Cancer and Oncology

Tag: family

  • Sexual Activity During Neutropenia and Immunosuppression: What Do You Tell Your Patient?

    JCO Oncology Practice: https://ascopubs.org/doi/10.1200/OP-25-00618

    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    • Counseling should be individualized and evidence-informed, not based on outdated blanket restrictions.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

    JCO Oncology Practice: https://ascopubs.org/doi/10.1200/OP-25-00618

    It is important to talk about:

    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.

  • Trust and Advocacy: The Doctor-Patient Relationship

    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.

    Everyday is a blessing. Thank God for it.

  • Arrogance and Humility

    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.

    Everyday is a new day. Learn something new daily.

    God is my guide.

  • The best Oncology app

    The best Oncology app in the world is ONCOAssist (my opinion).

    ONCOAssist

    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.

    https://apps.apple.com/ie/app/oncoassist/id558299114

    https://play.google.com/store/apps/details?id=com.oncoassist.core

    https://webapp.oncoassist.com/public/index.php/login

    Try it.

  • Cancer and Bucket Lists

    What is a bucket list?

    Defined as “a list of things a person wants to achieve or experience, as before reaching a certain age or dying”

    I see a fair number of patients in the clinic – public and private. Most people, rightly so, want to start treatment and get on with things as soon as possible. One of my jobs is to help people understand the various treatment options available and the rationale of each option. This includes talking about the risk versus benefit, the toxicity of treatment and the improvement in survival.

    All this sounds great on paper or when lecturing to students or junior doctors. In the real world, things can get very difficult.

    Some people want absolutely everything done to prolong life, even if it means that they are miserable for the entire time. Other people want nothing done with regard to our treatment, as they pursue alternative therapies. Yet others, can’t decide what they want.

    As the years go past, many of us learn the value of talking to people and understanding what they want. What are their wishes, their fears, their aims, their goals? What does the family want? What are the plans for vacations? Holidays? Time spent with loved one? Major events planned – weddings, waiting for a grandchild to be born, graduation ceremonies. The list goes on.

    I am slowly learning the importance of listening to people. It means a lot to them. And (now) me.

  • Christmas Time

    Christmas time is amazing. People try to be nicer. Families get together. Time for a break and reflection on life.

    It gets harder for people who have been diagnosed with cancer and are on treatment. I try my best to give people a break over this time, time to get away from the hospital setting, time to be with family and friends, time to recover from side effects of treatment, time to re-look at life.

    There are several people who are admitted to hospital and unfortunately cannot be discharged home for a variety of reasons. The idea is to give them a break for a few hours to have Christmas lunch at home.

    The saddest thing is when people are just diagnosed with cancer and need more investigations and reviews; and so many services or people are on leave. These patients and families are upset and frustrated. It does not really help them, when I explain that waiting for a few days will not make a huge difference in the bigger scheme of things. They want something done now. I can understand them.

    What about people who know that this is their last Christmas on earth? It is important to tell people to enjoy their time with families and loved ones, not just for the patient, but also for the loved ones who will cherish the memories.

    I continue to be amazed at the generosity of my patients – who will gift me and the team with cards, chocolates, gifts and so on. There are people who take the time to thank other members of the team (who are forgotten otherwise) – cleaners, support staff, pharmacy, reception staff, etc.

    I love this time of the year. It brings joy to most people. It also helps us understand that Jesus is the reason for the season.