Cancer patients get better care than patients in primary care

Why do my patients with cancer get better care than my patients in primary care? As the senior resident on my hospital’s inpatient leukemia service recently, this question troubled and intrigued me daily.

Despite the sheer complexity of treating leukemia (administration of chemotherapy, bone marrow biopsies, stem cell transplantation), the resources required (transplantation routinely costs $1 million), and the severity of the illness (patients with little to no functional immune system), I couldn’t help but marvel at how coordinated, integrated, and patient-centric the care was.

From the first day I saw that things in leukemia worked differently. Most inpatient ward teams consist of an attending, a senior medical resident, one or two interns, and medical students. Each member of the team is “on service” for 2-4 weeks after which they rotate to different parts of the hospital or to the outpatient or research setting. As a result a patient admitted to general medicine today is taken care of by a completely different team than took care of her 3 months earlier when she came in for the same problem. On leukemia, our medical team included an advanced practice nurse (APN) who did not rotate off and on service.

via kevinmd.com

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My neighbor depends more on me for care than on her own family. Caring.com

By Carol O'Dell, Caring.com Contributing Writer

Last updated: March 30, 2011

My neighbor depends more on me for care than on her own family.

By Carol O'Dell, Caring.com Contributing Writer

My neighbor and I are both widows and have enjoyed several years of going out to dinner, sharing errands, and even taking a few weekend trips. Last fall she got lung cancer, which has spread. Since her daughter lives two hours away, I took it on myself to check on her daily, provide some meals, and even take her to chemotherapy and other appointments. I was glad to do this -- that's what friends and neighbors should do.

But it's now become a full-time job, and I have my own health concerns. My neighbor is starting to treat me differently, expecting that I take her places and getting upset if I have other plans. I've hinted to the daughter that I can't take on this much care. But now I feel stuck -- and guilty for not doing more.

How do I get her daughter to provide the care that family should give, so that I can go back to being a good neighbor and friend?

via caring.com

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A Day in the Life of an Oncologist: “How Do You What You Do?” | GRACE :: Coping with Cancer / Social Work

On the rare occasion I’m in a social situation with people who aren’t in medicine (yes, I’m sure you know I don’t get out much, so this is largely from remote memory), the most common question that follows my answer to what I do for a living is, “How can you do what you do?”.   People imagine the obvious low points of telling people about a new cancer, about delivering bad news and discussing people’s difficult cancer-related symptoms and potential to decline despite our best efforts.  It’s fair to wonder what keeps us going.  So I thought I’d provide a brief sketch of a day in my clinic, which offers several ups along with the downs everyone might envision as dominating life in the oncology clinic.

   Work starts at about 7AM. At least the drive in avoids the big traffic.  I review my schedule, briefly reviewing the recent records of the people coming in that day, including a more detailed review of the records of new patients, including reviewing their scans that are usually delivered in anticipation of their arrival in my clinic.  Check e-mail, sign head shots in response to fan mail*, etc. (*in truth, it is perhaps technically more accurate to say that I sign dozens of orders for prescription refills and lab orders).

   Before clinic starts, I head to the hospital to round on inpatients of mine in the hospital.  One is a young man with testicular cancer who is doing fine on his chemo, though he’s grown weary of the hospital food after three admissions lasting 5 days each for inpatient chemo.  Fortunately, this is his last planned round of chemo, so the end is in sight.  And he knows I’m not responsible for the food.  At least his nausea is so well controlled that he’s interested in eating.

via cancergrace.org

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Nurse and Doctor, Neighbor and Friend By THERESA BROWN, R.N. - NYTimes.com

“Something there is that doesn’t love a wall,” begins Robert Frost’s poem “Mending Wall,” about two neighbors who meet to repair the gaps and holes in the stone wall separating their properties. They walk on either side of it, picking up and replacing fallen stones as they go.

Jeff Swensen for The New York Times Theresa Brown, R.N.

The poem came to mind one recent day on the oncology floor where I work. It’s a medical oncology floor, where we tend to medical issues that go along with cancer, like giving chemotherapy and dealing with complications of metastatic disease. But it turned out that one of my patients had a serious surgical problem.

Surgical oncology is several flights of stairs below us. Even if they were next door, though, I imagine we’d still be inhabiting different worlds. There’s “med onc” and “surg onc,” and never the twain shall meet.

via well.blogs.nytimes.com

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Discussing cancer treatment with the terminal patient, KevinMD.com

“Are you giving up on me?” My patient looks at me severely. “There must be other treatment options! Aren’t there some experimental drugs out there? I have beaten this cancer twice before. Are you saying that I can’t beat it again?”

No one can ever know with absolute certainty whether my patient’s newly recurrent cancer might miraculously disappear with one more treatment. His recurrence, however, has developed very quickly and is growing very rapidly. New cancer nodules are developing weekly. I have never seen a patient with a cancer this aggressive have a meaningful, sustained response to further treatment. The research literature confirms my impression.

It is always difficult to know what to recommend. Although “no further treatment” is always an alternative, I routinely run through all of the options, reviewing whatever is available, and hoping that we land on the combination that offers that improbable, one-in-a-thousand cure. However unlikely, we sometimes set up appointments and hope for the best.

Today, though, my sense is that it is time to focus on new goals.

The decision not to pursue more studies and more treatment can be very, very difficult. Surgeon and journalist Atul Gawande in an essay in The New Yorker entitled “Letting Go,” writes about how difficult it can be for physicians and patients to halt cancer treatment as the end of life draws near. The dilemma, he concludes, “arises from a still unresolved argument about what the function of medicine really is — what, in other words, we should and should not be paying for doctors to do.” In Gawande’s view, the profession should equip and supply doctors and nurses “who are willing to have the hard discussions and say what they have seen …”

via kevinmd.com

Article continues at KevinMD.com
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MedImmune-FluMist

At MedImmune, we seek to develop innovative, high-value products in which we have significant interest, both independently and in collaboration with our partners. By creating cutting-edge biological products, we're improving health, enhancing lives and helping to make a world of difference.

Synagis® (palivizumab) is the only monoclonal antibody approved by the U.S. Food and Drug Administration (FDA) to help prevent an infectious disease. Synagis is indicated for the prevention of serious lower respiratory tract disease caused by RSV in children at high risk of RSV disease. MedImmune is dedicated to assisting patients with access to support and resources. To learn more, click here. To learn more about Synagis, click here for Important Safety & Prescribing Information. Approved Synagis Distribution Network Members Approved Physician Purchase Channel Distributors Wholesale Accounts AmerisourceBergen Cardinal H.D. Smith McKesson Morris Dickson   FluMist® (Influenza Vaccine Live, Intranasal) is the first and only nasal spray flu vaccine approved in the United States to help prevent influenza and is indicated for the active immunization of eligible individuals 2 to 49 years of age against influenza disease caused by influenza virus subtypes A and B contained in the vaccine.

via medimmune.com

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Massachusetts Ask A Nurse Services

Massachusetts Ask A Nurse Services:

http://www.4nursing.com/ask

Cancer AnswerForm, University of Michigan:"Communicate with a cancer nurse online! The information you send through this form will go directly to a knowledgeable cancer nurse who will respond promptly. Note: The Cancer InformationLine will not review medical records or make a diagnosis based on the information you provide online."
If you would rather speak with a nurse directly, please call 1-800-865-1125
U-M, Comprehensive Cancer Center 1500 E. Medical Center Drive CCGC 6-303
Ann Arbor, MI 48109-0944
http://p53.cancer.med.umich.edu/contact.htm

Massachusetts Nursing Resources, http://www.4nursing.com/massachusetts/

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Nursefriendly, Inc. A New Jersey Corporation.
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Ask A Nurse, Cancer, Oncology

Cancer, Oncology

http://www.4nursing.com/ask

Ask the nurse, Breastcancer.org (Great Britain):"A diagnosis of breast cancer can leave you feeling afraid, shocked, angry, or any number of different emotions. We have prepared this website so you should be able to find information about your specific treatment, diagnosis or worry. We also have a team of specialist breast care nurses who can to address any queries you may still have. Email nurse@breastcancercare.org.uk and we guarantee to send a personal response within five working days. If your query is urgent, you may want to ring our helpline on 0808 800 6000 (textphone 0808 800 6001). See about us for details of opening hours."
http://www.breastcancercare.org.uk/content.php?page_id=119

Ask the Nurse, Bladder Cancer WebCafe:"Sharon McMullen, RN, CCRN, BSN, BA is a critical care nurse working in Philadelphia, Pennsylvania, USA with professional experience ranging from general surgical nursing to critical care nursing to emergency nursing. She will be glad to help you translate medical jargon, read between the lines of your medical records, or just navigate the often confusing world of health care."
Please send your questions to "Ask the Nurse" c/o wendy@blcwebcafe.org
http://blcwebcafe.org/askthenurse.asp

See Also: http://www.4nursing.com/cancer/ or http://www.4nursing.com/oncology/

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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.4nursing.com info@nursefriendly.com ICQ #6116137, AOL “nursefriendly”
856-415-9617, (fax) 415-9618

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