Shanel B. Bhagwandin, DO, MPH
As a surgical oncology fellow, I have had the privilege and the opportunity to treat patients afflicted with malignancies of different etiologies, mostly within the abdominal cavity. Variety is one of the primary reasons I was attracted to my specialty: On any given day, we perform a liver or pancreatic resection or an extremity sarcoma excision or deliver heated chemotherapy into the abdomen for advanced peritoneal malignancies.
The truth is, we don’t have the answer yet. There isn’t a magic pill, vaccination, or preventive treatment to get ahead of every type of cancer. The approach we most commonly advocate is behavior modification and screening modalities that detect cancer earlier, such as regular mammography or colonoscopy screenings. Often there are some tumors that present at such an advanced stage that surgery is no longer an option. It is difficult to present that reality to a patient who may very well still feel healthy, and knowing that disease progression is inevitable can quickly transition that conversation to focus on quality of life.
Starting the Process: I’m Sorry We’re Meeting Under These Circumstances
When patients are referred to a surgical oncologist, there has been very little opportunity for them to accept a recent cancer diagnosis. The denial, the rationalization of blame, compounded by any attempt to explain to their loved ones what may be going on, is only about to become even more complicated. I firmly believe it’s important to take a step back, recognize there is a person in front of you, and address any obvious misconceptions before proceeding.
A reassuring interview tone versus one of judgment is a formidable foundation for trust in patient–physician communication. Being able to professionally address barriers to health literacy or delays in care is an important quality of any patient advocate. During my first few months of fellowship, I was dumbfounded by how long patient symptoms persisted without intervention, how physicianled work-ups spiraled, and how patients were inappropriately treated. It didn’t take long for me to reflect on my training in public health to quickly recognize that the disparities among my patients were also a reflection of the inadequate referral patterns and poor follow-up in our healthcare system.
You Can’t See It All: Decisions for Surgery Are Complicated in Oncology
Following any cancer diagnosis, patients understandably seek consultation and sometimes second or third opinions to see if they can undergo surgery to remove their cancer. A subtle distinction between surgical oncologists and other surgical specialties is our underlying training in oncology that marries the technical feasibility with an understanding of the biology of the disease.
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