Most of us have heard the Beatles lyric, “I get by with a little help from my friends.” When you have a friend diagnosed with cancer, it is often hard to know how to help. Should you talk about the cancer? Should you avoid talking about the cancer diagnosis? What is the best way to help your friend?
It is helpful for good friends to know there are different ways that people cope with cancer. A range of feelings may occur: anger, fear, anxiety, or blaming themselves (because of something they did or did not do). These initial reactions will likely only last a short time. You may need to be patient and understanding and overlook some behaviors. Continue reading →
When you hear the word “cancer,” the last thing any newly diagnosed patient wants to do is take extra time to decide on treatment. The tendency is for patients to spring into action, often following advice of the first oncologist they see without investigating treatment options or second opinions. However, this isn’t necessarily the best course of action. In fact, Steven Katz, M.D, from the U-M Comprehensive Cancer Center leads a research team that studies treatment decision-making. His takeaway to date:
“I’m not talking about waiting months. I’m talking about an extra visit. Take time to discuss options with
Lynn Dworzanin (right) with her daughter
your spouse. Get a second opinion if you’re not sure.”
Decisions after cancer diagnosis, in most cases, don’t need to be made as though it’s a medical emergency.
Lynn Dworzanin is a Cancer Center patient who faced some tough decisions. Diagnosed with breast cancer, she had many things on her mind, including her survival, family, body image, over treating her cancer and peace of mind in the future.
Many patients are so afraid for their lives that they don’t stop to think about other Continue reading →
When a pregnant woman is diagnosed with cancer, her decisions are complicated by concern about how treatment may affect the baby’s health. Ideally, she can delay treatment until the baby is born, but sometimes a delay can allow the cancer to progress and make it harder to treat. The best time for beginning treatment to balance the baby’s and mother’s health needs isn’t always clear.
Cancer during pregnancy is rare, occurring in approximately one out of every 1,000 pregnancies, and little research is available to guide women and doctors. Breast cancer is the most common cancer in pregnant women; affecting approximately one in 3,500 pregnancies. The other common cancers in pregnancy are cervical cancer, lymphoma, and melanoma. A pregnant woman with cancer is capable of giving birth to a healthy baby, and some cancer treatments are safe during pregnancy. Cancer rarely affects the fetus directly.
If cancer is suspected during pregnancy, women may be concerned about diagnostic tests such as x-rays. However, research has shown that the level of radiation in diagnostic x-rays is too low to harm the fetus. When possible, women may use a lead shield that covers the abdomen for extra protection. Other diagnostic tests, such as magnetic resonance imaging (MRI), ultrasound, and biopsy, are also considered safe during pregnancy because they don’t use ionizing radiation.
Some diagnostic tests use liquid radioactive iodineto help stage cancer (figure out whether the cancer has spread to other parts of the body). Radioactive iodine cannot be used during pregnancy because it can damage or destroy the fetus’ thyroid gland.
When making treatment decisions for cancer during pregnancy, the doctor considers the best treatment options for the mother and the possible risks to the fetus.
The type of treatment given will depend on the following:
The trimester of your pregnancy
The type, location, size and stage of the cancer
What the woman prefers
Because some cancer treatments can harm the fetus, especially during the first trimester (the first three months of pregnancy), treatment may be delayed until the second or third trimesters. When cancer is diagnosed later in pregnancy, doctors may wait to start treatment until after the baby is born, or they may consider inducing labor early.
Some cancer treatments may be used during pregnancy but only after careful consideration to optimize the safety of the mother and the unborn baby. These include surgery and chemotherapy. Radiation is generally not utilized during pregnancy. After evaluation your doctor will develop a treatment plan based on individual circumstances.
Patients facing a cancer diagnosis deal with anxiety about the future, not feeling well and the high cost of care. That’s why the American Society of Clinical Oncology took a careful look at which tests and treatments oncologists are ordering that aren’t supported by evidence they help patients live longer and, in fact, could even be harmful.
“The issue is that many of the things we do are based on things somebody thinks are best practice and, often, there are not data to support their use,” says Kathleen A. Cooney, M.D., chief of the division of hematology/oncology at the U-M Medical School. “Excessive use of testing without adequate data can be dangerous to patients.”
The ASCO study was conducted as part of a national effort called Choosing Wisely® that challenged the medical community at large to identify five practices that are expensive, routinely used and for which there is insufficient proof the practice helps patients.
“These tests and treatment options should not be considered unless a patient and provider have worked together to discuss options,” she says. “The Top Five List doesn’t trump a clinical assessment. Hopefully this list will help stimulate dialogues about individual goals of cancer treatment and appropriate diagnostic testing and follow up.”
ASCO Top Five list for oncology*:
Cancer directed therapy for solid tumor patients with little or no benefit from prior treatment.
PET, CT and radionuclide bone scans in low-risk prostate cancer patients.
PET, CT and radionuclide bone scans in low-risk breast cancer patients.
Surveillance testing and imaging for breast cancer survivors with no symptoms
White cell-stimulating factors for primary prevention of fever/infection associated with neutropenia (a low number of a type of white blood cells) in low-risk patients.
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