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.
Desperate times help us to take desperate measures. When the medical teams tell people that there is nothing more which can be done for their cancer therapy… some people take on “the world”.
A great story:
# GitLab co-founder Sid Sijbrandij was diagnosed with osteosarcoma. All the standard therapies and clinical trials ran out. He decided to do things in his way. He started using AI platforms to study his tumour type and data. He collected teams for personalized experimental treatments, and open-sourced 25 TB of medical records. He has since then had really good cancer control (since 2025). You can read the story on https://sytse.com/cancer/
This takes time (and possibly lots of money), but is a start. As AI and software platforms get cheaper and more accessible, this trend will keep rising.
I can imagine people outsourcing their data to get help from across the world.
I recently watched a Netflix series called: “Diagnosis”. It is a collaboration between Dr Lisa Sanders and The New York Times. They try to help people with rare and undiagnosed illnesses. Their stories are outsourced online and people from across the world gives suggestions. https://www.netflix.com/title/80201543
Medicine is changing. Times are changing. People are no longer willing to just take “no more options” as answer. Exciting times (possibly).
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.
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.
