HP 330: Part 3 Information
HP 330: Part 3 Information HP 330
Popular in Cancer: Perspectives and Controversies
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This 2 page Class Notes was uploaded by Sydney Brummett on Thursday October 13, 2016. The Class Notes belongs to HP 330 at Wichita State University taught by Dr. Paul Danner in Fall 2016. Since its upload, it has received 6 views. For similar materials see Cancer: Perspectives and Controversies in Health Professions at Wichita State University.
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Date Created: 10/13/16
Part 3 Information • Radiotherapist, chemotherapists, and surgeons fought viciously for power and information o The war on cancer seemed to develop into a war within cancer • Between 1924 and 1928, Keynes attempted various strategies related to breast cancer. Must successful was a careful mixture of surgery and radiation, both at relatively small doses o Removed the malignant lumps locally with a minor operation • If the tumor were locally confined to start with, then it would be removed with local surgery. Radiation and manically stripped nodes added no benefit o If had already spread outside the breast, then surgery would be useless anyway, and more aggressive surgery would simply be more aggressively useless. • To get women to participate in a clinical trial was much more difficult than simply a drug trial test o It seemed that many surgeons were even more reluctant than their patients to participate in the study • 1981, the results of the trial were finally made public o The rates of breast cancer recurrence, replaces, death and distant cancer metastasis were statistically identical among all 3 groups § The group treated with the radical mastectomy had paid heavily in morbidity, but accrued no benefits in survival, recurrence, or mortality. • Between 1891 and 1981, in nearly 100 years of radical mastectomy, and estimated 500,000 women underwent the procedure o Many chose procedure o Many were forced o Many did not realize it was a choice o Many were permanently disfigured • The ominous toppling of radical surgery off its pedestal may have given cancer chemotherapists some pause for reckoning o Don’t go into excess treatment o But they had their own fantasy to fulfill • Cisplatin was unforgettable o Provoked unremitting nausea o On average, patients treated with the drug vomited 12 times a day o Many patients had to be given intravenous fluids to help with nausea • Biology of cancer was still poorly understood • Dissidents argued chemotherapy could not be the only strategy which to attack cancer o They wanted to develop a new drug by uncovering the deep biology of every cancer cell • Palliative care, the branch of medicine that focuses on symptom relief and comfort, had been perceived as an admission of failure to its rhetoric and success o Pain relieving drugs were deliberately denied o “If surgery is withheld the sufferer is doomed to opiate addiction, physical deterioration or even suicide” • in the last 1940s, Sicely Saunders encountered terminally ill patients who were denied dignity, pain relief, and often even basic medical care – their lives confined, sometimes literally, to rooms without windows o She responded by inventing or rather resurrecting, a counter discipline: palliative medicine o Avoided the phrase palliative care because “care” is a soft word o 19677 she created a hospice in London to care for terminally ill and dying o Would take a full decade for the movement to travel to America and penetrate its optimism o “the resistance to providing palliative care to patients was so deep the doctors would not even look us in the eye when we recommended that they stop their efforts, and transition to stabilize and start saving dignity instead,” • Doctors were allergic to the smell of death o Death meant failure, defeat – their death, the death of medicine, the death of oncology • In the history of medicine, no significant disease had ever been eradicated by a treatment-related program alone. o To put most of the effort into treatment is to deny all precedent • Was the life extension of a five-year-old “worth” more than the life extension of the 60-year-old?