Tag Archives: Oncology

The Art of Medicine

There’s a great deal of art in the practice of medicine. It just doesn’t usually find its way into medical meetings.

Lilly Oncology On Canvas©

 Yet, there in the poster hall at the Chicago Multidisciplinary Symposium in Thoracic Oncology, amongst all the talk of TKI resistance and MEK inhibitors, were easels full of art including a pastel of mischievous fairies dancing among daisies and a painting of a bald woman smiling out from behind a pair of rose-colored spectacles beside the words, “Life is full of surprises.”  

The pieces are part of the Lilly Oncology On Canvas project, an art competition and exhibition launched in 2004 with the National Coalition for Cancer Survivorship as a way for those affected by cancer to express themselves and provide inspiration to others. The competition is open to patients, family members, friends, and caregivers and, surprisingly, health care providers.

"Best of Exhibition" 2010 Lilly Oncology On Canvas©

More than 600 entries were received for the 2010 competition, with Annette Zalewski , a nurse of nearly 30 years, earning three awards including “Best of Exhibition” for her determination to continue weaving together a beautiful life that was “cut up, rearranged” by lung cancer.
 
 This past year, previous winning pieces toured no less than 285 cancer centers, hospitals and cancer advocacy events from San Francisco and D.C. to such tiny towns as Opelousas, La., and Yankton, S.D. Some of the art and remains behind, with cancer charities also receiving up to $10,000 donated in the name of the winners.
RxArt project founder Diane Brown has decided to take the art concept one step further after a frightening CT exam left the former gallery owner and curator wishing for a diversion. Ms. Brown now coordinates with artists to place original installations in exam rooms and even splashes them across pricey diagnostic equipment. The result blows the typical hospital lobby floral landscape out of the water.
Even the stoic Scots have launched the Art in Hospitals project, which coordinates art exhibitions from the dialysis room to the psychiatric ward and offers workshops where patients can experiment creating their own art.
I can’t help but think all of this would please the 56-year-old retired physician turned pastel artist detailed in a case report just two aisles over in the poster hall from the Lilly Oncology On Canvas display.
The artist was diagnosed with squamous cell carcinoma of the lung, an uncommon pathology in a never-smoker. After four cycles of adjuvant chemotherapy, physicians at Mayo Clinic Arizona found no evidence of disease on her latest CT.
The authors note, however, that lung cancer in never-smoking women is the fastest growing subset of patients with lung cancer. Hopefully, these women’s journeys through cancer will be enriched with healthy doses of both medicine and art.

Patrice Wendling (on Twitter @pwendl)

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Filed under Alternative and Complementary Medicine, Hematology, Hospice and Palliative Care, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology

Going Postal

 What’s delivered by the U.S. Postal Service, but can’t fit into a letter or package?

The untold hope that a bone marrow match can bring to patients with leukemia, lymphoma and other life-threatening blood diseases.

Since holding its first drive in Baltimore in 1997, the Postal Service has become the largest contributor to the National Marrow Donor Program’s Be The Match Registry, adding more than 40,000 potential donors to the nonprofit registry.

Postal workers comprise the second largest civilian workforce in the country, and perhaps more importantly, one of its most diverse. Offering free tissue type-testing to its employees, their spouses and dependents is one way of harnessing that diversity and leveling the playing field for patients with blood diseases.

About 70% of patients do not have a donor in their family, and only 7% of potential donors on the national registry are African American, according to the NMDP.

In hopes of improving awareness, the NMDP has tapped larger-than-life basketball star Shaquille O’Neal , while its fundraising arm gave the Postal Service its first-ever “Rod Carew Award for Leadership” in recognition of saving more lives – 80 – than any other business organization in the country.

Not bad for a group of workers that have been the butt of jokes for years and frequently endure our ire this time of year.

Anyone interested in becoming a potential bone marrow or cord blood donor can contact the registry at: www.marrow.org.

Patrice Wendling (on Twitter @pwendl)

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Filed under Family Medicine, Hematology, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Medical Genetics, Oncology, Pediatrics, Transplant Medicine and Surgery

Family matters in cancer care

Family: can’t live with them, can’t live without them.

The upcoming holiday season calls the sanity of this adage into question, but when a member of the clan is diagnosed with cancer, there’s nothing like family to ease the way forward. Or is there?

 A team of Argentinian researchers evaluating the influence of family on the care of cancer patients found that 50% of physicians acknowledged at least one negative feeling for the relatives. Wrath, anger, rejection, and anguish were all noted, with women physicians more likely to feel anguish, and anger rising to the top of the list among male physicians. 

“Negative emotions must be considered since the above mentioned emotions may be an obstacle to the correct performance of the professional,” Luisina Ongania and colleagues reported at the European Society for Medical Oncology meeting in Milan. 

Before physicians cry foul, however, the survey showed that relatives had secrets of their own. 

"The Secret" by Edmund Blair Leighton, image in the public domain

 

 A stunning 95% of physicians said they had been asked by relatives to hide information of an adverse diagnosis or prognosis from the patient. 

Only 35% of the sample – made up of 50 oncologists, surgeons, pathologists, pulmonologists, and NIC providers – rejected this demand.  

Contrary to the image of women as chatterbox cream puffs, female physicians were more likely to snub a request for secrecy than men (40% vs. 32%), as were seasoned practitioners when compared with those with less than 10 years of clinical experience (40% vs. 32%). 

The influence of family can place doctors at an “ethical crossroads” in relation to respect for the patient’s autonomy, the researchers, from the Centro Médico Austral OMI in Buenos Aires, noted in their poster. 

Proponents of family centered care argue that engaging families in the hospital and even the ED can provide medical teams with valuable clinical and social information and calm patients who find themselves in a frightening and unfamiliar setting. Conversely, family members who witness the massive medical efforts launched to save their loved one are said to be more accepting of the outcome, even when the patient dies. (Click here for related story).

Exactly how hospitals, EDs, and clinicians should navigate these tricky waters is unclear, although all physicians in the survey argue that it’s important to receive information and training about how to work with relatives. Only 16% believed they’d received enough of this training.

Getting relatives to behave in the hospital, or even at the holiday dinner table, may be a harder nut to crack. 

By Patrice Wendling (on twitter @pwendl)

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Filed under Emergency Medicine, Hospice and Palliative Care, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology, Practice Trends, Psychiatry

Palliative Care, a Rose by Any Other Name?

  If the first things that comes to mind when you hear “palliative care” is “terminal,” you’re not alone.

 Part of the confusion is that hospital-based palliative care in the United States has been separated from home-based palliative care or hospice, which is intended for patients expected to die within six months.

 The stigma remains however.

 “They always say that when you get diagnosed with an illness palliative care is appropriate then, but in practice nobody was getting referred to us,” Dr. Shalini Dalal, from the M.D. Anderson Cancer Center in Houston, said in an interview.

Dr. Shalini Dalal, photo by P. Wendling

In a recent survey of oncology clinicians at the institution, the overwhelming majority perceived the name palliative care to be a barrier to early patient referral. Several other studies have come to the same conclusion.

Although the department is still called Palliative Care and Rehabilitation Medicine, M.D. Anderson opted in November 2007 to change the name of its inpatient and outpatient palliative care consultation service to “supportive care.”

 The composition of the interdisciplinary team did not change nor did their goal of relieving psychological and physical symptoms and enhancing quality of life for patients and their families.

 After the name change, new patient referrals jumped 41% from 1,950 to 2,751 in comparable 18-month time frames, according to data presented by Dr. Dalal at the annual meeting of the American Society of Clinical Oncology.

 The overall increase was driven largely by an increase in inpatient referrals, but something intriguing was also occurring outside the hospital.

 Patients in the outpatient setting were living longer after the name change – a median of 6.2 months from their first supportive care consultation vs. 4.7 months from consultation before the name change.

 Dr. Dalal credits the improved survivorship to seeing patients earlier in their illness. She noted that several leading national organizations including ASCO advocate a simultaneous care model with integration of palliative care services in early stages of the cancer patient’s illness trajectory.

 For those still not convinced, a separate study presented at ASCO may light a fire. To the investigators’ surprise, patients lived longer with metastatic lung cancer when started on palliative care soon after diagnosis. For details of that clinical trial, click here.

 – Patrice Wendling (on Twitter @pwendl)
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Filed under Alternative and Complementary Medicine, Family Medicine, Geriatric Medicine, Hospice and Palliative Care, IMNG, Oncology, Practice Trends

Anchor Your Cutaneous Lymphoma Patients

Dermatologists: Don’t just send your patients out the door to a hematologist-oncologist when their early stage cutaneous T-cell lymphoma progresses.

Dr. Frank Glass

“I encourage dermatologists to stay involved, even with stage IIB or III patients. We know clinically what is going on, but a lot of times dermatology tends to drop out of the game,” Dr. Frank Glass said at the Florida Society of Dermatology and Dermatologic Surgeons meeting.

“Many patients tend to get overtreated if they are not anchored by what we’re doing in dermatology.” Chemotherapy is an example. “The consensus is that survival is likely to be the same even with aggressive chemotherapy,” said Dr. Glass of the University of South Florida College of Medicine in Tampa.

Dr. Elise Olsen (photos by D. McNamara)

“The oncologists are really moving away from doing chemotherapy, really because of the cross-pollination with dermatologists,” said Dr. Elise Olsen, professor of dermatology and oncology at Duke University. “This is a big shift for oncologists.”

The latest update to cutaneous T-cell lymphoma guidelines from the National Comprehensive Cancer Network–which recommend immunomodulators first and chemotherapy second–are a positive sign of increased collaboration between these specialties, Dr. Olsen said. “It’s important for patients to come through us … so we can try immunomodulators first.”

A move toward greater collaboration is coming in the form of the United States Consortium for Cutaneous Lymphomas. Dr. Olsen is working with dermatologists, oncologists,  radiation oncologists, and other clinicians to set up this new multidisciplinary effort. A web site and registry for early-stage patients is forthcoming. Dr. Olsen wants to private doctors to enter their early stage patients, even those in remission, to the registry. “We want to see if there are pockets of [cutaneous T-cell lymphoma] around the country, to look for environmental factors.”

–Damian McNamara, @MedReporter on Twitter
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Filed under Dermatology, Hematology, IMNG, Oncology, The Mole

Cutaneous Treatment of Nausea: You Can’t Get There From Here

At the annual assembly of the American Academy of Hospice and Palliative Medicine, Boston

Courtesy flickr user rjcox (CC)

Nausea and vomiting are a common reason for palliative care consultation and admission and are a frequent reason for “hospice failure” admissions, Dr. Thomas Smith of Virginia Commonwealth University said to no surprise to his palliative care colleagues at this meeting. He expressed the keen needs for guidelines for the cutaneous treatment of nausea and vomiting in palliative/hospice care, and bemoaned the fact that the lack of evidence-based therapies all but precludes the writing of such guidelines.

While topical compounds, including lorazepam, diphenhydramine, and haloperidol (ABH gel) with or without metoclopramide (ABHM gel), are routinely used and have anecdotally yielded promising results, “we have no data to show that any of the drugs are absorbed through the skin in therapeutic amounts,” Dr. Smith said.

He shared with the attendees his own failed attempt at getting an efficacy study of ABH gel approved. “I wrote a clinical trial, and since I am an oncologist, I sent it to the [review committee] at the NCI.” Among the comments he received from the review panel were:

  • “Poorly structured preliminary data,” despite the fact that the preliminary data were not his and, in fact, were precisely the data that proposed study aimed to improve;
  • “Reporting nausea and vomiting by subjective assessment isn’t good enough. There has to be some sort of objective assessment.” Huh?
  • “The study is needed, but frankly it’s not going to change clinical practice because people are so wedded to [ABH gel] already.”

Although the study didn’t get approved, Dr. Smith later received notice of a grant to conduct a small pilot study on the absorption of ABH gel, “so in 3-6 months, we will have some actual data about whether the drug is absorbed through the skin,” he said. “That’s a start.”

—Diana Mahoney (@DMPM1 on Twitter)

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Filed under Hospice and Palliative Care, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Oncology

It’s OK to be Negative

Image courtesy of Flickr user  (creative commons)

Image courtesy of Flickr user  (creative commons)

the annual meeting of the Pediatric Academic Societies in Baltimore, MD

Who wants to hear negative news?  I’ve come to believe that physicians do and that we all should.  I’m talking about negative studies, which reporters of all stripes have a tendency to overlook in favor of a study with postive results.  I’ve heard it countless times in the press rooms of medical meetings: “Yeah, but it’s a negative study.  I’m not going to write it up.”

I have to admit that I never paid much attention to this tendency myself until I started covering oncology—a world in which a treatment or drug failure is big news.  I think that the reason for this is two-fold.  First, oncologists really care about adding to their armamentarium.  Second, sadly oncology drugs are big business and the failure of an anticipated drug can mean the exchange of millions of dollars on Wall Street.

But there’s another reason why we all should care about negative studies—-and why some of us should do a better job of reporting them.  In science —and medicine—we learn more from our failures than from our successes.  Every successful treatment out there has some negative experiments or studies to thank.  Each failure not only takes us one step closer to success but has practical implications for how to treat patients right now.  I was reminded of this today as a I sat through a session with only one positive study reported.

So from now on, I promise to be a little more negative.

—Kerri Wachter

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Filed under Oncology, Pediatrics, Uncategorized