Doctor, please……GetPersonal with me!
So how would I like to change healthcare? Part 3 of 3
Doctor, please……GetPersonal with me!
Author: Lynch Syndrome Ireland
So how would I like to change healthcare? Part 2 of 3
- Every patient should be given easily understandable information about all aspects of their diagnosis
- Every patient should be told about all their options for treatment and care
- A patient should take responsibility for their lives and their diagnosis and work with the doctor
- Patients should not have to fight to get correct treatment
So how would I like to change healthcare? Part 1 of 3
I would like to see a dedicated organisation, with patients involved, looking at excellence in treatment
- This would not be an ever changing government looking at their own interests or survival.
- I would like to see centres of excellence, not general hospitals telling you, ‘There is no chance’
- I would like to see patients as the focus of their treatment, NOT their symptoms!
Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG) -2019
Lynch syndrome (LS)
- We recommend that for all people when first diagnosed with CRC, testing using immunohistochemistry (IHC) for MMR proteins or microsatellite instability is used to identify tumours with deficient DNA MMR, and to guide further sequential testing for LS. (GRADE of evidence: moderate; Strength of recommendation: strong)
- We recommend that colonoscopic surveillance should be performed at a 2 yearly interval for all LS patients. (GRADE of evidence: moderate; Strength of recommendation: strong)
- We recommend that age of onset of surveillance colonoscopy should be stratified according to the LS-associated gene. We recommend colonoscopy from age 25 years for MLH1 and MSH2 mutation carriers and 35 years for MSH6 and PMS2mutation carriers. There are insufficient data to support stratifying age of onset of surveillance by gender. (GRADE of evidence: moderate; Strength of recommendation: strong)
- We suggest that for LS patients with MLH1 or MSH2 mutations who develop colon cancer or colonic neoplasia not amenable to endoscopic control, the decision to perform segmental versus total/near total colectomy should balance the risks of metachronous cancer, the functional consequences of surgery, the patient’s age and patient’s wishes. (GRADE of evidence: Moderate; Strength of recommendation: strong)
- We recommend that for LS patients with MSH6 or PMS2 mutations there is insufficient evidence for oncological benefit of extended colectomy over segmental resection. (GRADE of evidence: low; Strength of recommendation: strong)
- We suggest that when abdominal-perineal excision can be avoided, a standard low anterior resection is a reasonable option to treat rectal cancers in LS patients, even though the residual colon is at high-risk of metachronous neoplasia. (GRADE of evidence: low; Strength of recommendation: weak)
- We recommend that gastric, small bowel, or pancreatic surveillance in LS patients is only performed in the context of a clinical trial. (GRADE of evidence: low; Strength of recommendation: strong)
- We recommend screening for H elicobacter pylori in patients with LS and subsequent eradication therapy if indicated. (GRADE of evidence: low; Strength of recommendation: strong)
Did Cancer Make You More Grateful?
One of my biggest cancer pet peeves is the one about cancer turning you into a new and improved version of your former self. Somehow cancer makes you a better person.
I don’t agree with that premise and have written about it in more depth here.
SURVIVOR GUILT
Survivor guilt is common in Cancer Land.
Sometimes, you wonder why you’re still here when so many others, often with similar initial diagnoses to yours, are not. Adding guilt into the crapshoot is unhelpful and unnecessary. Nonetheless, add it in we do.
Flushing Your PICC Line at Home
Results of phase I-II bridging study for Nous-209, a neoantigen cancer immunotherapy, in combination with pembrolizumab as first line treatment in patients with advanced dMMR/MSI-h colorectal cancer.
https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.16_suppl.e14665
Conclusions: The combination of Nous-209 and pembrolizumab is safe, well tolerated and shows encouraging clinical efficacy in patients with treatment-naive dMMR/MSI-H mCRC eligible for anti-PD-1 therapy.
The study is ongoing and expanding to Phase II randomisation with a new accelerated Nous-209 vaccination schedule.
Aging After Oophorectomy
“In navigating the effects of accelerated aging post-oophorectomy, HRT can be an essential tool for those who have not achieved menopause. While it can alleviate various symptoms and health risks, it is crucial to discuss its potential benefits and drawbacks with a healthcare provider.”
Improving Doctor, Patient, and Caregiver Communication
There is a great deal to be gained by improving communication between patients, family caregivers, and healthcare professionals — especially physicians. Better care for patients, less stress for caregivers, more efficient use of doctors’ time, and improved satisfaction for all concerned can be achieved when caregivers and patients communicate effectively with their care team.
Doctors at MSK are learning how to talk to patients, caregivers, and peers through their Communication Skills Research & Training (COMSKIL) program.
In this webchat, MSK experts will discuss how patients and caregivers benefit from this training, as well as how you can use communication techniques, research, and information from the program when talking to your doctors and loved ones.
