Diagnosis = Cancer (How Does It Feel?)



Best Friends, Victor-Gabriel Gilbert.

Recently, an old pal was diagnosed to have cancer in the course of routine screening.  It soon developed that, in his panic, my every word was allowed to supersede his usually uber- methodical decision process.  This may have had more to do with friendship and trust rather than my profession as he has loudly ribbed me about being a "relentless drug pusher" in the past. Whatever, it made me antsy that he wouldn't even entertain referrals to other oncologists.  Suboptimal!  In my mind, I may have defensively screened myself off for more than just a bit in order to buy some objectivity, so much so that, in hindsight, I'd become stern.

For while the best approach may be clear as day, just how in the heck patients summon the will to stay the course is beyond me.  In the case of friends, I prefer the job of pure emotional support of that will.  In fact, its the only job I should be doing in that situation, if I'm to reach for the old "Eureka!", i.e., the elegant clarity of rational management in a complex case.  

One can so easily become overburdened by this business when the distance that a clinic desk affords is breached. 

As usual, my friend taught me a few things, and the experience highlighted some truisms in clinical practice.

• Fostering acceptance of a dire diagnosis is a major job. 
• Primary physicians should be congratulated for all their patients who actually walked into an oncologist's clinic.
• I should pat myself in my back for all the times that I was entrusted with a stranger's care.  Why I accepted it as a routine aspect of the job before now is incomprehensible.
• Patients simply don't go for a tough fix until they've overcome their initial shock.  "Me, cancer!?"
• Success at making objective assessments does not imply that the patient has overcome his subjective assessment of you.
• Your recommendations, no matter how sound, become suspect when your foibles are hilariously familiar.
• In the absence of family, peer "sharing" by cancer survivors should not be expected to take up the entire slack.
• "Sharing" among cancer patients can lead to either "acceptance" or uncontrollable fears.Support groups should have clear guidelines on how to approach individual patients.  Big sign on each forehead: Caution– vulnerable!   
• For all our sakes, I should avoid my doctor-friends when I need personal medical advice.

Local Costs of Anti-Cancer Drugs

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• …Welcome to the ____ Family! We invite you to visit us at www.____.com and find our great medicine prices. We provide serious and first class service to all our customers 24/7. If we don’t carry a medicine you need just let us know and we will be more than glad to assist you! To show you our gratitude for past purchases and to offer you one more reason to continue purchasing with ____.com We are offering a limited time 30% discount include on all our medicines. We will keep on giving you the best price and service in the market. Welcome and enjoy your visit to www.____.com

I found this in my mailbox, along with similar North American offers for drug purchase over the Net. Its interesting to note that the list price of many drugs is significantly less in the Philippines even when 30% discounts apply overseas. We're also spared the additional costs of airmail and taxes. 

Third world pricing– what a huge mercy! Somebody Up There must feel pity about the absence of government subsidies because the costs of the newer drugs indicated for systemic cancer treatment seem to be miraculous hereabouts. In many instances, we can even afford to ignore the small differences between "original" and "copy".

As for the mindboggling biologics… patients who sourced or once contemplated importing cetuximab from the US gasped when the product was finally entered into the local market. With their subsequent savings, they could afford a US trip each month had they wished it.  Et tu, Neulasta?

 

Previous Comments

Dear Sir,

How much is Cetuximab in the Phils?
How effective is it for those who have the metastatic colorectal cancer?

Posted by carlo at January 12, 2008, 5:13 pm

Sorry for the late reply.
Cetuximab is expensive relative to other therapies for metastatic colorectal cancer. That fact holds true for the entire Planet Earth. Its use as a single agent or in combination with chemotherapy is supported by solid evidence for specific colorectal cancer disease settings but… yes, in those settings it affords benefit in terms of response & survival time. It is not curative.

Posted by oncodoc at February 18, 2008, 11:05 am