Questions for ASCO – on Tamoxifen, ATLAS and aTTom
The problem with Tamoxifen is that it has anti-estrogen effects that many young (and older) women consider undesirable. Already our breasts have been cut. Feeling “feminine” is not trivial.
How Much Do You Want Your Doctors To Say About Risks of Treatment?
This kind of paternalism, when a doctor assesses the risks and benefits, and spares the patient’s “knowing” seems anachronistic. But it may, still, be what many people are looking for when and if they get a serious illness. Not everyone wants a “tell me everything” kind of physician.
This Week’s Triple, Tough Dose of Real Stories on Women with Cancer
This news reminds us an aspect of cancer treatment some of us would rather put out of our heads….all cancer patients should take careful notes on their planned treatments and ask their doctors about the long-term consequences of therapy.
A Picture of Periwinkle
From this plant comes an old chemotherapy drug, called Vincristine (Oncovin). When I practiced, I used this agent to treat people with lymphoma, some forms of leukemia, Kaposi’s sarcoma and…
Lowering Cancer Care Costs by Limiting Chemotherapy in Patients Who Aren’t Responding
This is the sixth post on Bending the Cost Curve in Cancer Care, based on the 10 suggestions put forth by Drs. Smith and Hillner in the May 26 NEJM. We’re up to number 5 on the list for changing oncologists’ behavior: by limiting further chemotherapy to clinical trial drugs in patients who are not […]
Reducing Cancer Care Costs: Why Not Offer Neulasta in Smaller Vials?
This is the fifth in a series of posts on how we might reduce the costs of cancer care, based on 10 suggestions offered in a May, 2011 NEJM sounding board. We’re up to point 4: oncologists should replace the routine use of white-cell-stimulating factors with a reduction in the chemotherapy dose in metastatic solid cancers. In […]
Reducing Costs by Holding Back on Chemotherapy for Cancer Patients Who are Frail
This is the fourth in a series of posts on Bending the Cost Curve in Cancer Care, by Drs. Thomas J. Smith and Bruce E. Hillner, in a recent NEJM health policy piece. The authors’ third suggestion: to limit chemotherapy to patients with good performance status, with an exception for highly responsive disease, is surely one of the most […]
When Less Chemo is Just As Good, In Treatment for Acute Myeloid Leukemia (AML)
Today’s issue of the New England Journal of Medicine includes an article with the bland title Cytarabine Dose for Acute Myeloid Leukemia. AML is an often-curable form of leukemia characterized by rapidly-growing myeloid white blood cells. Cytarabine – what we’d call “Ara-C” on rounds – has been a mainstay of AML treatment for decades. The […]
Health Care Costs, Communication and Informed Choices
For those of you who’ve been asleep for the past year: the health care costs conundrum remains unsolved. Our annual medical bills run in the neighborhood of $2.4 trillion and that number’s heading up. Reform, even in its watered-down, reddened form, has stalled.
Despite so much unending review of medical expenses – attributed variously to an unfit, aging population, expensive new cancer drugs, innovative procedures, insurance companies and big Pharma – there’s been surprisingly little consideration for patients’ preferences. What’s missing is a solid discussion of the type and extent of treatments people would want if they were sufficiently informed of their medical options and circumstances.
Maybe, if doctors would ask their adult patients how much care they really want, the price of health care would go down. That’s because many patients would choose less, at least in the way of technology, than their doctors prescribe. And more care.
What I’m talking about is the opposite of rationing. It’s about choosing.
A Visit With My Oncologist
After a while my oncologist stepped out into the waiting area and guided me to the hall by her office. “The cells are low,” she said. “We’ll have to wait another week, that’s all.”
I knew she was right. But a week seemed like a lifetime to me then….
Looking Ahead: 7 Cancer Topics for the Future
Here’s my short list, culled from newsworthy developments that might improve health, reduce costs of care and better patients’ lives between now and 2020, starting this year: 1. “Real” Alternative Medicine. By this I don’t mean infinitely-diluted homeopathic solutions sold in fancy bottles at high prices, but real remedies extracted from nature and sometimes ancient […]
How Well Do You Really Want to Know the “Red Devil?”
I know what it’s like to get the “red devil” in the veins.
You can learn about Adriamycin, a name brand chemotherapy, on WebMD. Or, if you prefer, you can check on doxorubicin, the generic term, using MedlinePlus, a comprehensive and relatively reliable public venture put forth by the National Library of Medicine and National Institutes of Health. If you’re into organic chemistry, you might want to review the structure of 14-hydroxydaunomycin, an antibiotic and cancer therapy first described 40 years ago…