But Doc, What Is My Prognosis?

L. Michael Glode, MD, FACP, FASCO

Jul 02, 2019

{Many of us have been on the receiving end - or a lack thereof - of a prognosis. Most of us feel that "I don't have a crystal ball" is not helpful information. This commentary provides some insight and reflections. IMO, the (currently only) reply (by Denzler) provides an excellent example of the art of sharing what a practitioner knows about treatment and prognosis in an environment of uncertainty.}

https://connection.asco.org/blogs/doc-what-my-prognosis

HHS Inspector General Finds Serious Flaws In 20% Of U.S. Hospice Programs

There's no easy way for consumers to distinguish the good hospices from the bad. Two new government studies are the government's first to look at hospice deficiencies nationwide. The Office of the Inspector General in the Department of Health and Human Services found that from 2012 through 2016, health inspectors cited 87% of hospices for deficiencies. And 20% of hospices had lapses serious enough to endanger patients. The Centers for Medicare & Medicaid Services (CMS), doesn't make information on hospices previously cited for deficiencies available on Hospice Compare, its website for consumers, even though the agency has the authority to post at least some of that data.

https://www.npr.org/sections/health-shots/2019/07/09/739471717/hospice-oig-reports

How Long Is This Going to Take?

{In this memoir-esque piece, an oncologist reflects on his multi-year odyssey with a quirky stage 4 cancer patient.}

"There are times when I wished I might capture Leroy's spirit in a bottle to be passed around so that I and others might take a healthy swig of it from time to time.... {It} helps encourage us to "keep on keepin' on" at what we do."

https://ascopubs.org/doi/full/10.1200/JCO.19.01102

marijen I believe that chemo is reasonably effective at killing them systemically; radiation kills them locally; and aromatase inhibitors cut off their food supply if they are hormone driven. But there is still no good test for them.... especially if they are "hiding" somewhere in the body. Perhaps research on CTC (circulating tumor cells) will eventually allow an assessment of whether they are present in the sampled blood specimen....and, therefore, likely to be lurking elsewhere....

{Note: Upon rereading, I note that the article says "At present, there are no drugs that can kill cancer stem cells, but people are looking for them" so maybe chemo's systemic effect is limited to less potent cells that have broken off and are circulating. Still lots to figure out about this disease process.}

Why Elephants Rarely Get Cancer

They have multiple copies of a gene that causes mutated cells to commit suicide.

"I've always been so enamored with elephants -- one of the things that's just amazing to me is that elephants have such an incredibly low rate of cancer. And it doesn't make any sense that elephants have a low rate of cancer, because they're so big and their cells are dividing so fast,"

"Their cells are dividing so quickly that just by chance alone they should just have really high rates of mutation and cancer. But they have a gene -- they have many copies of this gene, as a matter of fact -- that causes their cells to commit suicide if they mutate. It could not have evolved to be that large if it did not also evolve to have that gene,"

Researchers at the University of Utah are now working with human cells to see whether the elephant's cancer-fighting technique could lead to new medical treatments.

https://www.insidescience.org/video/why-elephants-rarely-get-cancer

https://uofuhealth.utah.edu/huntsman/labs/schiffman/

More Attention Needed on Misdiagnosis, Experts Say

Study finds many cases fall into three disease categories

More money should be spent on researching ways to reduce misdiagnosis and to get patients diagnosed more quickly, several experts said here. "For too long, the problem of inaccurate and delayed diagnosis was not given the attention it deserved," Paul Epner, MEd, CEO and co-founder of the Society to Improve Diagnosis in Medicine (SIDM)... {A} study, published in Diagnosis, looked at nearly 12,000 diagnostic error malpractice cases and found that the "Big Three" disease categories -- vascular events, infections, and cancers -- accounted for 74.1% of high-severity cases, with the top five diseases in each category accounting for 47.1%. Roughly half of the cases involved primary care clinicians; the rest were divided between medical specialties like cardiology, gastroenterology, and neurology (16.3%), surgical specialties (15.4%), and diagnostic services like radiology and pathology (14.8%). Having physicians learn from their mistakes is important to improving diagnoses, Burstin said. "All of us can immediately think of a patient they saw where there is clearly an issue ... Some of it is that we don't know what the ultimate diagnosis was," she said. "Feeding that information back to clinicians is such a powerful learning tool ... Those opportunities [are needed] for better systems, better understanding, and outcome tracking." Several of the panelists told their own misdiagnosis stories. {Some are recounted in the article.} "Looking back, I just wish someone had listened to me..."

https://www.medpagetoday.com/publichealthpolicy/publichealth/81001?xid=nl_mpt_DHE_2019-07-13&eun=g1278169d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-07-13&utm_term=NL_Daily_DHE_Active

https://www.degruyter.com/view/j/dx.ahead-of-print/dx-2019-0019/dx-2019-0019.xml

DOI: https://doi.org/10.1515/dx-2019-0019