Cancer diagnosis GPs view of diagnosis and treatment
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Transcript of Cancer diagnosis GPs view of diagnosis and treatment
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Cancer diagnosis
GPs view of diagnosis and treatment
Bruce ArrollDept of General Practice and Primary
Health care School of Population Health
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Disclaimer• Asked to talk about experience• Some in audience may have had worse health
experiences• AML is rare and there may be some interest in
the treatment aspects
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Diagnosis• Pharyngeal pain 1 month• Difficulty in swallowing• Practice meeting in public holidays• Partners think they can see something and so
can I • Email ENT classmate offers to check • Referred to public system –CT scan normal
apart from lump on tongue
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Two biopsies• GA for biopsy• Preop/post op very friendly to everyone
– no special doctor treatment • ENT surgeon going overseas so phone call to
say possible lymphoma• 10 minutes later at Uni farewell and colleague
asks how biopsy went : decide on everyone knowing or no-one knowing
• Tell people –the word is out so pass it on
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Diagnosis• Needed bone marrow biopsy – painful • Needed lumbar puncture not painful
– Colleague advised me to enjoy the pain and not resist
• Registrar says I have acute myeloid leukemia on my tongue but not in the bone marrow- no other cases in the literature
• Gap to getting treatment knowledge – hematologists have a conference
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Toxic uncertainty• Will I be dead in a week or live to 90• Appreciation of what patients go thru• Relief to know that will only get chemotherapy
and not radiotherapy (teeth issues)• Although bone marrow clear will get ¾ rounds
of chemotherapy• Inspired by a patient who wanted
chemotherapy for her bowel cancer• Adopted a “bring on the chemotherapy”
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Getting the hardware• Insertion of a Groshong line in to chest. Goes
in to the superior vena cava • Done by radiology in small operating room• Some fentanyl and meditation and enjoy the
pain • Sits in chest indefinitely
– Two ports– Can infuse chemotherapy – Can take blood– Can give blood
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Removing the hardware• Klebsiella infection on Groshong• Removal like pulling a weed from the garden
– Not painful just alarming
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Single room or 4 patient room• Given choice most would take single room • For cyclical treatment advantage of 4 patient
room – Education – company
• For cyclical treatment advantage of 4 patient room
• First impression– We are all up the same creek –instant camaraderie
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Starting chemotherapy • Daunorubicin (red) and cytarabine• Nurses (? Informal meeting) decide to treat me
a normal patient rather than a doctor• Suited me as I was pretty clueless about what
was happening• Except when inserting IV lines later saying
doing this to a doctor made them nervous• Told I would need blood and platelet
tranfusions and get infections• Wont happen to me!!!!!- 10 of both
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Chemotherapy • Red chemo causes red urine• Blue chemo causes blue urine• No vomiting –most amazing
– Ondansetron • Historically patients would vomit the whole
time• Took anti-nauseants happily as too afraid of
nausea
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Aim of chemotherapy • “Wipe out” the bone marrow• Kept alive with transfusions and antibiotics• When bone marrow restarts they “wipe it out”
again
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First infection • A few days after completing first treatment
admitted with ‘infection” and neutropenia
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Infection versus septicemia• Admitted for infection
– Main risk is own flora not that of others• Colleagues “ingrown toenail versus
septicaemia” • Neutropenia and fever• Don’t usually grow bacteria• Klebsiella called bacteremia• Mortality for treatment 5%
– For BA 1%
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Platelets• What level safe to go to gym• 50 ???!!!• BA would consider rapid referral of someone
with platelets of 50. Can do eye surgery at about 80
• 4th standard deviation world
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Allergic reaction• 4th cephalosporin and gentamicin• Maculo papular rash on trunk –non itchy• Decided later to try gentamicin • I was amazed that they still use it
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Other effects
• Hair loss • Most people bald on ward
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Cancer out patients • Got to like going there –contrast to ward I was
not sick • “major stress” – 3hrly temperatures• “Forced retirement” – social contact
– More understanding of patients
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Sign that is was over • Next slide
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Next event
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