Cancer, Medicine and Life

Apple Inc rules

2012-10-06T22:35:00.001+09:30

At the recent ESMO (European Society of Medical Oncology) conference it was fantastic to see the number of folk who have iPhones and iPads. If they needed a laptop it was nearly always a Macbook Air.

Nearly 16500 delegates under one roof, everyone with a device to get onto the Internet and they crashed the Net server a few times.

The power of group computing.

Herceptin duration

2012-10-06T22:30:00.001+09:30

A few years ago when Herceptin (trastuzumab) was launched for the early stage of Her2+ breast cancer, the timing of treatment was fixed at one year. Why one year? No clue. Just a consensus figure decided by the oncology investigators.

At the European Oncology meeting held in the end of Sep 2012 - data from large studies were presented. The two main studies were comparing one year versus six months of Herceptin - this showed that probably one year is better than six months. The other study of one year versus two years showed that one is probably enough.

So the consensus a few years ago, was right. Twelve months is the magic figure (for now).

Hiatus in life

2012-08-20T20:52:00.001+09:30

I started this blog with gusto and then slowly faded away. I think I would broaden my horizons and write more regularly on a variety of topics.

Adjuvant GIST - Gastro Intestinal Stromal Tumours

2012-05-21T12:39:00.001+09:30

GIST is classically operated upon and thought to be cured by surgery. Unfortunately more and more clinicians are finding that patients have recurrence of disease. Nowadays, there are way to find possible recurrence risk rates, and treat accordingly.

If a patient has a high to moderate risk of recurrence, then they must be offered Imatinib (Glivec or Gleevec). The duration of treatment continues to be a matter of discussion - most people agree for one (1)year of treatment, but there is now data to show that three (3) years of treatment is necessary.

I suspect that treatment would be needed for long term (much longer than three years), as the survival curves at one year and three year of treatment are quite similar, when treatment is stopped.

The important thing is to ask your surgeon to consider Imatinib therapy or refer you to a Medical Oncologist for discussion.

Driving and Brain Metastasis

2012-05-20T19:22:00.002+09:30

People who have been driving their vehicles for several years (most times decades) are really upset when we tell them that they should not be driving their cars.

In Australia the onus is on the clinicians to get affected patients to stop driving their cars. The treating clinician is meant to tell the patient to stop driving and send a letter to the Driving Authority to withhold/revoke the patient's driver's license.

The number of clinicians who even know about this is minimal!!

If a patient's cancer has spread to their brain, the chances of seizures or altered consciousness are quite high. There is no specific time or place when things can get out of control. Also these patients have had radiotherapy, surgery, are on high dose steroids, narcotics, etc... and thus the mental cognition and reaction time is dramatically altered.

The conversation is a difficult one. But a very important one. It could save the patient's life and others on the road.

Terminally Ill Mum Sues Insurance Company

2012-05-20T19:02:00.004+09:30

Terminally ill mum suing insurer

It's a tough life. Can get tougher due to some folks.

The Gutsy Challenge

2012-05-20T18:51:00.003+09:30

The Gutsy Challenge

Movember

2012-05-20T18:48:00.001+09:30

MOooooooovember

I participated last year (2011) and we raised nearly $ 4000 (AUD). Pretty cool. Worth re-doing this year.

Best Oncology Textbooks

2012-05-06T18:06:00.002+09:30

Which is the best Oncology Textbooks?

I think:
# DeVita's Cancer: Principles and Practice of Oncology
# Abeloff's Clinical Oncology
are the best ones.

There are tons of other books, but these two seem to cover the maximum amount of information in the best possible manner.

Urine protein and Avastin / Bevacizumab

2012-05-06T17:50:00.000+09:30

Avastin (Bevacizumab) is a good medication in metastatic bowel cancer (both colon and rectum). It is used for extended periods of time with chemotherapy to control and reduce the burden of cancer.

It is very important to check the urine for proteins while on this medications, as it does have a potential to damage the functioning of the kidney. In case, the kidneys are secreting proteins, it is then important to check the quantity and then if needed to stop Avastin till the kidneys recover.

We have found that a significant number of doctors forget to check urine protein, while patients are on Avastin.

Infections from doctors

2012-05-02T15:04:00.002+09:30

Infections can also be transmitted from doctors and nurses to patients. It is quite well known. Hospitals across the world are trying to convince medical staff to clean their hands - wash with soap and water or use rubbing alcohol.

The other common things which are sources of infections are doctors' white coats (which are not washed very often), neck ties (never washed), stethoscopes (hardly ever cleaned), telephones, and the list goes on.

Think about it.

Doctors as patients

2012-05-02T14:57:00.003+09:30

One of the nightmares for medical units across the world is to have a doctor as a patient. Everything is has to be extra-careful in the discussion, tests, planning and implementation. Each thing is checked and double-checked.

I know that I am a terrible patient. I do not quite remember completing a full course of antibiotics or doing the things recommended to me.
The problem is that for some strange reason (?Murphy's law), when we are extra-careful; things go extra wrong. Some people term it the "VIP syndrome".

Hospice and Nursing Homes

2012-05-02T14:53:00.004+09:30

Today's ward rounds were a bit sad. I have a bunch of patients who are quite unwell, some due to cancer and some due to unrelated issues. One thing is certain that they would not be able to manage alone at home. A couple of these patients, do not have any family or friends to support them at home either.

The alternatives are a nursing home or a hospice. Telling a person that they cannot go back home and need to move to a nursing home for the rest of their life, is NOT an easy task. People who have been fiercely independent all their lives are not happy to be dependent on others.

The other major issue for some patients is the decision to move to a Nursing Home versus a Hospice. They are too well to be transferred to a Hospice and thus are planned for a Nursing Home... but by the time they find a Nursing Home place, they are too sick to move there.

Difficult decisions. Tough on just on the patients, but also their families, friends and the health personnel taking care of them.

Life moves on.

Merkel Cell Cancer: Rare Cancers

2012-04-29T04:48:00.001+09:30

Recently someone asked me about Merkel cell cancer. Relatively rare.

The website I suggested helped him - http://www.merkelcell.org/

Thought it might be worth sharing, in case more people need help with this condition.

Hindu customs and hair loss

2012-04-29T04:36:00.001+09:30

I have spent time doing oncology work in India and working with patients was very rewarding.

One day in the out-patient clinic, I met with three women consecutively who were to start chemotherapy. All three women would lose their hair and it was very distressing for each of them and their families.

Two days later, I suggested to one of these women to shave their hair and make a wig out of her own hair. It seemed like a good idea to me. It was NOT a good idea for her and her family. In traditional Hindu culture, a woman would shave her hair at the time of being widowed.

No more such suggestions. Ever!!

Hair loss and Chemotherapy

2012-04-29T04:21:00.001+09:30

One of the biggest worries about chemotherapy is hair loss. It seems to be a bigger issue than even fatigue and reduced appetite. This is what I seem to find in clinical practice. The worry seems to be more in women than men, but both genders are worried.

A lot of people are really surprised when I tell them that they would not be losing their hair. All chemotherapy drugs are not the same. Some drugs cause hair loss, some do not.

GIST: Gastro Intestinal Stromal Tumours

2012-04-29T04:12:00.001+09:30

GIST is a truly game changing cancer. It has been around for centuries, misdiagnosed as other types of cancers. In the past few years, GIST has found to have special markers and thus the diagnosis is definitive.

Treatment is to completely remove the tumour by surgery. This is possible when it is early stage. Once the cancer has spread, surgery is not possible (most times). Chemotherapy was as good as useless. Nothing seemed to work.

A few years ago, a pharmaceutical company launched a molecule called Imatinib (Glivec). This has changed everything for GIST. Now people with metastatic GIST, pop a pill a day and continue with life. Quite amazing.

Recent data has shown that even after surgery, Glivec should be given for at least 3 years.

Game changer. Looking for more such miracles.

Waiting Time for Appointments

2012-04-29T04:05:00.001+09:30

The huge problem is that once someone has been diagnosed to have cancer, or even if there is a suspicion of cancer; most families want an appointment with their doctor straightaway. This seems to be a valid request most times, as anxiety levels are HUGE.

As a specialist, we are usually keen to have a definitive diagnosis of cancer prior to an OPD review. The idea being that the patient's GP or doctor makes a diagnosis of cancer by a biopsy or needle aspiration and then makes the referral.

Depression

2012-04-21T10:35:00.002+09:30

What is depression? Is it just something which needs to be shrugged off, 'cos someone is having a bad day or days? Or is it something which is a lot more deeper and needs a through evaluation? Which treatment helps - counselling or medicines?

In Crocodile Dundee (a great Aussie movie), the actor asks - why do you need a psychiatrist, don't you have mates to talk to?

Have we lost touch with each other and not willing to say the right things to friends, since it might offend the other person?

Ohh, too much to read up and find out.

Malaria

2012-04-20T00:56:00.003+09:30

Wow. The number of people dying of malaria is rising by the decade. Apparently in 2010, over 1.2 million people died of malaria. Shocking. To think that just about a decade or so ago, we thought malaria was well controlled. It is back with a vengeance. A significantly amount of malaria is now thought to be multi-drug resistant.

Short URL

2012-04-20T00:47:00.002+09:30

Interesting.

http://medicaloncology.blogspot.com.au is the same as http://goo.gl/mlncD

Angry patients

2012-04-20T00:44:00.001+09:30

One of the most intimidating experiences is to be confronted by an angry patient and their family/friends. They might be upset about the long waiting time or the services or whatever. In the process of getting angry, the primary intention of sorting out the medical problem gets buried (to some extent).

I have found it quite effective to let the angry patient rant about everything. When the run out of steam, try and work through the problem.

There have been a couple of patients, who refuse to listen and only yell. It is not worth breaking your head with them. Ask them to leave, or leave the room yourself. I have the right to work in a safe environment.

Diabetes and Insulin

2012-04-19T22:52:00.000+09:30

Patients on chemotherapy seem to have a real problem controlling their blood sugar levels. Most times it is due to the fact that we give steroids pre-chemo and post-chemotherapy to prevent allergic reactions and nausea. Diet control and even Tablet based therapies may not work optimally.

Insulin for a short time might be the way to go. It is worth exploring the option with your GP or specialist. If people are getting 4 - 6 cycles of chemotherapy, short course of Insulin is all that maybe required.

Stop smoking. Right now.

2012-04-19T22:45:00.002+09:30

The number of people gasping to death from emphysema and bronchitis is worse than people dying of lung cancer. Smoking destroys the lung tissue and the lung airways, along with lots of other things in the body.

Pretty gruesome end. Not worth it. Lots more to life. Stop smoking now.

Which cancers are rising?

2012-04-19T22:32:00.001+09:30

Interestingly, the majority of cancer rates have reached a plateau or are reducing, except for cancers like lung cancer in young women. Unfortunately they seem to be a group which is picking up habits like smoking.

The problem is that by the time, it get publicised and all that, so many young women would have suffered.

Stop smoking. Everyone. Right now.