Archive for Healthcare and Ethics
I must say I found the following article in USA Today ( 4/1/09, by Liz Szabo) , bonechilling. A British study confirms what I’ve said many times: that when it comes to performing minimally-invasive radical prostatectomy or laparoscopy (which includes robotically assisted surgery, *although that was not the subject of this study*), NO amount of experience on the part of the surgeon is enough.
And there is another very important point being made which I have NOT heard before: That “open” surgeons (those who perform the traditional radical retropubic prostatectomy) who later switch to laparascopic surgery produce (much) worse results than doctors who initially specialize in this area.
Here are some excerpts from the USA Today article (more comments at end):
“Prostate cancer patients whose surgeons have anything less than the highest degree of experience with a popular new procedure may be at greater risk of relapse, according to a study in The Lancet Oncology April 1 edition.
<snip> “While it takes at least 250 surgeries for a doctor to become proficient at the traditional surgery — allowing patients to feel confident that doctors removed all of the cancerous tissue — surgeons need to do at least 750 keyhole procedures to become proficient. Doctors who are used to performing traditional surgery actually have a harder time learning keyhole techniques than novice surgeons who are learning to perform the procedure for the first time, the study shows.
“That suggests that doctors shouldn’t try to switch back and forth between techniques, but instead focus on perfecting their skills on just one type of prostate removal and patients who opt for keyhole surgery should go to cancer centers where doctors specialize in the procedure, authors say.”
The take-home message for men who have decided on laparascopic prostatectomy but do not live near a top-rated urologic oncology facility (“Center of Excellence) is that they should consider traveling to one or finding a “high-volume” surgeon in private practice. (For some guidance about top hospitals, look at usnews.com, “Rankings”, keyword “Cancer”, not Urology”. Also, at castleconnolly.com, “America’s Top Doctors for Cancer”.) A lot of people are unaware that there are charities which make arrangements for patients and their families to stay close to the hospital for the duration of treatment. I know because I was on the receiving end of such a favor. Ask the hospital social worker or chaplain about this.
My fellow blogger, Kathy Meade, alerted me to the following. It’s about time we developed holistic approaches to treating cancer patients!
“University of Edinburgh researchers have reported success with an interdisciplinary intervention for treating major depressive disorder in people living with cancer. The intervention is delivered by specially trained oncology nurses, is designed to work alongside a patient’s usual cancer care, and emphasizes screening for depression, antidepressant medication, and teaching patients problem-solving skills. Results from a randomized clinical trial of the program, called’Depression Care for People with Cancer’, were reported in the July 5 issue of Lancet. (2008;372:40-48).”
To read the entire article, go to: