Matthew Katz, MD
As medical director of radiation oncology at Lowell General Hospital in Massachusetts, Matthew Katz, MD, is well attuned to trends in breast cancer treatment.
He and his colleagues have adopted the practice of using shorter radiation courses—for example, treating lumpectomy patients when appropriate with a slightly higher dose for 3 to 4 weeks rather than a standard dose for 5 to 6 weeks. They have patients with left-sided breast cancers use deep inspiration breath hold to inflate the lungs, moving the heart momentarily to reduce its radiation exposure. And they’re interested in identifying older women who can avoid post surgical radiation that is unlikely to lengthen their lives.
But the area that most distinguishes Katz may be his interest in understanding the subtle nuances of doctor-patient communication that contribute to patients’ decision making and their experiences of treatment. That has led him to focus on supportive conversations in his practice and to venture into the wilderness of online social media to learn more about how patients view their treatment.
Katz said he’s tried to apply what he has learned to moments that are particularly stressful, such as routine scans after treatment has ended that can produce “scanxiety” about recurrence.
“It's just trying to be better at listening and reinforcing women's feelings, and trying to elicit them when they're discussing some of the stresses,” he said. “People need us to be there not just to fix things, but to be there for support. ‘Doctor' means teacher in Latin. So if we're not able to listen and interact well and educate our patients, I don't think we're doing our job.”
Katz said the opportunity to have more direct patient contact contributed to his decision to go into community practice in 2004. After his training he worked at Massachusetts General Hospital in Boston for a year and then joined Radiation Oncology Associates, a 17-doctor practice that provides services at Lowell General and other hospitals in New Hampshire and Massachusetts. He has also taught at Harvard and University of Massachusetts medical schools.
At Lowell General, Katz treats the gamut of cancers and works with multidisciplinary teams focusing on breast, genitourinary, and head and neck cancers. Massachusetts has a relatively large elderly population and its cancer rates are significantly higher than the national figures, though overall mortality is lower.
Breast cancer rates are particularly high in New England. Connecticut has 137 cases a year per 100,000 women, with Massachusetts at 136, New Hampshire 134, Rhode Island 130, and Vermont 129.1
The national rate is 123.
Considering the range of treatment options available to cancer patients and the crucial role they themselves play in deciding which course to follow, Katz has long been interested in understanding how patients understand their disease and treatment, and in helping educate them so they can make informed choices. As part of that effort he created and posted online a detailed 83-slide guide to breast cancer and radiation therapy to help patients make decisions.2
At the same time, he noted that providing clear information does not always result in a patient going with what a doctor considers the medically advisable choice. For example, many older women choose to undergo radiation after a lumpectomy in order to prevent recurrence of their cancer, even though studies show it will provide little survival benefit. Katz compared that choice with the decision to have a prophylactic mastectomy.
“It may not improve their physical health, but their mental health may improve,” he said. “It's a controversial area, but you always have to look at whether patients are making health decisions with the necessary evidence in front of them to make that choice.”
To get a better sense of how non-experts talk about cancer, Katz started communicating with the general public about the disease. In 2006 he began answering questions about oncology on Yahoo! Answers, a site that allows anyone to ask about anything, and anyone to answer.
“I was able to get a better idea of how people speak in plain language, and get a sense for the way I would say things that are medically important without it going over people's heads,” Katz said.
He moved for a time to Digg, a news-sharing site, but since 2010 has been active on Twitter, where he uses the nickname @subatomicdoc and posts a steady stream of article links and comments related to oncology, medicine in general, and other topics that pique his interest.
Twitter is a largely unstructured site where useful information can be difficult to find, especially for new users. About 3 years ago cancer survivors and advocates began organizing their discussions using hashtags like #BCSM, for breast cancer social media, and Katz joined in, providing information and answering questions.