Great collection of guides for various anti-cancer medications during radiotherapy by Dr Nina Niu Sanford @NiuSanford on X.com
There is an ongoing debate about which chemotherapy drugs can be continued or held during radiotherapy. How long do you hold it for? What the safety profile, etc? Dr Sanford has created four slides which cover the majority of medications.
Great article published in The Breast journal (April 2026) – “Association between alcohol consumption and breast cancer incidence and prognosis: A systematic review and meta-analysis”
The highlights are:
The study included over 2.5 million women
Any alcohol consumption +17% higher breast cancer risk
Light alcohol consumption +13% risk
Intermediate alcohol consumption +28% risk
Heavy alcohol consumption +52% risk
History of alcohol consumption is not associated with worse prognosis
The link seems to be stronger for hormone receptor–positive breast cancer, supporting the role of estrogen-driven mechanisms.
The possible reasons for increased risk with alcohol:
DNA damage (acetaldehyde)
Oxidative stress
Increased Oestrogen levels
Impaired DNA repair
Alcohol and breast cancer incidence seem to be linked. The risk rises as alcohol intake increases.
This topic is not discussed enough in the clinic. Most of us are not sure about the answers. Also the topic is awkward. A Journal of Oncology Practice article (2016) published a survey of cancer survivors. It found that 46% reported sexual health problems related to the diagnosis and treatment of cancer. Additionally, 71% said they had received no care for sexual dysfunction. There is a significant gap in knowledge and resources in this area.
This is a good article giving simple guidelines.
The gist of the article is:
Sexual health remains important for quality of life during cancer treatment
Evidence for strict sexual restrictions in neutropenia is limited
Stable monogamous partners: condoms not routinely required if partner healthy
Avoid anal sex/fecal exposure, new partners, or sex during severe mucositis
Gentle hygiene is sufficient; over-washing may harm mucosa
Condoms may be used briefly after chemotherapy to protect partners from drug exposure
Counseling should be individualized and evidence-informed, not based on outdated blanket restrictions.
Table: Sexual Health Guidance During Neutropenia and Immunosuppression
Fertility and contraception: Use reliable barrier methods or other contraception. Discuss fertility preservation early.
Emotions: Several patients notice changes in desire, body image, or function (dryness, erectile issues, pain).
Partner perspective: The healthy partner should be reassured that risk to them is low with basic precautions.
Intimacy is still possible and often beneficial. It is important to review the person’s situation and give clear and practical guidance for the patient and their partner.
One of the big privileges of being a doctor is that people trust you and tell you things which are very personal to them. They trust you with information which is not shared with others. It is very humbling and also scary at times.
Some of the most awkward times is when patients tell me things about their family members or close friends. Issues with money, altering a will, trust, so on and so forth.
The primary idea being to stand up for your patient and advocate for them. I have found that the best person who know the patient is their GP. It gets harder when the patient does not have a long term GP or keeps changing their GP.
Social workers are a great resource, but harder to find in the real world setting. The majority of social workers have “been-there-done-that” and seen it all, so speak from a standpoint of pure experience. That is hard to get.
I had an older patient who has been on treatment for a while. The patient comes independently and we have great chats. The patient was accompanied by their child on one of the visits. The child insisted that my patient was getting dementia and was forgetting things. The patient later broke down and told me that money was disappearing from their bank account. The patient is convinced that the child is responsible for it. Such a difficult situation for the family.
It is really hard to truly heal the situation. Even if the money issues are sorted, the trust is destroyed.
As I grow older and gain experience… the more I realise how little I know and more importantly – how little I control.
My sense of knowing things gets better over time. I am learning to say “no” more often to people, who I know that giving chemotherapy would be possibly detrimental. I am learning the difference between treating someone and actually giving people hope. I am learning that asking other people for help is vital.
Nurses who spend more time with the patient and their families give me phenomenal insights into patients. So many patients tell nurses the actual truth about their life circumstances, social supports (or lack of them) and more.
The Pastoral care person or social work gain immense knowledge about patients and their home situations.
It is available for various software platforms and tries to be as comprehensive as possible (including a web interface).
I use OncoAssist for staging cancer staging, decide the grade of toxicity, calculating chemotherapy doses, assess the status of my Geriatric patients and so on.
I strongly recommend it to my registrars and colleagues.
The standard of care for patients with cancer is to discuss their case with peers and peers of associated specialities. Medical Oncology, Radiation Oncology, Surgery, Pathology, Radiology, Nuclear Medicine, etc. Each of them are vital parts of the multi-disciplinary team.
We meet weekly to discuss and finalize the management plan for each patient.
One of the things which changed due to the Covid pandemic was the ability to adapt to video conferencing. Now, nearly all our meetings are hybrid with Face-to-face meeting along with Microsoft Teams or Zoom inputs.
It was an interesting challenge to convince people to use Teams and Zoom, but it has become the default now. The huge advantage being the ability to engage with people from across the city, state or beyond.
Most of us now have Teams or Zoom on our phones, ipads and laptops – working from offices and cars.
English and Medicine are not always the most complimentary areas.
Patients are told by their doctors that:
The disease has progressed – patients are happy, progress is a good word – but doctors mean that the disease has worsened
The lymph nodes are positive – patients are happy, positive is a good word – but doctors mean that the cancer has spread beyond the primary organ
HER2 is positive – patients are happy, positive is a good word – but doctors mean that the cancer is more aggressive
KRAS is positive – patients are happy, but negative KRAS is better
EGFR is mutant – patients are sad, but mutant is better
It is important to explain the terminology to the patient and their support members. Most times during the first consultation, after the patient hears that the cancer diagnosis is confirmed, they shut down internally. They do not hear most things after that.
I have spoken to several thousands of people over the years. Cancer continues to be one of the most feared illnesses known to us as humans. Cancer affects millions of people across the world.
What is Cancer? Cancer occurs when cells grow in an uncontrolled manner and do not die when they should. These abnormal cells can form tumours and spread to other parts of the body. These can occur due of genetics, lifestyle, or environmental exposure. It is vital to know that most times – we have no idea why the cancer occured. While cancer can affect almost any part of the body, early detection and proper care can greatly improve outcomes.
What is Oncology? Oncology is the medical field that studies cancer. It focuses on cancer prevention, diagnosis, and treatment. Doctors who treat cancer are called oncologists, who use different treatments such as surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.
Why this blog? I am starting this blog to help people understand more about cancer. My goal is to explain cancer and oncology in simple terms, raise awareness, and help people feel informed.
