Wendy Harpham on Healthy Survivorship

New Nutrition and Activity Guidelines for Survivors

Up-to-date, science-driven guidelines on nutrition and exercise after cancer were published in the April 12th issue of Ca - A Journal for Clinicians, a publication of The American Cancer Society. Although addressed to healthcare professionals, the material is accessible to patients (free, online) and includes a section written specifically for lay readers.

Grief and Acceptance - Part V (Promoting Acceptance)

The preceding four posts on grief and acceptance set the stage for a closer look at how patients can be Healthy Survivors at the end-of-life. In other words, how can you both get good care and live as fully as possible after a diagnosis of terminal disease?

Revoking FDA Approval: Conclusion

The FDA revokes approval of Avastin for breast cancer. What's a survivor to do?

Your Medical Mind

My recent posts have discussed some of the difficulties of modern medical decision-making in the context of PSA testing for prostate cancer. A new book by Harvard oncologist Jerome Groopman and Harvard endocrinologist Pamela Hartzband offers help to Healthy Survivors: Your Medical Mind: How to Decide What is Right for You.

Does PSA Testing Save Lives or Not? - Part II

Yesterday's post highlighted the controversy about screening healthy men for prostate cancer using the PSA test. The media does the public a disservice by claiming such testing does not save lives. It does. The issue is: at what price?

My Bad?

My August 6th post shares a report on a new technology for breast cancer screening. I confess: I did not check out the story.

Free CURE

One of the purposes for this blog is to bring attention to high-quality resources to help educate and empower Healthy Survivors.Today I'm shining the spotlight on CURE. Not only is this a superb magazine for cancer survivors and their caregivers, it is also free.

2011 Cancer Resource Guide

Cure in association with the American Cancer Society has published a superb booklet for people with cancer: the 2011 edition of their Cancer Resource Guide.

Healing After A Doctor Visit Gone Awry

Although I didn't have a magic answer for the patient in my last post who emailed me about her doctor visit gone awry, I was able to offer her some thoughts about moving forward as a Healthy Survivor.

Warning Strangers

Walking down the jetway, I hear a woman's voice behind me, "Umm, excuse me. May I ask if you work in the sun?"

The man behind me answers, "Huh? I work inside, but I play outdoor sports."

With a micro-chuckle of embarrassment, the woman says, "Gosh, I hope you don't think I'm crazy or overstepping my bounds, but were you aware of the black spot on your earlobe?

Free Toolbox

We are not born knowing how to become Healthy Survivors. We aren't taught in school how to get good care and live as fully as possible when living with, through and beyond cancer or other serious illness. I wish we were.

Stigma of Illness (Part III)

My last post offered tips for recognizing stigma. My key message was that Healthy Survivors have a right to choose whether or not they advocate to destigmatize the disease that has become part of their life.

Today I'll tackle the challenge of dealing with this stigma.

Tolerating Treatment

Your doctor dictates into your chart, "The patient is tolerating treatment well." Huh? After every treatment you feel nauseated, lightheaded, weak, headachy and, in a word, miserable. What does your doctor mean by "tolerating treatment well"?

Healthy Responses in The Gray Zone

When symptoms or signs are not dramatic, patients often find it stressful to decide whether or not to call the doctor or go straight to the emergency room. As a patient, I found it more stressful when a new problem put me in what I call "the gray zone" than when a sign or symptom was clearly a serious problem demanding immediate attention.

What's a Healthy Survivor to do?

The 5 Rs to Healthy Survivorship

For smokers, snubbing out their last-ever cigarette is a key element of "getting good care" in their pursuit of Healthy Survivorship. But smokers often feel miserable while quitting, enough that most relapse.

When a Healthy Survivor Feels Like Quitting

My 1/14/11 post refers to a post -- Why We Quit -- by a Buddhist physician who believes we quit when we can no longer avoid paying attention to the idea of quitting. He recommends building resilience by "trying again, no matter what the reason you failed before."

The Weed of Cancerous Tumors

When it comes to understanding cancer relapse, what is the significance of a cancer stem cell? According to a recent article by oncologist Siddhartha Mukherjee, maybe everything.

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?

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.

The Treatment Option You May Be Missing

As a scientist, I credit clinical trials with advancing our understanding of cancer and ability to treat it effectively. As a patient, I credit clinical trials with playing an essential role in my survival. 

From both perspectives it troubles me greatly that only ~3% of adult cancer patients participate in clinical trials.

Open Notes and Compassionate Care

For me, the crux of the problem is this: Do open notes conflict with the ideal of compassionate care? 

Open Notes: "Our" Chart

My recent posts set the stage for asking: Does the opportunity for patients to read their medical charts help or hurt patients' ability to become Healthy Survivors?

The OpenNotes Project - Why Do We Need It?

In my August 9th post, I introduced you to the OpenNotes project. If you are wondering why we need the study, here is a two-word answer: informational technology.

The OpenNotes Project - Introduction

Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?

For the next few posts, we'll explore the OpenNotes project in the context of Healthy Survivorship.

Costs and Benefits of Counseling

In Razing and Rising, I mention that Healthy Survivors "seek guidance and support." What if you've never needed professional counseling before?

HON

Patients wanting to learn about their illness used to search high and low for a few drops of patient-centered information. The dilemma for modern patients has become how to sort through the flood of information available on the Internet.

HON certification can help.

Mesotheli-what?

A friend from my early survivorship days -- another physician and lymphoma survivor -- is dealing with a new problem: mesothelioma. Mesotheli-what?

A friend from my early survivorship days -- another physician and lymphoma survivor -- is dealing with a new problem: mesothelioma. Mesotheli-what?

Mesothelioma

The post entitled "Mesothelioma" was under construction. The final post was published as "Mesothelio-what?"

Caveat Emptor re: Genetic Testing

Great progress has been made in linking disease to mutations in certain genes. So why the sudden brouhaha at the FDA about companies selling gene-testing kits directly to consumers?

Emotions After Cancer

When I was first diagnosed, my medical background made me more prepared than most for the physical and emotional challenges of cancer treatment. What blindsided me were the medical and emotional issues that arose after completion of treatment.

A Problem with the Electronic Health Record (EHR)

In the newsletter of the Texas Chapter of the American College of Physicians, Dr. Steve Urban shares an important concern about Electronic Health Records (EHR).

Not Waiting for Answers

How can Healthy Survivors get good care -- the first criterion of Healthy Survivorship -- if the data needed to make sound choices in their particular situation is not yet available?

Doing My Best Post-Radiation

Recent posts (June 22, 23, 25 and July 4) have dealt with the risk of carotid artery disease following irradiation of the neck for cancer. I made suggestions without explaining the back story that led to my conclusions. Let's look at how I came to my conclusions.

Late Effect of Radiation - Qualified

We need to revisit a prior post, so I can qualify what I said. On my June 22nd post, I mentioned the high incidence of changes in the carotid arteries in patients who received radiation years earlier. But I didn't provide any details.

Reacting to Post-radiation Risks

How did I go from rattled to relaxed in a matter of hours after learning about my risk of carotid disease due to radiation therapy I received 18 years ago? First, by putting the piece of information in perspective, as outlined in my last post. Second, by making a plan of action.

Late Effect of Radiation

Many of my friends and family assume that the further away I get from the mini-mantle irradiation I received in 1992, the more I can relax about my developing any complications of that treatment. Not so.

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.

"Right" or "Best"

Healthy Survivors make the best decisions, not the right ones. They take the best steps, not the right steps.  Right? Best? Is there any difference?

A Work in Progress

When I was a child, I thought people over 40 years of age were very old. I believed they were done growing up and knew everything one needs to know. Wrong.

Now over 50 years old, I often say, "I'm a work in progress." 

Letting Go

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

White Coat Hypertension

White coat hypertension (white coat syndrome) is when patients' blood pressure (BP) readings are high in clinical settings and normal in other settings.

Patient 2.0

Patients obtain medical information not only from their healthcare team but also from the Internet. Time Magazine's Bonnie Rochman discusses one potential benefit of this phenomenon in a fascinating article entitled, "When Patients Share Medical Data Online."

Valuing PCPs

What does it mean to "value" the time and expertise of primary care clinicians (PCPs)?

Update on Radiation-based Medical Scans

On January 26th I blogged about the risk of patients being accidentally injured by overdoses of therapeutic radiation therapy. I brought it up for many reasons, one of which was to lead into a post of mantras for dealing with bad news. Another was to point out that "bad" news can lead to good news.

Healthy Survivorship 101

Problems can arise when people have lengthy and passionate discussions without realizing they are talking about two (or more) different things. So to keep us all on the same page, periodically I will provide a refresher post about the basic tenets of Healthy Survivorship.

What are we talking about when we say "Healthy Survivor" or "Healthy Survivorship"?

Lost in Translation

Let's stop and think about one of the great challenges of being a physician: translating.

Too Upsetting

Healthy Survivors use language that helps them get good care and live as fully as possible. In the case of challenges, it is usually better to say "very" instead of "too." For example, "This newspaper article is too very upsetting."

What if a topic really is "too" upsetting? What's a Healthy Survivor to do? 

Mantras for Upsetting News

Yesterday's post introduced a front-page NYTimes story about the risks of receiving the wrong amount of radiation when undergoing treatment for cancer.

A Lifesaving Tool Turned Deadly

In Sunday's NY Times cover story, "Radiation Offers Powerful New Cures, and Ways to Do Harm," Walt Bogdanich reports on the risk of patients being accidentally injured by overdoses of therapeutic radiation. Computer glitches and inadequate oversight lead to mistakes that cause patients serious harm, including death. How are you supposed to respond to such news reports in the context of Healthy Survivorship?