I met a patient recently who has advanced cancer, which is treatment (but not curable). The options include chemotherapy, radiotherapy and surgery. Chemotherapy options include cytotoxic medications and targeted biological agents.
The problem is that the patient also has very advanced dementia and has no understanding of what is going on. The devastation on the family members is just heart-rending. They want to treat their loved one for the cancer, but know that it would prolong the suffering.
Where does informed consent come into the picture?
Where does compassion come?
Where does common sense come?
The art of medicine never ceases to amaze me.
Sunday 20 December 2015
Monday 2 November 2015
In the Shadow of Death: Life as a Palliative Care Nurse
Simple and clear ABC article about the absolute importance of a Palliative Care Nurse. The emotional toll each nurse undertakes is phenomenal. Hats off to each one around the world.
In the Shadow of Death: Life as a Palliative Care Nurse
In the Shadow of Death: Life as a Palliative Care Nurse
Sunday 1 November 2015
Cancer killing viruses
The cancer attacking virus is now FDA approved for melanoma. Good drug from a conceptual perspective. Will take time to get better data. Most probably the better idea would be combination therapy (T-VEC along with another immune modulating medication).
This is an article from ArsTechnica.
Cancer killing viruses
This is an article from ArsTechnica.
Cancer killing viruses
Saturday 24 October 2015
Myths about antioxidant supplements needs to die
The debate goes on. I doubt that people would stop using the alternative stuff... as it has been proven without doubt that evidence does not always change minds!!
Myths about antioxidant supplements need to die
(from Ars Technica)
Myths about antioxidant supplements need to die
(from Ars Technica)
Friday 23 October 2015
The Joy of a Wrong Diagnosis
Recently a young woman was referred to my clinic. She complained of chest discomfort and occasionally breathlessness for the past 3 - 4 weeks. Her doctor arranged for a Chest Xray, which showed a large mass in the lung. A CT scan showed a massive lung tumour arising from the middle of the chest (mediastinum). She was referred to me with a possible diagnosis of advanced lung cancer.
We repeated arranged for a core biopsy of the large lung mass. And we waited. And waited. And waited. That was the hardest part. The waiting. The reason being that the diagnosis was hard to make.
Everyone was convinced that she had a bad lung cancer or a thymic cancer (both of which do not have a good prognosis).
Amazingly, the pathologist (who I hassled daily for a diagnosis) called me up to tell me that she had a variant of Hodgkin's Lymphoma.
I was SO happy to be proven wrong, as she has a very good chance of a cure... not just getting better. But an actual cure.
So good to be proven wrong for the greater good.
We repeated arranged for a core biopsy of the large lung mass. And we waited. And waited. And waited. That was the hardest part. The waiting. The reason being that the diagnosis was hard to make.
Everyone was convinced that she had a bad lung cancer or a thymic cancer (both of which do not have a good prognosis).
Amazingly, the pathologist (who I hassled daily for a diagnosis) called me up to tell me that she had a variant of Hodgkin's Lymphoma.
I was SO happy to be proven wrong, as she has a very good chance of a cure... not just getting better. But an actual cure.
So good to be proven wrong for the greater good.
TV interview: Cancer Research for Immune based Medications
Northern Adelaide Cancer Centre at the Lyell McEwin Hospital
Thank you John, Karyn, Jacqui, Kyla and the entire team.
Thank you John, Karyn, Jacqui, Kyla and the entire team.
Experience of a TV interview for Cancer Research
Recently I was interviewed on TV for a series of research projects that our team were working on. This was my first experience being interviewed on TV. Very interesting. Amazing what the end product is compared to the "shoot time".
We enjoyed it as a Cancer Unit as it increased our profile dramatically.
Am proud to be a part of the Cancer Unit.
We enjoyed it as a Cancer Unit as it increased our profile dramatically.
Am proud to be a part of the Cancer Unit.
Tuesday 22 September 2015
Sunday 23 August 2015
Importance of Cancer Clinical Trials: Standard of Care
Patients with no options of treatment really do need access to clinical trials and research projects. In cancer care, clinical trials are standard of care!! Full stop.
If someone has an argument against this, am happy to discuss this further.
It really frustrates me, when bureaucrats think that clinical trials are a waste of time and are taking time away from patient care. How far from the truth is that.
I would urge every patient to ask their treating doctor for access to a clinical trial or research project, even if the same treatment or medication is available as standard of care. A clinical trials is managed very closely and no mistakes are tolerated. Several people keep a watch on the process and the patient gets the best possible care.
Ask your doctor or search online for a clinical trial.
If someone has an argument against this, am happy to discuss this further.
It really frustrates me, when bureaucrats think that clinical trials are a waste of time and are taking time away from patient care. How far from the truth is that.
I would urge every patient to ask their treating doctor for access to a clinical trial or research project, even if the same treatment or medication is available as standard of care. A clinical trials is managed very closely and no mistakes are tolerated. Several people keep a watch on the process and the patient gets the best possible care.
Ask your doctor or search online for a clinical trial.
Thursday 30 July 2015
Adelaide Doctor takes on Australian Insurance Giant!!
A doctor from Adelaide, Australia has written an open mail to Medibank Private challenging their new rules for health insurance.
He has laid bare, what most doctors and health professionals have been thinking about. Well done Peter.
"Dear Medibank Private,
I, like many other health professionals, have just cancelled my insurance policy that my wife (Katrina Devonish) and I have maintained with you since 2002.
The cynical attempt by your company to save money by refusing to fund your members' care for so-called "avoidable complications" is an abuse of trust towards those who believe your actions are in their best interest.
I received your letter regarding the breakdown of negotiations with the Calvary Hospital Network and the obtuse justification for why your clients will potentially be even more out of pocket when receiving private health care.
Whether this is the first step towards "USA style" managed care or just actuarial nonsense, I do not wish to put my family in the situation where we need to self fund for readmission (or joust for admission to a public hospital) should we suffer an unavoidable complication post-surgery. (The definition of "avoidable complication" we will need to agree to disagree at this juncture.)
I shall be spreading the message fair and wide and hopefully the sound of the thundering stampede of the mass exodus of your former members moving onto more ethical health funds may make you reconsider this ludicrous policy direction.
Yours sincerely,
Peter Devonish
Consultant Anaesthetist
Public and Private Health Sectors in South Australia"
The FaceBook post
He has laid bare, what most doctors and health professionals have been thinking about. Well done Peter.
"Dear Medibank Private,
I, like many other health professionals, have just cancelled my insurance policy that my wife (Katrina Devonish) and I have maintained with you since 2002.
The cynical attempt by your company to save money by refusing to fund your members' care for so-called "avoidable complications" is an abuse of trust towards those who believe your actions are in their best interest.
I received your letter regarding the breakdown of negotiations with the Calvary Hospital Network and the obtuse justification for why your clients will potentially be even more out of pocket when receiving private health care.
Whether this is the first step towards "USA style" managed care or just actuarial nonsense, I do not wish to put my family in the situation where we need to self fund for readmission (or joust for admission to a public hospital) should we suffer an unavoidable complication post-surgery. (The definition of "avoidable complication" we will need to agree to disagree at this juncture.)
I shall be spreading the message fair and wide and hopefully the sound of the thundering stampede of the mass exodus of your former members moving onto more ethical health funds may make you reconsider this ludicrous policy direction.
Yours sincerely,
Peter Devonish
Consultant Anaesthetist
Public and Private Health Sectors in South Australia"
The FaceBook post
Sunday 26 July 2015
Family and Cancer
The majority of patients come with family members for clinic and chemotherapy appointments.
I was not someone who would try and spend too much time figuring out the patient's family logistics and dynamics. This has changed over the past few years and I am learning that the family is one of the main reasons why patients keep fighting cancer positively.
When a patient comes to clinic alone... worth probing more about why he/she has come alone today. Could just be coincidence... but worth asking.
The first appointment in a cancer unit can be very daunting for patients having someone along is a huge emotional support. Also there is so much of information which is discussion, including breaking news about cancer, scan and biopsy results, treatment options available. It is really important to have another set of ears to take in all this. This can then be discussed at length at home with other family members or friends.
One of the saddest things is when the patient has never told the rest of the family about the cancer diagnosis or details till it is too late. Some family members get really angry with the doctors and nurses, about the lack of information given to them. The thing to remember is that the patient decides who gets told or not (as long as they have full mental capacity).
Some OPD appointments can be a battleground between family members and other times it is so comforting to watch family and friends take control and soothe the distraught patient.
Everyday is different. Learn something new. Everyday.
Thank you for making me a better person.
I was not someone who would try and spend too much time figuring out the patient's family logistics and dynamics. This has changed over the past few years and I am learning that the family is one of the main reasons why patients keep fighting cancer positively.
When a patient comes to clinic alone... worth probing more about why he/she has come alone today. Could just be coincidence... but worth asking.
The first appointment in a cancer unit can be very daunting for patients having someone along is a huge emotional support. Also there is so much of information which is discussion, including breaking news about cancer, scan and biopsy results, treatment options available. It is really important to have another set of ears to take in all this. This can then be discussed at length at home with other family members or friends.
One of the saddest things is when the patient has never told the rest of the family about the cancer diagnosis or details till it is too late. Some family members get really angry with the doctors and nurses, about the lack of information given to them. The thing to remember is that the patient decides who gets told or not (as long as they have full mental capacity).
Some OPD appointments can be a battleground between family members and other times it is so comforting to watch family and friends take control and soothe the distraught patient.
Everyday is different. Learn something new. Everyday.
Thank you for making me a better person.
CanTEEN: Cancer affecting Teens (12 - 24)
CanTeen is a great organization (CanTeen) who supports teenagers suffering with cancer or if they are affected with cancer (parents, family, friends). CanTeen supports kids from as young as 12 years to 24 years. I have occasionally had help for kids who are even younger than 12.
Great resource for patients, families and their health care providers. Thank you for everything you do.
Great resource for patients, families and their health care providers. Thank you for everything you do.
Death of a young patient
A young patient was referred to me with a diagnosis of metastatic colon cancer. The surgeon phoned me and asked if I could see her urgently.... I did. She was in her late 30's and had extensive cancer in her liver. There was hardly any normal liver seen on her scans.
During the consultation, I explained that she had a poor prognosis and we need to start chemotherapy soon. She was one of the most positive patients I had ever met. She had young children and they were her main motivation to get healthier and stronger.
She was started on chemotherapy with FOLFOX and Avastin... had one of the most spectacular responses you can imagine (her liver disease had a complete response). Two years later, she had relapse of disease and she was started on Cetuximab. On disease progression, Irinotecan was added... we reintroduced FOLFOX, a clinical trial, some more Capecitabine.
Today, after 4 and a half years of battle.... she is taking her last breaths. I met her, her children and her family. They thanked me immensely for everything I had done.
One of the saddest things is the inability to do enough. More. Something more.
In my mind, I still have the image of the lady who was positive as ever. Willing to fight any cancer or complication. The lady who was working and enjoying life, while still on chemotherapy.
Each time, I come across this situation.... I learn to appreciate life and everything that we have. And do not realize. Take things for granted.
Life goes on. Learn to love what we have and the people around us.
During the consultation, I explained that she had a poor prognosis and we need to start chemotherapy soon. She was one of the most positive patients I had ever met. She had young children and they were her main motivation to get healthier and stronger.
She was started on chemotherapy with FOLFOX and Avastin... had one of the most spectacular responses you can imagine (her liver disease had a complete response). Two years later, she had relapse of disease and she was started on Cetuximab. On disease progression, Irinotecan was added... we reintroduced FOLFOX, a clinical trial, some more Capecitabine.
Today, after 4 and a half years of battle.... she is taking her last breaths. I met her, her children and her family. They thanked me immensely for everything I had done.
One of the saddest things is the inability to do enough. More. Something more.
In my mind, I still have the image of the lady who was positive as ever. Willing to fight any cancer or complication. The lady who was working and enjoying life, while still on chemotherapy.
Each time, I come across this situation.... I learn to appreciate life and everything that we have. And do not realize. Take things for granted.
Life goes on. Learn to love what we have and the people around us.
Wednesday 22 July 2015
Cancer: The Emperor of All Maladies
"Cancer: The Emperor of All Maladies" is one of the best books on cancer that I have read in a long long time. Great book. Talks in simple language, but with a good medical background. There is a TV series on now. Not seen it, but has just been nominated for a Emmy.
Cancer: The Emperor of All Maladies
Cancer: The Emperor of All Maladies
Tuesday 21 July 2015
New PD-1 targeted drugs for melanoma
Patients in Australia presently have a option of getting Nivolumab or Pembrolizumab for advanced melanoma. Neither of the medications are presently funded on the Pharmaceutical Benefits Scheme (Pembro will be from 1st Sep 2015), but are available via Access programmes from the companies. Great drugs. Great benefits. Significantly lowered toxicity profile.
Worth having a discussion with your Oncology doctor.
Worth having a discussion with your Oncology doctor.
The Irresponsible Killing Cancer Talk
Everytime something is published in the newspaper or is mentioned on TV/radio, it is talked about being the cure of cancer. The study might have been done in rats or in a petri dish, but is portrayed as if that is going to solve all the problems of cancer. The next day, half the consult time is wasted talking down all the newspaper cuttings and reports!! :)
The Irresponsible Killing Cancer Talk
The Irresponsible Killing Cancer Talk
Tuesday 14 July 2015
ResearchKit and Big Pharma
Slowly but steadily big pharmaceuticals are starting to unravel the huge potential of ResearchKit. Cannot wait for this to come to Australia.
Researchkit gets Big Pharma interested
Researchkit gets Big Pharma interested
Do you need to poo daily?
One of major patient complaints is about their bowel habits. Too hard, too loose, too difficult, too much effort. This gets to a point where some people get obsessed with their bowel patterns. This is a major problem worldwide due to change in diet patterns and the medications. A fair number of cancer patients are on strong pain killers including opioids, which further contribute to constipation.
Do you need to poo daily?
Do you need to poo daily?
Monday 13 July 2015
Nintendo boss dies of biliary cancer
Nintendo CEO - the Wii man - died of possibly biliary tract cancer. He was only 55 years old. Major loss to the gaming world.
Nintendo boss dies of cancer
Nintendo boss dies of cancer
ResearchKit in Australia soon?
I am so looking forward to ResearchKit being available in Australia. The potential is just amazing. I can think of a variety of areas to use it. The folk in the US are having a really good go at the software.
Look forward to the future.
ResearchKit
Github and ResearchKit
Look forward to the future.
ResearchKit
Github and ResearchKit
Tuesday 7 July 2015
Great Cancer Genome Resource
This is a very good resource for health professionals to investigate about mutation analysis and genomic information.
My Cancer Genome
My Cancer Genome
Monday 6 July 2015
Sunday 31 May 2015
Simple way of preventing non-melanoma skin cancer
Simple way of preventing non-melanoma skin cancer
Data presented at ASCO 2015 in Chicago. Great thought. Minimal cost.
Data presented at ASCO 2015 in Chicago. Great thought. Minimal cost.
Saturday 30 May 2015
Advanced Lung Cancer will get converted to a chronic disease in our lifetime!!
I am convinced that diseases like advanced lung cancer will get converted into a chronic disease with ongoing treatment. The chances of getting rid of it completely will take a much longer time, but being able to get long term control it with medication will happen in our lifetime.
http://www.bbc.com/news/health-32936877
http://www.bbc.com/news/health-32936877
Saturday 16 May 2015
Sunday 15 March 2015
Homeopathy: Scientific review
The premium scientific organization in Australia - The National Health and Medical Research Council (NHMRC) has done a systematic review of homeopathy and found the lack of useful evidence in treating various medical conditions.
https://www.nhmrc.gov.au/health-topics/complementary-medicines/homeopathy-review
https://www.nhmrc.gov.au/health-topics/complementary-medicines/homeopathy-review
Thursday 5 March 2015
Survivorship
I recently attended a Survivorship conference. It changed me. Listening to people who have been through chemotherapy or people who have cared for people fighting cancer, does put things in a different perspective. These are people who are trying their best to make each day count for their loved one.
A decade or two ago, we really did not seem to care about long term needs of people going through cancer therapy. Not many survived... so why stress about the long term effects.
Now things are different, people are being cured of their cancer. They have to deal with the effects from fingers being numb, heart muscle problems, secondary cancers, etc.
The big issue about fertility and having their own family.
Lots to thing about.
A decade or two ago, we really did not seem to care about long term needs of people going through cancer therapy. Not many survived... so why stress about the long term effects.
Now things are different, people are being cured of their cancer. They have to deal with the effects from fingers being numb, heart muscle problems, secondary cancers, etc.
The big issue about fertility and having their own family.
Lots to thing about.
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