PEN Blog Archives

Patient Family Advisory Councils: What They Are, How They Help

Recently, the formation and active participation of Patient Family Advisory Councils has been gaining ground at major medical centers. These councils are comprised of patients, family members of patients and employees from different departments in the medical center.

The idea of families of patients being considered as part of the medical team and not as “visitors” is more practical, more helpful and results in much better patient satisfaction and overall patient outcomes. Patients want their family members as part of their team and their support group. They trust them and rely on them. And no one knows the patient better than those close to them.

The Institute for Patient and Family-Centered Care  has great information about creating PFACs, including recruiting participants, developing bylaws and processes, and sustaining the council.

The Agency for Healthcare Research and Quality (AHRQ) also has some good information about why a PFAC can help further patient-centered care efforts in improving the delivery of care. The cahps website  explains,

“These councils help overcome a common problem that most organizations face when they begin to develop patient-and family-centered processes: They do not have the direct experience of illness or the health care system. Consequently, health care professionals often approach the design process from their own perspective, not the patients’ or families’. Improvement committees with the best of intentions may disagree about who understands the needs of the family and patient best. But family members and patients rarely understand professional turf boundaries. Their suggestions are usually inexpensive, straightforward, and easy to implement because they are not bound by the usual rules and sensitivities.”

Many major health centers now have PFACs. Some are new and some have been around for quite a while. Mayo Clinic formed a PFAC in 2004 and on the website, they describe some of the projects it has participated in, including improving wheelchair access, improving health literacy, evaluating health history forms and others.

Dana Farber Cancer Institute in Boston, MA established a PFAC in 1998. According to the Dana Farber website, the council has spear-headed the following projects:

  • Helped design treatment, program, and common areas throughout the Institute, including the award-winning Women’s Cancers Program;
  • Participated in renovations to the radiation therapy unit at Brigham and Women’s Hospital;
  • Launched a “Patients as Educators” program to share experiences and feelings about oncology patient/provider relationships with small groups of nurses and doctors;
  • Advocated for increased psychosocial support services;
  • Addressed patient parking policies;
  • Worked with Patient Accounting to create more patient-friendly billing letters;
  • Participated in planning for the Complementary Therapies Program;
  • Launched Side by Side, a quarterly newsletter for patients;
  • Served as a national model for patient-family participation in clinical-care services.

MD Anderson Cancer Center in Houston, TX has always been involved in patient-centered care, but the PFAC was just created last year. Patients and family members actually helped in the creation of the council, writing bylaws, developing strategies and recruiting members.

I spoke with Kay Swint at MD Anderson who co-chairs their new PFAC with 2 patient/family member co-chairs. Swint was part of a group from MD Anderson that attended a seminar at the Institute for Patient and Family-Centered Care specifically designed for learning how to create a PFAC.

Swint spoke about patient-centered care in general, explaining that it is really about reducing anxiety and suffering and forming strong relationships with patients.

“When you do that, outcomes improve. It is not enough to write a treatment plan. You have to make sure the patient and family are fully engaged and on the same page. You have to understand what the patients really care about and what their values and needs really are.”

The MD Anderson PFAC has 27 patients and family members and has 10 MD Anderson employees. The Co-chairs report up to Barbara Summers, Chief Nursing Officer and Marshall Hicks, MD, Division Head of Diagnostic Imaging. Summers and Hicks are both Executive Sponsors of the Patient Experience Division at MD Anderson.

The MD Anderson PFAC is currently working on projects involving patient communication and education, including how to get information to patients when and where they need it. They are capturing patient/family stories that teach valuable lessons on what’s important for patients. Swint explained that these stories are a great way to convey to health care professionals patients’ values and needs.

The Council is also working on electronic health record implementation and what is important from the patient’s perspective.

When I asked Swint what the patient and family members that were on the council thought about the initiative, she said that they were extremely enthusiastic.

“Members really want to contribute. If the meeting is running late and we ask who can stay to give feedback, most will willingly stay. This is so important. Just 15 minutes with patients and family members really improves our decision-making; their feedback is so important.”

City of Hope cancer center in California initiated their Patient Family Advisory Council in 2008. In 2012, they also initiated El Concilio, a PFAC for Spanish speaking patients and caregivers. I spoke with PFAC Co-chair, Annette Mercurio, about the council and what it does.

Mercurio explained that the council Chair is always a patient or caregiver and is elected annually. The Co-chair is a hospital employee. The City of Hope PFAC is certainly patient driven, with 22 patient members and 3 hospital employee members.

Some projects that the City of Hope PFAC has been involved with:

  • Several PFAC members sat with City of Hope CMO, COO and other hospital leaders to discuss outpatient care redesign
  • PFAC members contributed to improving after-hours meal options for caregivers
  • PFAC members contributed to strengthening volunteer support for chemotherapy patients
  • PFAC members contributed to the designing of the patient portal
  • PFAC members served on Rapid Improvement Event teams that contributed to process improvements for patient registration, design of the ambulatory surgery center in Amini, specimen transport and chemotherapy patient education

Mercurio told me that the hospital really feels that the council’s help is crucial for tackling any project that involves patients, their families and caregivers. When asked about the patients and caregivers’ thoughts on the council, Mercurio explained,

“The members feel that using their insight will really benefit other patients and caregivers. That helping others by serving on the council is one of the most important ways to make a difference. I am humbled by the dedication of these individuals.”

The emphasis on patient-centered care, patient satisfaction and involvement of patients, their families and caregivers is actively making a difference in healthcare. We at the Patient Empowerment Network hope that it gains momentum as it moves forward. Join the Patient Empowerment movement!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hooray for the Ice Bucket Challenge!

The past couple of weeks, my Facebook newsfeed has been filled with friends and relatives dumping buckets of ice water over their heads as they participate in the ALS Association’s “Ice Bucket Challenge,” a grassroots and viral approach to raise awareness of a rare disease and to boost fundraising. As you probably know, it has taken on an unexpected momentum of its own and brought tremendous benefits to the effort. I have read that the Ice Bucket Challenge has helped the ALS Foundation raise over $40 million when they raised less than $2 million last year. While dollars are vital and important to advance research, awareness is critical, too. For example, I am living with a rare condition also, called myelofibrosis. Fortunately, the pharma companies are pouring money into therapies for it, therapies that, if safe and effective, could bring them revenue from other related conditions, as well.

ALS, a terrible and fatal condition that can take away your ability to eat, talk, and move, unfortunately, has no real effective medicines. And I haven’t heard of a magic bullet yet on the horizon. It’s very personal for me as a close friend, Daniel Mulhaney of Mercer Island, Washington (near Seattle), has ALS and, despite a terrific Ice Bucket Challenge attitude, his health is going downhill.

Daniel is very public about it now. And just a few days ago, with help from his daughter, Michaela, he produced his own Ice Bucket Challenge video. Please watch it.  Here’s what Daniel wrote announcing the video: “For me, the hurdle was less about having ice water dumped on my head (and, WOW, was it ever a shocker!), and more about exposing my physical self to you – I’ve lost so much upper body muscle mass.  Having been into fitness all my life, it’s quite a change. But the Daniel that you’ve known is still there, it’s the avatar that I’ve occupied all these years that’s approaching its ‘used by date.’ ”

As you will see, Daniel can no longer speak. The voice you hear is the computer voice of his iPad speaking what Daniel wrote. Daniel is right-handed. But he can no longer move his right hand. So imagine him plunking out the letters of his message to us slowly with his partly functional left hand. I recently sat with Daniel as he patiently did this. And he smiled as the computer voice “spoke” his words to me. Daniel can no longer swallow. He keeps a suction device close at hand. During my visit, like a dental hygienist, I helped operate the device when Daniel signaled it was needed.

Daniel can no longer “eat” like we do. He has a feeding tube that attaches to a little port on his belly. While I was with him, Daniel ate, and he smiled. Around him, his wife tended to chores, and Michaela visited with friends. It was a different experience then just about 6 months before in Barcelona when Daniel led his wife, daughter Michaela, and his college-aged son on a trip to Europe. They stayed with us for several days. Daniel could eat and talk then. But he needed me to sign credit card receipts, because his right hand was almost nonfunctional then. This was part of his “bucket list” trip and included a family reunion in France. Later, he stopped in Boston to explore a clinical trial. He decided not to participate as he didn’t feel this one offered real hope for him, and it would require him to be separated from family and friends.

So, as you can now see, I have seen ALS close up. Even as a two-time cancer survivor, it makes me feel healthy and blessed. My wife, Esther, and I have wanted to do our part. No, we have not dumped ice water on our heads. But we have joined ”Team Daniel” virtually to support a charity walk in Seattle in September. Here’s a link if you would like to support this, too.

The Ice Bucket Challenge has proven to be a bonanza for people researching and affected by an orphan condition. Maybe this is a model to help other little-known groups, as well. Not to be critical, but in this age of pink ribbons and pink baseball bats, awareness – and money – needs to be spread around.

I pray Daniel, who is as alert and sharp as ever, will have many quality days with his family and friends and know that by “speaking out” he is touching us all and hopefully setting the stage for treatments that can prevent suffering in the future.

Rather than sign off my blog my traditional way, here’s the quote Daniel uses as the sign-off for his email updates:

“I promise to smile and laugh and cry and love for every breath that remains in my body.”

        – Steve Gleason – #37, Former New Orleans Saints Safety

Robin Williams’ Death: A Message About Depression

We were all shocked by the sudden loss of actor and comedian Robin Williams. Just today I had breakfast with an old friend from Marin County, California. She went to high school with Robin and would run into him often in her home town of Tiburon. People in that area knew him and his family. I even once attended a party with his mother. But whether you lived in the Bay Area or not, Robin Williams’ death too soon seemed personal, as he made us laugh for so many years. Last night, our family, during a reunion, re-watched “Good Morning Vietnam.” He was an incredible talent.

Robin Williams didn’t die of natural causes. He died by taking his own life. Deep depression, in some cases an ongoing illness and in other cases an onset of deep anguish, must have made him feel hopeless. There are times when many of you reading this, perhaps with a cancer diagnosis or because a loved one has been diagnosed, feel hopeless too. I remember, a few years ago, seeing a friend off in the distance sitting under a tree drinking from a bottle of scotch. I walked over. He said, “It’s hopeless, I’ve just been diagnosed with pancreatic cancer.” The man was bewildered and as low as one could go. He hadn’t told his family yet and didn’t know if he could. True, as it turned out he did not have a long life. But increasingly, that is changing for some, and it is a very variable road for any of us on our cancer journey. Some beat the odds, and in more and more cases – especially some blood cancers now – the odds are improving greatly.

But no matter what, the diagnosis can send you reeling and unfortunately, some people fall into deep depression or even take their own life. This is so sad because there are treatments, and there is help. I know in myself, I work hard to see the positive in each day. But if depression was part of my illness, I would need help doing that. If you feel like your health is failing in this regard, don’t be ashamed to ask for help. And if you are a “support partner” of someone with a serious diagnosis like cancer, don’t be ashamed to ask for mental health help for the person you care about.

At major cancer centers now there are typically oncology social workers. Ask to meet one at the center or in your town. In the U.S., there are social workers at the Leukemia and Lymphoma Society and at CancerCare in New York. Their services are usually free. And check out our recent interview about how a social worker can help.

Other organizations provide such services in other countries. Dealing with the diagnosis and medicines for cancer are tough. The goal is to cure us or, if that can’t be done, to allow us to live well for an extended time. Don’t let depression dampen that time. And please, please, if you have thoughts of shortening your time on your own, get help! The National Suicide Prevention Lifeline: 1-800-273-TALK and the Crisis Text Line: www.crisistextline.org are both important resources.

We are a community and need each of us to work together to get well individually and as a group.

The death of a celebrity draws tremendous attention to an issue. In Robin Williams’ case, it’s depression and suicide. These are real and so unfortunate. But if we confront this in our own lives and families maybe, in a strange way, Robin Williams will have given us one last gift.

Live CLL Patient Forum @SeattleCCA Draws a Full House!

On July 26th at the Fred Hutchinson Center, Patient Empowerment Network, Seattle Cancer Care Alliance and Patient Power are hosting a live patient forum for those patients, families and caregivers who are coping with living with Chronic Lymphocytic Leukemia.

Expert physicians talk, panels discuss and patients tell their stories. All learn from this unique experience.

Physician experts included:

David Maloney, MD, PhD, Member, Clinical Research Division; Professor of Medicine, Division of Oncology, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine

John Pagel, MD, PhDAssociate Member; Associate Professor, Division of Oncology, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine

Drs Maloney and Pagel talked about treatment options and new developments in the field of CLL. The current treatment options of chemotherapy, antibodies, BTK inhibitors and combination therapies were discussed and the treatments in development were then presented and carefully explained. Dr Maloney talked about his work on Chimeric Antigen Receptors (CARS) as well as other new research developments. Great care was taken by both physicians to point out that treatment is extremely individual and should be a decision reached after careful and thorough discussions with the patient and medical team.

Patient panelists were:

Charlie, Patient Advocate , Esther Schorr, Caregiver, Rich Siegel, Patient Advocate, and Lisa Weiss, Patient Advocate

Screen Shot 2014-07-27 at 7.11.07 AMThe panelists introduced themselves and gave a brief history of their experience living with CLL. Experiences ranged from Charlie who has been asymptomatic and has never received treatment for CLL to Lisa who has had numerous treatments and relapses during her journey with the disease.

The common thoughts and messages running throughout the presentations were those about support of family and friends and the importance of living well, living healthy and enjoying each day as it comes. The feeling in the room was a positive one. Be as educated about the disease as you can be, make sure that you have an excellent doctor and medical team that you can rely on, join support groups or start them, and be grateful for each moment.

In the afternoon, Drs Maloney and Pagel spoke of treatments, side effects and the importance of communication and mutual trust. Several points were discussed:

  • Trust your doctor – get a second opinion if you wish, but once you have found a doctor that you feel comfortable with, trust him or her.
  • Be informed and read up on your condition
  • Communicate with your doctor and medical team and ask questions
  • Be careful about taking vitamins, supplements or other products. Discuss all products with your doctor
  • What works for one person may not work for another. All treatment is individualistic
  • Use common sense and lead as healthy a lifestyle as you can.

The patient and caregiver panel had some words to share on living with CLL:

Standing Room Only!

Standing Room Only!

  • You are not alone! Ask for help and include family members in the discussion; you need their support.
  • Do not depend on your oncologist/hematologist to provide emotional support. Get professional counseling or group support. There are many organizations and online patient support groups that can be very helpful.
  • Live well and live healthy. Use common sense with diet and exercise. If you want to take any vitamins or supplements, discuss with your doctor first.

Caregivers and family members were a large part of this event. They talked about their hopes and fears, about involving their children in frank discussions about illness, death, what the future may bring and how to cope with a family member who has a serious illness. Spouses, siblings and children of patients spoke out. The energy, hope and commitment was felt by all. It was a powerful meeting indeed!

9 Ways to Propagate Patient Power

A success story is about having a positive outcome. We mostly hear about success stories as monetary achievements, but that’s really selling the word “success” short. I’m a brain cancer survivor. That’s a success story! I was barely out of my 20s when I was first diagnosed with what was first believed to be a benign brain tumor. My oldest daughter was only a year old then. She just turned 25. She’s only four years younger than when I was first diagnosed.

Where did the time go? I think to myself, “life is half spent before we know it.” There’s a saying that experience is the best teacher, but the tuition is high. Oh, so true! Through my treatments and surgeries I’ve lost the hearing in my left ear; the ability to swallow on one side; certain vision abilities; my tongue is paralyzed on one side (amazingly, the other side works to the point that you mostly can’t tell about the paralyzed side); I also have some memory loss. But I’m still here.

While of course I wouldn’t have chosen these circumstances — they happened to me and because of them I’ve gleaned a great deal of knowledge in a few particularly important areas: doctors, the business of medicine and being a patient. It’s because of my medical history that I have met or been treated by so many doctors. Some of those doctors have at times actually slowed down my path to better health or recovery — but I have learned from those experiences. I also know that there have been doctors without whom I wouldn’t be here today.

The enlightenment that I have achieved is important to share with those that may be at the beginning of their own healing path or one day will be walking it. They pertain to any healing path. Here are nine of the most important things I’ve learned.

If you know something is wrong, something is most likely wrong 
There had been years in between my being diagnosed wrong, and being diagnosed right — I had many symptoms. My particular cancerous brain tumor was relatively slow growing; the yearly MRIs indicated that “it may be larger due to angle or technology.” Instead of this being an alarm bell, or at the very least an indication for further testing, my doctors were lulled into a state of complacency.

I was seen often, looked quite healthy, and so I was probably just overreacting. I wasn’t. The tumor that looked slightly larger every year, was slightly larger. By the time I found a doctor that listened to me, and didn’t just look at me… the tumor had grown to twice the size than it was when it was originally diagnosed and treated. None of my previous doctors had compared my most recent MRIs with my original MRI to see it had grown. Listen to yourself, and campaign heartily.

Freedom to Feel
After you’ve received your diagnosis, you need to have the freedom to feel what you feel. You may have friends and family members that will put different spins on your things. There are those that are full of “gloom and doom.” Then there are others that will tell you not to be depressed when you’re depressed. They will tell you to be appreciative instead for all you do have. The intentions of these upbeat souls, is in the right place, but it will be difficult not to feel depressed some of the time. It’s okay to feel down about being sick, it doesn’t mean you can’t feel positive about your outcome, nor does it mean you can’t feel appreciative about what you have. Just knowing that is part of Patient Power.

Doctors are just people 
We put doctors on a pedestal. We believe them to have our best interest in mind, and I’m sure most do. However, doctoring is also a business. Doctors either consciously or unconsciously make decisions based on their ego, their desire to be noticed in the medical field, maybe even based on multiple reasons. This may sound callous, but think about it. Haven’t we all made a business decision here and there based on multiple reasons? They do what they have to do-you do what you have to do. Again being aware that this may be a part of the landscape is part of having power as a patient. Don’t be flattered that a doctor is interested in taking you on as a patient just because he’s considered an excellent doctor. Think about why the doctor will be good for you.

Doctors will seldom say “I don’t know” 
How much easier the process would be if doctors that don’t know, just said it. You could then take this non-information and move on, but instead a “not knowing doctor” can really slow down the process. You end up wasting valuable time on an opinion that should not even be in the mix. This makes the process more difficult, but being aware that it does exist, keeps you aware and on your toes, and a better patient. Try asking your doctor “Do you know if this will work?” “How will it work?” More information is better. If the answer is not what you want to hear, that’s okay. It’s an answer. You won’t be going to that doctor.

Use the Internet
This may seem obvious, but there are still those that don’t have access to the internet, don’t know how to use it, or perhaps are feeling too overwhelmed after receiving a bad medical report to go searching on the internet for themselves. If you don’t have or know how to access the internet, find someone else that does. There have been stories written about how people self-diagnose online. We’ve all read these stories and it’s important to understand the difference between finding out information after you’ve already received a medical diagnosis and trying to hunt down information to diagnose yourself before you’ve even been to a doctor about what is ailing you. That difference is enormous.

The Internet is invaluable. When I had my first surgery in 1990, there was no real Internet. What did exist was extremely slow, and had very limited information. These days, if you dig, you can find out so much, not only about your illness, but about your doctor’s background, and what other treatments and research is available as well. There are services that allow patients to comment, even rate doctors with whom they’ve consulted. This is good information. Information is part of Patient Power.

The more information the better 
I like doctor rating sites. These services keep doctors on their toes. If a doctor asks you to sign a legal document agreeing that you will not participate in one of these sites (I’ve heard that this is something that some doctors are doing now), walk away. If a doctor is that worried about you going online and making a negative comment about them, then this is not the doctor for you. Most doctors aren’t concerned about these sites because they know they’re doing a good job.

No doctor should make you feel your questions are a waste of time
No doctor should make you feel your questions are stupid, or that you’re stupid. Again, not all doctors know all things. Sometimes condescension is “I don’t know” expressed differently.

Opinions, opinions, opinions
It’s said you can take opinions all day long. You can… and you should. The more complicated the medical issue, the more opinions you should get. Try and get as many as your insurance will pay for, or you can afford. Yes, It can get to be overwhelming to get/have many opinions; it’s definitely easier to get only one — but what price easy? The one opinion you have may be a wrong opinion. It is so worth taking the time and doing the research. The best solution for you will become clear. I know from experience that this is true.

Always trust your gut
I asked one of my doctors about a certain therapy, and he emphatically told me that the therapy was not for me. Turns out he was wrong. That therapy is what may have saved my life. When he told me it was not for me, it didn’t sit right. I trusted my gut and pursued it anyway. Over my years as a patient, I have had a doctor strangely come to my bedside and cry. I had another who only returned my calls at 11:30 at night. Another told me we would be seeing each for the rest of my life, only to then have a follow up conversation several days later where he wished me luck, but that I should be seeing another doctor for follow-up.

All these things at the time seemed strange, but looking back now with hindsight, I know that all of these responses might have been indications of either things that were not right in their own lives, or in the most glaring cases, failing on the part of that doctor. So listen to your gut. If it doesn’t feel right, it probably isn’t.

(This post was originally published in Huffington Post)

 

Brain Cancer Survivor Helps Others Through Life Crises

Heidi Gottlieb is a brain cancer survivor who uses her experience as a patient and cancer survivor to guide others through their own life crises.

Twenty-five years ago, Gottlieb was diagnosed with a brain tumor. Her experience with being diagnosed at a young age (29 years old) at a time when there was no internet and limited treatment options for brain cancer taught her perseverance and the importance of patient empowerment.

After being misdiagnosed, enduring two grueling brain surgeries, undergoing two bouts of radiation treatment and a long re-education period where she had to relearn certain life functions such as how to swallow, Gottlieb made a commitment to teach others how to help empower themselves and march forward rather than give up.

One of the first events Heidi Gottlieb undertook as a cancer survivor and advocate for patient empowerment was to create a

250-mile fundraising walk from New York to Boston. As she walked, she spoke at schools and organizations along the way about her experience and her thoughts and feelings about cancer survivorship.

That walk taught Gottlieb that she wanted to dedicate her life to helping others through their life crises. She enrolled in classes and recently earned her certificate through the International Coaching Federation  as a Professional Coach.

In her role as a Transformation Coach, Gottlieb teaches people (20% are cancer patients) how to overcome personal crises, energize themselves, reach their full potential and move toward a more productive, happier life.

There is a lot written about empowering the patient, which is good. But the people that I want to reach are the survivors. Those who want to lead a so-called normal life, have a job and have a personal life. These people are sometimes “lost”. They are thinking about getting new jobs and wondering if they should tell their potential employer that they have cancer. I would like to help them”.

I asked Gottlieb if she considered herself an empowered patient. She replied,

“Yes, I am an empowered patient. I have been a student of my illness for 25 years and if you have been a student of anything for 25 years, you live and breathe it. I have been immersed in the medical field since I became ill because I wanted to know everything I could about my condition. It was difficult. There was no internet. Since I was not a medical student, there was no way to research about my brain cancer. I was bounced around from one doctor to another. I underwent surgery and radiation without knowing much about what I was doing.

 After my experience, I really wanted to dedicate my time to finding out more about brain surgery, brain cancer, and cancer survivorship in general.”

I asked Gottlieb what advice she could give other cancer survivors. She explained her philosophy as follows:

 “I know that the fact that I have been through so much and am still here is highly unusual. Not many brain cancer patients are survivors. My cancer could come back at any time. I have come to a place where I try very hard to live in the now. You never know what will happen. Through my experience, I have been given the gift of understanding that I must enjoy every moment.”

 Heidi Gottlieb has her own website where you can learn more about what she does as a Transformational Coach. She blogs often about her feelings on being a cancer survivor and an empowered patient. I have posted one of her latest blogs; read it here.

Bribing Anxiety

So, the last time that I had my regular appointment was a year ago. I was more than a year past treatment and my blood work came back good, my energy level was good and I had no issues to report. I was told that my complete remission was still in place and that the next appointment would be in six months. As it happens, the treatment that I received in clinical trial for my “moderately severe” matrix of genetic type of chronic lymphocytic leukemia (CLL), mutation status and symptom presentation worked out pretty much perfectly. Time to negotiate. “Let’s make it a year?” I implored. They set the appointment for six months but assured me that they would get together and consider the proposed new plan that I put on the table. A few weeks later I noticed, while checking my records on the online portal, that my next appointment had, indeed, been moved out to a year. And now I have that appointment coming up in a week or so.

I have embraced my remission and attacked life. I’ve been doing more over the past year and am just plain getting after it. I hardly ever say no to an opportunity, I smile a lot, I travel, I explore… And now I’m filled with anxiety. I want to take a nap. Does the fatigue mean that remission is over? I had a strange, very mild rash on my hands that really didn’t itch, but lasted a few weeks. Does that mean that there’s some bizarre infection in my body? My joints have been achy. I’ve had some pretty amazing headaches. Does that mean I have to start adding the term “relapsed” to my cancer vocabulary? Or am I just being a normal human being reacting to the unknown?

I know that I am reacting normally to the stress of cancer and that my responses are pretty much how all of us, at least quietly, deal with all the little things. We are told to take an inventory of everything and always report changes to our health care providers. We do this because some changes can be the early warning trip wire that our cancer has decided to change the rules. So we (and by we I mean I!) will always wonder if the next item up on the “how do you feel” menu is a harbinger of cancer or just the soreness that a 50+ year old guy feels after shooting the rapids in an inner tube for 5 hours. Anxiety and stress is something that gets added to the lives of every single person that is touched by cancer, patients and caregivers. We really cannot banish it from our lives, but we can rein it in.

A week of worry is not going to change the results of the upcoming hospital assessment. I’m either still in remission or not. So I will try to occupy my time and be productive. I’ll cook some fabulous meals for my family, give a presentation to a local civic group, mow the grass, write some articles, research a project… And try to minimize the amount of time I allow the anxiety to actually interfere with my life. I know that I cannot banish it, so I will try to paint it into a corner. Oh, and I’m bringing my doctor a bottle of wine. I’m told he likes wine and maybe a “bribe” will keep me on the one year check up cycle? Don’t give away my secret plan!

Advanced Care Planning – What to Do Now!

This is important! And often overlooked, neglected, procrastinated, or ignored…for many reasons. If you are an adult, you need to think about your future and your wishes and desires in terms of your health care. And you need to discuss these wishes and desires with those close to you. It is only by doing this that you can ensure that your choices will be heard.

It is sometimes a difficult conversation to start, but those around you and close to you need to hear you. Start by thinking about quality of life, choices, and what is important to YOU. Think about who you can trust to listen to you and carry out your wishes if you are no longer capable of doing so.

If you are a cancer patient, think about what treatment options are available to you, what makes sense to you and what doesn’t. Do your research, talk to your provider or medical team and talk to those close to you. Then think about those discussions and what is important to you.

This is ultimately an individual and very personal decision. However, family members need to hear and respect your viewpoint, so include them in the conversation early on.

So many times, it happens that when a patient is unconscious or incapacitated in some way, family members get together and try to make decisions. Often, the family members cannot agree on what the patient would have wanted and their opinions and emotions cause conflict, anger and heartbreak. And then, since the patient never made her wishes clear, they are not carried out.

You can avoid this.

Take action now and start the conversation.

Once you have discussed your wishes with family members and loved ones, it is important to fill out the correct paperwork. Medical directives are legal documents that will state your wishes and help to see that they are followed. But do not rely on medical directives alone. Be sure to talk to family members or others close to you.

According to a recent article in the New York Times, large national studies showed that although more patients are completing medical directives, these directives are not always available to hospital staff when they need to be. Patients often keep them filed at home and they do not find their way into patient medical records or into the hands of those caring for the patient in an emergency situation. Be sure and make your wishes know to those closest to you and give them a copy of your directives.

Advance Care Planning is also a process. You can change your mind and may do that as time progresses. Be sure and update family members as your wishes change.

You do not have to do this alone. There are numerous avenues of help.

Resources

There are many resources that help with Advanced Care Planning. One good website is The Conversation Project.

Here, you can find information, a “starter kit” to help you get your thoughts together and start the conversation with your loved ones. This kit is available in Spanish, French and Mandarin as well as English.

There is also a PDF on how to have the conversation with your doctor, in Spanish and French as well as English. The website has a blog with patient stories and stories from staff members and advisors.

MD Anderson has an entire web page dedicated to Advance Care Planning . Specifically for cancer patients, this page was developed by an interdisciplinary team of doctors, patients, social workers, health educators and other health care professionals.

On this page, you will find step by step guidelines on how to start discussions with family members, talk with your provider, assign a family member to be your spokesperson and how to complete the legal paperwork necessary. PDFs are available in English and Spanish.

There is also a 5 part video series explaining the process of Advance Care Planning in depth with patient viewpoints and advice on how to make the decisions and discussions go as easily as possible.

The MD Anderson web page also includes information on Advance Medical Directive documents such as Living Wills, Power of Attorney and Out of Hospital DNRs (Do Not Resuscitate) with links to the legal documents and instructions and advice on filling them out.

This page is an excellent resource and also includes a number to call for further questions.

Don’t hesitate. Start the conversation now.

8 Beliefs That Can Hold Caregivers Back (from reaching out for help)

Family caregivers too often suffer from two very common things: overwhelm and isolation. Or, to it put another way, exhaustion and loneliness. So often, the nature of illness and trauma not only disrupts our normal ways of living, but also disrupts our connections with people who care about us. Caregivers who reach out for support gain the benefits of lessening their burdens and of feeling the warmth provided by people who care.

Too often, caregivers hold back from reaching out because of beliefs they have about doing so:

  •  Nobody else can do what I do for my loved one.
  •  My loved one won’t accept help from anyone but me.
  •  I’m too busy to even begin to think about doing anything more – even reaching out.
  •  The moment I start reaching out, our family will lose our privacy.
  •  I’m afraid of imposing on people.
  •  Reaching out shows weakness; doing it yourself shows strength.
  •  I’m afraid that nobody will come forward to help me.
  •  Since I’m able to handle things now, I’ll be able to continue to do so.

These, beliefs, while completely understandable and very common, are neither healthy for you as a caregiver or for your loved one. They get in the way of your resilience and your capacity to sustain yourself for however long your caregiving is required. Each week, I will be focusing in on one of these self-limiting beliefs and invite you to come along with me in exploring those that you are now willing to let go of and change into ones that help you not only survive, but thrive.

So let’s get started:

Nobody else can do what I do for my loved one

Think of the whole range of “things” you are currently doing. First think of the practical ones: dressing, managing and administering the meds, shopping, preparing, serving and cleaning up after meals, assisting with bathing and toileting, and so on. Now focus on the emotional and spiritual ones – showing love, being a trusted confidant, giving emotional support and comfort, etc.

Nobody else can do these things exactly how you’re doing them or would your loved one experience them in the same way if they were done by people other than you. No one else is so attuned to your loved one’s needs and preferences and, most likely, your loved one is most receptive to your way of doing these things. And, no one else would be as committed to your loved one’s comfort and be as vigilant as you are. This much is true.

But, the trap here is believing that, since no one else can do things the way you do, that no one else can do them or do them satisfactorily for you and your loved one.

Let’s take a look at some of those practical things that I listed above. Take one area for starters, e.g. grocery shopping. These days, it’s not like the days when our mothers used to look the butcher in the eye and tell him she wants a better cut of meat than the way he did it last week. Shopping simply means meal planning, list making and going out and getting the groceries – all very delegatable tasks. When you think about, I think you’ll agree that many if not most of the practical things can be done by others. Not necessarily with your intimate knowledge and way of doing things, but in their own ways. And, similarly, other people will bring their own and distinctly different ways of providing emotional and spiritual support as well.

Bottom line: Is this a belief you’ve been holding? If so, how does it serve you? How does it hinder you? How might you re-write that belief so that it serves you better? For example, “There are some things that other people can help with. I’m going to try this out with some simple things.” What practical step can you take to try out that new belief this very week? Let us know – by commenting on this blog. You’ll help yourself and other caregivers by doing so.

 

 

 

 

 

A Tribute to AJ Halavacs

AJ Halavacs of Fort Lauderdale, FL died unexpectedly earlier this month. Since learning of his death a few days ago, I have been shaken to my core.

I had met AJ only briefly on April 12 at Moffitt Cancer Center in Tampa, FL. But what an impression he made! With his big personality and his story.

AJ was among the patient guest speakers at a CLL Town Hall meeting at Moffitt, sponsored by Patient Power. The educational symposium featured two CLL specialists and was attended by more than 150 CLL patients and their families and friends.

He was a tall, strapping, handsome man with a ruddy complexion and a radiant smile. He never stopped smiling. You wouldn’t have known that AJ had suffered from CLL for many years. And that four months earlier, he’d been confined to a wheelchair, weak, with an ugly rash covering his body.

None of the treatments AJ had endured, much of it chemotherapy, worked for very long or very well. Until ibrutinib. The now FDA-approved treatment, trade name Imbruvica, is considered a breakthrough immunotherapy to treat CLL. It targets the malignant cancer B-cells but leaves the healthy T-cells of the immune system in tact. Best of all, it’s an oral medication. Three capsules a day. No chemo.

Days after AJ began to take ibrutinib in a clinical trial, he was out of that wheel chair. The rash disappeared. He quickly regained his strength. He traveled to Amsterdam and North Carolina for business. He expressed great joy in his longtime marriage to Jane, who had accompanied him to the town meeting, and unbridled pride in their three grown sons, one of whom is engaged to be married. Because of his seemingly miraculous response to ibrutinib, AJ and Jane were looking forward to the rest of their lives.

Something happened, however, after April 12. Apparently years of CLL and treatments had taken too harsh a toll. AJ developed Richter’s transformation, a CLL patient’s worst medical nightmare. AJ Halavacs died at Moffitt Cancer Center on June 3.

We CLLers think of these treatment advances as a bridge. Cross a bridge with a particular treatment to make it to the next bridge. Our goal is to cross enough bridges so that we can live with our CLL and die from something else. AJ reminds us that there is no cure yet for this disease. Patients remain hopeful, but after AJ’s death, this patient feels more vulnerable and less sure-footed about the path forward.

Nonetheless, I am glad that I met AJ Halavacs and learned about him. Mostly I am honored to have circled his spirited, positive orbit for a few hours. He’d be the first to tell CLLers not to waste a minute fretting, “live large” and say ‘yes’ to every opportunity for the time we’ve been given.

Twitter Tips and Resources for Cancer Patients

The “Twitterverse” is pretty mainstream now and not just for the younger generations any more. Of the many, many uses for twitter, cancer information, education and support are gaining ground. Twitter is fast, easy, mobile and instantly gratifying.  Information literally at your fingertips.

Several articles have been published on the increased use of twitter by cancer patients, from cancer patients tweeting through chemo, “power” cancer patient tweeters in Japan, and a controversial article in ASCO about a breast cancer patient tweeting about her disease.

Tweeting is easy. Set up an account and go! If you are interested in getting some good information back from Twitter though, you should choose carefully whom to follow.

All news sources are on Twitter, so it’s easy to find them and follow them.  All top cancer medical centers are on Twitter and they are a great source of information on cancer research, news, clinical studies and basic medical information. Here a just a few to start with:

@MDAndersonNews

@DanaFarber

@SeattleCCA

@MayoClinic

@MoffittNews

@LurieCancer

Patient support groups for cancer patients are numerous and you can usually find one that is specific to your illness. Again, here are some to start with:

@StupidCancer – mainly for young cancer patients

@ImermanAngels

@MyelomaCrowd

@MyelomaTeacher

@MyBCTeam – for breast cancer survivors

@CancerSupportCM

@PCFNews – Prostate Care Foundation

@PanCan – Pancreatic Cancer Action Network

There are many, many more – this is just a small sampling. To find specific groups or people to follow, you should use the search engine on Twitter or do a hashtag search and see what comes up. For instance, if you are interested in following groups or people that tweet about stomach cancer, do a search and research their profiles. For instance, I just searched “stomach cancer” and this is what came up:

You can now go to these twitter profiles and see if these are some people that you would be interested in following.

And if I do a hashtag search for #stomachcancer, I find this:

Screen Shot 2014-06-15 at 12.38.42 PM

So you can go to these twitter profiles and see if any of them appeal to you.

It’s quite simple and you can follow some groups and people for a while and then “unfollow” them if their tweets are not what you were looking for. Once you follow people or groups that you know have the same interests as you, you can use them as your “news stream” and tailor your stream to the kind of information that is most suited to you.

Twitter is easy, quick and gets to the point right away (it has to – with only 240 characters allowed by tweet!) It’s a great way to keep informed and have custom-made information at your fingertips.

Patient-Selected Controlled Clinical Trials: A Valid Proposal

Lagging patient accrual numbers for cancer clinical trials has always been an issue. In a previous post, I mentioned several reports that showed that the current system of enrollment for clinical trials just isn’t working for patients, researchers or sponsors from pharmaceutical companies.

In the current issue of the ASCO Post, Jim Omel, MD and Karl Schwartz, MFA have written a great article proposing a new type of clinical trial: A Patient-Selected Controlled Trial.

The authors explain that this approach is not meant to replace the randomized controlled trial design “when it’s feasible and ethical to use it”. They suggest that it be used as “an additional tool to consider when comparing treatments for cancer, such as (but not limited to) when the compared interventions have very different risks, or when both treatment protocols can be used off-study.”

The patient-selected controlled trial would let the patient decide whether to be randomly assigned to treatment or to choose the treatment arm they want to be in. Their decision would be based on their personal situation and, most often a detailed discussion with their physician.

This type of trial would most likely result in out of balance study arms. This shortcoming could be mitigated by factors such as the following:

  • This patient-selected design would be more attractive to patients, resulting in larger studies and faster accrual.
  • Statisticians may be able to apply methods to achieve balance – such as limiting accrual in the rapidly enrolling arms
  • Propensity scoring which can anticipate and account for confounding variables in order to adjust for bias may be used in this type of trial.
  • Study doctors can provide or capture the reason for choosing one arm or the other, thereby helping to interpret outcomes and to determine whether a larger study is needed.

and others.

The authors argue their case in part by saying, “We should not let the perfect be ‘the enemy of the good’ – that is, insisting on perfection can result in no improvement at all” In other words, isn’t it better to have a good, complete patient-selected controlled trial with a bias that can be mitigated than wasting time, energy and finances on a randomized controlled trial that has to be terminated because no one shows up.

The authors conclude,

We submit that the patient-selected controlled trial is clearly superior to any randomized clinical trial that is never started because it’s judged to be unfeasible, or to any randomized controlled trial that is terminated because of poor enrollment. What good is a statistically perfect well-designed randomized controlled trial if no one signs up? We hope and expect that the patient-selected controlled trial provides another way to do good science while practicing good medicine.”

Please read the full article here and comment!

 

 

Can(cer) Do! – Why We Should Talk About Cancer

I saw two productions about cancer in a 48-hour period this weekend…and went home smiling.

The first, produced at Washington, DC’s Theatre J, was called The Prostate Dialogues. It was written and acted by a very fine local raconteur, Jon Spellman. In 75 minutes – with no break – John unfurled his prostate cancer story from diagnosis to his treatment decision (surgical extraction at Johns Hopkins). Along the way, Jon peppered his experience with humor and a graphic depiction, through a normal and happy cell called “Glen,” of the development of those nasty mutated cancer cells. A five-minute description of a 20-year process. Brilliant!

Two days later, my husband and I saw a newly released movie in the U.S., “The Fault in Our Stars,” based on the best-selling, young adult book by John Green. The movie had received excellent reviews, so despite the subject matter, we went to see it. It’s about two teenagers, each with terminal cancer, who fall in love. Hazel and Augustus are doomed. We know it from the start of the movie. And yet, the film was done with grace and understatement and humor. There was no hyperbole. The acting was honest including the antics of Augustus’ now-blind-from-cancer buddy Isaac. Was it heart-breaking? Yes. Was it sometimes funny and often uplifting? Also yes.

As a nearly eight-year survivor, I expected to shed many tears at this movie. It was my non-cancer husband who welled up and forced himself not to cry in public.

Here’s the takeaway: In the U.S., we are talking about cancer! We are talking and laughing about it a lot and in the open, often with people who don’t have cancer. Cancer no longer is quietly discussed in the back room, in hush-hush tones with family and our doctors. Cancer has seeped, no, it is flowing into the mainstream consciousness. The more we learn, the less we fear. The less we fear, the more we live our lives through family, travel and work.

The mantra of my doc at MD Anderson in Houston is to “live large.” In other words, say ‘yes’ to as many opportunities and invitations as possible. If you live in the DC area, go see The Prostate Dialogues. In the U.S., cry and laugh with Hazel and Augustus at “The Fault in Our Stars.” And remember, cancer is not a dirty word. It’s a condition that we face, like Hazel and Augustus, with grace and humor, and now more than ever, in the open.

Mobile Apps for Cancer Patients

Which apps can be used by chronic cancer patients to help them with their illness and overall health?

There are literally thousands of medical apps in the marketplace and it is very difficult to sift through them and find out which ones are easy to use, practical and helpful.

I did some research, asked some patients, and read a lot of reviews to try and get an idea of which ones were helpful for chronic cancer patients.

Research and Information

I asked Cindy Chmielewski, (@MyelomaTeacher),  a multiple myeloma survivor and patient advocate for the disease what apps she uses to stay abreast of the latest news in cancer research and treatment.  She commented,

Cancer.net app is a wonderful resource for patients.  It provides information on specific cancers, provides a place to write questions, write/record answers, list medications, record symptoms and more. “

Cindy then gave me a list of some other research and information apps that she uses regularly to stay informed:

Clinical Trials

ClinicalTrialSeek by Novartis lets patients search NIH data for clinical trials that could be a fit based on the treatments and diseases under investigation, location, development phase and other aspects of the studies. The app  also provides information about how trials work and those that the company and others are sponsoring. Eli Lilly and others have launched similar apps in hopes of educating patients about clinical trials–and perhaps boost enrollment too.

Support and Networking

There are numerous patient support tools that help cancer patients stay connected with other patients and friends.  CaringBridge is a popular one.  And of course,  joining and participating in specific groups on Facebook is always a popular and easy way to connected and stay current.

For lymphoma patients, the Focus on Lymphoma app  from The Lymphoma Research Foundation includes information on lymphoma subtypes and disease stages, a set of tools to help patients manage their health and a variety of resources and networks that assists them and supports them through treatment and survivorship.

Fitness apps and nutrition and healthy eating apps are also important to keep fit, eat healthy and maintain a healthy lifestyle.  The internet has an abundance of these and each person can find one to fit his specific needs.

Notes and Organization

To stay organized and remind themselves of meetings and commitments, many patients use apps.  Cindy Chmielewski comments,

“Before Chemobrain, I didn’t need to rely on reminders, but now I use the calendars, reminders and a notes app on my iPad.”

Jenny Ahlstrom, a multiple myeloma survivor, developed an app,ChemoBrain DocNotes, specifically to help patients remember the important questions for their next doctor’s visit and what was said during the appointment.

ChemoBrain DocNotes provides patients with an easy way to record questions , either by voice or by text for their next doctor visit. Patients can also record their doctor’s visit in a voice memo and play it back later.  Jenny Ahlstrom comments,

“Remembering what the doctor said during the visit is an equally big challenge, especially when the doctor covers your diagnosis or treatment plan using complicated medical terms”.

Cancer caregiver, Sharon Reamer, adds,

“I try to be at every appointment to be an extra set of ears for my friend.  Now if I can’t be there, she can record the visit and email me the file so I know what the doctor said.”

Another cancer survivor, Liz Smith, volunteers,

“I am jotting down questions in Chemo Brain Doc Notes any time I think of an issue for my next appointment.  The app is simple and easy to use.”

Medication Reminders

Oral cancer treatments are more and more common, especially for chronic cancer patients.  Studies, such as the one conducted by research leader and CML survivor, Giora Sharf, show that medical adherence is an important topic.  Why is it so hard for patients to take their meds, and what tools would make it easier?

In this video,  Giora explains that 26% of the patients surveyed would use a mobile app to remind them to take their medication.  Here are some of the medication reminder apps available:

And for those who want to go with a non-digital reminder, there are vibrating pillboxes, watch alarms, etc on epill

Andrew Schorr, CLL and MPN survivor, and founder of the Patient Empowerment Network and Patient Power, has a rather unique way to remind him to take his oral medication.  Andrew really likes Bruno Mars and so every day, morning and evening, Andrew’s daughter set his iPhone up to play the song, “Lazy Day” and show the mention “Take Medicine”.  An easy and fun way to remember!

Find the App That Suits You Best

As chronic cancer becomes more prevalent, and apps get more sophisticated and easier to use, more and more patients will use them.  There are an overwhelming number of apps available; you need to find the one that suits you  best.

The above information is, of course, my opinion and the result of my gathering of information and is not a ‘formal’ review of these apps.  Comments or advice and suggestions about apps is more than welcomed in the comment section below!

Why Information is One of the Best Medicines for Cancer

From Mia Bonhomme in Belgium – Mia’s website: MiaCLL

It all starts with the statement “ You have cancer”. The next second you have the impression your head is too small because thoughts are fighting to take their place in the front row. You are often not able to see, hear or understand the rest of what your physician is saying.

At home, you feel as if someone hit you with a sledgehammer, paralyzed, not knowing what to do or how to react. In the back of your mind you still hope they’ve made a mistake, switched results.

The moment you realize that none of this is true and the diagnosis is for real, you start worrying about your dear ones. What will happen if you’re not around anymore to help them? You probably are even thinking of arranging your funeral.

You think of everyone except yourself and all this thinking and worrying is consuming so much energy that it leaves you with an empty battery.

When you reach your next appointment you feel drained of energy and happy that your doctor is taking care of your illness and upcoming treatment. You feel lucky you can leave it up to him because at that time there is no empty spot in your brain left to worry about treatment.

It is a fact that doctors know best but they’re also human, not almigthy. They try to take care of hundreds of patients and don’t have the time left to know everything there is to know about your disease. That’s why we patients have to inform ourselves, and seek answers to our questions, in order to understand what our doctor is telling us.

I had the luck to have the best specialist ever. He told me that in my case he had four different kinds of treatments available. I got the explanation of where each treatment would take me.

So he showed me four different kind of ways to fight my cancer and it was up to me to make the choice. The only thing I asked was: which treatment he would choose if he was in the same situation as me.

In our distress to cope with cancer we patients sometimes forget that there is a limit in what physicians can do.

We have to stand up for ourselves. No one is in a better position to fight for your life than you yourself! Your physician can provide you the ammunition to deal with cancer, however you have to make sure that you understand the options.

That’s why we have to inform ourselves and become empowered. In this way, we can take control of our health.

We are responsible for our own life, not our doctor, nurse, caregiver or family… No, it’s our responsibility, our decision. We can decide to leave it up to our doctor and I’m sure he will do the best he can, or we can decide to become an active participant, get empowered and help as much as possible on our road to survival.

I’m convinced that if we lose that battle in the end, we can make peace with it because we did everything possible to survive. If you have done everything that’s in your power and it doesn’t work out, you don’t have to blame yourself or anyone else. It’s just life as it is written for you.