Of all the sad pronouncements that oncologists deliver, this may be the one that stings the most. If you were expecting hope from your doctor, how would you react to these words? Would you sit with quiet disbelief, or storm out of the office?
All those who walk through your doorway become your responsibility, at least until you either cure them, satisfy them, or in the rare case of incorrigibles, banish them. Opening our office to all comers is part of every doctor's commitment to the sick, and the faster we accept this, the smoother our day will proceed. Sometimes, though, it ain’t easy.
Nationally, the number of drug shortages has tripled since 2005. Our county’s hospice agency has experienced shortages of liquid morphine, scopolamine patches, and medications to relieve nausea. Other generic drug shortages in our clinic have included paclitaxel, leucovorin, and doxorubicin. We have had limited ability to order fluorouracil (5-FU) and mitomycin.
The end of another year usually inspires us to interesting if not profound reflections, but in my case I am just trying to remember any rainbows of wisdom that appeared to me during 2011. Those who care for cancer patients cannot help but learn new insights about life and death, and since aphorisms are valuable only if spread, why not share a few?
Two recent reports show that the prognosis of MDS patients after secondary failure of hypomethylating drugs is poor, and switching from one failing hypomethylating drug to another cannot induce clinically significant responses.
As insurers, clinicians and the U.S. government attempt to slow the increasing rise of health care costs, many experts have identified the tool entitled “clinical pathways” as a solution. Oncologists who adhere to such pathways are thought to improve patient care and reduce expenses.
We are seeing a revolution in cancer care in this country, not just due to advances in chemotherapy and biological therapy, but also in how we communicate and connect with our patients.
ATG is associated with reduced risk of acute and chronic graft-versus-host disease without increasing the risk of relapse in myeloablative donor transplants. However, there has been an ongoing debate about the role of ATG in reduced intensity conditioning (RIC) HSCT, and there are still bone marrow transplant centers that use ATG in the RIC setting, and their main argument is that ATG could help with engraftment and reducing the risk of GVHD. Different types and doses of ATG have been used in the RIC setting.
I believe cancer doctors have a duty to be accessible to patients as much as possible. Taking treatment for cancer is to say the least an intense experience, sometimes an ordeal, and oncologists must be diligent in keeping everyone up to date on test results, logistics, complications, on good news as well as bad.
A recent case report in the New England Journal of Medicine highlights the promising potentials of adoptive T-cell immunotherapy by redirecting them, through chimeric antigen receptors, as a novel and effective therapeutic modality for cancer.