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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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This content is used in:
Mechanisms of Disease 2 2020/2021 UL
- Mechanisms of Disease 2 HC2: Cancer genetics
- Mechanisms of Disease 2 HC3: Cancer biology
- Mechanisms of disease 2 HC4: Cancer etiology
- Mechanisms of disease 2 HC5: Hereditary aspects of cancer
- Mechanisms of Disease 2 HC6: Cancer and genome integrity
- Mechanisms of Disease 2 HC7: Clinical relevance of genetic repair mechanisms
- Mechanisms of Disease 2 HC8: General principles: diagnostic pathology
- Mechanisms of Disease 2 HC9: Nomenclature and grading of cancer
- Mechanisms of Disease 2 HC10: General principles: metastasis
- Mechanisms of Disease 2 HC11: General principles: molecular diagnostics
- Mechanisms of Disease 2 HC12: How did cancer become the emperor of all maladies?
- Mechanisms of Disease 2 HC13: Heterogeneity in cancer
- Mechanisms of Disease 2 HC14: Cancer immunity and immunotherapy
- Mechanisms of Disease 2 HC15: Framework oncology and staging
- Mechanisms of Disease 2 HC16+17: Pharmacology I&II
- Mechanisms of Disease 2 HC18: Biomarkers for early detection of cancer
- Mechanisms of Disease 2 HC19: Surgical oncology
- Mechanisms of Disease 2 HC20: Radiation oncology
- Mechanisms of Disease 2 HC21: Medical oncology
- Mechanisms of Disease 2 HC22: Chemoradiation
- Mechanisms of Disease 2 HC23: Normal hematopoiesis
- Mechanisms of Disease 2 HC24: Diagnostics in hematology
- Mechanisms of Disease 2 HC25: Myeloid malignancies
- Mechanisms of Disease 2 HC26: Malignant lymphomas
- Mechanisms of Disease 2 HC27+28: Allogenic stem cell transplantation and donor lymphocyte infusion I&II
- Mechanisms of Disease 2 HC29: HLA & minor histocompatibility antigens
- Mechanisms of Disease 2 HC30: Changes in patients’ experiences
- Mechanisms of Disease 2 HC31: Targeted therapy and hematological malignancies
- Mechanisms of Disease 2 HC32+33: Primary hemostasis
- Mechanisms of Disease 2 HC34+35: Secondary hemostasis I&II
- Mechanism of Disease 2 HC36: Fibrinolysis and atherothrombosis
- Mechanisms of Disease 2 HC37: Cancer, coagulation and thrombosis
- Mechanisms of Disease 2 HC38: Bleeding disorders
- Mechanisms of Disease 2 HC39: Thrombosis
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Mechanisms of Disease 2 2020/2021 UL
Deze bundel bevat uitwerkingen van alle hoorcolleges, patientdemonstraties en eventuele (proef)tentamens van het blok Mechanisms of Disease 2 van de studie Geneeskunde aan de universiteit Leiden.
- Lees verder over Mechanisms of Disease 2 2020/2021 UL
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