Archives for June 2017

Cancer: Written in the Stars?

Cancer: Written in the Stars?

Among other things the summer equinox means

(besides the sunlight fracturing my sleep at 5:30 in the freaking morning), star-gazers know that the sun’s most northerly position on the day of the equinox is in Taurus – though it wasn’t always so. In ancient Greece, the sun would’ve ridden to its equinox peak in a different constellation: specifically, Cancer. When I stumbled on that tidbit in the paper yesterday, I was reminded how long that name’s been with us.

Cancer’s new prominence in the modern age – in incidence, and in awareness – often fools us into thinking it’s a new illness; but in fact, the disease is as old as our species. It was first named in the fifth century B.C.E. by Greek physicians in the Hippocratic tradition who, frustrated in their attempts to pry tumors free of their patients, called them karkinos (“the crab”) because of the tumors’ claw-like grip.

Greek knowledge formed the basis of much of Roman learning. As Hellenic power waned and Roman influence dominated the world, the Greek word for the disease was eventually replaced by the Latin synonym for crab: cancer.

There may even be another reason these tumors reminded Greek physicians of a crab, though I’ve no proof of this. In mythology, the goddess Hera tried to foil Hercules at every turn – and during his battle with the Hydra (when he needed all his wits and strength) she sent a large crab to bite at his feet during the battle, hoping it would affect his footing enough to cause his defeat. When Hercules instead crushed the crab, myth says Hera memorialized it in the heavens as one of the signs of the Zodiac.

In Hippocrates’ time lifespans were much shorter so cancer would’ve been rare, and would’ve affected the young and otherwise healthy. It would’ve seemed a random calamity of cosmically cruel proportions, biting at the heels of otherwise vibrant youth – like the one Hera sent to torment Hercules – and just like pediatric cancer still seems to us today.

U.S. Oncologists are Working Shorthanded

U.S. Oncologists are Working Shorthanded

The relationship between cancer patients and their oncologists is an intense one.

The stakes are high for everyone involved, and cancer patients especially have very high expectations of their doctors (more info here). There are approximately 15 million cancer survivors in the U.S. right now, and as our population ages and cancer treatments become more and more effective, the number of cancer survivors needing precious time with their oncologist keeps increasing. That number is expected to reach 20 million by 2026.

But the demand for cancer doctors is outrunning supply: in 2016, there were 12,100 practicing oncologists in the U.S., approximately one-fifth of whom are due to retire within the next five years. At present, graduate programs can only supply about 600 new oncologists per year – and with increasing financial pressures on educational programs, there’s almost no potential to increase that output within the next decade (more info here).

And it isn’t simply a matter of current oncologists stepping it up, either: the average oncologist is already working 63 hours per week.

It was hoped that widespread implementation of computerized medical records would yield a boon of efficiency, but unfortunately that hasn’t materialized either. It’s currently estimated that oncologists now spend 50% or more of their time on computer work, leaving less (rather than more) time for patients. Maybe physicians haven’t yet climbed the steep computer learning curve to gain new efficiencies, or maybe current technologies (as implemented) aren’t designed to make physician work easier, but either way it’s been more burden than benefit so far.

So if the work’s hard, getting harder, and there’s more of it than ever before, who in their right mind would go into medical oncology in the first place?

Good question; I’ll try to answer it in my next blog.

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