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Guidelines for Managing Fatigue in Cancer Survivors

Guidelines for Managing Fatigue in Cancer Survivors

With recent advances in cancer screening and treatment, the number of cancer survivors in the United States has increased substantially in recent years. The American Cancer Society estimates that there are about 13.7 million cancer survivors in the U.S., and this figure is expected to rise to nearly 18 million by 2022. Over the years, the Cancer Survivorship Committee of the American Society of Clinical Oncology (ASCO) has issued evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment. Recently, ASCO released a guideline for managing survivors who experience symptoms of fatigue after completing primary cancer treatment. The practice guideline pertains to cancer survivors diagnosed at age 18 or older who have completed treatment with curative intent and are in clinical remission without the need for therapy. It is also applicable to patients who are disease free and have transitioned to maintenance or prophylactic therapy. Examples of these patients include breast cancer survivors receiving hormonal therapy and people with chronic myelogenous leukemia receiving tyrosine kinase inhibitors. ASCO’s guidelines are intended to inform all members of patients’ healthcare team as well as patients, family members, and caregivers of cancer survivors. Fatigue Is a Common Problem “Many cancer survivors will experience some level of fatigue during their course of treatment,” explains Julienne E. Bower, PhD, who was co-chair of the ASCO writing group that developed the guidelines. “About 20% to 30% of cancer survivors deal with persistent fatigue for years after they’ve been treated for cancer. Fatigue is among the most common and distressing long-term effects of cancer treatment and...
Enhancing Care With Robotic Prostatectomy

Enhancing Care With Robotic Prostatectomy

During the last decade, the number of robot-assisted prostatectomies performed in the United States has risen steadily throughout the country. Several factors have led to more complex patients being offered surgery for organ-confined prostate cancer, including refined surgical techniques, a better understanding of anatomy, and more experience. Robot-assisted procedures help surgeons better visualize anatomy and control bleeding with the added benefit of increased dexterity. This has enabled surgeons to treat prostate cancers more effectively with fewer complications than was previously possible with traditional open surgery. Although rare, several studies have reported on complication rates associated with robot-assisted prostatectomy. However, few data exist when evaluating ureteral injuries that are sustained during these procedures. Further complicating matters is that there is no standardized universal criteria for reporting and grading of complications. “Identifying patient characteristics that may forewarn surgeons of such damage may further improve our ability to reduce complications,” says Jay K. Jhaveri, MD, MPH. Low Rates Observed In the Journal of Endourology, Dr. Jhaveri and colleagues had a study published that focused on 6,442 patients who underwent robotic prostatectomy by one of five surgeons over a 12-year period. Under the guidance of Mani Menon, MD, and James Peabody, MD, the study team found that three patients—operated on by two of the five surgeons—sustained complete transection of the ureter. One of the patients required readmission for further treatment. The study authors identified several risk factors that predisposed these patients to ureteral injury, including a history of: • Infection. • Abdominal surgery. • Radiation treatment. • Enlarged prostate glands. • Prior transurethral prostatic resection. Overall, the study group found a 0.046% rate...

What’s the Point of Medical Licensing?

A surgeon emailed me the following:. OK, I know this is radical but consider my argument… Medical licensing protects no one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I’m guessing not. When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? Its license is useless. Most people choose a surgeon based on recommendations and word-of-mouth reputation, and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work. If I was in private practice and had my license displayed on my wall, it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state. I contend again, that word of mouth and reputation are the best indicators of a surgeon’s ability, anything beyond that is useless. Caveat emptor, “let the buyer beware” remains the mantra of the informed consumer. Thanks for letting me vent....
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