Bad Scans/Results - How to stay sane?
Started by RainerMaria
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"The patient is the one with the disease" - the Fat Man
In all seriousness, it's obviously a crappy part of our career. Many other fields deal with similar poor outcome situations, often times worse than we do in many ways. I try to find to comfort myself that I (and the patient) made the best calls we could with the information we had at the time. You didn't fail your patient, the R-CHOP (or FOLFOX, AC->T etc.) did.
In all seriousness, it's obviously a crappy part of our career. Many other fields deal with similar poor outcome situations, often times worse than we do in many ways. I try to find to comfort myself that I (and the patient) made the best calls we could with the information we had at the time. You didn't fail your patient, the R-CHOP (or FOLFOX, AC->T etc.) did.
Unless you're giving R-CHOP for colon cancer or FOLFOX for lung cancer, it's important to recognize that it's the disease and the treatment that's the issue, not you or the patient. Yes, it's frustrating when the tumor doesn't read the study that showed it was supposed to respond, but then again, not everyone responds. as @HemeOncHopeful19 states, you and the patient are doing the best you can in the situation you find yourselves.
I will also say that it generally gets easier as you go further in your career. Not that giving that information gets easier, more that you get a much larger denominator of patients who do well so the bad ones don't hit so hard.
That said, there are some that still hit hard. So far this week I've seen 2 people under age 45 who are s/p pelvic exent for locally advanced rectal cancer, One with positive margins and one with 0% response to neoadjuvant chemo, as well as an under 40 woman who was diagnosed with met breast the week after she stopped her adjuvant endocrine therapy after 8 years. So...some days/weeks just suck.
I will also say that it generally gets easier as you go further in your career. Not that giving that information gets easier, more that you get a much larger denominator of patients who do well so the bad ones don't hit so hard.
That said, there are some that still hit hard. So far this week I've seen 2 people under age 45 who are s/p pelvic exent for locally advanced rectal cancer, One with positive margins and one with 0% response to neoadjuvant chemo, as well as an under 40 woman who was diagnosed with met breast the week after she stopped her adjuvant endocrine therapy after 8 years. So...some days/weeks just suck.
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If they happen bunched up with each other I can see that being stressful. I set expectations with patients at the start and go over contingency plans for when things don't go as desired. That said I do think in some common diseases we have outlets now that the prior gen of Oncologists didn't. It's nice to be able to refer that R/R Multiple Myeloma patient for CAR-T cell therapy for instance. Just recently I'm using Tarlatamab which I have high hopes for platinum resistant SCLC. In fellowship our options were just bleh.
Less nice when you are the IECT center and they relapse after CAR-T
2 patients this month on hospice, their DLBCL promptly and summarily told the investigational CAR-T they received to f*** off.
