Sentinel Lymph Node (SLN) Biopsy Decision Aid

The question of whether to undergo a SLN biopsy for melanoma is a difficult one.  It is clear that some experts recommend it while others don't.  Where does that leave a patient?  In England the National Institute for Clinical Excellence provides decision aids for many conditions. Here is a link to the SLN Decision Aid.  Please give it thought and discuss it with your dermatologist or surgeon.  The decision is really up to you.

The Problem With Miracle Cancer Cures

by Robert M. Wachter

April 22, 2018, NY Times

Robert Wachter is Professor and Chairmen of Department of Medicine at UCSF.  His book, “The Digital Doctor,” (2015) is a great trove of information presented in a palatable, non-geeky manner.

A new generation of cancer treatments have become available in recent years.  The medical literature now fairly gushes with terms like “revolutionary” and “cure.”  Oncologists are seeing patients whose cases they once would have pronounced hopeless experience Lazarus-like responses to these new therapies.

If these new treatments worked most of the time, this would be an unambiguously happy story. But they don’t. A recent analysis estimated that about 15 percent of patients with advanced cancer might benefit from immunotherapy — and it’s all but impossible to determine which patients will be the lucky ones.

What can we do to alleviate the hype?

·      First, it turns out that many patients can benefit from palliative approaches even as they continue aggressive treatment for their cancer.

·      Second, doctors need more training in how to have these hard conversations with patients in light of the new cancer treatments. Doctors will need to become more at ease with the prognostic ambiguity.

·      Finally, through the federal Cancer Moonshot program, the government is spending hundreds of millions of dollars to study immunotherapy and other emerging treatment options for cancer. The sooner we can work out which patients will — and just as important, won’t — benefit from these approaches, the better.

Let’s be sure that we don’t rob dying patients of a smaller, more subtle miracle: a death with dignity and grace, relatively free from pain and discomfort.

Throw Deep

The NFL Hall of Fame quarterback Ken Stabler was once being interviewed by Sports Illustrated when the journalist recited a quote from the author, Jack London that was near to London’s statue in Oakland:

“I would rather be ashes than dust!

I would rather that my spark should burn out in a brilliant blaze than it should be stifled by dry-rot.

I would rather be a superb meteor, every atom of me in magnificent glow, than a sleepy and permanent planet.

The function of man is to live, not to exist.

I shall not waste my days trying to prolong them.

I shall use my time.”

When sked what these words meant to him personally, Stabler replied with the gritty confidence of a veteran, “Throw deep.”