My travels over the past several days have taken me to a number of cities to participate in various meetings and speak before several groups on the topic of cancer care and cancer prevention.
Although the schedule has been a bit hectic, it has provided a number of opportunities to reflect on a variety of issues that are important to me personally and may be of interest to you as well.
This week I spoke at the annual meeting of the Oncology Nursing Society in Las Vegas (where there is still smoking on the casino floor, by the way. See my prior blogs for additional comments on this particular topic).
I gave a lecture at one of the sessions on the high costs of cancer drugs. I couldn’t avoid the opportunity to reflect with those in the audience on how far this profession has come over the past 35 years since I first began my training and practice in clinical oncology.
When I started my own practice in Baltimore in 1977, there was no such specific designation as an oncology nurse.
Certainly there were nurses who cared for cancer patients. But when it came to medical oncology in the community hospital, there was no cadre of specially trained nurses to draw from.
On the hospital side, I was able to find some nurses who were interested in caring for cancer patients and recruited them to staff the fledgling unit we established in the hospital. It took some effort to have my colleagues and others understand that the in-hospital administration of chemotherapy and the inpatient care of cancer patients in active treatment required special nursing expertise that was simply beyond the usual knowledge and practice of the typical RN.
The concept of cancer nursing care took hold, and the unit grew. The nurses took pride in their work, and were compassionate in their care. Other members of the support staff joined in, and when we made rounds we were joined by social workers, physical therapists, and dietitians among others. Even the housekeeping staff became part of the team.
Back then, that type of specialization was unique in oncology circles in community care. Now, it is standard and routine. Many of the wonderful nurses and others who are part of the cancer treatment team have no knowledge of what it was like when we started.
Much of cancer chemotherapy care is now provided in the office. Again, back in the mid-1970s, there were nurses who worked in the outpatient areas of major cancer centers. But there weren’t nurses trained to provide that same care in private oncology offices like mine.
So we started from scratch. First one and soon thereafter a second nurse and then a third nurse joined my practice as we ventured into unknown territory.
My patients and I will forever be indebted to those wonderful people who helped get my practice off the ground. We made an effort to establish an academic level outpatient practice, devoted to quality oncology care including participation in clinical trials through university affiliations. My nursing colleagues made it happen.
We learned a lot in those early days, including how to mix the drugs and care for the patients in a community setting.
A lot has changed in cancer care over the past 35 years. There are now thousands of oncology nurses, many of whom are certified.
What has not changed is the fact that these wonderful, devoted people are so committed and so caring for our patients.
As I mentioned at my presentation this past Tuesday, there isn’t a forum I participate in where the focus is on cancer care where the topic of cancer nursing and its value and importance to cancer patients isn’t discussed in the most glowing terms.
Doctors treat and doctors prescribe. Nurses care every day. Their patients know their value, and are grateful for their compassion. I am grateful to have had the opportunity to share my appreciation personally with those in the audience.
On another topic, last week I attended the annual meeting of the American College of Physicians in San Diego.
During that meeting, I attended a lecture on breast cancer diagnosis and prevention offered by a professor from a medical school in Chicago.
What interested me about this presentation was a quick poll of the physicians in the audience to see how many of them were aware of the Gail score and used the Gail score in the routine management of their female patients.
The Gail score, you may recall, is one of several measures that provides information to a woman about her potential risk of developing breast cancer over the next five years and her lifetime.
It takes into account a number of factors, including age, family history of breast cancer, personal history of breast biopsy, and other considerations. It is the foundation of making a recommendation to a woman that she is or is not a candidate for possible preventive treatment for breast cancer with tamoxifen or raloxifene. These treatments have the potential of reducing the incidence of breast cancer by 50% in women who have a 5 year risk of 1.66% or greater.
The reality is that, despite the enthusiasm of many experts in the cancer community, this is a treatment recommendation that has not gone far in the general medical community or among women at risk.
The experts keep saying that the reason for the underwhelming acceptance of this prevention option is that women and their doctors fear the side effects of the drugs.
That may well be the case, but I don’t completely agree. In my personal opinion, the issue is more fundamental.
The sad reality is that primary care doctors (including gynecologists) simply don’t know much about assessing breast cancer risk and the options available to reduce that risk. They simply don’t incorporate this knowledge and recommendation as part of their routine care processes.
If we are ever going to make progress in this area, we are going to have to rethink how we educate women and their physicians about breast cancer risk, and what options are available to reduce that risk when it is elevated.
Getting back to the lecture, in response to the quick poll on whether doctors knew their own Gail score and determined it for their patients, few hands went up. Most of the attendees in this lecture were primary care internists and the response supported my own impression (which doesn’t necessarily mean I am correct).
How we address this issue is important, especially since the experts tell us that millions of women are candidates for medical treatment that can significantly reduce the numbers of breast cancers diagnosed in this country every year.
(By the way, there is now a controversy going on in the medical community regarding the funding for the next clinical trial on reducing breast cancer risk which would compare the benefits of aromatase inhibitors to raloxifene. A major national cooperative clinical trial group designed the trial and received multiple approvals, only to have funding turned down by the National Cancer Institute at the last minute. That matter is now receiving intense scrutiny, but the final decision has not been made.)
Wednesday found me in Secaucus, NJ spending some time with my Cancer Society colleagues from our Eastern Division which covers New York and New Jersey.
What struck me about this meeting is that there are some pretty special folks who work for the American Cancer Society and help us to achieve our mission nationwide and internationally.
I have the privilege of working in our national home office in Atlanta. The group I met with Wednesday represent the people who are actually responsible “on the ground” for dealing with communities, constituents, businesses and others in their particular area of responsibility. They are the ones who “make it happen” for patients who need services in their communities. They are the people who have helped make Relay for Life such a success.
Their level of caring and commitment to their clients and their communities is what makes the Cancer Society mean so much to so many.
I feel blessed and privileged to work for an organization which is filled with people who share that commitment. Many of my colleagues get little recognition for what they do every day.
Throughout this Society, there are people who look at their daily efforts as much more than a job to pay the bills. There is a level of commitment to a cause that is palpable, and this commitment influences everything they do.
I suspect there are many people who read this blog who have been touched in some way by their efforts and also appreciate on a very personal level what it means to know there are people who care to help, and help to care.
A final thought as I sit in another meeting in Chicago is how to travel well and stay within some reasonable healthy limits when it comes to taking care of yourself “on the road”.
I suspect I am not alone in having problems with traveling for business and fitting in some personal time for eating properly, exercising, and just basically taking care of yourself. The demands of business travel are substantial, and I find too frequently that it is difficult to stick to my own standards while I travel.
I find myself now packing various protein bars, liquid concoctions of different types, and even the latest addition: packaged tuna fish all intended to try to keep my personal eating habits on track.
At least I am trying to avoid the bad stuff, but I can tell you I am not always successful. The temptation of the breakfast buffet is overwhelming. The excitement of eating properly at the dinner buffet is a rare moment of meeting the challenge.
Traveling through the airport in search of something healthy to eat is frequently a futile exercise. They sure don’t make it easy.
To provide an example of how little it takes to make me happy these days, I was thrilled to find a nice chef salad—with all the right stuff and not too much of the bad stuff—at a pizza outlet, of all places.
It is difficult enough to take care of yourself, your diet, your exercise and your basic health when you are in your own home. Avoiding the sauces, the fries, and the extras they put on your food when your travel is a test of commitment, to say the least.
So to those of you who share my concerns and try to do the right things for yourself while you are moving about the country and perhaps the world, my sympathy and understanding. And, my kudos and congratulations if you are successful in keeping your commitments.
It is certainly an uphill battle.
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