Wendy Harpham on Healthy Survivorship

Choosing Wisely Campaign - Part II

In my last post, I introduced the Choosing Wisely™ campaign, an effort by clinicians to avoid overuse or inappropriate use of tests and therapies. Obviously, a successful campaign would save lots of money. But the campaign is motivated by a higher goal that reflects the mission of Healthy Survivorship.

Grief and Acceptance - Part VII

Since my last post, I've been wrestling with what I believe about the struggle between grief and acceptance.

Needing more time, today I'll share Part 4 of the series "Managing Uncertainty," a topic germane to this discussion and newly available online at Oncology Times.

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."

The New Me

During my first remission I began work on After Cancer, a book to help patients understand and respond in healthy ways to the medical, practical and emotional challenges of recovery and long-term survivorship. The subtitle was Your Guide Back to Normal.  

But as I struggled with my own aftereffects and then recurrences, I realized my original approach wasn't going to work well for me.

Revoking FDA Approval: Right or Wrong? - Part VIII

The case of the FDA revoking approval of Avastin for the treatment of breast cancer is complicated by the urgency of the need for better therapies. We’re not talking about treatments to decrease the sniffles of the common head cold. At issue is a drug to help patients who are suffering -- and dying -- from metastatic breast cancer.

Revoking FDA Approval: Right or Wrong? - Part VII

Let's tease apart some of the sticky-wicket issues of FDA approvals and revocations. For one, how does the FDA measure success?

Revoking FDA Approval: Right or Wrong - Part III

In my November 28th and December 3rd posts I introduced the media storm regarding the FDA's recent revocation of approval of Avastin for the treatment of breast cancer. Today I'll provide an overview of the FDA approval process to help us talk about the controversy.

Managing Uncertainty - Part II

Here at the 2011 Life Beyond Cancer Retreat in Austin, Texas, a recurring theme in workshops and during meals has been the challenge of living with a heightened sense of uncertainty.

Searching for Hope - Part II

In a provocative 242-word essay -- Interruptions --  that prompted my November 13th post, Lucy Stanovick fishes for information about how hopeful her oncologist feels regarding her recovery. Is her doctor trying to cure or contain her cancer? Or just to keep her comfortable?

Managing Uncertainty Part I

Many patients struggle with uncertainty about what's happening now, what will happen in the future, and what they should do. Having dealt with illness-related uncertainty on both sides of the stethoscope, I've developed an approach that has helped me deal with my heightened sense of uncertainty in healing ways.

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?

From Promise to Disaster

Patients are not Healthy Survivors if they believe the promises of charlatans. What about patients who receive treatment from of team of professionals at a major university in a clinical trial that turns out to be based on wrong information?

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.

The Waiting

In a NYTimes essay titled The Waiting, David Rakoff writes about the waiting patients are forced to endure.

Mantra for Healthy Survivors: "We'll See."

In yesterday's post, I shared a short story that has changed my life. Ever since I first read it, when unwanted change or loss seems to be ruining everything, I've thought, "We'll see."

A Parable for Healthy Survivors

A short story for Healthy Survivors:

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?

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."

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?

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.

(Genetic) Testing My Children

In a piece entitled"The Genes That Bind" (summer issue of CURE magazine), Journalist Charlotte Huff covers the emotionally charged topic of when and how to share information on genetic risk with children.

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.

Dealing with Post-radiation Risks

In yesterday's post, I shared how I learned about my increased risk of carotid artery disease due to my past radiation therapy. So how did I get from rattled to relaxed? My thoughts went something like this:

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?

10 Rules for Good Medicine

I've been following a provocative blog, Musings of a Distractable Mind, hosted by primary care physician Dr. Rob Lamberts. His recent post entitled "10 Rules for Good Medicine." offers food for thought about modern healthcare. Here is a sampling, with my commentary added:

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.

Lost in Translation

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

It Is What It Is

A trying time of survivorship is the interval between knowing you might have a problem and learning your exact diagnosis. Why? Because you can't reassure yourself you are okay - or are going to be okay - if doctors are ordering tests for the purpose of finding out if you are okay or are going to be okay.

Stronger or Weaker?

Pastor Carlos Wilton refers to a quote by Friedrich Nietsche, "That which does not kill us makes us stronger." Wilton, a survivor whose lymphoma is currently stable, says, "Those who have the audacity to believe in the resurrection can attach a little addendum to that saying: Even the thing that one day kills us will do the same."

Right or Wrong?

When something goes wrong, people often conclude somebody did something wrong. Or that everybody did everything right, but the original decision - the choice that led to the problem - was wrong. But these may be the wrong conclusions.

Patients and the healthcare team can do everything right, and things can still go wrong.

Empathy-o-meter for Healthy Survivors

Empathy is the ability to understand and vicariously experience the feelings of someone else. This skill is adaptive, helping you respond to another person's needs in healthy ways.

With the rise of support groups -- and now Internet chats and blogs -- patients sharing similar problems can easily seek out and find each other. And they do. So can a Healthy Survivor ever have too much empathy?