I remember several years ago, sitting at my mom’s kitchen table with her. It was the day after Thanksgiving. I was a young medical resident then, and frankly probably didn’t know very much. Mom had had a mole removed from her back, and while we were sitting there talking, she received a phone call about the results of the biopsy. I distinctly remember her picking up a pen and writing on a yellow pad of paper. As she wrote m-e-l-a-, I felt like I couldn’t breathe. I remember somehow being able to shout in a terrified voice, “It’s a melanoma?” She finished the call and confirmed that they told her that indeed the “mole” was a melanoma and the margins were positive. My mom has no medical training, so to her, positive margins was of no great significance. For me, though, the one thing that I did know was that this would likely be very bad. Even today, I feel a lump in my throat when I think about that moment; all I could think was whether my mom would be around for the next Thanksgiving. Fortunately for my mom, her melanoma was identified very early and with a large excisional biopsy her cancer was completely removed. Back then, though, that was not the case for most people who were diagnosed with melanoma.
As you may have read in a recent VPMA Voice, our Holden Comprehensive Cancer Center was rated by Becker’s Hospital Review is a “Great Oncology Program”. We are on their May 2016 list of one hundred hospitals and health systems with Great Oncology Programs. We should congratulate our colleagues and be very proud that we can offer such great care to patients with cancer. It is therefore fitting that this blog is about how we treat our cancer patients.
Medical advances in the diagnosis and treatment of many disease states are occurring every day. Usually, these advances are slow to have significant impact on our patients. In the linked column below, written by our own Drs. George Weiner and Mo Milhem, you will see how cancer therapy really has gone through a period of disruptive innovation. What we remember from our training about the therapies and outcomes of patients with cancer is changing so rapidly. As we care for patients, we must make decisions based on their comorbidities; we must determine the best course of therapy based on the whole person. Understanding their comorbidities is very important for us to make the best recommendations to our patients. For example, how I approach aggressive versus conservative care, or even palliative care, for a patient with a cardiovascular event may be altered by my perception of their comorbidities, particularly the prognosis from their cancer. For this reason, I must make sure that I have the accurate information needed to give the best recommendation to my patient.
As you will read in the following column, Drs. Weiner and Milhem are encouraging us to more actively engage our oncologists, so that we know exactly what the treatment plan and the prognosis is for our patients. Our preconceived notions, based on remote education or experience, particularly for those of us they do not care for cancer patients every day, may not be in line with the reality of what options exist today. It is only through talking with our oncology partners that we will better understand the treatment that is available for the patient we are caring for, and be able to understand his/her prognosis. It is only then that we can present to the patient and their family the best options for their overall care.
Read Dr. Weiner and Dr. Milhem’s blog post: Disruptive Innovation in Cancer Medicine – See Cancer Differently
Whether you are the primary provider, the nurse, the social worker, the learner, the dietician, the pharmacist, or anyone who interacts with our patients, we need to make certain that when we speak to them, we have all the information, and that it is correct. It is frightening for them to hear differing opinions from members of their health care team. This fear and anxiety results in suffering for the patient and their family. Our patients deserve for us to speak with a common voice when it comes to their treatment plan. For this reason, we must treat each patient individually and make certain that we have all the information, the information is correct, and that the entire team is on the same page. In the future, before making assumptions about my patient, I will pick up the phone.
—Theresa Brennan, MD, Chief Medical Officer