Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How do you discuss avoiding pregnancy in the premenopausal patient while on chemotherapy and/or endocrine therapy?
We have an active discussion in any PRE-menopausal patient, which is documented in the chart along with their method of contraception. A pregnancy test is obtained prior to the start of chemotherapy, but not routinely repeated unless there is reason (e.g. patient reports not using an contraception, ...
How do you counsel a young woman carrying a BRCA 1 or 2 mutation and history of breast cancer who desires pregnancy?
Pregnancy subsequent to breast cancer does not worsen the prognosis. If a young BRCA carrier desires to become pregnant she should be supported. Points to emphasize: 1) the rates of ovarian cancer don't begin to rise until after 35 years; 2) she can be screened by breast ultrasound during pregnancy;...
Do you ever consider hormone replacement therapy in a woman who is suffering from early menopause that has been likely cured of her breast cancer and undergone bilateral mastectomies?
A short period of HRT is OK The fact she has or has not had a bilateral mastectomy does not change my answer
At what point do you refer patients to see a pain specialist?
Great question. In these instances, where the patient comes in for palliative RT for painful bone mets, for example, I tend refer back to the 'involved' palliative care professional or the pain specialist. In the last few years, I have rarely had to become involved with directly prescribing opiates...
Should patients who received pelvic radiation get colonoscopy screenings more often than what is recommended for the general population?
The excess risk of secondary cancer after radiation has been estimated at 0.5% in a 15 year follow-up period. This relatively low incidence would not justify a higher interval of screening colonoscopy after pelvic radiation. As a component of our patient-reported quality of life survey, we do screen...
In which patients do you prescribe Marinol?
The short answer to this question is I prescribe dronabinol to patients who are requesting medical marijuana but don't have a state-issued medical marijuana card yet. It can take 2-3 months for Illinois to issue the card (hooray for bureaucracy!) unless the patient is deemed "terminal" (i.e. <6 mont...
How do you sequence follow up mammograms in patients undergoing breast cancer treatment?
In the followup of patients treated with breast conservation therapy, continuation of yearly mammograms is standard practice, even if the cancer in question was not seen mammographically. It would be quite unusual to be undergoing RT when the yearly mammogram was due, since even with the diagnosis o...
How do you manage significant fatigue caused by androgen deprivation therapy in prostate cancer patients?
This is a great question and one that I think comes up regularly in the clinic. The fatigue often is due to the hypogonadal state, lack of muscle mass and subsequent loss of muscle power that may reduce stamina. I generally recommend a regular activity or exercise program. As in many other patient p...
What interventions besides lubricants do you advise to improve sexual satisfaction for patients s/p ChemoXRT for cervical cancer?
Advise a multimodal approach Additional strategies: 1) Vaginal dilator therapy. Additional visits outside of follow-ups may improve adherence 2) Vaginal moisturizers - Replens, Vitamin E oil, etc. This is outside of water-based lubricants during sexual activity 3) Topical estrogens (many of these pa...
Would you consider HRT in a young woman (<35 years old) with gBRCA mutated TNBC who underwent bilateral mastectomies and BSO?
I would use HRT for the beneficial effects of bone preservation, lipid improvement, sexual function, and quality of life. My preference is for women to have a concurrent hysterectomy with the BSO so the HRT can be estrogen alone, which has little, if any, risk for promoting breast cancer. In the les...