TY  - CHAP
M1  - Book, Section
TI  - Sticking by My Patients, No Matter What
A1  - Glitza Oliva, Isabella C.
A1  - Epner, Daniel E.
A2  - Epner, Daniel E.
PY  - 2022
T2  - Empathy: Real Stories to Inspire and Enlighten Busy Clinicians
AB  - I  AM  A  medical  oncologist  who  cares  exclusively  for  patients  with  advanced  melanoma,  most  of  whom  have  brain  metastases  or  leptomeningeal  disease  (LMD).  I  always  start  conversations  with  patients  during  our  first  meeting  by  asking  them  what  they  understand  about  their  illness.  By  doing  so,  I  get  a  sense  of  what  they  know,  and  where  I  have  to  spend  more  time  explaining.  I  have  found  that  one  of  the  best  things  about  Internet  search  engines  is  that  they  empower  my  patients  to  learn  about  their  cancer,  but  at  the  same  time,  these  same  Internet  search  engines  can  offer  a  lot  of  misinformation  and  false  hopes.  For  example,  one  of  my  patients  recently  replied,  “Oh  my  god,  I  searched  LMD  on  Google,  and  it  was  so  bad,  I  turned  the  computer  off  immediately  without  reading  further.”  However,  this  allowed  me  to  pick  up  where  the  patient  stopped  reading,  and  to  provide  more  understanding  of  their  disease.  Treatment  for  patients  with  metastatic  melanoma  and  othermalignancies  has  changed  dramatically  over  the  last  decade,  as  we  now  have  effective  options,  including  targeted  therapies  and  immunotherapy.  These  new  agents  yield  responses  that  we  could  only  dream  of  a  few  years  ago  while  being  fairly  well  tolerated.  Now,  many  patients  with  metastatic  melanoma  live  many  months  or  even  years,  and  we  oncologists  have  all  seen  patients  who  were  incredibly  sick  but  rose  like  a  phoenix  when  treated  with  these  new  agents.  However,  I  work  in  a  large  referral  center,  so  most  of  my  patients  come  to  see  me  for  a  second  opinion  after  having  already  received  all  those  novel  therapies.  These  patients  are  definitely  more  challenging  since  I  often  cannot  offer  further  treatment,  which  can  be  heartbreaking.  For  my  patients  with  LMD,  life  expectancy  is  typically  weeks  to  months,  and  one  of  my  jobs  is  to  develop  novel  treatments  for  patients  with  this  cancer  complication.  As  a  result,  I  constantly  face  heart-wrenching  conversations  with  my  patients  about  whether  to  offer  treatment  for  LMD  or  whether  to  forego  treatment  and  pursue  a  purely  palliative  approach.  
SN  - 
PB  - McGraw Hill LLC
CY  - New York, NY
Y2  - 2024/04/19
UR  - hemonc.mhmedical.com/content.aspx?aid=1190085803
ER  -