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March 19th, 2012
At the Blood & Cancer Clinic in Fayetteville NC, we have our “ups and downs”. When I say “we”, I include the patients, their spouses, children and significant others, and our staff – I mean all members of the staff. In order to celebrate our victories and learn from our setbacks, we have Support Groups. (We have no defeats!)
Our Support Groups are organized by Elizabeth. She is a friendly and happy person who helps with a variety of activities in the office. She has put together Support Groups for Multiple Myeloma and Breast Cancer. Both groups enjoy a good attendance on a monthly basis. Patients and family members rave about these groups. Given the success of these groups, Elizabeth has ventured into a Support Group for caregivers. She has hosted two meetings so far. Reviews have been excellent.
Today, I discussed the goings on at the meetings with Elizabeth. Since she sits through the whole meeting of the caregiver support group, I asked her to describe what she would tell a member of her family who might become the caregiver for a person with cancer. She writes “Everyone has different circumstances, but for the most part, it’s very relevant to any caregiver to discuss in detail all the steps of each process the patient has gone through, and how it affects both the patient and the caregiver”. Attendees describe the “end process” as a “Relief” as it “does end all the pain and suffering for your loved one”. In this support group meeting “we want you to laugh about the good times, cry about the sad, and have HOPE for the future”
The American Cancer Society has a booklet pertaining to death and dying. We will be sharing it with family members from now on. Families who have attended the meetings have found it helpful to prepare for death of a loved one.
It is not uncommon for people to wonder (loudly) if our work here is depressing. All the staff working here loves this work and takes pride in what it does. We are grateful for the opportunity to participate in the care of the sickest people. We celebrate the “Caregiver” as an important part of our team. We try to educate the Caregiver, so that collectively we can take better care of our sick family member.
BLESSED ARE THE CAREGIVERS
(Author ANONYMOUS)
Blessed are the caregivers who refuse to compare their responsibilities with others.
Blessed are the caregivers who have learned to laugh,
for it is their only chance for sanity.
Blessed are those caregivers who accept the disabilities of their charges,
letting each person develop at their own speed.
Blessed are the caregivers who can redirect negative behavior, without anger.
Blessed are the caregivers who involve their charges in the world around them,
for it develops the whole person.
Blessed are the caregivers who are teachable, for understanding brings love.
Blessed are the caregivers who love their task, for love is the greatest gift they give.
Blessed are the caregivers, for all the blessings they bestow upon their world.
Yes!!! BLESSED ARE THE CAREGIVERS!
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December 11th, 2009
The United States Preventive Services Task Force (USPSTF) reported its findings and new recommendations for breast cancer screening in the November 17th issue of Annals of Internal Medicine. It concluded that:
- Mammography screening reduces breast cancer mortality for women aged 39 to 69 years
- Data are insufficient for older women.
·False-positive mammography results and additional imaging are common
- No benefit has been shown for clinical breast examination or breast self-examination.
SOME STATS:
- In 2008, an estimated 182 460 cases of invasive and 67 770 cases of noninvasive breast cancer were diagnosed, and 40 480 women died of breast cancer.
- Incidence increases with age, and the probability of a woman developing breast cancer is 1 in 69 in her 40s, 1 in 38 in her 50s, and 1 in 27 in her 60s. Data suggest that incidence has stabilized in recent years
- Mortality has decreased since 1990 because of many factors, including screening
- In 2005, 68% of women aged 40 to 65 years had screening mammography within the previous 2 years in the United States.
FROM SCREENING TO DIAGNOSIS:
Breast cancer is known to have an asymptomatic phase that can be detected with mammography. Mammography screening is sensitive (77% to 95%), specific (94% to 97%), and acceptable to most women. If a woman has an abnormal mammographic finding on screening or a concerning finding on physical examination, additional imaging and biopsy may be recommended, including diagnostic mammography or mammography done with additional or special views, targeted breast ultrasonography, or breast MRI. Additional imaging may help classify the lesion as a benign or suspicious finding to determine the need for biopsy. Biopsy techniques vary in the level of invasiveness and amount of tissue acquired, which affects yield and patient experience.
FOCUS of the USPSTF:
Review of studies addressing the evidence gaps that were unresolved at the time of the 2002 USPSTF recommendation that include:
·Effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older;
·The effectiveness of Clinical (performed by a trained professional) Breast Exam (CBE)
·The effectiveness of Breast Self Exam (BSE) in decreasing breast cancer mortality among women of any age;
·Magnitude of harms of screening with mammography, CBE, and BSE.
MY TAKE OF THE RESULTS:
This report has tried to identify good studies from around the world and answer the questions posed above. The standards in various countries are significantly different that those in US. As a matter of fact, actual practice in various parts of this country varies significantly. To consider literature from Russia or China, though enlightening, is not appropriate for application in our country. Having read the report, there is insufficient evidence to change the current recommendations.There has been much speculation about how many women need to be screened to save one life in various age groups as well as this being related to the available finances available for healthcare. In my opinion, this article in the Annals of Internal Medicine is scientific and is not meant to value any one life as such or address the financial questions. There is going to be progress in our understanding of breast cancer and other disorders. We have empowered our government to assess this progress periodically. I expect future presentations about the progress will be done more responsiblyPersonally, I do not believe that this article is not going to change the coverage by insurance companies in this country. Therefore, I will end by listing the current guidelines.
CURRENT GUIDELINES FOR BREAST CANCER SCREENING (American Cancer Society):
- Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
- Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over.
- Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.
- Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.
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September 15th, 2007
The Blood and Cancer Clinic specializes in the diagnosis and treatment of Cancers and Diseases of the Blood. We seek to provide the community with An Enhanced Quality of Life by providing superior medical care in an Efficient and Compassionate manner.
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