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.

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

Empathy Cards for Cancer Patients (Slate)

Beautiful cards with great thoughts

http://www.slate.com/blogs/the_eye/2015/05/06/empathy_cards_by_emily_mcdowell_are_greeting_cards_designed_for_cancer_patients.html

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

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.

Why are mainly old magazines present in a doctors waiting area?

Great study published in the BMJ
http://www.bmj.com/content/349/bmj.g7262

Cost of Cancer Care - A Perspective

Good insight
http://well.blogs.nytimes.com/2014/12/11/the-punishing-cost-of-cancer-care/?_r=0

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.

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.

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

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.

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.

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

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.

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.

The Cost of Cancer Drugs from CBS News

Amazing bit of journalism. Worth a watch. More about this soon.

CBS news: Cost of Cancer Drugs

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

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.

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.

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.

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.

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

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.

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.

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.

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 :)

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

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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!!

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.