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'cancer' posts

Grieving and the holidays

A cancer doctor is very familiar with the anxious and fearful grief that accompanies a diagnosis of cancer. We are less acquainted with the lonely and empty grief that is experienced by those left behind when our patients die. However, when I wear my hospice medical director hat, I am privy to those struggles, and knowing that the loss of someone close is particularly difficult during the holidays, I have chosen to divert from subjects I am more familiar with and rely on the experts at hospice to help me present a meaningful discourse on grief during the holiday season.

For the bereaved, the joyous holidays trigger emotions of great conflict. Every act of preparing for the holidays, once a time of cheer and anticipation, becomes another stabbing reminder of ones loss. The demands of family and friends, always a bit stressful around Thanksgiving, Hanukkah, Christmas, and New Year, now are overwhelming, both physically and emotionally. Traditions, designed to create love and family unity, now seem empty and may even create divisions among the grieving. Even successful celebration may bring on a deep surge of guilt for enjoying the holiday alone. And those who have no physical or emotional reserves left for thanksgiving or joy making, may feel great pressure to “get on with their life, and join in the fun.”

It has been suggested that the key word in grief is “permission.” The bereaved need permission from themselves, and from family and friends, to grieve as long as necessary and in any way that works, remembering that what works may not always be the same. It means permission to only do what you can. A turkey and all the trimmings may just be too much this year. Eating out may be perfect. Having someone else do dinner may be better yet. 

Permission may also be needed to change some timeworn traditions. It must be recognized that ...

Radiosurgery treatment for brain metastases reduces risk of memory loss and improves survival

When a person has metastatic cancer, the brain is one of the organs that cancer cells can migrate to. If this happens, the condition is called brain metastases. The brain metastases will have the same cancer cell type as the primary cancer, such as lung or breast cancer.

If this occurs, radiation treatment is often used to control these areas of disease. Research is finding that utilizing stereotactic radiosurgery as the initial treatment for people with four or less brain metastases is associated with improved survival and reduced risk of memory loss compared to whole brain radiation. Stereotactic radiosurgery ....

Bisphosphonate medications and Osteonecrosis of the jaw

Bisphosphonate use has been increasing in recent years.  This is a class of medications that is used to solidify bone mass and prevent fractures.  They fight osteoporosis, but also prevent many cancers from spreading into skeletal bones (bone metastases).  Many patients with metastatic cancers (breast, prostate, renal cell, multiple myeloma, etc.) will require these medications to counteract the devastating consequences of bone metastases.

Bisphosphonates were described as early as the 19th century, and were approved by the FDA in the 1990s for human use.  Fosamax was the first FDA approved bisphosphonate in the USA.   The medications come in an oral (pill) form and an IV version.  Other commonly prescribed bisphosphonates include:

  1. Zometa  (Zolendronate)
  2. Actonel  (Risedronate)
  3. Boniva  (Ibandronate)
  4. Aredia  (Pamidronate)

An uncommon but significant potential side effect of bisphosphonates is the development of Bisphosphonate-associated Osteonecrosis of the Jaw (BONJ).  This is primarily associated with...

Resources and social support for dealing with cancer

Here at the Swedish Cancer Institute (SCI), we understand that individuals cope in their own unique ways, and that receiving personalized education and support is important in the healing process. For this reason, the SCI is devoted to providing complementary supportive services for newly diagnosed patients, those undergoing treatment, and those who have completed treatment, as well as their caregivers.

The SCI offers programs that promote education, hope, and healing. Many of these programs are offered free of charge, while others are offered on a sliding scale. These integrated care programs include:

  • American Cancer Society Patient Navigation: The American Cancer Society Patient Navigator helps patients find resources related to financial assistance, transportation, access to wigs and prosthetics, and much more.
  • Art Therapy: Art therapy is a confidential, supportive, and individualized experience for examining health issues through visual and verbal self-exploration.
  • Cancer Rehabilitation: Cancer rehabilitation integrates medical management of cancer treatment-related side effects with a variety of exercise therapies.
  • Health Education: The Swedish Cancer Education Centers offer complementary educational materials, innovative learning opportunities, and patient education classes.
  • Genetic Counseling and Testing: Genetic testing is available for individuals to determine their risk for developing certain cancers.
  • Massage Therapy: Massage therapy may help with cancer-related pain, fatigue and nausea.
  • Naturopathic Medicine: Combining modern science with natural remedies, naturopathic doctors are available for consultation and treat¬ment through coordination with the patient’s oncologist.
  • Nutrition Care Services: Nutritionists are available to help patients and caregivers make healthy dietary choices during cancer treatment.
  • Psychiatry: Psychiatrists help patients and caregivers maintain the emotional and mental well-being needed to cope with stresses of cancer.
  • Oncology Social Work: Licensed oncology social workers provide patients and caregivers ongoing counseling and assistance.
  • Support Groups: Support groups for patients and caregivers are offered weekly, creating an environment for people to share their feelings with others going through similar experiences. 

Patients often hear that it’s important to find a strong support system during and after treatment; this may include a partner, sibling, parent, child or close friend. These are ...

What should I do about a thyroid nodule?

Thyroid nodules are extremely common and studies have shown that about half of us have at least one!

Fortunately, most of these nodules do not pose any health risks. Not all thyroid nodules are benign, however, and in a minority of cases (about 5-15%) may contain a cancer.  The challenge, of course, is figuring out which nodules are cause for concern and which ones are not.

With increased use of high-resolution imaging, more nodules are being identified today than ever before.  It is also not uncommon for someone to learn they have a nodule “incidentally” after a CT scan, MRI or ultrasound that was performed for some other medical reason.

If you think you may have a thyroid nodule, or if one has been found incidentally by medical imaging, you should make an appointment to see your doctor. Your doctor will likely take several steps, including:

Breast cancer awareness is about information, not a color

In recent years, the colors of October seem to have changed from red, orange, and gold to pink, pink and more pink. I have always loved pink, well before becoming a breast cancer surgeon, but like many of us, I find the pink of October overwhelming, especially at this point in the month.

I appreciate and endorse the continued focus on breast cancer, but often the important information is drowned out by the rah-rah-rah of the awareness campaigns. Many women (and men) are “aware” of breast cancer, but never truly become aware of what it really is, what it really means, until they find themselves dealing with the cold terror of a palpable mass or a call-back after mammogram. They need information, not just pink blenders. 

Breast cancer is ...

Cancer control and survivorship

I recently attended the Southwest Oncology Group (SWOG) meeting, a consortium of research institutions doing clinical trials on cancer. The conference highlighted how new research will remarkably affect cancer survivorship, quality of life (QOL), integrative care and our ability to predict and provide needed services more accurately and with greater cost effectiveness for cancer survivors. The tools for implementing cancer control are evolving quickly.

Here are some highlights from the meeting:

  • Biomarkers, which are any human characteristics that are measurable including everything from gene expression (or over-expression) to pain surveys, can potentially predict long term survival as well as the specific services that will most benefit patients.
  • Symptoms that are increasingly predictable by biomarker assays include fatigue, insomnia, pain, anorexia, nausea, depression and others. This means that we will soon be able to better predict the patients who will be affected by these problems and deliver interventions much earlier and more effectively.
  • Patient satisfaction is frequently not related to treatment outcome. Factors such as QOL and survivorship are important.
  • Lung cancer patients suffer inordinately high, long-term QOL deficits. Many of these respond well to interventions but interventions are frequently not provided to patients with lung cancer.
  • Symptom clusters ...
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