Monday, March 19, 2012
abstract: Coordination of Breast Cancer Care Between Radiation Oncologists and Surgeons: A Survey Study
Coordination of Breast Cancer Care Between Radiation Oncologists and Surgeons: A Survey Study:
Purpose:
To assess whether radiation oncologists and surgeons differ in their attitudes regarding the local management of breast cancer, and to examine coordination of care between these specialists.
Conclusions:
Despite the widespread availability of tumor boards, a substantial minority of radiation oncologists indicated other providers failed to include them in the breast cancer treatment decision-making process early enough. Earlier inclusion of radiation oncologists may influence patient decisions, and interventions to facilitate this should be considered.
abstract: Role of Definitive Radiation Therapy in Carcinoma of Unknown Primary in the Abdomen and Pelvis
Role of Definitive Radiation Therapy in Carcinoma of Unknown Primary in the Abdomen and Pelvis
Objectives
Carcinoma of unknown primary (CUP) in the abdomen and pelvis is a heterogeneous group of cancers with no standard treatment. Considered by many to be incurable, these patients are often treated with chemotherapy alone. In this study, we determined the effectiveness of radiation therapy in combination with chemotherapy in patients with CUP in the abdomen and pelvis.
Patients and Methods
Medical records were reviewed for 37 patients with CUP treated with radiation therapy for disease located in the soft tissues and/or nodal basins of the abdomen and pelvis at the University of Texas M.D. Anderson Cancer between 2002 and 2009. All patients underwent chemotherapy, either before or concurrent with radiation therapy. Patients were selected for radiation therapy on the basis of histologic type, disease extent, and prior therapy response. Twenty patients underwent definitive radiation therapy (defined as radiation therapy targeting all known disease sites with at least 45 Gy) and 17 patients underwent palliative radiation therapy. Only 6 patients had surgical resection of their disease. Patient and treatment characteristics were extracted and the endpoints of local disease control, progression-free survival (PFS), overall survival (OS), and treatment-related toxicity incidence were analyzed.Results
The 2-year PFS and OS rates for the entire cohort were 32% and 57%, respectively. However, in patients treated with definitive radiation therapy, the rates were 48% and 76%, and 7 patients lived more than 3 years after treatment with no evidence of disease progression. Nevertheless, radiation-associated toxicity was significant in this cohort, as 40% experienced Grade 2 or higher late toxicities.Conclusions
The use of definitive radiation therapy should be considered in selected patients with CUP in the soft tissues or nodal basins of the abdomen and pelvis.Waiting for medicine’s black swans - CMAJ
Waiting for medicine’s black swans
"Over a decade has passed since the medical world quivered
with anticipation at the completion of the Human Genome Project.
For the most part, though, those heady days have been
replaced by the sobering realization that the path from knowledge to
product is riddled with potholes.
Time, tight budgets and delivery complications have emerged as major ruts in the drive toward the pot of therapeutic gold
that was promised for the end of road....."
Association for Psychological Science (Harvard): Is modern medicine ill with dehumanization?
Is modern medicine ill with dehumanization?
New article offers a diagnosis, unveils its causes, and prescribes a humanizing cure
"Anyone who has been admitted into a hospital or undergone a procedure, even if cared for in the most appropriate way, can feel as though they were treated like an animal or object," says Harvard University psychologist and physician Omar Sultan Haque. Health care workers enter their professions to help people; research shows that empathic, humane care improves outcomes. Yet dehumanization is endemic. The results can be disastrous: neglect of necessary treatments or prescription of excessive, painful procedures or dangerous drugs.
What are the causes and effects of dehumanization in medicine? And what can be done about it? In Perspectives in Psychological Science, a journal of the Association for Psychological Science, Haque and co-author Adam Waytz at the Kellogg School of Management of Northwestern University synthesize diverse literatures to distinguish when dehumanization is useful from when it is not. Then they recommend "simple, cheap, and effective" changes to "make medical institutions more humane and ethical, as well as efficacious in the service of improved health," says Haque.
The structures of institutions and the psychological demands of providing care can cause professionals to treat patients as less than human. "Deindividuation"—doctors as a sea of white coats; patients as half-naked bodies in smocks, identified by their disease or procedure ("the gallbladder in Room 38")—allows staffs to avoid taking responsibility for each patient. "Impaired patient agency" refers to medical staffs' treatment of patients as incapable of planning their own care, which is both infantilizing and demoralizing. "Dissimilarity"—hierarchies of power, differences of race, class, and gender between staff and patients—have roots outside the hospital. Nevertheless, they cause miscommunication and alienation, even maltreatment. None of these practices serves good medical care.
More complex are dehumanizing practices that may aid care. Diagnosis and treatment might necessitate "mechanization"—breaking the body into organs and systems. Scaling back empathy can diminish staff stress and burnout. Even moral disengagement can be adaptive. From giving a shot to slicing into the flesh to perform surgery, medical care often requires inflicting pain or invading the boundaries of the body in violation of deeply held human taboos. And patients may die after even the best of care. For the professional, guilt could be paralyzing.
Still, the authors argue, dehumanization is useful only in "specific contexts," such as acute care. Waytz says, "Dehumanization's functionality varies wildly across specialities from pediatrics to orthopedic surgery, so future research is needed to determine when dehumanization is most prevalent and most detrimental." In the meantime, the authors offer numerous humanizing fixes: Call patients by name, not numbers; discourage labeling people as diseases; personalize hospital rounds and pre-surgical preparation; eliminate opaque surgical masks; affix photos to CT scans and biopsies. Include patients in care planning. Let them choose their gowns—and design those gowns so they're no so humiliating. Increase physician diversity and hire people with good social skills. And, for med schools, perhaps most radical: Eliminate the "white-coat ceremony" when graduates don the mufti of the elect.
Finally, "we should train medical professionals to think of themselves as mortal – sharing a common humanity and vulnerability with their patients," says Haque. Although dehumanization can be useful, "even functional dehumanization should be viewed like a potent, salutary, but dangerous drug that can have disastrous side-effects" when overprescribed.
open access: Ten problematical issues identified by pathology review for multidisciplinary gynaecological oncology meetings -- McCluggage 65 (4): 293 -- Journal of Clinical Pathology
Ten problematical issues identified by pathology review for multidisciplinary gynaecological oncology meetings
- Accepted 16 August 2011
- Published Online First 19 October 2011
- J Clin Pathol 2012;65:293-301 doi:10.1136/jclinpath-2011-200352
Take-home message
Pathology review of
gynaecological cancer specimens is often carried out as part of the
working of gynaecological oncology
multidisciplinary team meetings.
Some errors are interpretational errors while others are
non-interpretational but may result
in the incorrect information being
relayed to the clinician. Studies have identified more numerous and
clinically significant
diagnostic discrepancies in the
field of gynaecological oncology than in other areas of pathology.
Healthcare Economist: (NY Times) Why are there no doctor reviews on the web?
Why are there no doctor reviews on the web?:
The N.Y. Times has an interesting article citing a number of reasons why there are no good websites with doctors reviews on the web. There are some ratings websites (HealthGrades, RateMDs, Angie’s List, Yelp), but the listings are often sparse, with few contributors and little of substance.)
For one, physicians don’t like them.
“Several years ago, a physician reputation management service called Medical Justice developed a sort of liability vaccine. Doctors would ask patients to sign an agreement promising not to post about the doctor online; in exchange, patients would get additional privacy protections.
blog: The Patient Will Rate You Now
The Patient Will Rate You Now:
By Bob Wachter, MD
These days, I’d never consider trying a new restaurant or hotel without reading the on-line ratings on TripAdvisor or Yelp. I seldom even bother with professional restaurant or travel critics.
Until recently, there was little patient-generated information about doctors, practices or hospitals to help inform patient decisions. But that is rapidly changing, and the results may be every bit as transformative as they have been in traditionally consumer-centric industries like hospitality. Medicine has never thought much of the wisdom of crowds, but the times, as the song goes, they are a-changin’.
abstract: Variation in thromboembolic complications among patients undergoing commonly performed cancer operations
Variation in thromboembolic complications among patients undergoing commonly performed cancer operations
Compared with breast cancer, the incidence of VTE ranged from a 1.31-fold increase in VTE associated with gastrectomy to a 2.68-fold increase associated with hysterectomy.
Oral Cancer Drugs Not Effective When Mixed With Some Other Medications - MediLexicon
Oral Cancer Drugs Not Effective When Mixed With Some Other Medications - MediLexicon
...........The cancer drugs which the researchers studied are called oral kinase inhibitors. They included:
- imatinib (Gleevec®)
- erlotinib (Tarceva®)
- dasatinib (Sprycel®)
- everolimus (Afinitor®)
- lapatinib (Tykerb®)
- nilotinib (Tasigna®)
- pazopanib (Votrient®)
- sorafenib (Nexavar®)
- sunitinib (Sutent®)
- calcium channel blockers
- some antibiotics
- antifungal agents
- steroids
- proton pump inhibitors..........
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