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Alcohol Abuse Among Physicians: Taking Control

Alcohol Abuse Among Physicians: Taking Control

Physicians, like many adults in the general public, enjoy drinking an alcoholic beverage in a socially-appropriate context when they are not taking call. But what happens when casual drinking becomes a problem? Nine out of 10 doctors recognize when they’ve reached their alcohol limit and stop drinking. However, an estimated 10% of doctors allow alcohol to adversely affect their overall well-being, health, and medical practices (1). The National Institute of Health (NIH) suggests a man—younger than 65 years of age—not have more than 14 drinks a week, and a woman—who is not pregnant or attempting to become pregnant—not exceed more than seven drinks per week (2). If you or a colleague drink more than that, an unhealthy drinking habit may be emerging. Rigorously honest self-evaluation or peer-reporting is the next necessary step to avoid developing more serious issues of alcoholism. Reporting Harmful Behaviors Benefits the Medical Community The American Medical Association (AMA) Code of Ethics, considered the most widely accepted ethics guide for physicians, requires all doctors to promote personal health and wellness and to promptly inform relevant authorities of an impaired or incompetent colleague (3). Yet, one in three (36%) physicians surveyed in a recent national poll said they’ve had firsthand knowledge of a physician struggling with drug and/or alcohol misuse and yet did nothing. Some of the reasons these surveyed doctors gave for ignoring harmful behaviors included: “someone else would take care of the problem,” “nothing would happen as a result of the report,” “fear of retribution,” and feelings of being ill-prepared to deal with an unstable colleague (4). If we are to continue safeguarding patients’ care...
Breast-Conserving Surgery for Invasive Breast Cancer

Breast-Conserving Surgery for Invasive Breast Cancer

Despite recent improvements in imaging technology, pathology assessments, and the use of systemic therapy, there is still controversy regarding the optimal margin width in breast-conserving surgery. About 25% of patients with invasive breast cancer return to the operating room after undergoing lumpectomy to obtain more widely clear margins. In about half of these cases, the margin is free of cancer cells, defined as no ink on tumor. However, it has long been believed that a larger amount of normal breast tissue might reduce the risk of local recurrence. Recommendations for Breast-Conserving Surgery In 2014, the Society of Surgical Oncology (SSO) and the American Society of Radiation Oncology (ASTRO) released recommendations for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer. “A definitive guideline can help minimize the use of unnecessary surgery while maintaining the excellent outcomes that have been achieved with lumpectomy and radiation therapy,” explains Monica M. Morrow, MD, FACS, who co-chaired the consensus panel that developed the recommendations. To develop the SSO-ASTRO guidelines, leaders in surgical, radiation, and medical oncology as well as pathology and patient advocacy considered a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR). The panel conducted a systematic review of 33 studies that included 28,162 patients as the primary evidence base. The panel recommended against the routine removal of larger amounts of healthy breast tissue beyond having no cancerous cells touching the edge of lumpectomy specimens. This recommendation was made regardless of patient age as well as for women with the more aggressive, triple-negative cancer types. “The standard definition of negative margins should be having no ink...
The Economic Burden of Cancer Survivors

The Economic Burden of Cancer Survivors

According to recent estimates, about 13.7 million people in the United States with a history of cancer were still living in 2012. “The prevalence of cancer survivors has increased substantially over time,” says Gery P. Guy Jr., PhD, MPH. “Even more cancer survivors are expected as advances are made in treatment and early detection and as life expectancy continues to increase.” As the number of cancer survivors grows, it is important to understand how medical expenditures and lost productivity affect these individuals. This includes exploring the role of employment disability, hours worked, and missed work days. In the past, studies of medical expenditures used cancer registry data, administrative claims, and other sources to describe the economic burden of patients who have survived cancer. However, analyses of expenditures on a national level tend to only include cancer survivors who are receiving cancer-related healthcare. Few studies have assessed multiple components of the economic burden of cancer survivorship, and most of these were conducted in a single state. “To gain a better perspective on this issue,” says Dr. Guy, “we need to quantify medical expenditures and the indirect morbidity cost of lost productivity among adult cancer survivors of all ages on a national level.” To address this need, Dr. Guy and colleagues conducted a study using the 2008 to 2010 Medical Expenditure Panel Survey to compare the economic burden of adult cancer survivors with individuals who did not have a history of cancer. The study, published in the Journal of Clinical Oncology, looked at the lost productivity that is associated with employment disability, missed work days, and lost household productivity. Considerable Costs...
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