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.
Sunday, 23 August 2015
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.
Sunday, 14 December 2014
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
http://www.bmj.com/content/349/bmj.g7262
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.
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| from www.lgfb.org.au |
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