When
I was young, most doctors refused to tell terminal patients that
nothing more could be done. They would lose hope, the rationalization
went. Anxiety or depression would make them suffer more than ignorance.
No one, of course, wants to be the messenger of death or face the
slippery slope that candor can evoke—painful discussions of what might
have gone wrong, witness to tears and fears, troubling questions about
the meaning of life. In my family, such silence resulted in intense
misery. A father saying nothing about the tumor that inexorably
enervated him; a young mother spinning webs of deceit; a son raging
against his enforced ignorance when the truth came out ... as it usually
does.
Tuesday, October 02, 2012
Implant-Based Breast Reconstruction Following Radiation Has High Patient Satisfaction Rate Despite Complications
Implant-Based Breast Reconstruction Following Radiation Has High Patient Satisfaction Rate
Despite Complications
Breast cancer patients who have received radiation therapy after mastectomy have more problems related to the use of implants for breast reconstruction, according to a review in the October issue of Plastic and Reconstructive Surgery(r), the official medical journal of the American Society of Plastic Surgeons (ASPS).
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Gene responsible for many spontaneous breast cancers identified - Medical Xpress
Gene responsible for many spontaneous breast cancers identified - Medical Xpress
Gene responsible for many spontaneous breast cancers identified Medical Xpress In a report appearing in the journal Genetics, researchers show that mutations in a gene called NF1 are prevalent in more than one-fourth of all noninheritable or spontaneous breast cancers. In mice, NF1 mutations are associated with hyper-activation ... and more » |
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Monday, October 01, 2012
The new rules of naturopathy (Canada/standards of practice)
The new rules of naturopathy
"Alberta has become the fifth province in Canada to regulate naturopathic doctors, following a push by the profession to ensure consistent regulations and practice standards across the country....
Annals of Internal Medicine | A Patient's View of OpenNotes
Annals of Internal Medicine | A Patient's View of OpenNotes
Editorials
|
2 October 2012
A Patient's View of OpenNotes FREE
Although
individual variations persist, things have changed. Today, medicine has
discarded the norm of evasion and deceit. As we enter the age of
electronic medical records, with access to patient information almost a
civil right, it is good to remember that communication patterns change
in ways that reflect different community expectations and values.
I
remember this history when I hear doctors object to making lab reports
or visit notes available to patients because they may cause pain and
anxiety.
Expected Benefits of Topotecan Combined With Lapatinib in Recurrent Ovarian Cancer According to Biological Profile: A Phase 2 Trial
Expected Benefits of Topotecan Combined With Lapatinib in Recurrent Ovarian Cancer According to Biological Profile: A Phase 2 Trial:
Objective: Lapatinib, a tyrosine kinase inhibitor targeting epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2), also inhibits breast cancer resistance protein (BCRP) involved in resistance to topotecan. The aim of this multicenter study was to assess the efficacy of the combination topotecan-lapatinib in epithelial ovarian cancer relapsing after a first line of chemotherapy.
Methods: Patients having relapsed within 6 months (n = 20) or between 6 and 12 months (n = 19) received weekly topotecan (3.2 mg/m2 given intravenously on days 1, 8, and 15) and daily oral lapatinib (1250 mg). Translational studies were performed on tumor and serum.
Erythropoietin Is Detectable in the Ascitic Fluid in Patients With Ovarian Tumors
Erythropoietin Is Detectable in the Ascitic Fluid in Patients With Ovarian Tumors:
Background and Objective: Erythropoietin (Epo) is a glycoprotein that stimulates proliferation and migration of human endothelial cells and promotes angiogenesis, which are crucial phenomena in cancer biology. The objective of this study was to investigate whether Epo is detectable in the ascitic fluid of patients with ovarian tumors.
Patients and Methods: We investigated the presence of Epo in the ascitic fluid of 100 women undergoing laparotomy for an ovarian tumor. Epo concentration was quantitated with an immunochemiluminometric assay.
New Report Finds Almost Half of Family Caregivers Perform Medical and Nursing Tasks
New Report Finds Almost Half of Family Caregivers Perform Medical and Nursing Tasks
WASHINGTON, Oct. 1, 2012 /PRNewswire-USNewswire/ -- Today, AARP Public Policy Institute (PPI) and the United Hospital Fund (UHF) released a new report that finds 46 percent of family caregivers perform...
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Prognosticating in patients with advanced cancer--observational study comparing the accuracy of clinicians' and patients' estimates of survival
Prognosticating in patients with advanced cancer--observational study comparing the accuracy of clinicians' and patients' estimates of survival
BackgroundClinicians' prognoses in patients with advanced cancer are imprecise. The aim of this study was to compare doctors', nurses' and patients' survival predictions and to identify factors which influence accuracy.
Patients and methodsSome 1018 patients with advanced cancer were recruited. Survival estimates were obtained from the attending doctor, nurse, multidisciplinary team (MDT) and patient (n = 829, 954, 987 and 290 estimates, respectively) and were compared with actual survival. Clinician and patient characteristics were recorded.
ResultsMDTs', doctors' and nurses' predictions were accurate 57.5%, 56.3% and 55.5% of occasions, respectively. Nurses were less accurate than the MDT (P = 0.007) but were no worse than doctors (P = 0.284). Estimates of clinicians and patients were more optimistic (doctors: 31%; nurses: 34%; MDT: 31.1%; patients: 45.1%) than pessimistic (12.7%, 11%, 11.4% and 2.7%). Nurses' accuracy increased if they had reviewed the patient within 24 h. Most patients (61.4%) wanted to know their prognosis. Only 37.1% were willing to offer an estimate regarding their own survival. Patients' prognostic estimates were less accurate than health care professionals' (P < 0.001).
ConclusionsMDTs were better at predicting survival than doctors' or nurses' alone. Patients were substantially worse. Among nurses, recency of review was related to improved prognostic accuracy.
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Sunday, September 30, 2012
repost 2/2012: Paraneoplastic Thrombocytosis in Ovarian Cancer — NEJM
Paraneoplastic Thrombocytosis in Ovarian Cancer — NEJM
"Platelets are highly reactive cellular effectors of hemostasis, immunity, and inflammation.1 The concept that platelets play key roles in cancer growth and metastasis is long-standing. In fact, the clinical observation that thrombocytosis (defined as a platelet count of >450,000 per cubic millimeter) occurs in patients with solid tumors was made more than 100 years ago.2,3 Nearly 40% of persons incidentally found to have platelet counts exceeding 400,000 per cubic millimeter in the absence of iron deficiency and benign inflammatory conditions have an occult cancer, most commonly a primary gastrointestinal, lung, breast, or ovarian cancer.....
Prevention and handling of acute allergic and infusion reactions in oncology.
Prevention and handling of acute allergic and infusion reactions in oncology.
Abstract
Drug hypersensitivity reactions (HSR) are adverse events resembling allergy which occur at therapeutic doses. Both anticancer chemotherapeutics and monoclonal antibodies have the potential for acute HSR. all infusion reactions involve the immune system; however, some (anaphylactic) are allergic in nature and usually are mediated by immunoglobulin E (IgE), whereas others (anaphylactoid) are not true allergic reactions and are not mediated by IgE. although HSR can be allergic or nonallergic, the clinical manifestations are the same and require prompt, accurate assessment and management to avoid severe adverse events, including fatality. Monoclonal antibodies have a unique side-effect profile that includes the potential for nonallergic HSR caused by cytokine release. Chemotherapeutic agents with the highest potential for acute HSR include the platinum salts, taxanes, procarbazine, asparaginase and the epipodophyllotoxins. From all anticancer agents, rituximab causes the majority of HSR (27%), followed by paclitaxel (10%). The most frequent symptoms in patients experiencing acute HSR include chest pain, dyspnea, wheezing and exanthema for the taxanes, dyspnea and exanthema for platinum salts, chills and rigor for antibodies. Patients with mild-to-moderate acute HSR can be rechallenged following intensified prophylaxis, but rechallenge is usually not recommended following severe HSR.
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