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Mechanisms of Disease 2 HC30: Changes in patients’ experiences
HC30: Changes in patients’ experiences
Patients versus medical professionals
While patients experience cancer treatment as a unique life-changing series of events, to medical professionals it constitutes routine work practice.
Joanna Baines
Joanna Baines wrote an article containing 3 stories of 3 generations of breast cancer:
- Grandmother
- Stayed at home after diagnosis, died at the age of 56
- For her, cancer was an experience of silence
- Mother
- Was diagnosed with breast cancer at 35
- Treatment
- Radical mastectomy
- Removal of the entire breast, nipple, lymph nodes, vessels and muscles → severe and mutilating operation
- Became less and less popular throughout the 1970s
- Ovarian ablation throughout radiotherapy
- 5 year follow up of remaining breast and glands
- Radical mastectomy
- Hardly received any information about her condition → saw cancer as an event
- Joanna Baines
- Diagnosed with breast cancer at 32 years old
- Received several supplementary tests
- Abdomen
- Liver
- Bones
- Treatment
- Removal of the lump and lymph nodes in the armpit
- Chemotherapy (5 months)
- Radiotherapy
- Tamoxifen (5 years)
- Herceptin
- She was part of an RCT (randomized control trial)
- Saw cancer as a part of her life
Timeline
A timeline of emerging cancer therapies has been created:
- 1850-1920: radical surgery
- 1900-1950: radiation
- Major alternative to surgery before chemotherapy
- High energy radiation equipment
- Huge machine surrounding the patient
- Emerged in the early 20th century
- 1950-1970: chemotherapy
- Emerged after the WWII
- 3 types
- Nitrogen mustards
- Discovered during WWII
- Don’t produce lasting remission
- Hormones
- Increased use in the 1940s-1950s
- Now regarded as palliative
- Tamoxifen became available in the 1970s-1980s
- Antimetabolites
- Sydney Farber diagnosed ALL in a 2-year-old and injected him with aminopterin (an antifolic) → worked very well
- Nitrogen mustards
- Didn’t become the cure that everyone had hoped → only prolonged the lives for several months
- Issues
- Drug resistance
- Death due to new complications
- Survival isn’t worthwhile
- Many experiments where done in the 1960s
- 1970-1990: combination therapy
- Dr. Pinkel made a breakthrough by combining high dose chemotherapy and radiation
- More toxic chemicals
- Radiotherapy in the brain and chemotherapy in the spinal fluid
- Double doses in case of no success
- “Total therapy” → a total hell for patients
- Even though there was a huge therapeutic optimism, there were several problems
- Toxicity, response, life impact and trauma, complications, drug resistance, etc.
- Ethical dilemmas in research of cancer treatment
- 1978: cisplatin was introduced
- Highly effective
- Many toxic effects → kidney failure later on
- Dr. Pinkel made a breakthrough by combining high dose chemotherapy and radiation
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Follow the author: nathalievlangen
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