Friday, October 13, 2017

Goals and Preferences

As an oncologist, I want to provide the best treatment for everyone. That should mean the best chance at a long-lasting remission, if not cure—whatever that might take. Surgery, chemotherapy, radiation therapy—a dark tunnel that I hope patients will enter and then exit, with the sun shining on the other side. But, every now and then, I have a patient who chooses not to pursue the regimen that I think will bring her the best chances. Such was the case with Jean*.

Wednesday, September 6, 2017


I was reading my emails this morning and came across one from the Foundation for Women’s Cancers, announcing September as Gynecologic Cancer Awareness Month. Their social media campaign centered on the hashtag above, with a focus on clinical trial awareness and participation. It got me thinking again about the enterprise of clinical trials, and just how much goes in to clinical trial enrollment.

Tuesday, July 25, 2017

“At Least”: Helping Our Patients Live Life on Their Terms

I’d known her for almost three years. She had advanced ovarian cancer—clear cell—and was diagnosed with disease already in her chest, stage IV. She had a terrific response to neoadjuvant chemotherapy, which had resolved her extra-abdominal disease sites after three cycles. She had an aggressive interval surgery that achieved complete resection of residual cancer (an R0 resection). She had completed adjuvant chemotherapy and I declared her to be in remission at that time—but it was short-lived; within four months, her disease had returned. Platinum resistance, we call it. We started a new regimen then—not for cure, I told her and her husband. The goal was control.

Thursday, June 15, 2017

When Cure Isn’t What It’s Supposed to Look Like

In oncology, we strive for cure and short of that, we strive for stability. In some instances, particularly with recurrent disease, cure is rare, and the process of curative treatment can be quite extreme (for example, bone marrow transplantation for recurrent lymphoma, with the real risk of graft versus host disease substantial and, in its most extreme, debilitating). But in solid tumor oncology (for the most part), we have been driven toward less-toxic treatments, less-complicated regimens, while continuing to strive for better survival.