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)

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.

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.

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.

USA cost of cancer drugs

US cost of cancer drugs

What not to say to someone with cancer

Great article from the ABC site.
What not to say to someone with cancer

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.

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

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.

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.

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.

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

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.

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

Great Article from Cosmo: I have Cancer and It Sucks

Great article: "i have cancer and it sucks"

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

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?

Heavier babies more likely to develop cancer

Interesting study. Will wait for more data.

Heavier babies more likely to develop cancer

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

Nursing in Palliative care

Great article about palliative care


Communicating with dying patients

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

Great Cancer Genome Resource

This is a very good resource for health professionals to investigate about mutation analysis and genomic information.

My Cancer Genome

Genetic Screening for all?

Genetic Screening for all?

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