Welch Company
San Francisco, CA


S U M M A R Y


DIARY: June 6, 2003 04:30 PM Friday; Rod Welch

Millie meeting at Kaiser on increase in new lump, plan cancer treatment.

1...Summary/Objective
2...Recovery Progress CA 15-3 Cancer Marker Rises 20% from 45 to 54
3...CA 15-3 Cancer Marker Reverses Trend and Shows Increase of 20%
4...20% Rise CA 15-3 Cancer Marker Does Not Alarm Doctor
5...CT Scan Shows No Evidence of Carcinoma Activity
6...Redness Breast Reduced Thickening Skin Not Evidence of Recurrance
7...Cancer Relapse Not Diagnosed Maintain Life Style Exercise
8...Lump Under Left Arm Very Definite But Not Charasteric of Cancer
9...Routine Life Work Exercise Positive Attitude Healthy Immune System
10...Life Style Maintain Normal Exercise Cancer Recurrance Not Diagnosed
11...Symptom Growing Lump Under Arm Indicates Scar Tissue Not Cancer
12...Pea-like Cluster and Firmness Indicates Cancerous Lumps Not Present
13...Scar Tissue from Surgery and Radiation Diagnosis for Lumps Under Arm
14...Tests Requested Immediately for Cancer Enables Timely Treatment
15...Treatment Timely Attention Prevent Cancer Cascading Out of Control
16...Relapse Symptoms Require Immediate Tests Treatment to Control Disease
17...Symptoms Require PET Test and Biopsy Evaluate Relapse Control Disease
18...Age Not Factor Testing to Diagnose and Treat Cancer Patients
19...Chemotherapy Accumulates to Eventually Cause More Harm that Good
20...Treatment Timely Attention Prevent Cancer Cascading Out of Control
21...Side Effects Treatment Accumulate Cannot Be Tolerated Cause More Harm than Cancer
22...Steady Dose Level Chemotheray for Effective Treatment Recover Cancer
23...Exercise Increases Fitness Blood Counts Rise Strengthens Immune System
24...Exercise Stimulates Bone Marrow Blood Creation
25...Timely Change Treatment When Cancer Mutated and Disease Progresses
26...Mutated Cancer Becomes Increasingly Resistant to Treatment
27...Cancer Mutates Resists Treatment Requires Change to Treat New Mutation
28...Bad News Discussion Sensitive to Tollerance for Emotionally Traumatic
29...Feel Good Management Sensitive Low Tolerance Cancer Managed Not Cured
30...Quality of Life Sensitive Low Tolerance Truth Use Feel Good Management
31...Cure Metastatic Cancer Not Goal Relapse Requires Control and Management
32...Kaiser Relies on Patient Symptoms to Determine Treatment for Relapse
33...Reasonable Testing Timely Treatment to Control Disease
34...Physically Fit Patients Good Candidates for Aggresive Cancer Treatment


..............
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CONTACTS 

SUBJECTS
Meeting with Doctor at Kaiser Review Rising CA 15-3 Cancer Marker Di
CA 15-3 54 Rises from 45 Reversing Prior Trend Reported Last Month

0504 -
0504 -    ..
0505 - Summary/Objective
0506 -
050601 - Follow up ref SDS 50 0000. ref SDS 49 0000.
050602 -
050603 - Meeting today a month ahead of schedule responds to patient request
050604 - last week for examination of red rash suddenly flaring up again on the
050605 - left breast, and growing lump under left arm.  The doctor examined the
050606 - growing lump under Millie's arm where surgery was performed for cancer
050607 - on 020312, and advised this is most likely scar tissue, based on
050608 - experience examining other patients, and on testing. ref SDS 0 N66U
050609 - Doctor's examination today found no significant inflammation of left
050610 - breast. ref SDS 0 7C6W  Millie asked about risk factors for relapse,
050611 - and whether her age at 67 is deterring Kaiser from resuming aggressive
050612 - testing with biopsy, PET and CT scans to evaluate need for further
050613 - treatments? ref SDS 0 NE7L  The doctor said that withholding treatment
050614 - on the basis of age is against the law. ref SDS 0 NE84  He noted
050615 - Millie is in the category of high risk for relapse, and that close
050616 - attention is being given for symptoms and tests that signal the need
050617 - to resume treatment. ref SDS 0 NE4G  Millie's health and vigor are
050618 - characteristic of a strong person age 50, which clearly supports
050619 - aggressive follow up treatment.  This will be evaluated again next
050620 - month in July. ref SDS 0 NE57
050621 -
050622 -
050623 -
050624 -
050625 -
050626 -
050628 -  ..
0507 -
0508 -
0509 - Discussion
0510 -
051001 - Recovery Progress CA 15-3 Cancer Marker Rises 20% from 45 to 54
051002 - CA 15-3 Cancer Marker Reverses Trend and Shows Increase of 20%
051003 -
051004 - Follow up ref SDS 50 SM6M, ref SDS 49 SM6M.
051005 -
051006 - Blood test reported during the meeting on 030508 showed CA 15-3 cancer
051007 - marker increased from 45 to 54, continuing the rise reported on
051008 - 030220, now up 20% in a few months....
051010 -           ..
051011 -          030503......... 54 H............. 030508, ref SDS 50 SM6M
051012 -          030403......... 45 H............. 030403, ref SDS 50 SM6M
051013 -          030220......... 46 H............. 030220, ref SDS 49 5E6L
051014 -          030106......... 37 H............. 030109, ref SDS 47 SM6M
051015 -          021202......... 41 H?............ 021204, ref SDS 43 SP5G
051016 -          021102......... 36 H?............ 021113, ref SDS 42 Y65I
051017 -          021023......... 33 H?............ 021023, ref SDS 41 SQ5I
051018 -          020930......... 33 H?..29........ 021002, ref SDS 40 SQ5I
051019 -          020917......... 36 H?............ 020924, ref SDS 39 SQ5I
051020 -          020717......... 59 H?............ 020726, ref SDS 38 YN5K
051021 -          020629......... 75 H ............ 020705, ref SDS 36 UX6I
051022 -          020608........  67 H ............ 020614, ref SDS 32 0001
051023 -          020603........ 108 H ............ 020607, ref SDS 30 X67F
051024 -          020511........ 117 H ............ 020603, ref SDS 29 PJ4J
051025 -          020419......... 81 H ............ 020430, ref SDS 25 7N5H
051026 -          020321......... 85 H ............ 020405, ref SDS 15 6T8K
051027 -
051029 -  ..
0511 -
0512 -
0513 - Analysis
0514 -
051401 - 20% Rise CA 15-3 Cancer Marker Does Not Alarm Doctor
051402 -
051403 - Follow up ref SDS 50 GJ5M, ref SDS 49 GJ5M
051404 -
051405 - Discussed CA 15-3 in connection with treatment planning below.
051406 - ref SDS 0 NE7L
051407 -
051408 -
051409 -
051410 -
051411 -
0515 -

SUBJECTS
PET Scan Findings Show Previous Metastatic Lymphadenopathy No Longer
Distant Metastasis New Nonspecific May be Post Treatment Trauma Infla
CT Scan Performed for Comparison with PET Scan to Evaluate New Metast
CT Scan Findings Show Previous Metastatic Lymphadenopathy No Longer A
2 New 1 CM Masses in Area of Prior Surgery for Lymph Nodes CT Scan Fi
Distant Metastasis Not Reported in CT Test on 030508

1108 -
110901 -  ..
110902 - CT Scan Shows No Evidence of Carcinoma Activity
110903 -
110904 - Follow up ref SDS 50 LK5L, ref SDS 49 LK5L.
110905 -
110906 - Discussed CT scan test results reported on 030508, ref SDS 50 SP5S, in
110907 - relation to increased symptoms, see below. ref SDS 0 N66J
110908 -
110909 -
110910 -
110911 -
110912 -
1110 -

SUBJECTS
Redness Breast Skin Thickening Firmness Diagnosed as Scaring Healing

1403 -
140401 -  ..
140402 - Redness Breast Reduced Thickening Skin Not Evidence of Recurrance
140403 -
140404 - Follow up ref SDS 50 7C6W, ref SDS 49 0T6N.
140405 -
140406 - Last week sudden severe redness on Millie's left breast led to
140407 - requesting an emergency meeting to examine this condition in advance
140408 - of the next regularly scheduled meeting in July, also, cited in
140409 - relation to increased discomfort from a lump under the left arm,
140410 - discussed below. ref SDS 0 Y45M
140412 -  ..
140413 - The doctor examined Millie's breasts and commented that coloration of
140414 - both breasts now appears to be similar and that there is no pronounced
140415 - "redness" as observed a week ago.  It seemed during the meeting that
140416 - coloration was reduced in the left breast in relation to last week,
140417 - which was a great relief.  The doctor described the condition as
140418 - slightly flushed, typical of post-radiation effects, and largely
140419 - similar to the right breast.
140420 -
140421 -     [On 041117 Doctor Benz in a 2nd opinion from UCSF Medical Center
140422 -     explained that IBC symptoms vary in intensity that wax and wane.
140423 -     ref SDS 65 OS6W
140425 -  ..
140426 - Previously, on 030109 a PET scan test reported mild diffuse uptakes in
140427 - the upper left chest wall. ref SDS 47 L66M  At that time, the doctor
140428 - observed redness of the left breast, ref SDS 47 KW5F, and diagnosed
140429 - cellulitus. ref SDS 47 0T6N  Antibiotic treatment was prescribed,
140430 - ref SDS 47 GK7T, and a month or so later the doctor reported this
140431 - seemed effective, since then red coloration appeared less pronounced,
140432 - ref SDS 49 0T6N, up until last week when things flared up again.  Now,
140433 - today, inflammation has thankfully subsided again.
140435 -  ..
140436 - Today, the doctor noticed thickening of the skin that causes firmness
140437 - in the left breast, and attributed this to normal scaring and healing
140438 - from surgery and radiation, similar to the report on 030109.
140439 - ref SDS 47 KW5F
140440 -
140441 -     [On 030710 temporary redness of the breast can be caused by
140442 -     medication, and since the condition has not persisted, this
140443 -     indicates that observed "redness" does not indicate cancer
140444 -     recurrance. ref SDS 52 7C6W
140446 -      ..
140447 -     [On 040318 redness in left breast treated for cellulitus, delays
140448 -     starting chemotherapy treatment for cancer. ref SDS 57 IM6J
140450 -      ..
140451 -     [On 040429 breast cancer diagnosed in breast skin will require
140452 -     masectomy surgery treatment after 4 - 6 months chemotherapy to
140453 -     reduce redness of skin; tumor board review pending. ref SDS 58
140454 -     4K5J
140456 -      ..
140457 -     [On 040504 during brief meeting prior to chemotherapy treatment,
140458 -     The Doctor mentions inflammatory breast disease. ref SDS 59
140459 -     UR6M
140461 -      ..
140462 -     [On 040517 the pathology report on the biopsy diagnoses metastatic
140463 -     Carcinoma involving dermal lymphmatics consistent with
140464 -     inflammatory carcinoma of the breast. ref SDS 60 6T5G
140466 -      ..
140467 -     [On 040517 research on the Internet indicates that in addition to
140468 -     redness, another symptom of inflammatory breast cancer is
140469 -     thickening of the skin, ref SDS 60 S65H, which might be described
140470 -     as firmness first reported on 030109. ref SDS 47 KW5F
140471 -
140472 -
140473 -
140474 -
1405 -

SUBJECTS
Lump Under Left Arm Bigger More Sensitive to Touch Discomfort Increa
Quality of Life Treatment Objective Metastatic Cancer Not Cure Prolo
Exercise Millie Asks If Rising Cancer Symptoms Should Cause Reducing
Symptom New Lump Under Arms where Cancer Surgery Performed on 020312
Lump Under Left Arm Scar Tissue Cancer Harder to Touch Small Isolate
Discomfort Due to Exercise Stretching Scar Tissue

2108 -
210901 -  ..
210902 - Cancer Relapse Not Diagnosed Maintain Life Style Exercise
210903 - Lump Under Left Arm Very Definite But Not Charasteric of Cancer
210904 - Routine Life Work Exercise Positive Attitude Healthy Immune System
210905 - Life Style Maintain Normal Exercise Cancer Recurrance Not Diagnosed
210906 -
210907 - Follow up ref SDS 50 7C84.
210908 -
210909 - Millie said that in addition to redness in the left breast,
210910 - ref SDS 0 7C6W, the area under the left arm has become increasingly
210911 - more sensitive to the touch, and there is greater discomfort during
210912 - activity, especially exercise at the gym, which she is doing 3 - 5
210913 - times a week.  These symptoms seem to be getting worse, since the
210914 - meeting on 030508, ref SDS 50 7C84, and so, together with increased
210915 - inflammation in the left breast, this meeting was requested in advance
210916 - of the regularly scheduled examination next month.
210918 -  ..
210919 - PET testing on 021218 was reported on 030109 to show mild diffuse
210920 - uptakes in the left axillary, ref SDS 47 L66M, and CT testing on
210921 - 030428 reported last month on 030508 small 1 cm lyhmph nodes in the
210922 - left axilla. ref SDS 50 VM8N
210924 -  ..
210925 - Millie asked if these "dots" line up with discomfort under the left
210926 - arm, and should vigorous exercise be avoided; or, should she cut back
210927 - on normal activities?
210929 -  ..
210930 - The doctor asked if it is painful using the left arm for normal
210931 - activity, including exercise.
210933 -  ..
210934 - Millie explained the problem is more of a "tug" under the left arm
210935 - that does not occur when raising the right arm.  Since it is new and
210936 - different, "worrisome discomfort" is a better description than "pain."
210938 -  ..
210939 - The doctor advised that until there is actual pain patients should
210940 - maintain normal activities that fit their overall capacities.  Since
210941 - there is no evidence of cancer, Millie can continue routine work and
210942 - exercise that maintain a postitive, forward looking attitude.  An
210943 - active life going to work and engaging family and friends doing daily
210944 - routine of normal life, with regular exercise all help maintain the
210945 - body's natural immune system, that is under attack by both cancer and
210946 - chemotherapy treatment to fight cancer.
210948 -      ..
210949 -     [On 070301 research ANC blood counts neutropenia weakens immune
210950 -     system; when ANC fall below 500 causes severe risk of disease and
210951 -     infection. ref SDS 86 R13I
210953 -  ..
210954 - Keeping active with an agenda of things to do and engaging other
210955 - people creates positive synergy with medical care that greatly aids
210956 - recovery by allowing time for treatment to be effective.  Patients who
210957 - disengage from normal activities on the job and at home, create
210958 - negative synergy from worry, stress, and anxiety about having a life
210959 - threatening disease, causing patients to give up on performing the
210960 - rigours of treatment and continuing exericse essential for recovery,
210961 - discussed again below. ref SDS 0 5B4H
210962 -
210963 -     [...below, the doctor cites Millie's good health aided by vigorous
210964 -     exercise enables vigorous treatment of cancer, rather than concern
210965 -     to reduce treatment due to frailties of age. ref SDS 0 NE57
210967 -      ..
210968 -     [...below, the doctor explains chemotherapy treatments accumulate
210969 -     to eventually cause more harm than good. ref SDS 0 NE84
210971 -      ..
210972 -     [On 031205 doctor commended patient's good habits maintaining
210973 -     general good health through sensible diet and exercise are factors
210974 -     that stabalize and control advance of disease. ref SDS 55 GW8F
210976 -      ..
210977 -     [On 041019 Doctor Guardino made a similar recommendation during a
210978 -     meeting at Stanford Cancer Center. ref SDS 64 NN6N
210980 -      ..
210981 -     [On 050609 article reports study found exercise repairs some of
210982 -     the cumulative damage chemotherapy causes to the immune system;
210983 -     this prolings effectiveness of chemotherapy treatment to aid
210984 -     recovery from breast cancer, ref SDS 74 F88M; quality of life from
210985 -     strength and range of motion are obvious benefits of exercise.
210986 -     ref SDS 74 F93X
210988 -      ..
210989 -     [On 060217 patient experiences emotional trauma from dramatic
210990 -     recovery; status NED, strength, vigor, engagement return, but
210991 -     adjustment needed from emotional shock; primary care physician
210992 -     makes referral to BMS for counseling, and recommends continuing
210993 -     exercise, and normal activity to ease adjustments. ref SDS 78 Y642
210995 -      ..
210996 -     [On 060810 Millie ANC 1408 blood counts too low refused treatment
210997 -     becuase immune system weakened by chemotherapy, ref SDS 81 5K4F;
210998 -     conflicts case study showing Millie's patient history getting
210999 -     chemotherpay regularly when blood counts low. ref SDS 81 5K4F
211001 -      ..
211002 -     [On 070301 research ANC blood counts neutropenia weakens immune
211003 -     system; when ANC fall below 500 causes severe risk of disease and
211004 -     infection. ref SDS 86 R13I
211006 -      ..
211007 -     [On 080401 Millie notified NP of plans for returning to work under
211008 -     advice of the doctor in order to improve chances of recovery from
211009 -     cancer. ref SDS 90 5E9R
211011 -      ..
211012 -     [On 080501 exercise and fitness increases after starting
211013 -     Carboplatin chemotherapy on 2nd arm of clincial study Millie
211014 -     treated on referral at UCSF. ref SDS 91 FW5J
211016 -      ..
211017 -     [On 080807 Millie released from medical disability leave by UCSF
211018 -     to return to work at NP after demonstrating recovery from 4th
211019 -     relapse of cancer. ref SDS 93 HX8G
211021 -      ..
211022 -     [On 080918 favorable examination and testing despite missing 20%
211023 -     of treaments and lower dose of chemotherapy attributed to
211024 -     increased fitness from increased exercise that strengthens the
211025 -     immune system to resist cancer. ref SDS 94 3E4G
211027 -      ..
211028 -     [On 081018 report in seminar that recent research indicates
211029 -     exercise improves recovery from cancer and resists recurrence by
211030 -     60%. ref SDS 95 IT68
211032 -  ..
211033 - The doctor examined the lump under Millie's left arm.  He commented
211034 - that the lump is now very definite, whereas in the meeting on 030508
211035 - the doctor did not notice the lump at that time. ref SDS 50 7C9G
211036 -
211037 -     [On 040713 doctor examines lump under left arm and reports that
211038 -     swelling seems significantly reduced, indicating favorable
211039 -     response to chemotherapy treatment. ref SDS 62 RW9H
211040 -
211042 -  ..
211043 - Symptom Growing Lump Under Arm Indicates Scar Tissue Not Cancer
211044 - Pea-like Cluster and Firmness Indicates Cancerous Lumps Not Present
211045 - Scar Tissue from Surgery and Radiation Diagnosis for Lumps Under Arm
211046 -
211047 - The doctor explained that he has examined many patients with similar
211048 - lumps.  He drew a diagram on the marking board showing the lump he
211049 - feels under the left arm is just beneath the surface of the skin.  The
211050 - doctor noted that the CT scan report, reviewed during the meeting on
211051 - 030508, showed two (2) new 1 CM masses in the lymph node area under
211052 - the left arm, ref SDS 50 SP5S, which he feels are deeper in the body
211053 - than the "surface" lump examined today.  The CT scan, therefore, did
211054 - not "see" this lump because it is too soft.
211056 -         ..
211057 -        [On 030710 new CT test showed that lymph nodes in left axilla
211058 -        increased in size from 1 CM to 1.5 CM. ref SDS 52 VM7I
211060 -  ..
211061 - The Doctor pointed to the tip of his nose as an example of
211062 - firmness connoting cancer that produces an image detected in CT scan
211063 - testing.  He also explained that cancer often seems like several
211064 - small, isolated peas, rather than a single large cushy soft mass that
211065 - characterizes the lump under Millie's arm today.
211067 -  ..
211068 - This is all good news.
211070 -  ..
211071 - The doctor noted that these criteria together with the location of the
211072 - lump directly beneath where the incision was made for surgery on
211073 - 020312, ref SDS 10 0001, are, therefore, more indicative that the lump
211074 - is scar tissue and not cancerous.  He further seemed to indicate that
211075 - discomfort during exercise is a positive sign, because it shows Millie
211076 - is stretching the scar tissue.  Without exercise, healing scar tissue
211077 - diminishes range of motion.  As a result, he is pleased to hear about
211078 - mild discomfort, because this means good patient practice that aids
211079 - recovery from surgery scar tissue.
211080 -
211081 -        [On 040713 doctor examines lump under left arm and reports that
211082 -        swelling seems significantly reduced, indicating favorable
211083 -        response to chemotherapy treatment. ref SDS 62 RW9H
211085 -  ..
211086 - Millie asked about the prospect that hard, cancerous material might be
211087 - occurring beneath the scar tissue?  In other words, could there be
211088 - both cancer forming that can be treated, as well as scar tissue that
211089 - may be concealing cancer?
211091 -  ..
211092 - The doctor said that may be possible but is very unlikely, based on
211093 - available data.
211095 -      ..
211096 -     [On 040429 breast cancer diagnosed in skin will require masectomy
211097 -     after 4 - 6 months chemotherapy to reduce redness of skin; tumor
211098 -     board review pending. ref SDS 58 4K5J
211099 -
211100 -
211101 -
211102 -
211103 -
2112 -

SUBJECTS
CA 15-3 Kaiser Close Attention Cancer Marker 54 Increase 50% Since E

2903 -
290401 -  ..
290402 - Tests Requested Immediately for Cancer Enables Timely Treatment
290403 - Treatment Timely Attention Prevent Cancer Cascading Out of Control
290404 - Relapse Symptoms Require Immediate Tests Treatment to Control Disease
290405 - Symptoms Require PET Test and Biopsy Evaluate Relapse Control Disease
290406 -
290407 - Follow up ref SDS 50 7C98.
290408 -
290409 - Millie cited 20% rise in CA 15-3 reported during the meeting on
290410 - 030508, per above, ref SDS 0 SM6M, together with new reports of red
290411 - rash spreading on the left breast, just examined, ref SDS 0 7C6W, and
290412 - the CT scan test that found new masses having formed, discussed above.
290413 - ref SDS 0 N66J  Recent research on the Internet showed cases where
290414 - there was relapse that required additional treatment following
290415 - occurrence of similar indicators.  Such indicators together with high
290416 - risk conditions in the pathology report following surgery on 020312,
290417 - ref SDS 10 7V61, require increased attention in light of the doctor's
290418 - review in a meeting on 020321 that pointed out metastatic carcinoma
290419 - tumor infiltrating through the capsule into the perinodal fatty
290420 - tissue, left breast sentinel lymph node. ref SDS 13 4U8X
290422 -  ..
290423 - The doctor said that Millie's patient history, including rising CA
290424 - 15-3 cancer marker, definitely deserves attention.  That is why he
290425 - agreed to a meeting today on short notice, a month prior to the follow
290426 - up meeting previously scheduled for July.  The doctor indicated that,
290427 - at this time, there is not sufficient evidence from tests and clinical
290428 - examinations that suggests progression of disease requiring treatment
290429 - for recurrence.
290430 -
290431 -     [On 050311 the doctor plans to follow up to get feedback from the
290432 -     surgeon on a consultation for surgery, because worsening symptoms
290433 -     deserve attention. ref SDS 69 PB6J
290435 -      ..
290436 -     [On 050729 doctor maintains aggressive chemotherapy treatment to
290437 -     avoid another relapse, based on another rise in CA 15-3.
290438 -     ref SDS 75 VP4N
290440 -      ..
290441 -     [On 071023 Doctor Rugo at UCSF explains cancer marker increase
290442 -     from 56 in May to 74 in October guides looking more carefully and
290443 -     does not suggest cut off of 80 for consideration of treatment
290444 -     regimen. ref SDS 89 V65R
290446 -  ..
290447 - Millie became emotional.  She is worried her cancer is spreading, and
290448 - asked about doing a biopsy, and PET scan to test immediately for signs
290449 - of cancer in addition to severe red rash on her left breast discussed
290450 - today, per above, ref SDS 0 7C6W, and also discomfort under the left
290451 - arm, which required an emergency examination today, per above,
290452 - ref SDS 0 Y45M, in order to begin treatment that attacks new cancer
290453 - before it grows out of control?
290455 -  ..
290456 - The doctor advised that his oncology team is paying close attention to
290457 - start Millie's treatment in time to prevent cancer from spreading out
290458 - of control to a point that cannot be treated effectively.  He
290459 - emphasized that delaying treatment without careful monitoring risks
290460 - allowing cancer to become so severe that nothing can help the patient.
290462 -  ..
290463 - The doctor feels at this time that monitoring with a biopsy is still
290464 - not necessary to test for cancer, as discussed last month on 030508,
290465 - ref SDS 50 7C98  The doctor feels next month will be a good time to
290466 - order biopsy and PET scan tests, based on results of the CT test
290467 - already scheduled for the end of the month.  He feels that if the CT
290468 - test reveals problems or is unclear, then a biopsy can be ordered, and
290469 - another PET scan test can update fidings for the PET scan test on
290470 - 021228, and analysed in a meeting with the patient on 030109.
290471 - ref SDS 47 GK51
290473 -  ..
290474 - There was discussion that good intentions of busy people to take
290475 - future action often get derailed, because people cannot remember how
290476 - small details that are separated by time and distance line up to
290477 - signal actionalble issues.  As the saying goes, things "fall through
290478 - the cracks," and "get lost in the shuffle," reviewed on 950204.
290479 - ref SDS 1 0550  A one month delay proposed today stretches into two,
290480 - then three months go by while damage accumulates making recovery more
290481 - and more difficult.  Without continuing attention, people forget until
290482 - suddenly a critical mass of unintended consequences explodes an
290483 - initially small problem into major crisis.
290485 -  ..
290486 - The doctor assured that this will not happen in this case.
290487 -
290488 -     [On 030710 the doctor deferred biopsy and PET scan tests.
290489 -     ref SDS 52 WS3M
290491 -      ..
290492 -     [On 030710 the doctor explained theory and practice to delay
290493 -     follow up treatments until observable symptoms of metastasis
290494 -     appear. ref SDS 52 RU4P
290496 -      ..
290497 -     [On 030915 patient requests PET scan and other tests to schedule
290498 -     treatment of rising symptoms. ref SDS 53 7C6W
290500 -      ..
290501 -     [On 040517 inflammatory breast cancer diagnosed in pathology
290502 -     report of biopsy taken from left breast. ref SDS 60 736K
290504 -      ..
290505 -     [On 090205 Doctor Johnson trying to improve communication with
290506 -     UCSF on referral treatment, so that Millie does not "fall through
290507 -     the cracks. ref SDS 96 278T
290508 -
290509 -
290510 -
290511 -
2906 -

SUBJECTS
Chemotherapy Side Effects Accumulates to Eventually Cause More Harm
Test Immediately for Cancer Enables Timely Treatment Doctor Johnson
Recurrence Metastatic Cancer Cure Impossible Due to High Risk Factor
Chemotherapy Levels Steady Effective Treatment Balanced Against Chem

3706 -
370701 -  ..
370702 - Age Not Factor Testing to Diagnose and Treat Cancer Patients
370703 - Chemotherapy Accumulates to Eventually Cause More Harm that Good
370704 - Treatment Timely Attention Prevent Cancer Cascading Out of Control
370705 - Side Effects Treatment Accumulate Cannot Be Tolerated Cause More Harm than Cancer
370706 -
370707 - Millie asked if her age at 67 is limiting the doctor's treatment, and
370708 - related having seen reports that doctors, HMOs and insurers have
370709 - arbitrarily avoided care for older patients in order to allocate
370710 - greater resources to treat younger people?
370712 -  ..
370713 - The doctor said that allocating treatment on the basis of age is
370714 - against the law.
370715 -
370717 -  ..
370718 - Steady Dose Level Chemotheray for Effective Treatment Recover Cancer
370719 - Exercise Increases Fitness Blood Counts Rise Strengthens Immune System
370720 -
370721 - The doctor explained that infirmities from loss of fitness increase
370722 - with advancing age.  Patients need a steady level of chemotherapy in
370723 - order for treatments to be effective recovering from cancer.  Several
370724 - factors make this difficult.
370726 -  ..
370727 - Cancer treatments compound infirmities of age, because chemotherapy
370728 - drugs are "poisons" that attack cancer, but also kill healthy cells,
370729 - discussed above. ref SDS 0 LZ3L  Therefore, treating cancer reduces
370730 - the body's natural process of bone marrow replenishing blood counts
370731 - that maintain the immune system.  WBC and neutrophils are primary
370732 - components of Absolute Neutrophils Count (ANC).  Chemotherapy has
370733 - "side effects" that continually lower ANC.  As the the immune system
370734 - weakens, risks increase for cancer to cascade out of control,
370735 - requiring more chemotherapy, which in turn further weakens the immune
370736 - system.  Reducing immunity also increases risk of disease and
370737 - infection that become more lethal than cancer, e.g., pneumonia.
370738 -
370739 -        [On 030710 doctor discussed a theory of delaying treatment for
370740 -        cancer until patients suffer symptoms of cancer. ref SDS 52
370741 -        FZ55
370743 -         ..
370744 -        [On 040416 Doctor Johnson explained again that cancer patients
370745 -        need a steady level of chemotherapy in order for treatment to
370746 -        be effective. ref SDS 61 6T7F
370748 -         ..
370749 -        [On 060721 Kaiser implemented policy to maintain dose level of
370750 -        chemotherapy for effective cancer treatment. ref SDS 80 KP6J
370752 -         ..
370753 -        [On 101228 1007 Millie's son diagnosed Hodgkin's Lymphoma
370754 -        having difficulty maintaining blood counts after chemotherapy;
370755 -        got blister; trying to exercise, needed blood transfusion to
370756 -        continue treatment despite dose reduction. ref SDS 97 X88L
370768 -  ..
370769 - Synergy of compounding dynamics reduce ability of older patients with
370770 - inevitable declining exercise and fitness to endure aggressive
370771 - chemotherapy that enables recovery from cancer sufficient to have a
370772 - normal to near-normal life.  Maintaining fitness through regular
370773 - exercise helps maintain the immune system that resists cancer, and
370774 - also enables aggressive treatment.
370776 -         ..
370777 -        [On 041019 Doctor Guardino recommended Millie stay active on
370778 -        the job, and exercies, during a meeting at Stanford Cancer
370779 -        Center. ref SDS 64 NN6N
370781 -         ..
370782 -        [On 050609 article reports study found exercise repairs some of
370783 -        the cumulative damage chemotherapy causes to the immune system;
370784 -        this prolings effectiveness of chemotherapy treatment to aid
370785 -        recovery from breast cancer, ref SDS 74 F88M; quality of life
370786 -        from strength and range of motion are obvious benefits of
370787 -        exercise. ref SDS 74 F93X
370789 -         ..
370790 -        [On 060810 Millie ANC 1408 blood counts too low refused
370791 -        treatment becuase immune system weakened by chemotherapy,
370792 -        ref SDS 81 5K4F; conflicts case study showing Millie's patient
370793 -        history getting chemotherpay regularly when blood counts low.
370794 -        ref SDS 81 HV45
370796 -         ..
370797 -        [On 070301 research ANC blood counts neutropenia weakens immune
370798 -        system, ref SDS 86 O59H; ANC below 500 causes severe risk of
370799 -        disease and infection. ref SDS 86 R13I
370801 -         ..
370802 -        [On 080502 Millie shows good response to treatment on clinical
370803 -        study cetuximab and Carboplatin; tolerating Carboplatin
370804 -        Chemotherapy enables exercise that helps maintain blood counts
370805 -        along with Neupogen. ref SDS 92 ZD9O
370807 -         ..
370808 -        [On 080502 after 7 years of chemotherapy treatment, Millie
370809 -        having trouble maintaining blood counts to get additional
370810 -        treatment; exercise and Neupogen trying to solve problem.
370811 -        ref SDS 92 NL4W
370813 -         ..
370814 -        [On 081018 report in seminar that recent research indicates
370815 -        exercise improves recovery from cancer and resists recurrence
370816 -        by 60%. ref SDS 95 IT68
370818 -  ..
370819 - The doctor noted that Millie's lifestyle of fitness enables aggressive
370820 - chemotherapy despite advancing age.  He encouraged staying active on
370821 - the job, engaged with family, and keeping fit, as much as possible in
370822 - the face of debilitating side effects of cancer and chemotherapy,
370823 - also, discussed above. ref SDS 0 LZ3L
370824 -
370825 -        [On 050609 article reports study found exercise repairs some of
370826 -        the cumulative damage chemotherapy causes to the immune system;
370827 -        this prolongs effectiveness of chemotherapy treatment to aid
370828 -        recovery from breast cancer, ref SDS 74 F88M; quality of life
370829 -        from strength and range of motion are obvious benefits of
370830 -        exercise. ref SDS 74 F93X
370832 -         ..
370833 -        [On 070607 Millie Cellulitis recurrence from exercise to
370834 -        maintain fitness and strengthen immune system to resist
370835 -        cancer. ref SDS 88 6A7J
370837 -         ..
370838 -        [On 080918 favorable examination and testing despite missing
370839 -        20% of treaments and lower dose of chemotherapy attributed to
370840 -        increased fitness from increased exercise that strengthens the
370841 -        immune system to resist cancer. ref SDS 94 3E4G
370843 -         ..
370844 -        [On 081018 report in seminar that recent research indicates
370845 -        exercise improves recovery from cancer and resists recurrence
370846 -        by 60%. ref SDS 95 IT68
370848 -  ..
370849 - Standard of care for cancer tests blood counts the day before and/or
370850 - the day of treatment to verify the strength of the immune system so
370851 - that the patient can safely receive treatment.  If counts are too low,
370852 - then treatment may be delayed until another test shows rising blood
370853 - counts that signal recovery of the immune system to withstand further
370854 - attack by chemotherapy.  Sometimes the dose of treatment is reduced so
370855 - that the patient continues to attack cancer and prevent metastatsis
370856 - from cascading out of control.  Patients may receive complementary
370857 - treatment with neupogen that accelerates the rate of blood counts
370858 - increasing.
370860 -         ..
370861 -        [...below, Millie asks about age again as grounds for not
370862 -        treating current symptoms; doctor cites Millie's general health
370863 -        from commitment to regular exercise enables aggressive
370864 -        treatment. ref SDS 0 NE5G
370866 -         ..
370867 -        [On 050729 doctor attributes symptoms pulmonary embolism
370868 -        shortness of breath, fatigue, heavy chest, ref SDS 75 JP9J, to
370869 -        loss of fitness from not exercising due to debilitating effects
370870 -        of chemotherapy treatment for cancer, ref SDS 75 RZ4I; doctor
370871 -        cites Millie's lifestyle of fitness contributing to ability to
370872 -        recover from cancer. ref SDS 75 Y85G
370874 -         ..
370875 -        [On 060607 Millie hospitalized diagnosed with pneumonia.
370876 -        ref SDS 79 PR5R
370878 -         ..
370879 -        [On 060810 treatment denied ANC blood count slightly below
370880 -        Kaiser criteria for safe treatment while CA 15-3 cancer marker
370881 -        rising. ref SDS 81 5K4F
370883 -         ..
370884 -        [On 060810 case study shows Millie's good health from life
370885 -        style of exercise permits aggressive treatment despite low
370886 -        blood counts. ref SDS 81 HV45
370888 -         ..
370889 -        [On 070116 protocol for cetuximab clinical study requires
370890 -        weekly blood tests for normal cancer care. ref SDS 83 5U7Z
370892 -         ..
370893 -        [On 070201 UCSF scheduled blood tests every 4 weeks rather than
370894 -        weekly, because Millie randomized to get treatment with only
370895 -        cetuximab. ref SDS 84 XR40
370897 -         ..
370898 -        [On 070301 example ANC low blood counts; cetuximab clinical
370899 -        study weekly treatments not enough time for bone marrow to
370900 -        replenish blood, wicked problem because cancer spreading
370901 -        requires increasing chemotherapy which reduces blood counts;
370902 -        weakening the immune system increases risk of contracting other
370903 -        infectious diseases. ref SDS 86 D24M
370905 -         ..
370906 -        [On 070516 patient reports working out training hard in the gym
370907 -        to build fitness. ref SDS 87 TN3M
370909 -         ..
370910 -        [On 070607 Millie suffers recurrence Cellulitis
370911 -        inflammation envelopes left arm trauma complications
370912 -        lymphedema, high fever possibly from working out and
370913 -        training too hard in the gym. ref SDS 88 ZH6I
370915 -         ..
370916 -        [On 080502 after 7 years of chemotherapy treatment, Millie
370917 -        having trouble maintaining blood counts to get additional
370918 -        treatment. ref SDS 92 NL4W
370919 -
370921 -  ..
370922 - Exercise Stimulates Bone Marrow Blood Creation
370923 -
370924 - The doctor explained that maintaining fitness through regular exercise
370925 - stimulates blood creation that maintains the immune system.  Cancer
370926 - causes fatigue, tiredness, weakness, and feeling "lousy," which leads
370927 - to reducing exercise, causing loss of fitness and shortness of breath
370928 - with normal exertion which are common side effects of prolonged
370929 - chemotherapy.
370931 -         ..
370932 -        [On 040614 exercise stimulates process of bone marrow creating
370933 -        new blood that maintains immune system; but, age and treatment
370934 -        for cancer with chemotherapy sap energy to reduce energy; since
370935 -        chemotherapy reduces blood counts, reducing the rate of blood
370936 -        creation delays treatment which increases risk of cancer
370937 -        cascading out of control and that other diseases will infect
370938 -        the patient's weakened immune system. ref SDS 61 6T7F
370940 -         ..
370941 -        [On 050609 article reports study found exercise repairs some of
370942 -        the cumulative damage chemotherapy causes to the immune system;
370943 -        this prolings effectiveness of chemotherapy treatment to aid
370944 -        recovery from breast cancer, ref SDS 74 F88M; quality of life
370945 -        from strength and range of motion are obvious benefits of
370946 -        exercise. ref SDS 74 F93X
370948 -         ..
370949 -        [On 070607 Millie Cellulitis recurrence from exercise to
370950 -        maintain fitness and strengthen immune system to resist
370951 -        cancer. ref SDS 88 6A7J
370953 -         ..
370954 -        [On 081018 report in seminar that recent research indicates
370955 -        exercise improves recovery from cancer and resists recurrence
370956 -        by 60%. ref SDS 95 IT68
370958 -         ..
370959 -        [On 101228 1007 Millie's son diagnosed Hodgkin's Lymphoma
370960 -        having difficulty maintaining blood counts after chemotherapy;
370961 -        got blister; trying to exercise, needed blood transfusion to
370962 -        continue treatment despite dose reduction. ref SDS 97 X88L
370964 -  ..
370965 - Harmful side effects of chemotherapy drugs accumulate in all patients.
370966 - Many scenarios arise, when, at some point, a particular drug is no
370967 - longer effective, and/or cannot be tolerated because of debilitating
370968 - side effects that sap energy, vitality, and even interest in life.
370969 - This is a bigger problem for older, infirm, and inactive patients,
370970 - than for younger people, who can exercise regularly to maintain the
370971 - immune system; but, eventually continuous chemotherapy accumulates
370972 - side effects in all patients that become debilitating.
370974 -         ..
370975 -        [On 110124 2110 Peggy called and reported that Millie's
370976 -        son, Ron Junior, age 56, died from heart attack while in
370977 -        hospital for another blood transfusion to recover from low
370978 -        blood counts caused by chemotherapy to treat cancer
370979 -        diagnosed in November 2010, as Hodgkin's Lymphoma.
370980 -        ref SDS 98 PL4F
370982 -  ..
370983 - The doctor explained that switching treatments can reduce accumulation
370984 - of side effects.  Each patient reacts somewhat differently to
370985 - chemotherapy based on body chemestry and other factors, e.g., fitness,
370986 - age, prior illness, etc.  When a chemotherapy agent becomes
370987 - intolerable or ineffective, the doctor switches to another treatment
370988 - that might be better tolerated and still effective for a particular
370989 - type of cancer - breast, lung, pancreas, esophageal, etc.  This is
370990 - experimentation switching among a short list of proven agents, like
370991 - Millie was switched to Taxotere last year on 020603, because her
370992 - cancer resisted treatment with AC. ref SDS 29 WO4O
370993 -
370994 -     [On 041130 Doctor Johnson was upset being asked for a list of
370995 -     chemotherapy treatments available at Kaiser for Millie to recover
370996 -     from cancer, ref SDS 66 YR8F; he scribbled a list on tissue torn
370997 -     from the examination table. ref SDS 66 FY5F
370999 -      ..
371000 -     [On 070105 1040 Doctor Johnson prescribes cetuximab that is a new
371001 -     kind of therapy targeted to the genetic profile of cancer, and so
371002 -     kills cancer better than chemotherapy, and enables quality of life
371003 -     during treatment, because "targeted" treatments kill only cancer,
371004 -     and do not kill healthy cells, so there are no painful side
371005 -     effects that occur with chemotherapy, thus providing recovery from
371006 -     cancer with quality of life. ref SDS 82 JE7N
371008 -  ..
371009 - Many patients recover enough to end chemotherpay, at least for awhile.
371010 - In rare cases, cancer is "cured."  The patient never relapses,
371011 - discussed further below. ref SDS 0 589J  Often patients achieve
371012 - remission where there are no symptoms for months even years.  Most
371013 - often patients recover enough to take a break from treatment,
371014 - sometimes called a "treatment holiday."  When treatment ends or is
371015 - paused for at least a few weeks, most side effects dissipate, enabling
371016 - patients to live normal to near normal lives while off treatment.
371017 -
371018 -     [...below, doctor notices Millie is in excellent condition from
371019 -     life style of regular exercise. ref SDS 0 NE57
371021 -      ..
371022 -     [On 031205 doctor commended patient's good habits maintaining
371023 -     general good health through sensible diet and exercise are factors
371024 -     that help stabalize and control advance of disease. ref SDS 55
371025 -     GW8F
371027 -      ..
371028 -     [On 050422 patient diary of side effects. ref SDS 71 JY3N
371030 -      ..
371031 -     [On 050516 during treatment for relapse when patient contracts
371032 -     IBC, one of the most severe forms of cancer, Kaiser pauses
371033 -     treatment with capecitabine (Xeloda) because debilitating side
371034 -     effects make death seem better than continuing treatments.
371035 -     ref SDS 72 AQ6G
371037 -      ..
371038 -     [On 050520 patient makes remarkable progress toward recovery from
371039 -     IBC, ref SDS 73 025H; doctor reduces dose of capecitabine (Xeloda)
371040 -     by 25% to experiment finding a level of treatment the patient can
371041 -     tolerate, while being effective to continue recovery. ref SDS 73
371042 -     V43H
371044 -      ..
371045 -     [On 050729 side effects escalate, very difficult to tolerate
371046 -     again, even with 25% reduced dose on 050520, ref SDS 75 DS5J,
371047 -     doctor maintains strength of capecitabine (Xeldoa) for two (2)
371048 -     more treatments to guard against another relapse. ref SDS 75 VP4N
371050 -      ..
371051 -     [On 050729 Kaiser's pharmacist reports practice of starting
371052 -     patients with maximum dose of chemotherapy drugs, then reduce to a
371053 -     level the patient can tolerate. ref SDS 76 407N
371055 -      ..
371056 -     [On 070218 energy increases, shortness of breath, fatigue,
371057 -     weakness subside 10 weeks after ending treatment for 3rd relapse
371058 -     of IBC with Taxotere and cacecitabine; Millie is exercising in the
371059 -     gym again, playing tennis 2 days her pulse reached 144.
371060 -     ref SDS 85 N05H
371061 -
371062 -
371063 -
371064 -
3711 -

SUBJECTS
Mutated Cancer Becomes Increasingly Resistant to Treatment Biology T

4303 -
430401 -  ..
430402 - Timely Change Treatment When Cancer Mutated and Disease Progresses
430403 - Mutated Cancer Becomes Increasingly Resistant to Treatment
430404 - Cancer Mutates Resists Treatment Requires Change to Treat New Mutation
430405 -
430406 - The doctor explained that cancer cascades quickly out of control
430407 - without timely treatment, including switching chemotherapy agents,
430408 - when side effects of a particular drug can no longer be tolerated, and
430409 - when effectiveness declines because cancer cells mutate over time into
430410 - a form that resists treatment.
430412 -  ..
430413 - Cancer is a biological growth of mutated DNA cells that attack, rather
430414 - than sustain life.  New cancer cells vary slightly under a theory of
430415 - evolution that drives biological gene mutation.
430416 -
430417 -     [On 040312 lectures on 21st century science describe "genes
430418 -     mutate" as the basis for a theory of evolution in biology,
430419 -     ref SDS 56 JT9K, which further reflects a theory of emergence in
430420 -     the universe arising from random numbers. ref SDS 56 V47I
430422 -  ..
430423 - Some variations of new cancer cells resist the drug prescribed to
430424 - treat the cancer.  Over months, and hopefully years, eventually a
430425 - resistant variant expands and replaces the original disease that has
430426 - been mostly suppressed if not totally died out from treatment.  At
430427 - this stage, cancer "progresses" because firstline treatment is no
430428 - longer effective, and so must be changed to secondline drug agent that
430429 - can attack the mutated cancer cells.  Selecting secondary, and
430430 - tertiary treatment appears to be a matter of trial and error.  Mutated
430431 - cancer becomes increasingly difficult to treat by any method.
430432 -
430433 -     [On 040318 primary care physician explains treatment with
430434 -     drugs in clinical trials implements Kaiser's standard of care
430435 -     for oncology by allowing the doctor to hold in reserve
430436 -     powerful established drugs until needed to prolong quality of
430437 -     life. ref SDS 57 DG4X
430439 -      ..
430440 -     [On 041117 UCSF 2nd opinion cites Millie likely to relapse.
430441 -     ref SDS 65 OU5V
430443 -      ..
430444 -     [On 041130 the doctor explained strategy for starting and changing
430445 -     protocols in treating relapse of IBC with a new drug trial.
430446 -     ref SDS 66 028N
430448 -  ..
430449 - Changing treatment protocols, discussed above, ref SDS 0 RY5J, are
430450 - judgement calls, which the doctor makes on a case-by-case basis in
430451 - consultation with the patient, and colleagues under Kaiser's Team Care
430452 - practice.  The goal of case management for metastatic disease is to
430453 - stretch out use of a limited number of available treatments to enable
430454 - long term effectiveness for quality of life, rather than overload the
430455 - body all at once, which prevents prolonged care.
430457 -      ..
430458 -     [On 030616 research shows emotional challenges of recovering from
430459 -     cancer. ref SDS 51 0001
430461 -      ..
430462 -     [On 030710 treatments are delayed and witheld in reserve to
430463 -     stretch out and prolong quality of life until cancer progresses to
430464 -     a point where treatment will have maximum effect. ref SDS 52 FZ55
430466 -      ..
430467 -     [On 030710 treatments become less effective with each relapse,
430468 -     switching to another drug occurs sooner until no drugs are
430469 -     effective. ref SDS 52 IV4N
430471 -      ..
430472 -     [On 031010 article reports 50% of breast cancer patients relapse
430473 -     within five (5) years, which underscores importance of timely
430474 -     discovery and treatment to prevent cancer from getting out of
430475 -     control. ref SDS 54 GX8K
430477 -      ..
430478 -     [On 040318 Millie's triple negative status limits drugs for
430479 -     treatment; clinical trials expand drugs for treating metastatic
430480 -     cancer. ref SDS 57 DG4J
430482 -      ..
430483 -     [On 040517 inflammatory breast cancer (IBC) diagnosed in pathology
430484 -     report of biopsy taken from left breast. ref SDS 60 736K
430486 -      ..
430487 -     [On 040517 research found IBC is a rare, aggressive, and most
430488 -     lethal form of breast cancer that requires timely treatment
430489 -     targeted for the IBC disease. ref SDS 60 LK8L
430491 -      ..
430492 -     [On 040517 case study developed, ref SDS 60 S66O, for treatment
430493 -     planning, ref SDS 60 S79G, and consideration of lessons learned.
430494 -     ref SDS 60 PW8F
430496 -      ..
430497 -     [On 040713 doctor examines lump under left arm and reports that
430498 -     swelling seems significantly reduced, indicating favorable
430499 -     response to chemotherapy treatment. ref SDS 62 RW9H
430501 -      ..
430502 -     [On 041130 the doctor explained treatment strategy to avoid using
430503 -     combinations (couplets) of drugs in order to lengthen the time for
430504 -     treatment, as patient tolerance for side effects forces change to
430505 -     a different drug among a limited number of drugs available for
430506 -     cancer. ref SDS 66 5X4J
430508 -      ..
430509 -     [On 041130 the doctor provided a list of chemotherapy drugs which
430510 -     can be tried to stretch out the opportunity for recovery and/or
430511 -     quality of life beyond the period when side effects become
430512 -     intolerable for any particular drug treatment. ref SDS 66 FY5F
430514 -      ..
430515 -     [On 050609 article reports study found exercise repairs some of
430516 -     the cumulative damage chemotherapy causes to the immune system;
430517 -     this prolongs effectiveness of chemotherapy treatment to aid
430518 -     recovery from breast cancer, ref SDS 74 F88M; quality of life from
430519 -     strength and range of motion are obvious benefits of exercise.
430520 -     ref SDS 74 F93X
430521 -
430522 -
430523 -
430524 -
430525 -
430526 -
4306 -

SUBJECTS
Bad News Doctor Discussion with Patient Communication Sensitive to L
Quality of Life Treatment Objective Metastatic Cancer Not Cure Prolo

4804 -
480501 -  ..
480502 - Bad News Discussion Sensitive to Tollerance for Emotionally Traumatic
480503 - Feel Good Management Sensitive Low Tolerance Cancer Managed Not Cured
480504 - Quality of Life Sensitive Low Tolerance Truth Use Feel Good Management
480505 - Cure Metastatic Cancer Not Goal Relapse Requires Control and Management
480506 -
480507 - Follow up ref SDS 50 7C98.
480508 -
480509 - The doctor advised that good practice caring for cancer patients
480510 - requires being sensitive to emotional tolerance for bad news.  Most
480511 - cancer is not "cured" in the traditional sense, discussed above,
480512 - ref SDS 0 435J, but rather is managed for quality of life, cited last
480513 - month on 030508. ref SDS 50 7C98  Some patients become so distraught
480514 - by knowledge that cancer is not "cured" that they give up efforts to
480515 - manage, control, and stabalize disease, which, if performed, often
480516 - enables patients to lead a normal or near normal life for many years.
480518 -  ..
480519 - Negative attitudes of fear and lost hope reduce ability to cope.
480520 - Despair devolves toward inactivity, which weakens the immune system.
480521 - Patients become sickly suffering a widening range of ailments, causing
480522 - the patient to reduce and even stop implementing treatment guidance.
480523 - This has dire and opposite dynamics of a positive attitude and healthy
480524 - life style, discussed earlier. ref SDS 0 LZ3L  Doctors therefore often
480525 - explain pathology and prospects only generally in order to maintain
480526 - patient emotional strength and resolve to undergo treatment.
480528 -  ..
480529 - The doctor said that he has always viewed Millie's cancer as more
480530 - likely to relapse, requiring multiple treatments in the mode of case
480531 - management for metastatic cancer, rather than outright cure, because
480532 - of facts discussed today, per above. ref SDS 0 NE7L  The doctor
480533 - complimented Millie for being proactive by doing independent research
480534 - to learn about risks for relapse.  The doctor gave assurance that
480535 - Kaiser's medical team is paying close attention to avoid losing
480536 - control of Millie's condition, discussed above, ref SDS 0 N27L, by
480537 - early discovery and timely treatment of advancing disease. ref SDS 0
480538 - VY7G
480539 -
480540 -     [On 030710 the doctor explained theory and practice to delay
480541 -     follow up treatments until observable symptoms of metastasis
480542 -     appear. ref SDS 52 FZ55
480544 -      ..
480545 -     [On 031010 article reports breast cancer relapses in 50% of cases
480546 -     within 2 years. ref SDS 54 IM6N
480548 -      ..
480549 -     [On 031205 doctor commended patient's good habits maintaining
480550 -     general good health through sensible diet and exercise are factors
480551 -     that stabalize and control advance of disease. ref SDS 55 GW8F
480553 -      ..
480554 -     [On 040318 biopsy on lumps in the neck show cancer, confirmed by
480555 -     CT tests; patient regresses from stable to recurrence. ref SDS 57
480556 -     8R6M
480558 -      ..
480559 -     [On 041018 meeting at UCSF relapse of metastatic cancer likely.
480560 -     ref SDS 63 EO3Y
480562 -      ..
480563 -     [On 041117 UCSF 2nd opinion cites Millie likely to relapse.
480564 -     ref SDS 65 OU5P and ref SDS 65 OU5V
480566 -      ..
480567 -     [On 041209 Stanford 2nd opinion cites 66% risk for relapse without
480568 -     consideration for out of capsule finding. ref SDS 67 SN6K
480570 -      ..
480571 -     [On 041210 patient's daughter asks why her mom's cancer cannot be
480572 -     cured; doctor explains treatment goals for quality of life.
480573 -     ref SDS 68 9Q7H
480575 -      ..
480576 -     [On 050826 surgeon in Kaiser's Oakland office explains mastectomy
480577 -     surgery for patients with metastatic cancer limited to regional
480578 -     disease and no evidence of distant metastasis fits a curative
480579 -     treatment model for stage III cancer. ref SDS 77 947O
480580 -
480581 -
480582 -
480583 -
4806 -

SUBJECTS
Recurrence Metastatic Cancer Cure Impossible Due to High Risk Factor

5103 -
510401 -  ..
510402 - Kaiser Relies on Patient Symptoms to Determine Treatment for Relapse
510403 - Reasonable Testing Timely Treatment to Control Disease
510404 - Physically Fit Patients Good Candidates for Aggresive Cancer Treatment
510405 -
510406 - Follow up ref SDS 50 7C98.
510407 -
510408 - Millie asked again about age, per above, ref SDS 0 XR7I, and recalled
510409 - the doctor's comment during the meeting on 030508 about focusing care
510410 - to maintain quality of life during a patient's demise. ref SDS 50 7C98
510411 - Millie said she is focused on getting things done.  This requires
510412 - taking reasonable steps for recovery to avoid an early exit, rather
510413 - than diverting effort from treatment in order to experience a "soft
510414 - landing" under a rubric for "quality of life."
510416 -  ..
510417 - The doctor said that Millie at age 67 chronologically has the body of
510418 - a strong, healthy woman of 50, and so is a good candidate for full,
510419 - aggressive treatment.  He emphasized again the importance of normal,
510420 - active lifestyle.  Commitment to regular exercise, discussed above,
510421 - ref SDS 0 XQ3N, reduces frailties that often impair treatment.  This
510422 - gives the doctor flexiblity to prescribe chemotherapy on a regular
510423 - schedule for maintaining dose levels that make treatment effective
510424 - for Millie.
510426 -      ..
510427 -     [On 030710 testing has not established recurrence; CA 15-3 test
510428 -     continues rising to 68, ref SDS 52 XX4G; doctor relates that when
510429 -     CA 15-3 reached 80 in another patient, this signaled need for
510430 -     action. ref SDS 52 WS42
510432 -      ..
510433 -     [On 030710 doctor comments again that Millie's fitness aids
510434 -     treatment prospects from maintaining dose levels. ref SDS 52 FZ4N
510436 -      ..
510437 -     [On 031205 doctor commended patient's good habits maintaining
510438 -     general good health through sensible diet and exercise are factors
510439 -     that help stabalize and control advance of disease. ref SDS 55
510440 -     GW8F
510442 -      ..
510443 -     [On 040318 recurrence diagnosed based on pathology report from
510444 -     biopsy taken of neck, ref SDS 57 8R6M, CT test found evidence of
510445 -     two prominent nodes in the neck, ref SDS 57 GJ69, CA 15-3 rises
510446 -     another 10 points to 70. ref SDS 57 GJ5M
510448 -      ..
510449 -     [On 040517 inflammatory breast cancer diagnosed in pathology
510450 -     report of biopsy taken from left breast. ref SDS 60 736K
510452 -      ..
510453 -     [On 040517 case study developed, ref SDS 60 S66O, for treatment
510454 -     planning, ref SDS 60 S79G, and to develop lessons learned.
510455 -     ref SDS 60 PW8F
510457 -      ..
510458 -     [On 040614 chemotherapy and age reduce blood counts that degrade
510459 -     immune system, ref SDS 61 6T7F; Millie's fitness gives flexibility
510460 -     to prescribe effective chemotherapy treatment. ref SDS 61 356L
510462 -      ..
510463 -     [On 050422 patient diary of side effects. ref SDS 71 JY3N
510465 -      ..
510466 -     [On 050609 article reports study found exercise repairs some of
510467 -     the cumulative damage chemotherapy causes to the immune system;
510468 -     this prolings effectiveness of chemotherapy treatment to aid
510469 -     recovery from breast cancer, ref SDS 74 F88M; quality of life from
510470 -     strength and range of motion are obvious benefits of exercise.
510471 -     ref SDS 74 F93X
510473 -      ..
510474 -     [On 050729 side effects escalate, very difficult to tolerate
510475 -     again, even with 25% reduced dose on 050520, ref SDS 75 DS5J,
510476 -     doctor maintains strength of capecitabine (Xeldoa) for two (2)
510477 -     more treatments to guard against another relapse. ref SDS 75 VP4N
510479 -      ..
510480 -     [On 060721 treatment advanced ahead of regular cycle to accomodate
510481 -     Kaiser's schedule, because patient's fitness gives flexibility on
510482 -     treating patient with low blood counts. ref SDS 80 UZ4F
510484 -      ..
510485 -     [On 060810 treatment denied ANC blood count slightly below
510486 -     Kaiser criteria for safe treatment while CA 15-3 cancer marker
510487 -     rising, ref SDS 81 5K4F; case study shows Millie's good health
510488 -     from life style of exercise permits aggressive treatment
510489 -     despite low blood counts. ref SDS 81 HV45
510491 -      ..
510492 -     [On 070218 energy increases, shortness of breath, fatigue,
510493 -     weakness subside 10 weeks after ending treatment for 3rd relapse
510494 -     of IBC with Taxotere and cacecitabine; Millie is exercising in the
510495 -     gym again, playing tennis 2 days her pulse reached 144.
510496 -     ref SDS 85 N05H
510498 -      ..
510499 -     [On 070301 example ANC low blood counts; cetuximab clinical
510500 -     study weekly treatments not enough time for bone marrow to
510501 -     replenish blood, wicked problem because cancer spreading
510502 -     requires increasing chemotherapy which reduces blood counts;
510503 -     weakening the immune system increases risk of contracting other
510504 -     infectious diseases. ref SDS 86 D24M
510506 -      ..
510507 -     [On 080501 exercise and fitness increases after starting
510508 -     Carboplatin chemotherapy on 2nd arm of clincial study Millie
510509 -     treated on referral at UCSF. ref SDS 91 FW5J
510510 -
510511 -
510512 -
510513 -
510514 -
510515 -
5106 -