Wendy Harpham on Healthy Survivorship

Letting Go Part IV

We're talking about what it means to "let go." Because if patients run out of treatment options or they are nearing death, "letting go" plays a major role in Healthy Survivorship. So here's another definition:

Letting Go Part III

For cancer patients who run out of treatment options, how can "letting go" help in the pursuit of Healthy Survivorship? How can it hurt?

Altered Immune Cells Beat Leukemia

Yesterday's NYTimes article about the 11th-hour rescue of a dying 6-year-old girl with an investigational treatment created a lot of buzz. Here are a few reflections on the story that might be useful to Healthy Survivors.

How We Die: Love and Dementia

Writers choose words and phrases with care. In all my years of writing, only once or twice have I repeated a sentence word-for-word in a single essay. So when surgeon Nuland did so in How We Die, I took notice.

How We Die: Discriminate Specialization

In my last post I share my discomfort with a passage from How We Die. Reading on, however, Nuland offers a useful insight about a risk of increasing specialization:

How We Die: The Problem With Specialists

Most pages of my copy of Nuland's How We Die sport underlinings and check marks. On page 72, though, I drew a big question mark in the margin beside a paragraph that preceded another that earned a "great insight!"

How Long Do I Have?

Few questions evoke physicians' discomfort like “Doctor, how much time do I have?”

In oncology it's a common question that comes with the territory, forcing clinicians and patients to grapple with issues of trust, hope, uncertainty, disappointment, and grief....

How We Die: Natural Law

Dr. Nuland opens Chapter 2 of How We Die saying, "No one dies of old age, or so it would be legislated if actuaries ruled the world."  Later in the chapter he introduces a perspective on aging that can serve Healthy Survivors well.

How We Die: Naturally Bad Responses

In Chapter 2 of How We Die, Dr. Nuland illustrates how sometimes the body's natural response to injury or illness is maladaptive, a notion critical to a Healthy Survivor's understanding of treatment.

What a Difference a Letter Can Make

When young parents are dying, they face the loss of everything they know and hold dear. Arguably their greatest pain is losing the chance to raise their child(ren). To help such parents find hope in desperate times, I offer a suggestion:

Decreasing The Risk of Delirium

A study designed to determine risks associated with hospitalization and delirium in patients with Alzheimer's Disease (AD) contains important lessons for Healthy Survivors.

To Survive with Cancer

James C. Salwitz, MD doesn't use the term Healthy Survivor. Still, the story he tells offers a name and face to the idea that patients in difficult circumstances can find Happiness in a Storm.

Grief and Acceptance - Part IX (Time)

A reader commented on my last post, eloquently sharing his hard-won insights about grief. In doing so, he highlighted an important element of grief: time.

Grief and Acceptance - Part IV (PEACE tool)

The preceding post discussed grief experienced in the setting of bereavement. Let's return our focus to grief and acceptance at the end of life.

Grief and Acceptance - Part III (Prolonged Grief Disorder)

A blogger commented on part I of this series, "One friend, after five years of grief and going to therapy is still grieving, and it is hard for me to deal with what to say to her." Is this normal?

Grief and Acceptance - Part II (Realistic Goals)

Yesterday's post linked to an editorial by two well-credentialed psychiatrists with special interest in end-of-life care. Their studies led them to consider grief as "the state of emotional unrest and frustration associated with wanting what one cannot have."

Hope or Letting Go - Part IV

Perhaps most troubling to me of  Hope or Letting Go, was Dr. Youn's question about whether the patient and his wife should be given a chance to say good-bye. 

Hope or Letting Go - Part II

In my last post, Hope or Letting Go, I shared the story of a physician, Dr. Youn, still troubled by an incident that happened ten years ago. Since reading it, I've been bothered by some of the questions he posed.

For example, Dr. Youn asked if concern for the needs of the patient's loved ones ever take precedence over the patients' needs?

Derek Miller's Posthumous Post

Like Randy Pausch of The-Last-Lecture fame, Derek Miller loved his life and was ready to die. Only 41 years old, Miller prepared his last blog post to be published after he died of stage IV colorectal cancer, leaving behind a beloved wife, two precious daughters and extended family and friends.

Disenfranchised Grief

What is disenfranchised grief?

105-Year-Old Healthy Survivor

Esther Mauzy can teach us all a thing or two about how to become a Healthy Survivor.

Abigail's Alliance

On my recent post about clinical trials, commenter Steve Walker wrote, "The Phase III trial is being run primarily to satisfy the rigid, formulaic and in many cases scientifically obsolete requirements imposed by the FDA's Office of Oncology Drug Products for most cancer drugs...." 

Is the randomized clinical/controlled trial (RCT) obsolete?

The Problem with Accelerated FDA Approval

In Phase I trials researchers test an experimental treatment in a few patients for the first time. The purpose is NOT to see if the treatment kills cancer cells, but only to:

• evaluate the drug's safety
• determine a safe dosage range
• identify side effects

What if the patients in a Phase I trial experience shrinkage of their tumors? Should this speed up FDA approval of the trial drug?

Anguished Debate on Witholding Rx for the Control Arm

My last post introduced a dilemma regarding modern clinical trials: Is it ethical to randomize some patients to the "control arm" of a trial where they will NOT receive the trial drug?

According a NYTimes article, one particular trial of a therapy (called PLX4032) for malignant melanoma "ignited an anguished debate among oncologists about whether a controlled trial that measures a drug's impact on extending life is still the best method for evaluating hundreds of genetically targeted cancer drugs being developed."

Witholding Rx in Clinical Trials

Sunday's NYTimes ran an article tackling a complex ethical dilemma in cancer care: The witholding of treatment in clinical trials. Because I was treated in 3 clinical trials in the 1990s, the topic is close to my heart.

Vacation From Late Stage Cancer

When a parent has late-stage cancer with limited life expectancy, everyone wants to rewrite the expected ending. The doctors and nurses, the parent with cancer, the family's loved ones and especially the children want to make it "all better."

The Jack and Jill Late Stage Cancer Foundation

If fairy godmothers existed, cancer survivors with late-stage disease who are rearing children might ask: "Fairy Godmother, can you give my family a vacation from my illness? Please?"

Now some parents can.

Baby, Do You Remember?

When my three children were young, every night I put them to bed one at a time. We'd talk for a few minutes before beginning our ritual interactive songs, tucking-in, kisses, "Nighty night" and lights out.

One evening as I began the routine with my youngest, he said something that practically stopped my heart: "Mom, do you remember when...."

When Losing a Loved One Leaves a Hole

After losing a loved one, you might feel that you've been left with a huge hole in your life. The "hole" houses your sadness, loneliness and emptiness along with other painful thoughts and feelings.

Naturally, many people try to get rid of the hole, say, by trying to fill in the hole or trying to run away from the hole. Not me.

Cancer Survivorship Research: Recovery and Beyond

What a three days I've had here at the 2010 Biennial Conference. While packing my suitcase for the return home, I'm thinking about all I've heard.

Last Acts

"Imagine you know you have only a few months to live. What would you do with your remaining time?"

Letting Go

Illness and injury have a nasty habit of causing losses. Can such loss be good?

Letting Go

A prolific blogger on survivorship has decided to pull back from her popular blog. She still has cancer. So why now?

Rob Pardi Responds

My April 6th and April 11th posts focused on a  NYTimes story about Dr. Desiree Pardi, a palliative care physician who refused palliative care when dying.

Today let's look at her husband's view of the article. Robert Pardi's comments were posted on Pallimed to enrich -- or shall I say, to straighten out -- the discussion about his wife's decision. Although he doesn't use the term, he's telling us his wife was a Healthy Survivor. 

Palliative Care

In my April 6th post I discuss the case of Dr. Pardi, a palliative care physician who chose to continue aggressive cancer therapy when she was dying. Letters to the editor about the article don't mention what I consider to be a key point.

Palliative Care Doctor Refuses Palliative Care

A NYTimes story of Dr. Pardi's dying illustrates that it is difficult to project what you will think or feel when faced with a grim prognosis.

A Good "Bye" Before Hospice

Why would oncologists (or any physicians) not say "good-bye" when they know this is the last office visit for a patient before being transferred to hospice care?

Abandoned to Hospice?

Denise commented on yesterday's post "I would feel badly if my oncologist referred me to hospice, he said goodbye, and I had no further contact with him..." Is it unrealistic to expect oncologists to stay involved with patients who are now in hospice?

Hospice and Healing Hopes

How can compassionate physicians suggest hospice without causing the patient to lose all hope?

Stopping Treatment with Hope

Commenting on a recent post, "Talking About Death,"Judy, an experienced hospice nurse, shares two illustrative experiences with end-of-life care -- one good, one awful.

A question came up: "What should an oncologist do if the patient and family insist on more treatment so the patient won't lose hope?"

Talking About Death

Discussions about end-of-life can benefit patients and their families in dramatic ways. Unfortunately, the emotional discomforts for both physicians and patients often serve as insurmountable obstacles to initiating these important discussions. 

A study at the Dana-Farber Cancer Institute and reported in JAMA may help.

Jane Brody Walks the Walk

Jane Brody, the NY Times Personal Health columnist, has been guiding Americans on matters of health since 1965. On occasion she offers readers a glimpse into her personal life, such as the time she described the uncontrolled pain she suffered following her knee replacements. 

This week, Jane Brody shares a deeply personal life event in real time: the dying of her husband of 43 years.

Facing End-of-LifeTalks, Doctors Choose to Wait

In last week's Science section of the NYTimes, Denise Grady reported on a recent study in which most of the doctors who responded to a survery indicated they would wait until their terminally ill patients felt worse or were out of options before talking about end-of-life care, such as hospice.

I was moved to write a letter to the editor (p.D4 or click here) when I read one of the possible reasons cited: fear that patients will lose hope or that physicians will “yank away” hope by talking about end-of-life wishes.

Facing Facts, At Least Briefly

Right or Wrong? extols the benefits of good communication between doctors and patients. But what if a patient makes the request, "Doctor, if a time comes that I'm dying, please don't tell me I'm dying." 

It seems a reasonable request, if knowing "would only increase my anxiety and make it impossible for me to hope for future better days," as described in the post's comments by Bint Alshamsa.