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By Elaine Schattner, MD, on November 3rd, 2011
 I began reading August Farewell on the seventh day of that summer month. The date coincides with the beginning of David Hallman’s narrative of his lover’s death two years prior, and memory of their decades-long relationship.
A book by a gay Canadian Christian man might seem remote to a woman like me, who’s married, Jewish and lives in New York City. But Hallman connects, effectively; his story sticks and might influence the near-death arrangements of any person living in our modern world.
Hallman recounts the death of a man, his partner William (Bill) Conklin, who’d lived for years with multiple sclerosis and its debilitating effects. In August, 2009 Conklin learned he had advanced pancreatic cancer. The story works through the author’s 16 daily notes on meetings with doctors, nurses and palliative care specialists, and visits with old friends and family.
The patient chose to die at home and his partner, Hallman, honored
See more August Farewell: A Short Tale of a Peaceful Ending of Life
By Elaine Schattner, MD, on August 18th, 2011
We’re up to point 9 on the list – and nearing the end — on Bending the Cost Curve in Cancer Care from the May 26 NEJM. The suggestion from Drs. Smith and Hillner is that doctors better integrate palliative care into usual oncology care.
The authors start this important section well:
We can reduce patients’ fears of abandonment by means of better-integrated palliative care. This topic is fraught with misunderstanding given the references to “death panels” during the recent debate concerning health care legislation…
Here they’re on target: Some patients think, mistakenly, that inclusion of palliative care in their treatment means their doctors are throwing in the towel. I’ve known some oncologists who think the same, who perceive palliative care as a last resort.
The truth is that palliative care, which aims to relieve symptoms, can be implemented at any point in the treatment of disease.
The authors go on
See more Reducing Costs by Better Integration of Palliative Care in Cancer Treatment
By Elaine Schattner, MD, on July 22nd, 2011
This is the sixth post on Bending the Cost Curve in Cancer Care, based on the 10 suggestions put forth by Drs. Smith and Hillner in the May 26 NEJM. We’re up to number 5 on the list for changing oncologists’ behavior: by limiting further chemotherapy to clinical trial drugs in patients who are not responding to three consecutive regimens.
They’re right.
Giving one drug or combination regimen, and then another, and another, and another, to cancer patients whose tumors resist multiple regimens is more likely to cause harm than good. Oncologists need be realistic with themselves and with their patients, in a kindly way, when treatments fail.
Options to consider, besides chemo, include palliation (which can be started at any time, including before and during chemotherapy), alternative approaches (such as hormonal or immune-based therapy, for some tumors), hospice care and participation in a clinical trial, as the authors suggest, based on the patient’s
See more Lowering Cancer Care Costs by Limiting Chemotherapy in Patients Who Aren’t Responding
By Elaine Schattner, MD, on June 29th, 2011
 Today’s Wednesday Web sighting is Pallimed, a blog about hospice and palliative care. It’s 6 years old and growing strong.
The site speaks to the need (and why not a demand?) for this kind of care, and for information about of this widely misunderstood medical field.
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Related Posts:Lowering Cancer Care Costs by Limiting Chemotherapy in Patients Who Aren’t RespondingWhat’s Next on the Big C? (Hopefully a Second Opinion)Looking Ahead: 7 Cancer Topics for the FutureHow Well Do You Really Want to Know the “Red Devil?”What Does it Mean if Primary Care Doctors Get the Answers Wrong About Screening Stats?
By Elaine Schattner, MD, on November 24th, 2010
When I practiced oncology, I relished time talking with patients and their loved ones about tough decisions – when an indolent condition accelerated and it seemed time to bite the bullet and start treatment, or when a cancer stopped responding to treatment and it seemed right to shift gears and, perhaps, emphasize palliation instead of more chemo, and at every value-loaded decision checkpoint in between.
These conversations weren’t easy; speaking of levels of care, palliation and end-of-life wishes are discussions that many doctors, even oncologists, still avoid.
See more Engage with Grace: Talking About the Hard Stuff
By Elaine Schattner M.D., on January 25th, 2010
It was sometime in April, 1988. I was putting a line in an old man with end-stage kidney disease, cancer (maybe), heart failure, bacteria in his blood and no consciousness. Prince was on the radio, loud, by his bedside. If you could call it that – the uncomfortable, curtained compartment didn’t seem like a good place for resting.
See more How to Avoid Death in the ICU
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