Thursday, October 23, 2008

Mag Citrate #3: JCO Edition - Cancer & Suicide, More

This is the Journal of Clinical Oncology iteration of Magnesium Citrate.  

There are 3 rearch papers on suicide in cancer patients - more or less defining the problem with contemporary data:  two on suicide rates (approximately double the general population) - hereand here, and one on suicidal thoughts (point prevalence about 8%).   If you were going to read one thing however I'd read the fantastic accompanying editorial which summarizes the papers and further defines the issues involved.

There are some personal reflections from someone who blogged about his wife's terminal illness which discusses the power of personal blogging, as well as some of the drawbacks.  

A large meta-analysis looking at trials comparing chemotherapy (any chemotherapy) with supportive-care alone for advanced non-small cell lung cancer confirms that it has a 1) real, and 2) modest survival benefits (median survival improves by 1.5 months to 6 months overall; 1 year survival increases from 20 to 29%).   The analysis does not look at QOL.  

A survey of academic pediatric oncology centers found that only about 60% of them had access to pediatric palliative care and hospice services.  

There's a trial of a collaborative case management program to treat depression in cancer patients.  This involved a structured care model including MSW therapists, psychiatrists, and care navigators and involved cancer outpatients with expected prognoses greater than 6 months.  It seemed to be pretty successful and is particularly notable for targeting a largely poor Hispanic population - a traditionally understudied population particularly with regard to supportive cancer services.

Finally, there's a really well written Art of Oncology piece discussing a poem about a 'miracle' cure for cancer.  The poem totally made my day insofar as it riffs on c-abl (the oncogene)  and Cain and Abel!  The discussion is about how different care can seem from the patient's and physician's perspective:

I believe that we begin to earn the gratitude of our patients for saving their lives by what we do before we prescribe any treatment. What is it that we do? We do what the doctor did in this poem. Compared with the new science, it is so ordinary that we lose sight of its importance. We take a careful history. We examine thoroughly. We think before making a diagnosis. Werecommend treatment. We take the time to talk, to explain, and to encourage. We put order into a chaotic situation. We define a way forward. We suggest to the patient that she is not alone. We will fight with her for her life. The threat becomes less imminent; the fear, less intense. Helplessness is reduced; hope is restored. A basis for gratitude is established.  It is hard work to do this. It is not hard work to take a history, perform an examination, make a diagnosis, or recommend treatment, but it is hard work to do it carefully and thoughtfully for each patient. It is hard work to respond to the threat felt by each patient. Making what we do personal for patients who fear for their lives takes skin off us. We sometimes fall short. Almost without realizing it, we focus on disease, treatment, and probabilities. We make it less personal. This poem reminds me of the importance of the most basic things that I do. So often what I do seems routine. Often, I just try to get through the day. This poem challenges me to keep it personal.

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