|
I find it extremely difficult to deal with children who have cancer, and their families. It is the single biggest reason why I do not treat kids. Too hard. The doctors and nurses who treat paediatric malignancies are absolutely fantastic. More power to them.
The only favourable point about kiddie cancers are that they are relatively more treatable as compared to the adult cancers. The horrible part is failing.
0 Comments
Clinical Trials for medications and drugs are broadly divided in four groups or phases:
Phase 1: Very early type of research. In some types, it would be a “first in human” study Phase 2: Studies would have shown the medication to be relatively safe and it is now being tested for efficacy Phase 3: The safety and efficacy have been shown to be favourable, and now it is being tested against the present standard of care Phase 4: This study is primarily to gain more information about the medication, as it has already been approved for routine use in the market Enrolling onto clinical trials is a good thing. It gives access to newer molecules or different ways of using older molecules. It is possible that the full benefits of the study medication may never be seen in the patients enrolled on the study, bur future generations would benefit from the same. All trials are governed via an Ethics Committees, which may be locally or centrally based. They are the guardians of patients and their families, and would not give permission to conduct a study, unless they are convinced about safety. The first principle remains – “First do no harm” 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. 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. 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 urinary protein while on this medication, as it does have a potential to damage the functioning of the kidney. In case, the kidneys are secreting increased amounts of 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. Which are 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. 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. Medicine in Australia is top class. It may not be as cutting edge as some hospitals in the US or Western Europe, but for all practical purposes… medicine in Australia is fantastic.
There is a talk about dearth of the latest molecules, but in terms of being pragmatic and the true value for the dollar… there is almost everything available. When I talk about being available, I am talking about being funded by the government (which means free to the patient). Everything, which is not funded by the government, is available on the market (for a price). The quality of care even in remote towns is great. If a facility is not available or there is a emergency, the Royal Flying Doctors help out. What is the evidence of low bacterial diet in patients with chemotherapy for solid tumours? I could not really find anything conclusive in the data available.
Can someone help me out here. Most of the data is anecdotal about a patient getting this illness or that illness, but the majority of the patients get along fine with clean, cooked food. This concept of scaring patients and their families into only eat this or that and avoid this and that…. it a complete overkill. Now patients undergoing a bone marrow transplant with sustained neutropenia… that is a completely different story. I am talking only about patients with solid tumours undergoing chemotherapy. The period of neutropenia is relatively short and patients bouncy back fairly soon. Eat well. Stay strong and healthy. All doctors working in public and private hospitals should get the best possible medical indemnity insurance for themselves. Most doctors working in the public system have insurance with the govt health dept, but they also need extra insurance to cover themselves.
I think it is worth the effort. Also it is tax deductible. I signed up with Twitter. Am trying to figure this whole social media thing out 🙂
My Twitter account is @Med_Oncology See you on Twitter!! All pain is not the same in cancer.
Different types of pain requires different medications: Anti-inflammatory medications – paracetamol, ibuprofen Opioids – morphine, oxycodone, fentanyl, hydromorphone, methadone Neuropathic agents – pregabalin, gabapentin, amitryptilline Most times it is a combination of these drugs which would help. |
Rohit JoshiCancer, Medicine and Life: A cancer and medicine blog to help on the journey of life. Medicine and Medical Oncology are rapidly changing fields and is hard for most people to keep up. A diagnosis of any illness, in particular cancer is devastating news for anyone, and the hope is that we can share knowledge and support each other. Archives
May 2024
Categories
All
|
RSS Feed
Created and nurtured by RJ & JJ