by Sarah A. O. Isenberg
I was pretty much the last person you’d think of when you thought “Zen.” I was a driven lawyer, a litigator, no less. I worked 90+ hour weeks. I drove fast, talked fast, and ate meals on the run. I didn’t nap; I hardly slept. I was on the fast track to corporate and personal success: loved work, just got married, recently bought a house, was trying to have my first baby. I was checking all the boxes on the “Young Adult Success” checklist. But then, at 32, I was diagnosed with breast cancer.
I was blindsided. No family history, no inkling, even, that I could ever have gotten cancer. It was found by accident. It was sheer luck. Nothing palpable. But it was cancer, and worse than we thought. I would need chemo, then radiation, then tamoxifen for five years. So while my contemporaries’ lives were on a trajectory for the exciting, I was sidelined.
by S. David Nathanson MD
I told my patient Sandy that she looked ‘wonderful’ when she greeted me at a fund raising event, dressed in an elegant form-fitting outfit that revealed nothing of her breast cancer surgery done 4 years ago. She no longer wore a wig since her own hair had grown back quite thick and lush after she completed chemotherapy.
‘Well, it may be because I lost 180 pounds,’ she responded.
I didn’t remember her as being morbidly obese when I treated her initially so I was puzzled. Enjoying my confusion she said gleefully: ‘My husband left me.’ Apparently she herself had not lost weight but she thought of her ex-spouse as a weight on her mind, and he was gone. He couldn’t cope with her surgical wounds and then with her baldness from chemotherapy. He distanced himself emotionally and didn’t support her, stayed in their house until she started radiation after completing surgery and chemotherapy and then left as divorce proceedings were initiated.
by Kristine Nally, B.S., Microbiology
Whether or not to continue working can be an important concern for individuals preparing for chemotherapy. However, there is very little published research regarding work patterns, factors that affect the decision to work and support from employers during active cancer treatment. The decision and indeed the ability to continue working is highly individual and may be affected by physical and mental health, type and stage of cancer, age, type of work and finances.
For many people, working is an integral part of feeling “normal” and can have a positive psychological impact during a difficult time. In addition, the increased length of cancer treatments means that some people will need to work for financial reasons. Luckily, there have been great advances in the treatment of chemotherapy related side effects and some people that want to work, find that they can.
A Resident Education Article
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by Robin Urquhart, MSc, Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, NS.
Across Canada, synoptic reporting tools are increasingly being implemented into clinical practice, in specialties such as radiology, endoscopy, surgery, and pathology. Synoptic reports capture data items in a structured, standardized format and contain information critical for understanding a disease, the technical details of a procedure, and the subsequent impacts on patient care. Most synoptic reporting tools are now electronic, with data entered on a computer screen via drop-down menus, check boxes, and radial buttons. For many of these reports, all of the details considered essential to the procedure are often mandatory, which means the clinician cannot complete the report and sign-off without entering the required information.
by G.E. Darling, A.J. Dickie, R.A. Malthaner, E.B. Kennedy, R. Tey
In non-small-cell lung cancer (nsclc), invasive mediastinal staging is typically used to guide treatment decision-making. Here, we present clinical practice guideline recommendations for invasive mediastinal staging in nsclc patients who have been staged T1–4, N0–3, with no distant metastases.
by T. Younis, D. Rayson, C. Skedgel
The adoption of a chemotherapeutic regimen in oncologic practice is a function of both its clinical and its economic impacts on cancer management. For breast cancer, U.S. Oncology trial 9735 reported significant improvements in disease-free and overall survival favoring adjuvant tc (docetaxel 75 mg/m2 and cyclophosphamide 600 mg/m2 every 3 weeks for 4 cycles) compared with ac (doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 every 3 weeks for 4 cycles). We carried out an economic evaluation to examine the cost–utility of adjuvant tc relative to ac, in terms of cost per quality-adjusted life year (qaly) gained, given the improved breast cancer outcomes and higher costs associated with the tc regimen.