin - Cyclophosphamide, Vincristine (alternating week regimen).
Curable diseases must always be treated.
Thursday 9 October 2014
KRAS mutation in colorectal cancer
KRAS mutation analysis is a vital part of the treatment algorithm for metastatic bowel cancer. The absence of the KRAS mutation means that medications like Cetuximab and Panitumumab can be used effectively in these patients.
Presence of the mutation does not always mean that these medications cannot be used. The mutation in G13D might still have benefit with Cetuximab (still under investigation).
Worth discussing with your Oncologist.
Presence of the mutation does not always mean that these medications cannot be used. The mutation in G13D might still have benefit with Cetuximab (still under investigation).
Worth discussing with your Oncologist.
Tuesday 7 October 2014
Monday 6 October 2014
Web site creation
I am trying to create a website to link everything together. Fascinating project. Found a website creation site - www.weebly.com and then had to think of a site name. Harder than I thought. The content creation is great. Am loving it as of now.
Project underway.
http://medicaloncology.weebly.com
Project underway.
http://medicaloncology.weebly.com
Decoding Annie Parker: Movie regarding the BRCA gene
Recently watched the movie "Decoding Annie Parker". Was really touched by the movie. Not so much by the content, but for some reason it struck a chord with me regarding the suffering a person goes through. Recommend watching the movie. One of the most significant cancer discoveries in the past few decades. The determined Dr King and her team. The amazing Annie Parker. Well done.
Cancer is horrible and I hope that it would just disappear. The joy on the patient and their families faces, when we tell them that the disease has gone away. Hope the joy remains forever.
Cancer is horrible and I hope that it would just disappear. The joy on the patient and their families faces, when we tell them that the disease has gone away. Hope the joy remains forever.
Sunday 5 October 2014
Best First Line HER2+ Breast Cancer Chemotherapy Regimen
The best first line chemotherapy regimen for a patient with HER2+ breast cancer is now Herceptin + Perjeta + Docetaxel. The data was presented recently in Madrid at the European Cancer Conference (ESMO) as part of the CLEOPATRA study. The data revealed a nearly 17 month survival benefit!!
It is so rare to see such massive benefits in cancer treatments that it would be hard for funding agencies to ignore this data.
Well done to all the patients, their families, friends and all the medical personnel who made this possible in collaboration with the pharmaceutical companies.
It is so rare to see such massive benefits in cancer treatments that it would be hard for funding agencies to ignore this data.
Well done to all the patients, their families, friends and all the medical personnel who made this possible in collaboration with the pharmaceutical companies.
Sunday 14 September 2014
The Fault in Our Stars: Cancer based Movie
Saw the movie "The Fault in Our Stars" today. Nicely done. Good acting. More importantly taught me about the the "person suffering" as compared to the "patient with an illness".
What about life beyond doctors visits, chemotherapy sessions, support groups, etc? What about friendship circles? What happens to relationships? What about families? Parents, brothers, sisters, Husbands, Wives, Children? The trauma of the entire process of treatment and poor prognosis (several times).
Good movie.
What about life beyond doctors visits, chemotherapy sessions, support groups, etc? What about friendship circles? What happens to relationships? What about families? Parents, brothers, sisters, Husbands, Wives, Children? The trauma of the entire process of treatment and poor prognosis (several times).
Good movie.
Saturday 10 May 2014
Best Cancer Chemotherapy Reference Website in the World
I think that the best true cancer chemotherapy reference website in the world is www.eviq.org.au
It is a free registration for access, and gives you detailed information about chemotherapy regimes, protocols, patient information sheets, supportive care data, etc.
Brilliant site.
It is a free registration for access, and gives you detailed information about chemotherapy regimes, protocols, patient information sheets, supportive care data, etc.
Brilliant site.
Wednesday 7 May 2014
Women and the Cancer Gene - ABC
Nice article from the ABC by Elise Worthington. This highlights the issues with BRCA1 genes.
http://www.abc.net.au/news/2014-05-07/worthington-deadly-decisions-women-and-the-cancer-gene/5432570
http://www.abc.net.au/news/2014-05-07/worthington-deadly-decisions-women-and-the-cancer-gene/5432570
Thursday 24 April 2014
Look Good Feel Better - for cancer patients
Look Good Feel Better - www.lgfb.org.au
For patients with cancer who feel dreadful about their appearance, this workshop is great. I personally think that it is not so much for the make-up and cosmetics that help them.... as much as the fellowship of knowing that there are so many other people in the same boat as them.
Massive boost to their esteem and confidence.
This is an initiative of the Australian cosmetic industry for cancer patients in Australia.
A definite suggestion to patients.
For patients with cancer who feel dreadful about their appearance, this workshop is great. I personally think that it is not so much for the make-up and cosmetics that help them.... as much as the fellowship of knowing that there are so many other people in the same boat as them.
Massive boost to their esteem and confidence.
This is an initiative of the Australian cosmetic industry for cancer patients in Australia.
A definite suggestion to patients.
 |
| from www.lgfb.org.au |
Alternative Medicine in Curable Cancer
One of the most frustrating things in the clinic is meeting with patients and their families who refuse standard proven treatment in favour of options which may not have any logical or scientific basis.
It gets worse when the cancer is completely curable with standard treatment.
Most of us can reason with patients to an extent, after which it is their call. Their life. Their responsibility.
Or is it?
Do we as a medical community need to increase awareness about wrong information being dissipated amongst patients and their families? Or do we already have enough work than to spend time on this. This is a relatively small proportion of patients who are so extreme. Should we just leave them to their thoughts and ideas?
Recently I met a lady who had a breast mass but refused all treatment including a biopsy. After lots of chatting, she told me that her spiritual leader had not given her permission for treatment. We negotiated and ultimately she agreed that God has given us common sense. Prayer is vital for everything. We also need to use our brains for decisions. She agreed for treatment in the end.
"Dr Web-browser" seems to have the answers. Depends on what we are looking for.
It gets worse when the cancer is completely curable with standard treatment.
Most of us can reason with patients to an extent, after which it is their call. Their life. Their responsibility.
Or is it?
Do we as a medical community need to increase awareness about wrong information being dissipated amongst patients and their families? Or do we already have enough work than to spend time on this. This is a relatively small proportion of patients who are so extreme. Should we just leave them to their thoughts and ideas?
Recently I met a lady who had a breast mass but refused all treatment including a biopsy. After lots of chatting, she told me that her spiritual leader had not given her permission for treatment. We negotiated and ultimately she agreed that God has given us common sense. Prayer is vital for everything. We also need to use our brains for decisions. She agreed for treatment in the end.
"Dr Web-browser" seems to have the answers. Depends on what we are looking for.
How to say No More Cancer Treatment?
One of the hardest things for me as a doctor to to tell the patient and family that there is no more active treatment available. The simplest thing is usually to keep giving some treatment or the other. The harder thing is to say NO.
For most patients and their families - ongoing treatment means ongoing hope (however small it may be). When we say no, we are dashing that hope.
There are ways to dilly dally with words and talk about best supportive care and symptom management and stuff like that.
Hard decisions. Hard implementation.
For most patients and their families - ongoing treatment means ongoing hope (however small it may be). When we say no, we are dashing that hope.
There are ways to dilly dally with words and talk about best supportive care and symptom management and stuff like that.
Hard decisions. Hard implementation.
Wednesday 23 April 2014
Social Media and Doctors
Where do we stand as far as social media is concerned? How many doctors/nurses have accounts for Facebook, Twitter, Pinterest, MySpace, etc, etc etc? More importantly how many doctors/nurses have been contacted by patients, their friends or relatives to become "friends".
Where does the line of professionalism and personal info blur? I think this is dangerous. Be very careful.
Most hospitals in Australia would not want staff to have social media accounts giving or discussing information about patients or about the hospital activity.
Social media is a great source of engagement and information with friends and family. Stick with that :)
Where does the line of professionalism and personal info blur? I think this is dangerous. Be very careful.
Most hospitals in Australia would not want staff to have social media accounts giving or discussing information about patients or about the hospital activity.
Social media is a great source of engagement and information with friends and family. Stick with that :)
Learning Cancer Research and Protocol Development
Research seems simple to do. We read about it daily... someone has found something somewhere, etc etc etc. Learning to do a proper research in a scientific manner is a completely different ball game.
One of the best learning experiences I had was at the ACORD workshop - Australia and Asia Pacific Clinical Oncology Research Development Workshop. This is held every two years in Queensland, Australia for seven days.
Each of the applicants submit a concept which is evaluated by a panel and 70 participants are selected. The workshop teaches us to take the concept and develop it into a proper protocol, complete with statistics and everything needed to launch a study.
Absolutely phenomenal. The 2014 workshop's last date to apply is over, but worth looking out for the future.
www.acord.org.au
One of the best learning experiences I had was at the ACORD workshop - Australia and Asia Pacific Clinical Oncology Research Development Workshop. This is held every two years in Queensland, Australia for seven days.
Each of the applicants submit a concept which is evaluated by a panel and 70 participants are selected. The workshop teaches us to take the concept and develop it into a proper protocol, complete with statistics and everything needed to launch a study.
Absolutely phenomenal. The 2014 workshop's last date to apply is over, but worth looking out for the future.
www.acord.org.au
Alphabets for Doctors
Several doctors write very poorly with regard to their handwriting. Some doctors who have a good handwriting seem to be folk, who missed their illegible handwriting course!!
I received this picture from a friend today and am not sure about the origin of the picture (thus cannot acknowledge the author).
I received this picture from a friend today and am not sure about the origin of the picture (thus cannot acknowledge the author).
Tuesday 22 April 2014
Asia Pacific Cancer Mentoring and Fellowship Program in Australia
COSA - Clinical Oncological Society of Australia is now open for applications for a fellowship to support a 12 week teaching program at an Australian Cancer Centre. This is for cancer personnel who are from a developing nation in the Asia Pacific region.
Definitely worth the effort. All the best.
Definitely worth the effort. All the best.
Saturday 12 April 2014
Social History and Cancer Patients
In the setting of incurable cancer... over time most of us learn about the more important things versus the not-so-important things. Hugs from grandchildren are more important than the risk of infections.... an overseas holiday is more important than completing that last infusion of chemotherapy.
It is so important to take a proper social history - who is at home with the patient, spouse (lives along or not), who supports the patient. Do children support their parents - or just weekend hellos?
We learn over time that we as humans take social issues to be vital.
It is so important to take a proper social history - who is at home with the patient, spouse (lives along or not), who supports the patient. Do children support their parents - or just weekend hellos?
We learn over time that we as humans take social issues to be vital.
Nurses and Doctors
I wonder if nurses and doctors can work together in a true sense. Are nurses intimidated by doctors? Do doctors try and show superior theoretical knowledge to prove a point? Do doctors raise their voices to seem better? Do nurses clan together to protect themselves?
Not sure.
Am looking for answers.
Not sure.
Am looking for answers.
Saturday 5 April 2014
Praying with patients
How many doctors or nurses pray with their patients? Not many, but there are some who do so. Most doctors either do not care, are you convinced or are worried about the system. I need to start praying with my patients and their families. There are so many reports of the peace and the calm which is brought in.
Found a great book called " Gray Matter: A Neurosurgeon Discovers the Power of Prayer... One Patient at a Time" by David Levy and Joel Kilpatrick. Worth a read.
Gray-Matter
If I do not pray with the patient and their families, at least I should at least pray for them.
Found a great book called " Gray Matter: A Neurosurgeon Discovers the Power of Prayer... One Patient at a Time" by David Levy and Joel Kilpatrick. Worth a read.
Gray-Matter
If I do not pray with the patient and their families, at least I should at least pray for them.
Wednesday 2 April 2014
Generic versus Innovator Medicines
There are so many generic molecules available worldwide, yet we in Australia do not realize the extent of the same. In the past few months, the generic molecules are being pushed more by chemists (yet might charge patients/medicare for the innovator molecule).
Is there a true difference in the salt or preparation? I am really not sure. Would I use a generic for myself... probably not, would prefer the original molecule. My impression is that the big pharma guys who made the molecule, also invest heavily in removing impurities. This is hardly ever mentioned in the data presented. Everyone talks about the amount of the active pharmacological moiety, which needs to be at a concentration of at least 90%.
The biggest problem is the cost. Even after the big pharma have made their zillions on a molecule, yet flog the cost to a point that generics take over.
What do you think? I think it is a personal decision for people.
Is there a true difference in the salt or preparation? I am really not sure. Would I use a generic for myself... probably not, would prefer the original molecule. My impression is that the big pharma guys who made the molecule, also invest heavily in removing impurities. This is hardly ever mentioned in the data presented. Everyone talks about the amount of the active pharmacological moiety, which needs to be at a concentration of at least 90%.
The biggest problem is the cost. Even after the big pharma have made their zillions on a molecule, yet flog the cost to a point that generics take over.
What do you think? I think it is a personal decision for people.
Best Research Masterclass Sessions in the World
The best research masterclass sessions in Oncology are:
# ACORD - Asia Pacific
# Vail - USA
# Flims - Europe
If possible... attend one in a lifetime. Will change your perspective of research and analysis.
# ACORD - Asia Pacific
# Vail - USA
# Flims - Europe
If possible... attend one in a lifetime. Will change your perspective of research and analysis.
Tuesday 1 April 2014
Social Issues and Cancer
The spectrum of social issues explodes in some patients and their families.
As you get to know the patient better and the family trust you, details come out. Who is truly supportive, who is the true carer, who matters in the time of trouble, etc etc. Sad. Very sad most times. There are others, whom you would love to be a part of your family. They leave everything and are there for their parents or family or friends. Fantastic.
A social worker's job is quite phenomenal as they must be taking in all this stuff day-in-and-day-out. Wonder how they cope with this. Really. How do they cope with all this?
Family matters. Stick close.
As you get to know the patient better and the family trust you, details come out. Who is truly supportive, who is the true carer, who matters in the time of trouble, etc etc. Sad. Very sad most times. There are others, whom you would love to be a part of your family. They leave everything and are there for their parents or family or friends. Fantastic.
A social worker's job is quite phenomenal as they must be taking in all this stuff day-in-and-day-out. Wonder how they cope with this. Really. How do they cope with all this?
Family matters. Stick close.
Really good social media site - Quora
I found this really good site called - Quora.com
Great concept. Good layout.
Worth a visit.
Social Media and Oncology Blogs
I am totally thrilled... just signed up for a bunch of social media sites. Some are just so cool. Tumblr, Stumble Upon, etc etc.
In the next few weeks, I will slowly learn about these better and work my way around them.
Will keep you posted.
Monday 31 March 2014
Best Pain Killer Medications in Cancer
All pain is not the same in cancer. Different types of pain requires different medications:
Anti-inflammatory medications - paracetamol, ibuprofen
Opioids - morphine, oxycodone, fentanyl, hydromorphone, methadone
Neuropathic agents - pregabalin, gabapentin, amitryptilline
Most times it is a combination of these drugs which would help.
Anti-inflammatory medications - paracetamol, ibuprofen
Opioids - morphine, oxycodone, fentanyl, hydromorphone, methadone
Neuropathic agents - pregabalin, gabapentin, amitryptilline
Most times it is a combination of these drugs which would help.
Twitter and Cancer
I just signed up with Twitter. Am trying to figure this whole social media thing out :)
My Twitter account is @Med_Oncology
See you on Twitter!!
My Twitter account is @Med_Oncology
See you on Twitter!!
Medical Indemnity and Insurance
All doctors working in public and private hospitals should get the best possible medical indemnity insurance for themselves. Most doctors working in the public system have insurance with the govt health dept, but they also need extra insurance to cover themselves.
I think it is worth the effort. Also it is tax deductible.
I think it is worth the effort. Also it is tax deductible.
COSA Asia Pacific Mentoring Cancer Fellowship Program
The 2014 Fellowship program which supports a 10 - 12 week program at an Australian Cancer Institution. Details available at:
https://www.cosa.org.au/grants-awards/asia-pacific-mentoring-program/fellowships.aspx
Close date: 4th July 2014
https://www.cosa.org.au/grants-awards/asia-pacific-mentoring-program/fellowships.aspx
Close date: 4th July 2014
Low Bacterial Diet and Chemotherapy
What is the evidence of low bacterial diet in patients with chemotherapy for solid tumours? I could not really find anything conclusive in the data available.
Can someone help me out here.
Most of the data is anecdotal about a patient getting this illness or that illness, but the majority of the patients get along fine with clean, cooked food. This concept of scaring patients and their families into only eat this or that and avoid this and that.... it a complete overkill.
Now patients undergoing a bone marrow transplant with sustained neutropenia... that is a completely different story. I am talking only about patients with solid tumours undergoing chemotherapy. The period of neutropenia is relatively short and patients bouncy back fairly soon.
Eat well. Stay strong and healthy.
Can someone help me out here.
Most of the data is anecdotal about a patient getting this illness or that illness, but the majority of the patients get along fine with clean, cooked food. This concept of scaring patients and their families into only eat this or that and avoid this and that.... it a complete overkill.
Now patients undergoing a bone marrow transplant with sustained neutropenia... that is a completely different story. I am talking only about patients with solid tumours undergoing chemotherapy. The period of neutropenia is relatively short and patients bouncy back fairly soon.
Eat well. Stay strong and healthy.
Australian Medicine
Medicine in Australia is top class. It may not be as cutting edge as some hospitals in the US or Western Europe, but for all practical purposes... medicine in Australia is fantastic.
There is a talk about dearth of the latest molecules, but in terms of being pragmatic and the true value for the dollar... there is almost everything available. When I talk about being available, I am talking about being funded by the government (which means free to the patient). Everything, which is not funded by the government, is available on the market (for a price).
The quality of care even in remote towns is great. If a facility is not available or there is a emergency, the Royal Flying Doctors help out.
There is a talk about dearth of the latest molecules, but in terms of being pragmatic and the true value for the dollar... there is almost everything available. When I talk about being available, I am talking about being funded by the government (which means free to the patient). Everything, which is not funded by the government, is available on the market (for a price).
The quality of care even in remote towns is great. If a facility is not available or there is a emergency, the Royal Flying Doctors help out.
Working Overtime and Medicine
How do most of doctors deal with working overtime? I am really not sure. Most of us... just work. I am learning that I need to protect myself and stick to time schedules.
Work never gets over. Ever.
We need to do as much as possible and get out of the workplace to come back the next day to do the remaining.
Take time for yourself and your family/friends. Absolutely vital.
Work never gets over. Ever.
We need to do as much as possible and get out of the workplace to come back the next day to do the remaining.
Take time for yourself and your family/friends. Absolutely vital.
Adjuvant Herceptin / Trastuzumab Treatment Duration
A few years ago when Herceptin (trastuzumab) was launched for the early stage of Her2+ breast cancer, the timing of treatment was fixed at one year. Why one year? No clue. Just a consensus figure decided by a few oncology investigators.
At the European Oncology meeting held in the end of Sep 2012 - data from large studies were presented. The two main studies were comparing one year versus six months of Herceptin - this showed that probably one year is better than six months. The other study of one year versus two years showed that one is probably enough.
So the consensus a few years ago, was right. Twelve months is the magic figure (for now).
- taken from my older blog
At the European Oncology meeting held in the end of Sep 2012 - data from large studies were presented. The two main studies were comparing one year versus six months of Herceptin - this showed that probably one year is better than six months. The other study of one year versus two years showed that one is probably enough.
So the consensus a few years ago, was right. Twelve months is the magic figure (for now).
- taken from my older blog
Adjuvant GIST - Gastro Intestinal Stromal Tumours
GIST is classically operated upon and thought to be cured by surgery. Unfortunately more and more clinicians are finding that patients have recurrence of disease. Nowadays, there are way to find possible recurrence risk rates, and treat accordingly.
If a patient has a high to moderate risk of recurrence, then they must be offered Imatinib (Glivec or Gleevec). The duration of treatment continues to be a matter of discussion - most people agree for one (1) year of treatment, but there is now data to show that three (3) years of treatment is necessary.
I suspect that treatment would be needed for long term (much longer than three years), as the survival curves at one year and three year of treatment are quite similar, when treatment is stopped.
The important thing is to ask your surgeon to consider Imatinib therapy or refer you to a MedicalOncologist for discussion.
- taken from my older blog
If a patient has a high to moderate risk of recurrence, then they must be offered Imatinib (Glivec or Gleevec). The duration of treatment continues to be a matter of discussion - most people agree for one (1) year of treatment, but there is now data to show that three (3) years of treatment is necessary.
I suspect that treatment would be needed for long term (much longer than three years), as the survival curves at one year and three year of treatment are quite similar, when treatment is stopped.
The important thing is to ask your surgeon to consider Imatinib therapy or refer you to a MedicalOncologist for discussion.
- taken from my older blog
Driving and Brain Metastasis
People who have been driving their vehicles for several years (most times decades) are really upset when we tell them that they should not be driving their cars.
In Australia the onus is on the clinicians to get affected patients to stop driving their cars. The treating clinician is meant to tell the patient to stop driving and send a letter to the Driving Authority to withhold/revoke the patient's driver's license.
The number of clinicians who even know about this is minimal!!
If a patient's cancer has spread to their brain, the chances of seizures or altered consciousness are quite high. There is no specific time or place when things can get out of control. Also these patients have had radiotherapy, surgery, are on high dose steroids, narcotics, etc... and thus the mental cognition and reaction time is dramatically altered.
The conversation is a difficult one. But a very important one. It could save the patient's life and others on the road.
- taken from my older blog
In Australia the onus is on the clinicians to get affected patients to stop driving their cars. The treating clinician is meant to tell the patient to stop driving and send a letter to the Driving Authority to withhold/revoke the patient's driver's license.
The number of clinicians who even know about this is minimal!!
If a patient's cancer has spread to their brain, the chances of seizures or altered consciousness are quite high. There is no specific time or place when things can get out of control. Also these patients have had radiotherapy, surgery, are on high dose steroids, narcotics, etc... and thus the mental cognition and reaction time is dramatically altered.
The conversation is a difficult one. But a very important one. It could save the patient's life and others on the road.
- taken from my older blog
Best Oncology Textbooks
Which is the best Oncology Textbooks?
I think:
# DeVita's Cancer: Principles and Practice of Oncology
# Abeloff's Clinical Oncology
are the best ones.
There are tons of other books, but these two seem to cover the maximum amount of information in the best possible manner.
- taken from my older blog
I think:
# DeVita's Cancer: Principles and Practice of Oncology
# Abeloff's Clinical Oncology
are the best ones.
There are tons of other books, but these two seem to cover the maximum amount of information in the best possible manner.
- taken from my older blog
Urine Protein and Avastin / Bevacizumab
Avastin (Bevacizumab) is a good medication in metastatic bowel cancer (both colon and rectum). It is used for extended periods of time with chemotherapy to control and reduce the burden of cancer.
It is very important to check the urinary protein while on this medications, as it does have a potential to damage the functioning of the kidney. In case, the kidneys are secreting increased amounts of proteins, it is then important to check the quantity and then if needed to stop Avastin till the kidneys recover.
We have found that a significant number of doctors forget to check urine protein, while patients are on Avastin.
- taken from my older blog
It is very important to check the urinary protein while on this medications, as it does have a potential to damage the functioning of the kidney. In case, the kidneys are secreting increased amounts of proteins, it is then important to check the quantity and then if needed to stop Avastin till the kidneys recover.
We have found that a significant number of doctors forget to check urine protein, while patients are on Avastin.
- taken from my older blog
Infections from Doctors
Infections can be transmitted from doctors and nurses to patients. It is well known. Hospitals across the world are trying to convince medical staff to clean their hands - wash with soap and water or use rubbing alcohol.
The other common things which are sources of infections are doctors' white coats (which are not washed very often), neck ties (never washed), stethoscopes (hardly ever cleaned), telephones, and the list goes on.
Think about it.
- taken from my older blog
The other common things which are sources of infections are doctors' white coats (which are not washed very often), neck ties (never washed), stethoscopes (hardly ever cleaned), telephones, and the list goes on.
Think about it.
- taken from my older blog
Doctors as Patients: VIP syndrome
One of the nightmares for medical units across the world is to have a doctor as a patient. Everything has to be extra-careful in the discussion, tests, planning and implementation. Each thing is checked and double-checked.
I know that I am a terrible patient. I do not quite remember completing a full course of antibiotics or doing the things recommended to me.
The problem is that for some strange reason (?Murphy's law), when we are extra-careful; things go extra wrong. Some people term it the "VIP syndrome".
- taken from my older blog
I know that I am a terrible patient. I do not quite remember completing a full course of antibiotics or doing the things recommended to me.
The problem is that for some strange reason (?Murphy's law), when we are extra-careful; things go extra wrong. Some people term it the "VIP syndrome".
- taken from my older blog
Merkel Cell Cancer: Rare Cancers
Recently someone asked me about Merkel cell cancer. Relatively rare.
The website I suggested helped him - http://www.merkelcell.org/
Thought it might be worth sharing, in case more people need help with this condition.
- taken from my older blog
The website I suggested helped him - http://www.merkelcell.org/
Thought it might be worth sharing, in case more people need help with this condition.
- taken from my older blog
Hindu Customs and Hair Loss
I have spent time doing oncology work in India and working with patients was very rewarding.
One day in the out-patient clinic, I met with three women consecutively who were to start chemotherapy. All three women would lose their hair and it was very distressing for each of them and their families.
Two days later, I suggested to one of these women to shave their hair and make a wig out of her own hair. It seemed like a good idea to me. It was NOT a good idea for her and her family. In traditional Hindu culture, a woman would shave her hair at the time of being widowed.
No more such suggestions. Ever!!
- taken from my older blog
One day in the out-patient clinic, I met with three women consecutively who were to start chemotherapy. All three women would lose their hair and it was very distressing for each of them and their families.
Two days later, I suggested to one of these women to shave their hair and make a wig out of her own hair. It seemed like a good idea to me. It was NOT a good idea for her and her family. In traditional Hindu culture, a woman would shave her hair at the time of being widowed.
No more such suggestions. Ever!!
- taken from my older blog
Hair loss and Chemotherapy
One of the biggest worries about chemotherapy is hair loss. It seems to be a bigger issue than even fatigue and reduced appetite. This is what I seem to find in clinical practice. The worry seems to be more in women than men, but both genders are worried.
A lot of people are really surprised when I tell them that they would not be losing their hair. All chemotherapy drugs are not the same. Some drugs cause hair loss, some do not.
- taken from my older blog
A lot of people are really surprised when I tell them that they would not be losing their hair. All chemotherapy drugs are not the same. Some drugs cause hair loss, some do not.
- taken from my older blog
Gastro Intestinal Stromal Tumours - GIST
GIST is a truly game changing cancer. It has been around for centuries, misdiagnosed as other types of cancers. In the past few years, GIST has found to have special markers and thus the diagnosis is definitive. The main markers are c-kit (CD117) and DOG1
Treatment is to completely remove the tumour by surgery. This is possible while it is in an early stage. Once the cancer has spread, surgery is not possible (most times). Chemotherapy was as good as useless. Nothing seemed to work.
A few years ago, a pharmaceutical company launched a molecule called Imatinib (Glivec). This has changed everything for GIST. Now people with metastatic GIST, pop a pill a day and continue with life. Quite amazing.
Recent data has shown that even after surgery, Glivec should be given for at least 3 years.
Once Glivec stops working, there are other medications (Sunitinib) available.
Game changer. Looking for more such miracles.
- modified from my older blog
Treatment is to completely remove the tumour by surgery. This is possible while it is in an early stage. Once the cancer has spread, surgery is not possible (most times). Chemotherapy was as good as useless. Nothing seemed to work.
A few years ago, a pharmaceutical company launched a molecule called Imatinib (Glivec). This has changed everything for GIST. Now people with metastatic GIST, pop a pill a day and continue with life. Quite amazing.
Recent data has shown that even after surgery, Glivec should be given for at least 3 years.
Once Glivec stops working, there are other medications (Sunitinib) available.
Game changer. Looking for more such miracles.
- modified from my older blog
Angry Patients
One of the most intimidating experiences is to be confronted by an angry patient and their family/friends. They might be upset about the long waiting time or the services or whatever. In the process of getting angry, the primary intention of sorting out the medical problem gets buried (to some extent).
I have found it quite effective to let the angry patient rant about everything. When they run out of steam, try and work through the problem.
There have been a couple of patients, who refuse to listen and only yell. It is not worth breaking your head with them. Ask them to leave, or leave the room yourself.
I have the right to work in a safe environment.
- taken from my older blog
I have found it quite effective to let the angry patient rant about everything. When they run out of steam, try and work through the problem.
There have been a couple of patients, who refuse to listen and only yell. It is not worth breaking your head with them. Ask them to leave, or leave the room yourself.
I have the right to work in a safe environment.
- taken from my older blog
Death or Dying
I wonder what is worse - death or dying. I suspect most people are worried about the process of dying, with regard to pain or breathlessness; but there would be a fair number of people who are also worried about what would happen after they die. What would happen to them, their families, their friends, their assets, etc.
Difficult question. Personal. As always.
- taken from my older blog
Difficult question. Personal. As always.
- taken from my older blog
Research and Clinical Trials
Clinical Trials for medications and drugs are broadly divided in four groups or phases:
Phase 1: Very early type of research. In some types, it would be a "first in human" study
Phase 2: Studies would have shown the medication to be relatively safe and it is now being tested for efficacy
Phase 3: The safety and efficacy have been shown to be favourable, and now it is being tested against the present standard of care
Phase 4: This study is primarily to gain more information about the medication, as it has already been approved for routine use in the market
Enrolling onto clinical trials is a good thing. It gives access to newer molecules or different ways of using older molecules. It is possible that the full benefits of the study medication may never be seen in the patients enrolled on the study, bur future generations would benefit from the same.
All trials are governed via an Ethics Committees, which may be locally or centrally based. They are the guardians of patients and their families, and would not give permission to conduct a study, unless they are convinced about safety.
The first principle remains - "First do no harm"
- taken from my older blog
Phase 1: Very early type of research. In some types, it would be a "first in human" study
Phase 2: Studies would have shown the medication to be relatively safe and it is now being tested for efficacy
Phase 3: The safety and efficacy have been shown to be favourable, and now it is being tested against the present standard of care
Phase 4: This study is primarily to gain more information about the medication, as it has already been approved for routine use in the market
Enrolling onto clinical trials is a good thing. It gives access to newer molecules or different ways of using older molecules. It is possible that the full benefits of the study medication may never be seen in the patients enrolled on the study, bur future generations would benefit from the same.
All trials are governed via an Ethics Committees, which may be locally or centrally based. They are the guardians of patients and their families, and would not give permission to conduct a study, unless they are convinced about safety.
The first principle remains - "First do no harm"
- taken from my older blog
Pulmonary Embolism - PE
One of the big problems with cancer is clots in the blood vessels of the lungs. It is a significant cause of death in cancer patients. Most people do not really know or understand the condition.
Cancer is a condition which makes blood stickier. If you combine this with the fact that the patient is not very mobile, not drinking enough of fluid, is on chemotherapy via intravenous access device, is on medication which also affects the clotting of blood... it is a fairly strong combination for clot formation.
People can develop clots in their legs, which then break off and shower small clots in the blood vessels of the lungs. A large blood clot in the lung vessels can potentially kill the patient.
The treatment is making the blood thinner with medications - heparin, heparin like drugs (Clexane, Fragmin) or warfarin.
The important issue being awareness of the condition. Sudden shortness of breath, cough, sharp chest pain, etc are some of the main symptoms.
- modified from my older blog
Cancer is a condition which makes blood stickier. If you combine this with the fact that the patient is not very mobile, not drinking enough of fluid, is on chemotherapy via intravenous access device, is on medication which also affects the clotting of blood... it is a fairly strong combination for clot formation.
People can develop clots in their legs, which then break off and shower small clots in the blood vessels of the lungs. A large blood clot in the lung vessels can potentially kill the patient.
The treatment is making the blood thinner with medications - heparin, heparin like drugs (Clexane, Fragmin) or warfarin.
The important issue being awareness of the condition. Sudden shortness of breath, cough, sharp chest pain, etc are some of the main symptoms.
- modified from my older blog
Negatives and Positives
English and Medicine are not always the most complimentary areas.
Patients are told by their doctors that:
- The disease has progressed - patients are happy, progress is a good word - but doctors mean that the disease has increased
- The lymph nodes are positive - patients are happy, positive is a good word - but doctors mean that the cancer has spread
- HER2 gene is positive - patients are happy, positive is a good word - but doctors mean that the cancer is more aggressive
- KRAS is positive - patients are happy, but negative KRAS is better
- EGFR is mutant - patients are sad, but mutant is better
- modified from my old blog
Oncology and Sympathy
Most people who realize that I work with cancer patients, are quite sympathetic towards me. Their logic is that most patients would die with cancer. The problem is that most people never hear about the brighter side of oncology care. They rarely hear about patients who are cured and live long and fulfilling lives. They never hear about women and men, who go through chemotherapy and go on to have children and families.
Oncology is a good field. I can cure some. Give hope to others. Care for all of them.
Oncology is a good field. I can cure some. Give hope to others. Care for all of them.
Pancreatic cancer and breast cancer
The advert by the Pancreatic cancer UK campaign is sad, but well thought out.
http://www.dailymail.co.uk/health/article-2552308/I-wish-I-breast-cancer-Pancreatic-cancer-charitys-campaign-slogan-causes-outrage-sufferers-disease.html
It managed to create the buzz that was so desperately needed for cancers like pancreatic (which no one except the sufferers seems to care about).
Well done.
Children and Cancer
I find it extremely difficult to deal with children who have cancer, and their families. It is the single biggest reason why I do not treat kids. Too hard. The doctors and nurses who treat paediatric malignancies are absolutely fantastic. More power to them.
The only favourable point about kiddie cancers are that they are relatively more treatable as compared to the adult cancers. The horrible part is failing.
- this is taken from my old blog
The only favourable point about kiddie cancers are that they are relatively more treatable as compared to the adult cancers. The horrible part is failing.
- this is taken from my old blog
Friends and Professionals
What do I do when a friend of mine is on treatment and I am pretty sure that they are not getting optimal treatment? Do I keep intervening on my friend's behalf and undermine their primary doctor? Difficult. Very difficult.
- this is copied from my old blog
- this is copied from my old blog
What does the doctor feel?
I realize that most patients and their relatives are petrified by the first appointment with their cancer doctor. A fair number of times, they have not been clearly told about the diagnosis. Ever wonder what the doctor must be feeling at the start of the new conversation?
- this is taken from my old blog and copied here
- this is taken from my old blog and copied here
Medications available
Cancer therapy is treated via:
Slowly working towards cure or at least prolonged remission/stable disease.
- cytotoxics
- biologicals
- targeted agents
- hormonal manipulation
- best supportive care
Slowly working towards cure or at least prolonged remission/stable disease.
Sunday 30 March 2014
Previous work
Some of my previous work is on - http://medicaloncology.blogspot.com.au/
I'll copy and paste some of the previous blogs and update them. Might help some folk.
The idea is give information and help people. Communicate. Interact. See what happens!!
I'll copy and paste some of the previous blogs and update them. Might help some folk.
The idea is give information and help people. Communicate. Interact. See what happens!!
Starting Life Again
Long break. I wrote a bit a couple of years ago and then stopped. Extreme case of laziness. Am starting again. Let's see what happens now.
Subscribe to:
Posts (Atom)