That sense of having some control over your situation goes a long way often - particularly in the decision making part of a cancer diagnosis. It sounds like common sense but for some reason we needed a study to prove it to the scientists (and because we need more studies to keep the scientists busy).
This was published in the recent issue of Cure Magazine (which if you have cancer and do not read it, you really should - online or paper copies on the mail are free). As part of the many stressors that accompany cancer, being part of the decision making process where you can learn the different options and their potential impacts and side effects. It gives the patient back some control over their situation.
Why didn't this happen sooner???
Showing posts with label medical decisions. Show all posts
Showing posts with label medical decisions. Show all posts
Sunday, May 24, 2015
Wednesday, April 8, 2015
A Way to End the What Age for Mammograms Controversy?
Work with me here, what if everyone could agree on one option for the mammogram controversy? Wouldn't it make a lot more sense? I mean there has been so much ink about this single issue. On one hand is prevention and on the other is over diagnosis and false positives, with a lot of other data, crap, history, and arguments added on to each. So what is the real answer?
I believe JAMA has the right idea here. In the age of personalized medicine, why are we hung up on cross the board requirements? JAMA suggests that we "Stop One Size Fits All Mammography".
"A woman's decision to undergo mammography "should be individualized based on patients' risk profiles and preferences," concludes a systematic review of 50 years of breast cancer screening data, published in the April issue of JAMA.
How to best go about achieving that individualization is not entirely clear, but clinicians need to make an effort with the tools that are currently available, such as decision aids and risk models,
suggest Lydia Pace, MD, MPH, and Nancy Keating, MD, MPH, both from Brigham and Women's Hospital in Boston, in their review."
Their argument is that a woman should be able to make a decision on mammography with their doctor based on their risk. The problem is that current science does not allow us to accurately estimate all women's risk of breast cancer. So the problem isn't with mammography but with the ability to predict breast cancer.
Before we jump ahead to that issue, let's stick with making mammography a personalized decision. I think this is a great idea. If someone has a high risk background, they should start mammograms earlier. If they do not have one, they should decide with their doctor when they should start them. Insurance companies should cover them regardless. There doesn't have to be a national rule on when they should be started.
Now switching to being able to predict breast cancer. We can't really. The BRCA genes allow us to predict women who are high risk but that does not cover all women who will get breast cancer, really less than 10% I believe. There can be other risk factors, family history, genetic background, and more.
Since we can't really tell who will or will not get breast cancer and may never be able to, we do need to use whatever screening methods we have. Until we have something better than mammography, it is our tool to use as best we can. But it should be the patient's choice and not the insurance company's.
I believe JAMA has the right idea here. In the age of personalized medicine, why are we hung up on cross the board requirements? JAMA suggests that we "Stop One Size Fits All Mammography".
"A woman's decision to undergo mammography "should be individualized based on patients' risk profiles and preferences," concludes a systematic review of 50 years of breast cancer screening data, published in the April issue of JAMA.
How to best go about achieving that individualization is not entirely clear, but clinicians need to make an effort with the tools that are currently available, such as decision aids and risk models,
suggest Lydia Pace, MD, MPH, and Nancy Keating, MD, MPH, both from Brigham and Women's Hospital in Boston, in their review."
Their argument is that a woman should be able to make a decision on mammography with their doctor based on their risk. The problem is that current science does not allow us to accurately estimate all women's risk of breast cancer. So the problem isn't with mammography but with the ability to predict breast cancer.
Before we jump ahead to that issue, let's stick with making mammography a personalized decision. I think this is a great idea. If someone has a high risk background, they should start mammograms earlier. If they do not have one, they should decide with their doctor when they should start them. Insurance companies should cover them regardless. There doesn't have to be a national rule on when they should be started.
Now switching to being able to predict breast cancer. We can't really. The BRCA genes allow us to predict women who are high risk but that does not cover all women who will get breast cancer, really less than 10% I believe. There can be other risk factors, family history, genetic background, and more.
Since we can't really tell who will or will not get breast cancer and may never be able to, we do need to use whatever screening methods we have. Until we have something better than mammography, it is our tool to use as best we can. But it should be the patient's choice and not the insurance company's.
Tuesday, January 20, 2015
Retaining the sense of control
That sense of having some control over your situation goes a long way often - particularly in the decision making part of a cancer diagnosis. It sounds like common sense but for some reason we needed a study to prove it to the scientists (and because we need more studies to keep the scientists busy).
This was published in the recent issue of Cure Magazine (which if you have cancer and do not read it, you really should - online or paper copies on the mail are free). As part of the many stressors that accompany cancer, being part of the decision making process where you can learn the different options and their potential impacts and side effects. It gives the patient back some control over their situation.
Why didn't this happen sooner???
This was published in the recent issue of Cure Magazine (which if you have cancer and do not read it, you really should - online or paper copies on the mail are free). As part of the many stressors that accompany cancer, being part of the decision making process where you can learn the different options and their potential impacts and side effects. It gives the patient back some control over their situation.
Why didn't this happen sooner???
Saturday, January 17, 2015
The impact of the decision.
The doctor makes a decision but do they stop and think about the impact? We hope so. But not always.
Here's the story of a 51 year old man who was admitted to the ER with liver and kidney problems. He needed to be stabilized before they could do necessary surgery. Stabilizing was not easy and not even sure that it could be done. He was in intensive care. Two internists stopped by to see him and in less than ten minutes decided what he needed was comfort care and not intensive care. So they moved him out of the ICU and into a regular ward where he died the next day.
What went wrong? Several things but the main one was the decision by the two internists to move him to a general ward for comfort care. A patient with multiple organ failure needs ICU if they are expected to survive. But to the younger interns, perhaps he was an older patient where he was ready for the end of life? But if he had been young, would more effort been made?
Also, was he a terminal patient? Or did he have a terminal disease? Could he have survived with the proper care?
The author concludes with:
"Perhaps what bothers me most is less the fate of our patient than the memory of those two doctors, both so young, efficiently dispatching a complicated decision in a matter of minutes, then dancing off without looking back. They knew a lot about the cost-effective deployment of intensive care. It would have been good to see them spend a little time struggling with the limitations of their analysis."
This is what bothers me - are we raising a new generation of doctors who don't think about the impact of their decision?
Here's the story of a 51 year old man who was admitted to the ER with liver and kidney problems. He needed to be stabilized before they could do necessary surgery. Stabilizing was not easy and not even sure that it could be done. He was in intensive care. Two internists stopped by to see him and in less than ten minutes decided what he needed was comfort care and not intensive care. So they moved him out of the ICU and into a regular ward where he died the next day.
What went wrong? Several things but the main one was the decision by the two internists to move him to a general ward for comfort care. A patient with multiple organ failure needs ICU if they are expected to survive. But to the younger interns, perhaps he was an older patient where he was ready for the end of life? But if he had been young, would more effort been made?
Also, was he a terminal patient? Or did he have a terminal disease? Could he have survived with the proper care?
The author concludes with:
"Perhaps what bothers me most is less the fate of our patient than the memory of those two doctors, both so young, efficiently dispatching a complicated decision in a matter of minutes, then dancing off without looking back. They knew a lot about the cost-effective deployment of intensive care. It would have been good to see them spend a little time struggling with the limitations of their analysis."
This is what bothers me - are we raising a new generation of doctors who don't think about the impact of their decision?
Wednesday, January 14, 2015
Making your own medical decisions
The newest trend in medical care is to involve the patient in the decision making process. Sometimes it can be easy to just go with the flow. The doctor says you have this so we need to do that. Simple?
But what if the doctor says 'what do you want me to do for treatment?' Eek! Now you can't sit there passively you have to become a participant. This can take research. It can take time online. It can take deep thought. And it can impact your life significantly.
Using the example of a woman with breast cancer where the choices with relatively equal outcomes are lumpectomy and radiation or mastectomy. Shouldn't the patient get to decide, not the doctor on whether they want disfiguring surgery? Some women do and some don't. But it should be their choice.
The other side of the coin is patients go to the doctor for a sore throat and expect to be sent home with a prescription for antibiotics. And the doctor says we do not prescribe antibiotics for a cold or flu only when there is a need. The patient then gets mad because they feel under treated. This is the result of a change in medical practice that patient's need to keep up on to prevent frustrations.
Let's go back to a cancer diagnosis. The doctors say things like we want to remove the tumor and then do chemotherapy and follow up every three months with a scan. The patient should ask why that order - surgery then chemo, what are the alternatives, what about the patient's other health issues and possibly even age.
The real question the patient should ask is what are my options for the best possible prognosis and why do you consider that to be the best as compared to other protocols? I mean that is the goal after all.
Doctors need to allow patients to ask questions and make the decisions based on the doctors advice. If the doctor doesn't want the patient's input, it may very well be time for a new doctor.
Patients need to learn to set aside their preconceptions on what they think is possible and learn what are the latest advances and what has the best possible outcomes. Then they can, with the help of their doctor, make the best possible decisions about their health.
But what if the doctor says 'what do you want me to do for treatment?' Eek! Now you can't sit there passively you have to become a participant. This can take research. It can take time online. It can take deep thought. And it can impact your life significantly.
Using the example of a woman with breast cancer where the choices with relatively equal outcomes are lumpectomy and radiation or mastectomy. Shouldn't the patient get to decide, not the doctor on whether they want disfiguring surgery? Some women do and some don't. But it should be their choice.
The other side of the coin is patients go to the doctor for a sore throat and expect to be sent home with a prescription for antibiotics. And the doctor says we do not prescribe antibiotics for a cold or flu only when there is a need. The patient then gets mad because they feel under treated. This is the result of a change in medical practice that patient's need to keep up on to prevent frustrations.
Let's go back to a cancer diagnosis. The doctors say things like we want to remove the tumor and then do chemotherapy and follow up every three months with a scan. The patient should ask why that order - surgery then chemo, what are the alternatives, what about the patient's other health issues and possibly even age.
The real question the patient should ask is what are my options for the best possible prognosis and why do you consider that to be the best as compared to other protocols? I mean that is the goal after all.
Doctors need to allow patients to ask questions and make the decisions based on the doctors advice. If the doctor doesn't want the patient's input, it may very well be time for a new doctor.
Patients need to learn to set aside their preconceptions on what they think is possible and learn what are the latest advances and what has the best possible outcomes. Then they can, with the help of their doctor, make the best possible decisions about their health.
Saturday, January 10, 2015
Thoughts on alternative cancer treatments
There are lots of alternative cancer treatments out there. They include everything from all natural to the vast pharmaceutical industry conspiracy to get rich on the backs of the average American cancer patient.
When I say alternative I do not refer to things like acupuncture etc which I consider to be additional, holistic options that are added to other treatment protocols. I am referring to things like herbs or supplements or dietary changes to cure cancer. I also believe that everyone is entitled to their own opinion on what should be their treatment protocol. But they need to understand that their choices may not lead to the best outcomes.
When I was first diagnosed I met a woman who was probably in her early 70s. She had decided that she was only going to have surgery and was going to skip the suggested chemotherapy and radiation because it was her time and she did not want to go through it. She had told her children as well and made her decision. She seemed pretty calm about it too. I was a little shocked at the time but then decided that it was her option.
I am also an avid follower (well maybe a little less these days simply because I am busier) of Kris Carr and her Crazy Sexy Cancer. (A tip from me - if you are a woman diagnosed with any kind of cancer, go read her first book and see her movie and you will understand why you need your posse and attitude to get you through it.) She is chock full of wellness and living healthier and is probably close to ten years out from a diagnosis of untreatable cancer. There are all sorts of alternative ideas in her head and on her website - which you should also join. Raw veganism may not be my cup of tea but I admire what she has done for all of us cancer people and I have adopted some of her suggestions.
However, some of the things that I have seen people adopt to treat their cancer just amaze me. I have a friend who decided that she could treat her cancer by taking some herb every day - I can't remember the name but even online it was recommended not to be taken every day but three weeks on and one week off. I don't know how much she was taking it but she has since had a recurrence.
Then there is a case in the news this week where a woman in Colorado died after injecting Cesium chloride into her breast cancer. Cesium is a chemical element which is actually a metal. It has a radioactive isotope that is used in medical applications. Cesium chloride is a supplement which some proponents say will help cure cancer. But has no medical proof. And it is not supposed to be injected.
Finally, if you adopt an alternative treatment instead of a traditional treatment protocol for your cancer, I do not think you should be surprised if your insurance doesn't cover it and it will not cover additional tests and scans to see if your disease has progressed. Insurance companies have protocols based on proven treatment protocols. For example, the standard to treat that cancer is a CT scan followed by six rounds of whatever chemotherapy infusion and then follow with another CT scan to see how the cancer has responded to treatment. But if you skip the treatment they cover, they aren't going to pay for another CT scan.
Its your body and your choice but you need to remember you have to accept the outcome of your decisions.
When I say alternative I do not refer to things like acupuncture etc which I consider to be additional, holistic options that are added to other treatment protocols. I am referring to things like herbs or supplements or dietary changes to cure cancer. I also believe that everyone is entitled to their own opinion on what should be their treatment protocol. But they need to understand that their choices may not lead to the best outcomes.
When I was first diagnosed I met a woman who was probably in her early 70s. She had decided that she was only going to have surgery and was going to skip the suggested chemotherapy and radiation because it was her time and she did not want to go through it. She had told her children as well and made her decision. She seemed pretty calm about it too. I was a little shocked at the time but then decided that it was her option.
I am also an avid follower (well maybe a little less these days simply because I am busier) of Kris Carr and her Crazy Sexy Cancer. (A tip from me - if you are a woman diagnosed with any kind of cancer, go read her first book and see her movie and you will understand why you need your posse and attitude to get you through it.) She is chock full of wellness and living healthier and is probably close to ten years out from a diagnosis of untreatable cancer. There are all sorts of alternative ideas in her head and on her website - which you should also join. Raw veganism may not be my cup of tea but I admire what she has done for all of us cancer people and I have adopted some of her suggestions.
However, some of the things that I have seen people adopt to treat their cancer just amaze me. I have a friend who decided that she could treat her cancer by taking some herb every day - I can't remember the name but even online it was recommended not to be taken every day but three weeks on and one week off. I don't know how much she was taking it but she has since had a recurrence.
Then there is a case in the news this week where a woman in Colorado died after injecting Cesium chloride into her breast cancer. Cesium is a chemical element which is actually a metal. It has a radioactive isotope that is used in medical applications. Cesium chloride is a supplement which some proponents say will help cure cancer. But has no medical proof. And it is not supposed to be injected.
Finally, if you adopt an alternative treatment instead of a traditional treatment protocol for your cancer, I do not think you should be surprised if your insurance doesn't cover it and it will not cover additional tests and scans to see if your disease has progressed. Insurance companies have protocols based on proven treatment protocols. For example, the standard to treat that cancer is a CT scan followed by six rounds of whatever chemotherapy infusion and then follow with another CT scan to see how the cancer has responded to treatment. But if you skip the treatment they cover, they aren't going to pay for another CT scan.
Its your body and your choice but you need to remember you have to accept the outcome of your decisions.
Thursday, January 8, 2015
A Way to End the What Age for Mammograms Controversy?
Work with me here, what if everyone could agree on one option for the mammogram controversy? Wouldn't it make a lot more sense? I mean there has been so much ink about this single issue. On one hand is prevention and on the other is over diagnosis and false positives, with a lot of other data, crap, history, and arguments added on to each. So what is the real answer?
I believe JAMA has the right idea here. In the age of personalized medicine, why are we hung up on cross the board requirements? JAMA suggests that we "Stop One Size Fits All Mammography".
"A woman's decision to undergo mammography "should be individualized based on patients' risk profiles and preferences," concludes a systematic review of 50 years of breast cancer screening data, published in the April issue of JAMA.
How to best go about achieving that individualization is not entirely clear, but clinicians need to make an effort with the tools that are currently available, such as decision aids and risk models,
suggest Lydia Pace, MD, MPH, and Nancy Keating, MD, MPH, both from Brigham and Women's Hospital in Boston, in their review."
Their argument is that a woman should be able to make a decision on mammography with their doctor based on their risk. The problem is that current science does not allow us to accurately estimate all women's risk of breast cancer. So the problem isn't with mammography but with the ability to predict breast cancer.
Before we jump ahead to that issue, let's stick with making mammography a personalized decision. I think this is a great idea. If someone has a high risk background, they should start mammograms earlier. If they do not have one, they should decide with their doctor when they should start them. Insurance companies should cover them regardless. There doesn't have to be a national rule on when they should be started.
Now switching to being able to predict breast cancer. We can't really. The BRCA genes allow us to predict women who are high risk but that does not cover all women who will get breast cancer, really less than 10% I believe. There can be other risk factors, family history, genetic background, and more.
Since we can't really tell who will or will not get breast cancer and may never be able to, we do need to use whatever screening methods we have. Until we have something better than mammography, it is our tool to use as best we can. But it should be the patient's choice and not the insurance company's.
I believe JAMA has the right idea here. In the age of personalized medicine, why are we hung up on cross the board requirements? JAMA suggests that we "Stop One Size Fits All Mammography".
"A woman's decision to undergo mammography "should be individualized based on patients' risk profiles and preferences," concludes a systematic review of 50 years of breast cancer screening data, published in the April issue of JAMA.
How to best go about achieving that individualization is not entirely clear, but clinicians need to make an effort with the tools that are currently available, such as decision aids and risk models,
suggest Lydia Pace, MD, MPH, and Nancy Keating, MD, MPH, both from Brigham and Women's Hospital in Boston, in their review."
Their argument is that a woman should be able to make a decision on mammography with their doctor based on their risk. The problem is that current science does not allow us to accurately estimate all women's risk of breast cancer. So the problem isn't with mammography but with the ability to predict breast cancer.
Before we jump ahead to that issue, let's stick with making mammography a personalized decision. I think this is a great idea. If someone has a high risk background, they should start mammograms earlier. If they do not have one, they should decide with their doctor when they should start them. Insurance companies should cover them regardless. There doesn't have to be a national rule on when they should be started.
Now switching to being able to predict breast cancer. We can't really. The BRCA genes allow us to predict women who are high risk but that does not cover all women who will get breast cancer, really less than 10% I believe. There can be other risk factors, family history, genetic background, and more.
Since we can't really tell who will or will not get breast cancer and may never be able to, we do need to use whatever screening methods we have. Until we have something better than mammography, it is our tool to use as best we can. But it should be the patient's choice and not the insurance company's.
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