CONTACTS
SUBJECTS
2nd Opinion Stanford Medical Center Treatment Plan Recover IBC Cance
Stanford Meeting 2nd Opinion on Scope of Disease Treatment Options D
Admission Forms Payment $606 Submitted Medical Records Hand Carried
2nd Opinion Reports on Meeting Stanford Medical Center Cancer Center
2nd Opinion Meeting Stanford Medical Center Ellie Todd Denise Examin
Stanford Meeting 2nd Opinion on Scope of Disease Treatment Options D
1008 -
1008 - ..
1009 - Summary/Objective
1010 -
101001 - Follow up ref SDS 25 0000. ref SDS 24 0000.
101002 -
101003 - Great experience visiting the Stanford Cancer Center. Their new
101004 - facility is a tribute to all who value excellence. ref SDS 0 T18I The
101005 - staff worked through patient history, ref SDS 0 LT60, showing gradual
101006 - increase in IBC symptoms beginning on 021206, which will be discussed
101007 - in the doctor's report. ref SDS 0 TX36 Stanford took time to review
101008 - medical records on issues presented for a 2nd opinion. ref SDS 0 0R49
101009 - Impressions from examination today indicate continuing treatment may
101010 - be needed. ref SDS 0 5W6H Surgery is not needed now; possibly later
101011 - depending on the course of disease. ref SDS 0 TX96 Patient has follow
101012 - on options after the Avastin trial, based on history of prior
101013 - treatments. ref SDS 0 BV6K Doctor Guardino will submit a report and
101014 - plans to call Doctor Johnson for consultation. ref SDS 0 BV8N Lessons
101015 - learned may aid future work. ref SDS 0 TX4K
101016 -
101017 - [On 041030 submitted the record to Denise for distribution to the
101018 - Doctor and to Todd. ref SDS 34 0001
101020 - ..
101021 - [On 041209 received Doctor Guardino's report dated 041019.
101022 - ref SDS 41 LO5L
101024 - ..
101025 - [On 041230 primary care physician at Kaiser implements Doctor
101026 - Guardino's 2nd opinion to try AC again, planning to qualify
101027 - patient to participate in a new drug trial for capecitabine that
101028 - will implement 2nd opinion recommendation by Doctor Benz at UCSF.
101029 - ref SDS 43 IM5H
101031 - ..
101032 - [On 051008 Peggy is being treated by Doctor Guardino for breast
101033 - cancer; first meeting is early November 2005. ref SDS 57 KS8H
101035 - ..
101036 - [On 051108 letter to Doctor Guardino commending work on 2nd
101037 - opinion, reporting results of implementation, and noting
101038 - opportunity for Peggy to get high quality treatment from the
101039 - doctor. ref SDS 60 KS5N
101040 -
101041 -
101042 -
101043 -
101045 - ..
1011 -
1012 -
1013 - Progress
1014 -
101401 - Admission Forms Prepare and Submit for 2nd Opinion
101402 -
101403 - Follow up ref SDS 29 W66I.
101404 -
101405 - Arrived 30 minutes early and got directions from the information
101406 - person in the lobby to clinic F for meeting Doctor Guardino. Millie
101407 - filled out and signed all of the forms requested by the admitting
101408 - nurse, per notice from Michelle on 041012. ref SDS 29 W66I
101410 - ..
101411 - Medical records received from Kaiser on 041014, ref SDS 31 0001, were
101412 - submitted to the nurse, with tabs added to the documents for biopsy,
101413 - and imaging tests. ref SDS 31 PF7I
101415 - ..
101416 - Doctor Benz at UCSF said yesterday that he needed a chronology, and so
101417 - was forced to draw on the patient's memory for a general impression
101418 - interpreting test reports, because doctor's notes in the record are
101419 - sparse and illegible, and because UCSF was unable to access case
101420 - studies submitted by the patient online via email.
101422 - ..
101423 - Based on experience at UCSF yesterday showing that chronology is used
101424 - for a 2nd opinion, ref SDS 32 EN63, and further, since Michelle
101425 - reported on 041011 that she did not submit patient history for the
101426 - doctor to be prepared meeting with the patient today, ref SDS 29 8F42,
101427 - a printed version of chronology showing case history was handed to the
101428 - Admissions nurse, which had been submitted to Stanford previously
101429 - online with the letter dated 041002. ref SDS 21 Y29R
101431 - ..
101432 - The nurse said she will alert the doctor about the two (2) case
101433 - studies on patient history.
101435 - ..
101436 - Millie paid $606 for a report on the work today, per Stanford's
101437 - requirements reported on 041004, ref SDS 22 GG5T, because Kaiser
101438 - failed to make a referral, noted by doctor Johnson in the record on
101439 - 040912. ref SDS 20 AW6M
101441 - ..
101442 - After submitting medical records, and paying for the report on
101443 - referral for a 2nd opinion, we walked through the Stanford Cancer
101444 - Center and stopped at the cafeteria for lunch.
101446 - ..
101447 - Millie got soup and a grilled cheese sandwich.
101449 - ..
101450 - While Millie ate lunch, I visited a patient oriented, and
101451 - computer-based medical research library located just across the huge
101452 - hallway from the cafeteria in the Cancer Center. This facility is
101453 - called the....
101454 -
101455 - Stanford Health Library (SHL)
101457 - ..
101458 - The attendant in the library explained their free service.
101460 - ..
101461 - People can ask for information on symptoms, diagnosis, and treatment,
101462 - and the attendants will perform a query, then prepare a packet. We
101463 - requested that research be submitted via email so that we have command
101464 - and control to integrate new material with the existing record, per
101465 - POIMS. ref OF 7 1113
101466 -
101467 - [On 050414 John Maloney cited similar support at UCSF which has
101468 - resources on the Internet provided by a Center for Knowledge
101469 - Management. ref SDS 48 HS4J
101471 - ..
101472 - The request we made was for...
101473 -
101474 - IBC avastin trial treatment options
101475 -
101476 -
101478 - ..
1015 -
1016 - 1330
101701 - ..
101702 - Meeting Todd and Denise Initial Case Orientation Review Chronology
101703 -
101704 - Follow up ref SDS 29 W06M.
101705 -
101706 - We walked back to the breast cancer clinic F. A nurse called Millie
101707 - into an exam room, and asked her to dress down for an examination.
101708 -
101710 - ..
1018 -
1019 -
1020 - 1338 document review...
1021 -
102101 - An intern, Todd, and an RN, Denise, came into the waiting room and
102102 - explained they need to review documents on patient history for about
102103 - 20 minutes. Todd suggested we get a cup of coffee at the cafeteria.
102105 - ..
102106 - Millie reminded Todd to review the chronology in addition to records
102107 - prepared by Kaiser.
102109 - ..
102110 - Millie dressed, and we then walked through the Cancer Center. This is
102111 - a magnificent facility, similar to the new hotels in Las Vegas. The
102112 - impression is conveyed of competence and attention to detail, based on
102113 - a strong ethic to work intelligently, using good management, set out
102114 - in POIMS. ref OF 3 1X6G
102116 - ..
102117 - After about about 30 minutes, we returned to Clinic F, and to the
102118 - patient room where Millie changed back into a gown to prepare for
102119 - meeting the doctor.
102120 -
102121 -
102122 -
102123 -
1022 -
SUBJECTS
Meeting Initial Case Orientation Review Patient History Link Chronol
Doctor Patient Partnership through Communication and Collaboration
Errors Organizing Medical Records Resolved by Collaborating with Pat
1305 -
1306 - 1400
130701 - ..
130702 - Patient History Correlate with Pathology
130703 - Doctor Patient Partnership through Communication and Collaboration
130704 - Stanford Empowers Patients with Responsibility in Health Care Process
130705 -
130706 - Todd and Denise came into the examination room. They had the stack of
130707 - documents submitted by Kaiser, and, also, the two (2) case studies in
130708 - the record on 040517, and submitted to the nurse earlier today, per
130709 - above. ref SDS 0 KH5G
130711 - ..
130712 - Todd said they need help correlating the sequence of events in the
130713 - studies on patient history chronology shown in the printed versions of
130714 - the record on 040517, with the medical records received from Kaiser
130715 - that show reports on imaging and pathology tests.
130716 -
130717 - [On 041209 Stanford excellent work in 2nd opinion showing patient
130718 - history with very few errors applying case studies and test
130719 - reports from Kaiser. ref SDS 41 OW4T
130721 - ..
130722 - Todd indicated that reviewing case history online in a few minutes
130723 - would be more accurate, efficient and less expensive by clicking on
130724 - links that connect symptoms, diagnosis, discussion, and analysis
130725 - directly with relevant pathology reports and tests, cited in the
130726 - letter submitted to Stanford on 041002. ref SDS 21 Y29R Stanford
130727 - policy protects patient privacy by using printed documents, rather
130728 - than reduce cost and increase accuracy with computers.
130729 -
130730 - [On 050728 Susan at GE worked through a complex case quickly and
130731 - accurately, using SDS granular addressability with explicit links
130732 - for precision access. ref SDS 54 AN58
130734 - ..
130735 - Denise explained Stanford policy for empowering patients to take
130736 - responsibility for their own health care, rather than become dependent
130737 - on paternalistic support by the doctor and medical staff. She gave an
130738 - example that rather than use computers for efficiently scheduling
130739 - patient visits based on medical analysis of case history, patients
130740 - with varying degrees of infirmity are asked to call Stanford's staff
130741 - and request meetings for health care.
130743 - ..
130744 - Denise did not explain how Stanford's policy is applied when Stanford
130745 - takes responsibility for building their own hospital, rather than
130746 - become dependent on paternilistic support by the contractor to perform
130747 - professional work? How about when buying a car; does the doctor take
130748 - responsibility for building their own car, rather than become
130749 - dependent on paternilistic support by the manufacturer?
130751 - ..
130752 - Goals for empowerment reflect trends for a doctor patient partnership
130753 - model to strengthen health care, reviewed on 990625. ref SDS 2 4185
130754 - At that time, communication between doctor, patient, and the staff was
130755 - cited as a major factor in effective care. ref SDS 2 2924 and
130756 - ref SDS 2 4752 Patient's are responsible for capturing the record,
130757 - and doctors are responsible for feedback to make additions and
130758 - corrections using a "ping pong" method, ref SDS 2 3190, that reduces
130759 - the high cost of medical mistakes reported on 990912. ref SDS 3 0001
130761 - ..
130762 - Empowerment leverages patients self-interest incentive to balance
130763 - privacy with the need for accurate, comprehensive understandings
130764 - within the time doctors allocate to patients, about 15 minutes for
130765 - routine visits, reported on 990625, ref SDS 2 2652, and today about 3
130766 - hours for a 2nd opinion, reported on 041007. ref SDS 28 0001 Patients
130767 - can increase the quality of care by leveraging the time of high-priced
130768 - talent with efficient methods to navigate and absorb a long, complex
130769 - record by adding connections to research and pathology reports.
130771 - ..
130772 - Todd gave an example. He said the staff was unable to find all of the
130773 - reports in the medical records received from Kaiser that relate to
130774 - patient history in the case studies on issues that require a 2nd
130775 - opinion reported on 041002, ref SDS 21 K138, and listed below.
130776 - ref SDS 0 ER8O As a result, Todd asked...
130777 -
130778 - Can you help us, since you assembled the chronology?
130780 - ..
130781 - One problem was that the Stanford staff rearranged the stack of paper
130782 - provided by Kaiser on 041014. ref SDS 31 PF7I Stanford's intent was
130783 - correct, attempting to segment test reports from doctor notes;
130784 - however, the separation was done incorrectly due to the awkward order
130785 - that Kaiser printed discrete events as a continuous stream of paper.
130786 - This made it harder to find documents that correlate to the
130787 - chronology.
130789 - ..
130790 - Another problem was that Kaiser commingled blood tests with biopsy and
130791 - imaging tests. This compounded difficulty finding the latter, which
130792 - are the primary focus of a 2nd opinion. Work by the patient on 041015
130793 - adding tabs and highlights that make separate types of data readily
130794 - visible, made finding biopsy and test reports easier, ref SDS 31 PF7I,
130795 - but segmenting documents incorrectly required looking in several
130796 - different places, and this made the work more difficult, and so took
130797 - more time than if the original order had been retained until after
130798 - meeting with the patient to discuss case history.
130800 - ..
130801 - Working with Todd and Denise was an effective collaboration that took
130802 - about an hour. Denise provided guidance for Todd to generate a
130803 - history in the form Doctor Guardino needs, based on the chronology
130804 - submitted by the patient, which empowered the Stanford staff with
130805 - references to relevant biopsy and test reports that show evolving
130806 - diagnosis and treatment. Todd prepared hand written notes in a new
130807 - chronology based on medical records and debriefing the patient. Like
130808 - Doctor Benz yesterday at UCSF, ref SDS 32 EN69, Todd made a lot of
130809 - cross outs, additions, and arrows typical of hurried, first impression
130810 - notes on a new matter that seem meaningful at the time, time based on
130811 - momentary mental connections.
130812 -
130813 -
130815 - ..
130816 - Understanding Chronology Enables Accurate Diagnosis
130817 - Collaboration Reduces Medical Mistakes through Feedback
130818 -
130819 - Denise advised that the patient will get a copy of Stanford's work
130820 - product today reveiwing chronology patient history, in order to
130821 - provide feedback that refines accuracy in the record.
130822 -
130823 - [...see below the doctor will submit a 2nd opinion, and call to
130824 - consult with Doctor Johnson at Kaiser. ref SDS 0 BV8N
130826 - ..
130827 - Todd said that having the chronology along with input from the patient
130828 - to clarify correlations, implications, and links to the actual context
130829 - of the full record, greatly reduced the time required for the medical
130830 - team to understand the case. He asked if the chronology could be
130831 - submitted on a disk in order to expedite handling the record?
130833 - ..
130834 - A disk could be provided, but that would require training to use a
130835 - special knowledge tool. Much easier for Stanford to use the listing
130836 - on the Internet provided by the patient for that purpose, because that
130837 - requires no training beyond using a web browser which most people can
130838 - learn quickly.
130839 -
130840 -
130841 -
130842 -
1309 -
SUBJECTS
IBC Symptoms Increased Gradually from 021206 to Diagnosis on 040614
1503 -
150401 - ..
150402 - Morbidity Reduced by Prompt Treatment of IBC
150403 - IBC Symptoms Increased Gradually from 021206 to Diagnosis on 040614
150404 -
150405 - There was discussion today that early treatment helps reduce morbidity
150406 - to avoid excessive pain and suffering during late stages of cancer
150407 - that lead to death. Doctor Guardino explained that sometimes delayed
150408 - treatment for cancer increases morbidity challenges causing prolonged
150409 - trauma and higher discomfort.
150411 - ..
150412 - Todd and Denise commented on the long delay starting treatment for IBC
150413 - that occurred in Millie's case, beginning with observation on 021206
150414 - of new swelling under the left arm diagnosed as drainage from surgery
150415 - eight (8) months earlier on 020327. At that time, biopsy test for
150416 - relapse was not ordered, as listed in the record of chronology on
150417 - 040517, ref SDS 17 2F4G
150419 - ..
150420 - A month later on 030109 the doctor observed increased coloration of
150421 - the breast. In May 2003 the lump under the arm was worse, CT tests
150422 - reported new nodes; a biopsy requested by the patient was deferred by
150423 - Kaiser. ref SDS 17 QSPT Later that month in May or the first part of
150424 - June the patient requested an emergency examination of increased
150425 - pressure under the arm and increased redness of the breast that
150426 - correlated with steady rise in CA 15-3. During the examination that
150427 - followed on 030606 the doctor felt that the red rash had subsided,
150428 - commenting that the left breast looks similar to the right breast.
150429 - Patient asks for more testing to verify diagnosis; PET scan biopsy
150430 - tests were again deferred. ref SDS 17 836O
150431 -
150432 - [On 041030 letter to Stanford reviews worsening IBC symptoms.
150433 - ref SDS 34 XJ5R Request clarification of comments on morbidity.
150434 - ref SDS 34 XJ6Y
150436 - ..
150437 - Later on 030710, CT tests showed conditions worsening, nodes grew from
150438 - 1 to 1.5 CM, and skin thickening of left breast. ref SDS 17 13UW No
150439 - biopsy taken; testing suspended until December when Kaiser reported
150440 - "great," because a CT test did not account for growing lumps in prior
150441 - tests. In March coloration of the left breast worsened, and was
150442 - explained as cellulitus, and then as reaction to radiation in 2004.
150443 - ref SDS 17 YY84 In May 2004, biopsy taken in April that disclosed IBC
150444 - was unexpected because pathology reports invariably come back
150445 - negative. ref SDS 17 KY5K
150446 -
150447 -
150448 -
150449 -
1505 -
SUBJECTS
Interview Team Presents Case to Doctor Guardino Review Tests and Pat
1603 -
1604 - 1500
160501 - ..
160502 - Interview Team Presents Case Doctor Guardino Makes Effective Review
160503 -
160504 - After going through the chronology and medical records from Kaiser,
160505 - Todd and Denise said they were ready to present the case with Doctor
160506 - Guardino. They said this would take 20 - 30 minutes.
160507 -
160508 -
160510 - ..
1606 -
1607 -
1608 - 1545 case reveiw by doctor...
1609 -
160901 - Denise came into the examination room and said they are still
160902 - reviewing the case, and asked us to be patient, because there is a
160903 - lot to absorb in a short time.
160904 -
160905 -
160906 -
160907 -
160908 -
160909 -
160910 -
1610 -
SUBJECTS
Doctor Examines Patient Discusses First Impressions on Issues Presen
Issues 2nd Opinion Patient Submits for Determination by Doctor
Several Months Elapsed Before Examination of Lumps by Kaiser
1905 -
1906 - 1645
190701 - ..
190702 - Doctor Examines Patient Discusses First Impressions
190703 -
190704 - Doctor Guardino and Todd came into the examination room. The doctor
190705 - apologized for taking so long, noting Millie has an extensive, complex
190706 - medical record that takes time to understand, per Denise earlier.
190707 - ref SDS 0 G2F4
190709 - ..
190710 - Doctor Guardino seemed to indicate they reviewed all of the CT scan
190711 - films for all of Millie's the tests at Kaiser, unlike work at UCSF
190712 - yesterday relying solely on analysts' reports of scan film contents.
190713 - ref SDS 32 L246 Understanding chronology and context presented by
190714 - Denise and Todd, per above, ref SDS 0 ID5Q, helps address patient
190715 - issues presented to Stanford for a 2nd opinion in the letter on
190716 - 041002, which says in part...
190717 -
190718 - 1. I need to make a decision on whether to continue, stop and
190719 - have a mastectomy, or simply to stop treatment altogether
190720 - on the grounds that diagnostics using CT scans have not
190721 - identified distant metastasis, and show that all tumors
190722 - have been significantly reduced or been eliminated. A
190723 - complicating factor seems to be that if I opt for surgery,
190724 - then I can no longer get treatment with Avastin, even if
190725 - the evidence shows the treatment is effective. So, there
190726 - is a dilemma, and I need guidance on resolving it.
190727 - ref SDS 21 Y25R
190728 -
190729 - [On 041209 Stanford addressed the 2nd opinion to
190730 - Kaiser, rather than to the patient. ref SDS 41 WY9I
190732 - ..
190733 - 2. I would like a physician to review the case history to see
190734 - if anything has been overlooked that might indicate distant
190735 - metastasis. Kaiser had the case reviewed by a "Tumor
190736 - Board" in April. Their report did not seem comprehensive
190737 - nor offer helpful guidance. The Tumor Board made no
190738 - finding on distant metastasis; the attending physician
190739 - feels that lumps in the neck, which are symptoms of IBC,
190740 - establish metastasis. I want a 2nd opinion. ref SDS 21
190741 - Y27U
190742 -
190744 - ..
190745 - Several Months Elapsed Before Examination of Lumps by Kaiser
190746 -
190747 - The doctor asked how long the original lump was noticed prior to
190748 - examination at Kaiser in February 2002, as shown in the chronology in
190749 - the record on 040517? ref SDS 17 OW3I
190751 - ..
190752 - Millie explained several months may have elapsed from when she first
190753 - noticed a lump in the breast. She has had a number of similar lumps
190754 - at various locations on her body over the past 10 years or so that
190755 - were all examined and found to be "fatty" tissue of some kind, and so
190756 - in this case, she waited to have another the new lump examined during
190757 - a regularly scheduled visit to Kaiser for an annual check up. There
190758 - may have been discussion today that in February of 2002 the sudden
190759 - occurrence of a lump under the arm led to a request for an immediate
190760 - meeting, and at that time the lump in the breast was examined, which
190761 - led to a biopsy, and then surgery on March 12, 2002, ref SDS 4 0001,
190762 - with a follow up to achieve clear margins on 020327. ref SDS 5 0001
190763 -
190764 -
190765 -
190766 -
1908 -
SUBJECTS
Cure Not Current Strategy for Patient to End Treatment at this Time
2003 -
200401 - ..
200402 - Doctor's Examination on Patient's Request for 2nd Opinion
200403 - Avastin Trial Protocol Should Continue Until Disease Progresses
200404 -
200405 - The doctor examined Millie with Todd assisting and taking notes.
200406 - During examination, the doctor commented on issues submitted for a 2nd
200407 - opinion, per above, ref SDS 0 ER8O, saying approximately that...
200408 -
200409 - [On 070130 Doctor Rugo used similar practice at UCSF.
200410 - ref SDS 62 TX6K
200412 - ..
200413 - 1. There is no cure for the patient to no longer need treatment,
200414 - due to the out of capsule condition on 020312, listed in the
200415 - chronology on 040517, ref SDS 17 OW3I, and other risk factors
200416 - which Doctor Guardino will list in her opinion. (see, also,
200417 - discussion with Doctor Benz at UCSF on 041018. ref SDS 32 EO3Y)
200419 - ..
200420 - This aligns with understandings from meeting with the primary
200421 - care physician at Kaiser on 030606 explaining mutation process
200422 - of metastatic cancer. ref SDS 11 N27L
200423 -
200424 - [On 041209 Doctor Guardino's report lists breast cancer
200425 - risk factors. ref SDS 41 O151
200427 - ..
200428 - [On 041209 Doctor Guardino's report relates a 66% risk of
200429 - relapse without regard to out of capsule condition.
200430 - ref SDS 41 SN7I
200432 - ..
200433 - [On 051027 following surgery patient NED. ref SDS 59 M58G
200435 - ..
200436 - Millie explained 6 month history of side effects on the
200437 - Avastin/Taxol trial, including severe coughing, shortness of
200438 - breath, and heavy chest, as presented to Doctor Benz at UCSF
200439 - yesterday on 041018, ref SDS 32 LX96, and citing consideration
200440 - on 040812 of public notice by Genentec of deaths from pulmonary
200441 - emboli suffered by patients treated with Avastin/Taxol trial.
200442 - ref SDS 19 MG4G
200443 -
200444 - [On 041209 Doctor Guardio 2nd opinion cites side effects of
200445 - fatigue, cough, and shortness of breath. ref SDS 41 O18R
200447 - ..
200448 - Doctor Guardino did not comment on side effects; she indicated
200449 - support for the current treatment in the Taxol Avastin drug
200450 - trial protocol, which further aligns with understandings from
200451 - Doctor Benz at UCSF yesterday on 041018. ref SDS 32 LX7L
200452 - Doctor Guardino emphasized maintaining treatment to recover
200453 - from IBC, and quickly switching to another chemotherapy
200454 - regimine in the event the current trial is no longer leading to
200455 - recovery, which aligns with research on 040517 that found IBC
200456 - is a vigorous form of cancer that requires aggressive
200457 - treatment. ref SDS 17 YM3M
200458 -
200459 - [...see below research submitted by Stanford Medical
200460 - Library may support the doctor's discussions on ending
200461 - treatment; change in current protocoal using Avastin with
200462 - Taxol may yield better results for Millie. ref SDS 0 U656
200464 - ..
200465 - [On 041104 Kaiser reports dramatic improvement patient CA
200466 - 15-3 cancer marker drops to normal for 1st time in 2 years,
200467 - ref SDS 36 GJ5M; CT test shows no evidence of cancer
200468 - pathology, ref SDS 36 Q49F; Kaiser ends treatment of IBC on
200469 - Taxol Avastin trial due to discovery of pulmonary emboli in
200470 - a CT test, ref SDS 36 N438; plans switch to new treatment
200471 - for IBC as soon as possible; no evidence distant disease.
200472 - ref SDS 36 WT60
200474 - ..
200475 - [On 041130 primary care physician at Kaiser recommends
200476 - immediate resumption of treatment. ref SDS 39 Y66F
200478 - ..
200479 - [On 041209 Doctor Guardino's 2nd opinion confirms
200480 - understandings from the meeting today, that she recommends
200481 - continuing treatments with Taxol and Avastin in the trial
200482 - protocal, ref SDS 41 XS4I, and further recommends switching
200483 - immediately to another treatment regimen in the event
200484 - continuing in the protocol is no longer improving patient
200485 - prospects. ref SDS 41 SN8P
200487 - ..
200488 - [On 041230 primary care physician meets with patient and
200489 - discovers worsening IBC relapse after no treatment since
200490 - 041104; begins treatment with AC; no evidence distant
200491 - disease. ref SDS 44 CW53
200493 - ..
200494 - [On 050329 inflammation spreads toward neck; cancer
200495 - blisters appear on breast, CA 15-3 rises to over 100;
200496 - treatment plan changed from AC to combination of Taxotere
200497 - and capecitatine (Xeloda) recommended in 2nd opinion by
200498 - Doctor Benz at UCSF. ref SDS 47 AW5G
200500 - ..
200501 - [On 051007 patient improves; testing shows no distant and
200502 - no local disease; doctor recommends mastectomy for
200503 - palliation. ref SDS 56 MW6O
200505 - ..
200506 - [On 051027 examination of surgical wound from mastectomy on
200507 - 051021 shows normal healing; doctor says patient now
200508 - disease-free; local control and no distant metastasis
200509 - indicates complete response to treatment based on biopsy
200510 - and image testing; current treatment is CA 15-3 and imaging
200511 - tests to monitor for relapse. ref SDS 59 0001
200513 - ..
200514 - Can the doctor comment on potential significance of "response
200515 - rate" success reported in an earlier study of Avastin and
200516 - another drug, reported below. ref SDS 0 NU54
200518 - ..
200519 - Doctor Guardino commented on the record showing PET scan
200520 - testing in this case has been more effective identifying cancer
200521 - activity than using CT tests, noted in lessons learned on
200522 - 040517. ref SDS 17 RZ5O Doctor's 2nd opinion will discuss
200523 - scenarios for the patient's energy to recover as requested in
200524 - the letter to Stanford on 041002. ref SDS 0 ER8O
200525 -
200526 -
200527 -
200528 -
200529 -
200530 -
2006 -
SUBJECTS
CA 15-3 Not Used Stanford Cancer Center Cancer Marker Assess Respons
2603 -
260401 - ..
260402 - 2. Stanford does not rely on CA 15-3 cancer testing.
260403 -
260404 - Today, Doctor Guardino seemed to report that Stanford has not
260405 - incorporated CA 15-3 cancer biomarker diagnostics into oncology
260406 - practice at the Breast Care Medical Center.
260408 - ..
260409 - Yesterday Doctor Benz reported that UCSF does not rely on the CA 15-3
260410 - cancer marker. ref SDS 32 L16Q
260412 - ..
260413 - On 030220 research indicates ASCO guidance indicates CA 15-3 helps
260414 - identify recurrent disease. ref SDS 9 SZ4G The primary care
260415 - physician in the Oncology Department at Kaiser in Walnut Creek
260416 - commented on 030508 that steady rise of CA 15-3 did not support
260417 - patient concerns about relapse. ASCO guidance was cited which seems
260418 - to recommend CA 15-3 to assess relapse. ref SDS 10 M28G On 040517 rise
260419 - of CA 15-3 was discussed in a document submitted on the Tumor Board
260420 - "minutes" as indicating failed treatment in this case. ref SDS 17 4R59
260422 - ..
260423 - Patient history shows evident correlation between CA 15-3 and symptoms
260424 - of disease.
260425 -
260426 - [On 070328 cancer biomarkers, like CA 15-3, technology rapidly
260427 - advancing for diagnosis and treatment. ref SDS 63 0001
260428 -
260429 - [On 070406 UCSF submits results blood tests showing CA 15-3 has
260430 - dropped to near normal range with cetuximab treatments provided
260431 - by UCSF within a clinical study. ref SDS 64 EQ6I
260432 -
260433 -
260434 -
2605 -
SUBJECTS
Surgery Mastectomy Not Needed Until IBC Becomes further Reduced 9
2703 -
270401 - ..
270402 - 3. Surgery is not appropriate at this time until more progress
270403 - occurs treating IBC.
270405 - ..
270406 - There was no discussion during the meeting today about
270407 - criteria for determining sufficient "progress" to support a
270408 - surgical solution.
270410 - ..
270411 - Doctor Guardino made no determination from examination that the
270412 - IBC tumor is "breaking up" in the skin of the left breast, as a
270413 - predicate to surgery. There may have been discussion comparing
270414 - softness of the left breast being close to right breast
270415 - condition, which Millie has expressed previously.
270417 - ..
270418 - There is seeming conflict with understanding from meeting with
270419 - Doctor Benz at UCSF yesterday on 041018, who indicates surgery
270420 - is not an option for Millie. ref SDS 32 EO3Y
270421 -
270422 - [On 041117 2nd opinion from Doctor Benz confirms
270423 - understanding of recommending against a surgical solution
270424 - in Millie's case. ref SDS 37 OU5P
270426 - ..
270427 - [On 041209 2nd opinion received from Stanford says that
270428 - surgery may be possible after regression of inflammatory
270429 - breast condition. ref SDS 41 SN97
270431 - ..
270432 - [On 041210 doctor proposes surgery to treat IBC; case study
270433 - reviews history considering surgery for Millie. ref SDS 42
270434 - ZV5J
270436 - ..
270437 - [On 050324 research indicates metastatic cancer involving
270438 - regional lymph nodes, diagnosed on 040318, ref SDS 12 8R6M,
270439 - may be operable to reduce chances of relapse, which is
270440 - different from "distant metastasis," that surgery cannot
270441 - cure, but may play a palliative role, ref SDS 46 O84N,
270442 - further explained from research on 050712. ref SDS 53 B65G
270444 - ..
270445 - [On 050329 inflammation spreads toward neck; cancer
270446 - blisters appear on breast, CA 15-3 rises to over 100;
270447 - treatment plan changed from AC to combination of Taxotere
270448 - and capecitatine (Xeloda) recommended in 2nd opinion by
270449 - Doctor Benz at UCSF. ref SDS 47 AW5G
270451 - ..
270452 - [On 050913 patient reports progress on due diligence for
270453 - surgery. ref SDS 55 0001
270455 - ..
270456 - [On 051007 patient improves; testing shows no distant and
270457 - no local disease; doctor recommends mastectomy for
270458 - palliation. ref SDS 56 MW6O
270460 - ..
270461 - [On 051021 surgery performed for very wide mastectomy to
270462 - reduce risk of relapse. ref SDS 58 EG5L
270464 - ..
270465 - [On 051027 examination of surgical wound from mastectomy on
270466 - 051021 shows normal healing; doctor says patient now
270467 - disease-free; local control and no distant metastasis
270468 - indicates complete response to treatment based on biopsy
270469 - and image testing; current treatment is CA 15-3 and imaging
270470 - tests to monitor for relapse. ref SDS 59 0001
270472 - ..
270473 - [On 051108 letter to Doctor Guardino commending work on 2nd
270474 - opinion, reporting results of implementation, and noting
270475 - opportunity for Peggy to get high quality treatment from
270476 - the doctor. ref SDS 60 KS5N
270477 -
270479 - ..
270480 - 4. Slight redness in left breast compared to right breast was
270481 - observed, indicating disease still present, but has declined
270482 - considerably compared to the report on 040318. ref SDS 12 IM6J
270483 - Doctor Guardino described "peau d'orange" coloration, noted in
270484 - research on 040517. ref SDS 17 S65H The doctor described a
270485 - healing punch biopsy consistent with recovery from the
270486 - underelying IBC symptoms.
270488 - ..
270489 - This confirms findings at UCSF cancer center yesterday on
270490 - 041018. ref SDS 32 M66H
270491 -
270492 - [On 041209 2nd opinion received from Stanford describes a
270493 - "poorly healed" punch biopsy. ref SDS 41 O23X
270494 -
270495 -
270496 -
270497 -
2705 -
SUBJECTS
Patient Has Good Treatment Options Due to Early Change from Adriamyc
2803 -
280401 - ..
280402 - 5. Patient has good treatment options due to early change from
280403 - Adriamycin and Cytoxan (AC) to Taxotere ordered on 020603 for
280404 - the 3rd and 4th treatments in phase 1 of chemotherapy, reported
280405 - in the chronology on 040517, ref SDS 17 SU9W, suggests that AC
280406 - can be used later in the current treatment cycle, if cancer
280407 - begins to progress under the current protocol using Taxol and
280408 - Avastin.
280410 - ..
280411 - Primary care physician reported on 020628 that AC has a
280412 - cumulative impact on the heart, and so can only be given
280413 - for 12 treatments; since only 2 AC treatments have been
280414 - given so far, 10 more are available to treat the patient.
280415 - ref SDS 7 ZO8J
280417 - ..
280418 - [On 041230 primary care physician at Kaiser implements
280419 - Doctor Guardino's 2nd opinion to try AC again, planning to
280420 - qualify patient to participate in a new drug trial for
280421 - capecitabine that will implement 2nd opinion recommendation
280422 - by Doctor Benz at UCSF. ref SDS 43 IM5H
280424 - ..
280425 - [On 050329 IBC worsesn, primary care physician switches
280426 - treatment from AC to Taxotere and capecitabine (Xeloda).
280427 - ref SDS 47 AW5G
280429 - ..
280430 - [On 050610 patient has favorable response to treatment;
280431 - begin considerations for surgery. ref SDS 52 0001
280432 -
280433 -
280434 -
280435 -
280436 -
280437 -
280438 -
280439 -
2805 -
SUBJECTS
Work Routine Good Therapy Treatment Do Familiar Things with Familiar
3203 -
320401 - ..
320402 - 6. Working and exercise are good therapies at this time to
320403 - maintain a routine of normal engagement with life that focuses
320404 - on doing familiar things, with familiar people, so long as
320405 - physical stamina is not taxed.
320407 - ..
320408 - This aligns with recommendations by the primary care physician
320409 - and oncologist at Kaiser, reported 020924, ref SDS 8 EV7N, and
320410 - later on 030606. ref SDS 11 Y45M
320411 -
320412 - [On 050609 article reports study found exercise repairs
320413 - some of the cumulative damage chemotherapy causes to the
320414 - immune system; this prolongs effectiveness of chemotherapy
320415 - treatment to aid recovery from breast cancer, ref SDS 51
320416 - F88M; quality of life from strength and range of motion are
320417 - obvious benefits of exercise. ref SDS 51 F93X
320419 - ..
320420 - [On 060217 patient experiences emotional trauma from
320421 - dramatic recovery; status NED, strength, vigor, engagement
320422 - return, but adjustment needed from emotional shock; primary
320423 - care physician makes referral to BMS for counseling, and
320424 - recommends continuing exercise, and normal activity to ease
320425 - adjustments. ref SDS 61 Y642
320427 - ..
320428 - [On 080807 Millie released from medical disability leave by
320429 - UCSF to return to work at NP after demonstrating recovery
320430 - from 4th relapse of cancer. ref SDS 65 HX8G
320432 - ..
320433 - Millie related plans to try going back to work on a 3.5 day
320434 - schedule, with time off for treatments, beginning next week,
320435 - based on the report received on 041007 that CA 15-3 has dropped
320436 - to normal for first time in several years, ref SDS 26 2N5J, and
320437 - CT test on 040921 reported on 041005 shows no evidence of
320438 - adenopathy. ref SDS 23 NL4N Hopefully, IBC which will continue
320439 - to respond to treatment, which is a goal today in getting a 2nd
320440 - opinion to resovle the dilemma cited by the doctor on 041005.
320441 - ref SDS 23 GJ5M
320442 -
320443 -
320444 -
320445 -
320446 -
3205 -
SUBJECTS
Accurate Understanding Patient History Priority at Stanford Doctor V
Money Alphabet Productivity Control Organic Structure Knowledge SDS
ASB Planning Collaboration Standard SDS Enables Accurate Understandi
Accuracy Precision Access Requirements Situational Awareness Organiz
Accuracy Care About Medical Record for Effective Management Wish I H
5607 -
560801 - ..
560802 - 7. Accuracy critical for effective care.
560803 -
560804 - Near the end of the examination, the doctor commented from her
560805 - notes that the biopsy report that disclosed IBC was taken on
560806 - 040416.
560808 - ..
560809 - The patient advised that the biopsy was actually taken on
560810 - 040419. ref SDS 14 1572
560812 - ..
560813 - The doctor asked Todd to leave the examination room and go
560814 - authenticate this part of the conversation by verifying
560815 - accuracy of patient history cited on 040517, ref SDS 17 525U,
560816 - and reviewed by Todd and Denise earlier today, per above.
560817 - ref SDS 0 WR9F Doctor Guardino's emphasis on accurate medical
560818 - records follows comments yesterday at UCSF by Doctor Benz
560819 - requesting documentation to authenticate accuracy of CA 15-3
560820 - cancer marker, ref SDS 32 L16Q Standford's support for
560821 - investing time to verify accuracy of patient medical history
560822 - aligns with requirements in Kaiser's Healthwise Handbook
560823 - reviewed on 990625. ref SDS 2 3960 Standford's requirements to
560824 - authenticate accuracy conflict with Kaiser's medical practice
560825 - that is less precise than engineering, reported on 040812,
560826 - ref SDS 19 TQ62, and further conflicts with industry practice
560827 - to ignore requirements for good management to verify accuracy
560828 - shown by the study on 020504, ref SDS 6 NS6F, and, so helps
560829 - redress high cost of medical mistakes reported on 990912.
560830 - ref SDS 3 0001
560832 - ..
560833 - Todd left the room. He returned about five (5) minutes later
560834 - saying he saw the pathology report in records received from
560835 - Kaiser on the biopsy taken 040419, ref SDS 14 1572, as shown in
560836 - patient history listed in the record on 040517, ref SDS 17
560837 - L68F, and submitted to Stanford today, per above. ref SDS 0
560838 - WR9F
560840 - ..
560841 - Stanford's practice to authenticate conversation for accurate
560842 - understandings of patient history was considered on a related
560843 - matter at Kaiser on 040402. Obtaining written records in an
560844 - efficient form to make verification fast and easy significantly
560845 - impacts accuracy. ref SDS 13 OR6R
560846 -
560847 - [On 041130 discussion at Kaiser on getting a written work
560848 - plan and review by Tumor Board on treating the patient,
560849 - ref SDS 39 YR8F, after major change in status due to
560850 - pulmonary emboli ended participation in the Avasting Taxol
560851 - trial. ref SDS 39 WL9M
560853 - ..
560854 - [On 041209 Stanford's support for accuracy in the record is
560855 - aided by review that refines understanding of patient
560856 - history listed in the 2nd opinion ref SDS 41 OW4T
560858 - ..
560859 - [On 041230 primary care physician asked patient for reasons
560860 - chemotherapy regimine was changed to another drug,
560861 - illustrating importance of timely, accurate records.
560862 - ref SDS 43 XQ84
560864 - ..
560865 - [On 050415 the pharmacist at Kaiser recommended keeping a
560866 - diary to accurately assess side effects of new treatment
560867 - for adjusting the dosage. ref SDS 49 2W6I
560869 - ..
560870 - [On 050422 the doctor asked Millie about the diary on side
560871 - effects following change to a new treatment. ref SDS 50
560872 - VE68
560874 - ..
560875 - [On 051108 letter to Doctor Guardino commending work on 2nd
560876 - opinion, reporting results of implementation, and noting
560877 - opportunity for Peggy to get high quality treatment from
560878 - the doctor. ref SDS 60 KS5N
560880 - ..
560881 - Millie explained this report was discussed in general, but not
560882 - submitted, by the surgeon on 040429. ref SDS 15 0001 It was
560883 - discussed again by the primary care physician on 040504, but
560884 - not submitted, nor was diagnosis of IBC disclosed. ref SDS 16
560885 - WI8F The pathology report for the biopsy was submitted two (2)
560886 - weeks later by primary care physician during a meeting on
560887 - 040517, ref SDS 17 736K, and was not discussed at that time.
560888 - ref SDS 17 6T5G IBC was diagnosed a month later on 040614 in
560889 - response to a question by the patient. ref SDS 18 6T5G
560890 -
560891 -
560892 -
5609 -
SUBJECTS
Stanford Issue Written Report on Findings and Recommendations for 2n
Stanford Call Kaiser Discuss Findings from 2nd Opinion and Ideas for
5804 -
580501 - ..
580502 - Stanford Issue Report on 2nd Opinion to Patient
580503 - Doctor Guardino Call Doctor Johnson for Consultation on Findings
580504 -
580505 - Following the examination, Doctor Guardino explained plans to dictate
580506 - an opinion today or tomorrow that responds to the patient's request
580507 - submitted to Stanford on 041002, per above. ref SDS 0 ER8O The 2nd
580508 - opinion will be supported by patient history, per Denise. ref SDS 0
580509 - 5W3J Doctor Guardino will send a copy of the report to Kaiser, per
580510 - patient instructions, even though Kaiser did not make a referral.
580511 - Doctor Guardino further plans to call Doctor Johnson to discuss her
580512 - findings and ideas on treatment, so that the patient can meet with
580513 - Kaiser in the next few weeks to develop a new work plan based on the
580514 - 2nd opinion. Todd indicated that submission of the 2nd opinion may
580515 - take a week or so to be processed by Stanford's document managmenet
580516 - people.
580518 - ..
580519 - [On 041124 called Stanford on progress getting the report for a
580520 - 2nd opinion. ref SDS 38 SF6H
580522 - ..
580523 - [On 041201 Michael in Medical Records plans to get 2nd opinion
580524 - report signed and distributed. ref SDS 40 N86H
580526 - ..
580527 - [On 041209 received Doctor Guardino's report dated 041019.
580528 - ref SDS 41 LO5L
580530 - ..
580531 - [On 041209 Stanford addressed the 2nd opinion to Kaiser, rather
580532 - than to the patient. ref SDS 41 WY9I
580534 - ..
580535 - Millie was pleased Stanford invested time today to understand case
580536 - history, check pathology slides, and examine test films. ref SDS 0
580537 - 0R49 Efforts maintaining an accurate record lend confidence to the
580538 - quality of care, indicated by Stanford's attention to detail, per
580539 - above. ref SDS 0 BV92
580540 -
580541 -
580542 -
580543 -
5806 -
SUBJECTS
Lessons Learned Stanford Empowers Patients for Document Management P
Health Care 2nd Opinion Process Stanford Empowers Patients for Docum
6004 -
600501 - ..
600502 - Lessons Learned Patient Care Improved through Partnership
600503 -
600504 - Follow up ref SDS 17 PW8F.
600505 -
600506 - Does experience in this case support lessons learned...
600507 -
600508 - 1. Document Management Problematic Requires Patient Support
600509 -
600510 - On 041005 the primary care physcian recommended the patient get
600511 - a second opinion, and advised that the oncology nurse would
600512 - coordinate timely, accurate transfer of medical records. The
600513 - Oncology nurse said that the Business Office is responsible for
600514 - transferring medical records, and her responsibility was to
600515 - explain how to find the Business Office. Later on 041007 at
600516 - the Business Office the patient filled out forms that specified
600517 - the scope and order of records to transfer, reported on 041007.
600518 - ref SDS 27 GI9F Subsequent work on 041014 showed that transfer
600519 - failed. ref SDS 31 0001
600521 - ..
600522 - After meeting today, Doctor Guardino and Todd left the exam
600523 - room while Millie dressed. Todd came back about 10 minutes
600524 - later and returned medical records submitted earlier today.
600525 - ref SDS 0 LV9L He recommended keeping the CT tests in the
600526 - event another examination is needed. Millie asked if Stanford
600527 - can do this, so that patients do not have to haul a big stack
600528 - of documents around to different organizations? Todd explained
600529 - Stanford empowers patients to manage medical records used for
600530 - diagnosis and prescribing treatment, because Stanford does not
600531 - have the power to accomplish this task. This aligns with
600532 - Stanford's recommendation on 041011 for patients to hand carry
600533 - medical records, and to organize the record for accurate
600534 - understanding by the doctor, rather than rely on the hospital.
600535 - ref SDS 29 8E66 This, also, fits the model of doctor patient
600536 - partnership discussed with Denise today. ref SDS 0 EQ5J
600538 - ..
600539 - Previously, on 041012 Sheridan reported information management
600540 - has failed at UCSF. ref SDS 30 4Q7Y The same problem occurs in
600541 - legal practice, reported on 960406. ref SDS 1 5922 The problem
600542 - is widespread, especially in technology companies selling
600543 - products for solving the problem. ref SDS 1 4249
600544 -
600545 -
600546 -
6006 -
SUBJECTS
Medical History Sparse Illegible Requires Patient Support
6203 -
620401 - ..
620402 - 2. Medical History Sparse Illegible Needs Patient Support
620403 -
620404 - Stanford's attention to accuracy for the date of chronology,
620405 - shown by Doctor Guardino today, ref SDS 0 BV92, suggests that
620406 - accuracy on chronology and content can strengthen patient care.
620408 - ..
620409 - Review of patient medical records on 041014 found that Doctor
620410 - reports on examinations and analysis to develop treatment
620411 - options are sparse and illegible. ref SDS 31 W78K
620413 - ..
620414 - Doctor Benz at UCSF reported his experience shows information
620415 - prepared by doctors on patients is generally of little use to
620416 - understand patient diagnosis and treatment history. (see the
620417 - meeting yesterday on 041018. ref SDS 32 EN63)
620419 - ..
620420 - This aligns with the study reported on 990912 that found
620421 - medical mistakes cause 300% more deaths than automobile and
620422 - airplane accidents combined, ref SDS 3 0001, and a major cause
620423 - of medical mistakes is failed communication. ref SDS 3 0960
620424 - Illegible records is, also, cited in the study. ref SDS 3 0900
620426 - ..
620427 - Does this pose a lesson learned for patients to improve their
620428 - care by taking responsibility, as Denise indicated Stanford
620429 - supports, ref SDS 0 EQ5J, for investing time to report and
620430 - analyse doctor examinations? Would this help fill the gap to
620431 - help doctors in the same way that Stanford has found that care
620432 - improves when patients manage their documents, under lesson one
620433 - (1)? ref SDS 0 BW5J Can doctors be empowered to implement good
620434 - practice set out in Kaiser's Healthwise Handbook calling for
620435 - review of patient records by providing feedback to refine
620436 - accuracy, reported on 990625? ref SDS 2 3190 Would better
620437 - accuracy reduce medical mistakes?
620439 - ..
620440 - Suppose this record were provided to the doctor by the patient
620441 - online, with granular linking and indexing, so that doctors and
620442 - staff do not have to shuffle a bunch of papers, but could click
620443 - from one issue to the next. Could this methodology draw
620444 - doctors toward a practice of relying on the record, rather than
620445 - reacting on impulse to information out of context?
620446 -
620447 -
620448 -
620449 -
6205 -
SUBJECTS
Care Improved Cost Reduced Doctor Patient Collaboration Review Medic
6403 -
640401 - ..
640402 - 3. Quality Increased Cost Reduced Doctor Patient Collaboration
640403 -
640404 - The case history was submitted to Stanford on 041002, listing
640405 - issues to be addressed in a 2nd opinion. ref SDS 21 K138 On
640406 - 041011 Michelle reported that the request for a 2nd opinion,
640407 - along with patient history was not presented to the doctor,
640408 - because Stanford's policy is to make a consolidated review.
640409 - ref SDS 29 8F42
640411 - ..
640412 - Can costs be reduced and care improved by patients empowering
640413 - doctors to review the record in advance of meeting for an
640414 - examination? If Todd and Denise had reviewed the chronology
640415 - prior to meeting for the examination, then they could have
640416 - saved time while also increasing understanding of a complex
640417 - record by notifying the patient to assemble medical records
640418 - into alternate views directed by the doctor ref SDS 0 LT60
640419 - This eliminates tension with attendant error shuffling papers
640420 - at the last minute, leading to unsupported assumptions. In
640421 - other words, patients have relatively more time for their case
640422 - than doctors have. Can this be applied productively to meet
640423 - the coming avalanche that will hit health care in the next 10
640424 - years?
640426 - ..
640427 - Instead of showing up and the staff saying "Hey can you help
640428 - us?" while everybody is tying up expensive talent and real
640429 - estate, call the patient, or send a letter with email and
640430 - explain what is needed. The record can be reconstituted, and
640431 - sent back in the form that is helpful. This can be done
640432 - several times, without the pressure of a clicking clock.
640433 -
640434 -
640435 -
640436 -
640437 -
640438 -
6405 -
SUBJECTS
Other Lessons Learned Case Study IBC Symptoms Diagnosis Treatment
6503 -
650401 - ..
650402 - Case Study IBC Symptoms Diagnosis Treatment Lessons Learned
650403 -
650404 - Follow up ref SDS 17 PW8F.
650405 -
650406 - Can Stanford comment on other potential lessons learned from the case,
650407 - reported on 040517? ref SDS 17 PW8F
650408 -
650409 -
650410 -
650411 -
6505 -
SUBJECTS
Stanford Health Library Research Inflammatory Breast Cancer IBC Avas
6603 -
660401 - ..
660402 - Stanford Health Library Research on IBC Avastin Treatment Options
660403 -
660404 - When we got home from the hospital in the evening, about 2100, there
660405 - were 13 messages, all dated 041019, responding to the inquiry this
660406 - afternoon, per above. ref SDS 0 8Z31
660407 -
660408 - [On 050414 John Maloney cited similar support at UCSF which
660409 - has resources on the Internet provided by a Center for
660410 - Knowledge Management. ref SDS 48 HS4J
660412 - ..
660413 - 1. Pubmed Search Results
660414 - Entrez nobody@ncbi.nlm.nih.gov
660416 - ..
660417 - This seems to be an annomous report from....
660419 - ..
660420 - National Library of Medicine (NLM)
660421 -
660422 - http://www.nlm.nih.gov/
660424 - ..
660425 - This is a report on CA 125, which is different from CA 15-3
660426 - being used at Kaiser. This report concludes...
660427 -
660428 - The significance of CA 125 elevations in breast cancer is
660429 - uncertain. Although CA 125 production has been demonstrated
660430 - in the normal breast, it has been reported most often as a
660431 - marker of pleural involvement with metastatic breast
660432 - cancer. Further information on CA 125 in breast cancer is
660433 - required to delineate its role in the management of this
660434 - disease.
660436 - ..
660437 - Nothing of evident import to Millie is reported.
660439 - ..
660440 - 2. Pubmed Search Results
660441 - Entrez nobody@ncbi.nlm.nih.gov
660443 - ..
660444 - This turns out to duplicate the 1st report. ref SDS 0 QJ3O
660445 -
660447 - ..
660448 - 3. Stanford Health Library
660449 - Article from Journal of Clinical Oncology
660450 - healthlibrary@stanfordmed.org
660452 - ..
660453 - The Stanford Health Library has sent this article to you from
660454 - Journal of Clinical Oncology:
660456 - ..
660457 - Long-Term Follow-Up for Locally Advanced and Inflammatory
660458 - Breast Cancer Patients Treated With Multimodality Therapy
660459 -
660460 - http://www.jco.org/cgi/reprint/22/20/4067?eaf
660462 - ..
660463 - Opening the article yields a notice that access requires a
660464 - subscription.
660466 - ..
660467 - Nothing of evident import to Millie is reported.
660468 -
660470 - ..
660471 - 4. Pubmed Search Results
660472 - Entrez nobody@ncbi.nlm.nih.gov
660474 - ..
660475 - Curr Treat Options Oncol. 2000 Aug;1(3):228-38
660476 -
660477 - This might be dated from Aug 2000????
660479 - ..
660480 - Locally advanced breast cancer.
660482 - ..
660483 - Sikov WM.
660485 - ..
660486 - Department of Medicine, Room 320, The Miriam Hospital, 164
660487 - Summit Avenue, Providence, RI 02906, USA.
660488 -
660489 - ...Partial mastectomy should be accompanied by standard nodal
660490 - dissection in patients with clinically or radiographically
660491 - positive axillae; in patients with negative axillae, sentinel
660492 - lymph node (SLN) sampling, with subsequent axillary dissection
660493 - reserved for patients with involved nodes, may reduce
660494 - postoperative morbidity.
660495 -
660496 - Not clear that the doctor discussed morbidity today, per
660497 - above. ref SDS 0 TX36 May have deferred to discuss with
660498 - Doctor Johnson.
660500 - ..
660501 - 5. Pubmed Search Results
660502 - Entrez nobody@ncbi.nlm.nih.gov
660504 - ..
660505 - This duplicates report #4. ref SDS 0 WR9X
660506 -
660508 - ..
660509 - 6. Wiley Inter-Science Content Link
660510 - healthlibrary@stanfordmed.org
660512 - ..
660513 - The following link to content from Wiley InterScience has been
660514 - sent to you by The Stanford Health Library
660516 - ..
660517 - Prognostic value of P53, MDM-2, and MUC-1 for patients with
660518 - inflammatory breast carcinoma Cancer
660519 -
660520 - http://www3.interscience.wiley.com/cgi-bin/abstract/109579324/ABSTRACT
660522 - ..
660523 - CONCLUSIONS
660524 -
660525 - Expression of P53 and MUC-1 may be predictive of treatment
660526 - efficacy and outcome for patients with IBC. Furthermore,
660527 - these two markers may represent novel therapeutic targets in
660528 - such patients. Cancer 2004. c 2004 American Cancer Society.
660529 -
660531 - ..
660532 - 7. Pubmed Search Results
660533 - Entrez nobody@ncbi.nlm.nih.gov
660535 - ..
660536 - Clin Cancer Res. 2004 Sep 15;10(18 Pt 1):6215-21
660538 - ..
660539 - p53 expression as a prognostic marker in inflammatory breast
660540 - cancer.
660542 - ..
660543 - Gonzalez-Angulo AM, Sneige N, Buzdar AU, Valero V, Kau SW,
660544 - Broglio K, Yamamura Y, Hortobagyi GN, Cristofanilli M.
660546 - ..
660547 - Department of Breast Medical Oncology,
660548 - The University of Texas
660549 - M. D. Anderson Cancer Center,
660550 - Houston,
660551 - Texas 77030, USA.
660553 - ..
660554 - PURPOSE: Inflammatory breast cancer (IBC) is a rare and
660555 - aggressive form of breast cancer....
660557 - ..
660558 - CONCLUSIONS: This retrospective analysis demonstrates that
660559 - nuclear p53 protein expression may represent an adverse
660560 - prognostic marker in IBC and may provide a valuable tool for
660561 - selecting treatment for this aggressive disease.
660562 -
660564 - ..
660565 - 8. HWRC Documents: FDA approves Avastin Manufacturing Vacaville
660566 - hwrc@galegroup.com
660568 - ..
660569 - This is publicity email notifying that Avastin is approved for
660570 - manufacture, and this is being done in Vacaville, CA.
660571 -
660573 - ..
660574 - 9. HWRC Documents: Cancer Drug Avastin Use Increases
660575 - Risk of Stroke
660576 - hwrc@galegroup.com
660578 - ..
660579 - Cancer drug Avastin use increases risk of stroke, heart attack.
660580 - Medical Letter on the CDC & FDA. Sept 12, 2004 p16.
660582 - ..
660583 - This notice was received and then reviewed with Doctor Johnson
660584 - at Kaiser on 040812. ref SDS 19 EX5F The doctor indicated at
660585 - that time that since Millie has no personal history of blood
660586 - clot problems, the fact that her mother died of a blood clot
660587 - heart condition at the age of 42, and her son suffered blood
660588 - clot problems a year ago at the age of 50, does not suggest
660589 - risk for Millie in connection with the Avastin trial based on
660590 - recent reports of patients dying from blood clots caused by
660591 - Avastin. ref SDS 19 W35K
660592 -
660593 -
660594 -
6606 -
SUBJECTS
Progression Free Survival Avastin Trial Not Achieved
Avastin Progression Free Survival Trial Not Achieved 2002 Study Avas
6804 -
680501 - ..
680502 - Taxol Avastin May Yield Better Results
680503 - Study 2002 Progression-free Survival Not Achieved
680504 - Progression Free Survival Avastin Trial Not Achieved
680505 -
680506 -
680507 - 10. HWRC Document: bevacizumab Genentech clinical data
680508 - hwrc@galegroup.com
680509 -
680510 - bevacizumab Genentech clinical data. R&D Focus Drug News.
680511 - March 31, 2003 pNA.
680513 - ..
680514 - Full Text: COPYRIGHT 2003 IMSworld Publications Ltd.
680516 - ..
680517 - A Phase III trial of bevacizumab (AVASTIN) in relapsed
680518 - metastatic breast cancer patients did not meet its primary
680519 - efficacy endpoint of progression-free survival. Four hundred
680520 - and sixty two patients were randomised to receive bevacizumab
680521 - plus capecitabine (XELODA) or capecitabine alone to patients
680522 - who previously were treated with anthracycline and taxane-based
680523 - drugs. A phase III trial in colorectal cancer has completed and
680524 - results are available. A decision on further phase III
680525 - development will be taken second half 2003. These results were
680526 - reported at Roche's Full Year Results 2002 Meeting, 26 February
680527 - 2003, London, UK.
680529 - ..
680530 - This report fits closer to Millie's profile of a relapsed metastatic
680531 - breast cancer, described by Doctor Johnson in a meeting on 040318, and
680532 - based on biopsy of swelled lymph nodes in the neck. ref SDS 12 8R6M
680534 - ..
680535 - Report that Avastin with capecitabine (XELODA) did not reach efficacy
680536 - end point of progression- free survival, may support Doctor Guardino's
680537 - comments today on goals for ending treatment, per above. ref SDS 0
680538 - 5W6H Millie's trial is using Taxol instead of capecitabine (XELODA),
680539 - which yield different results.
680541 - ..
680542 - Report continues...
680543 -
680544 - bevacizumab, MAb, vascular epithelial growth factor, rhuMAb,
680545 - VEGF, AVASTIN, L1X, Other Cytostatics, S1, Ophthalmologicals,
680546 - Genentech, clinical-data
680548 - ..
680549 - Record Number: A99310226
680550 -
680551 -
680553 - ..
680554 - 11. HWRC Document: Genetech, Inc., (Phase 3)
680555 - hwrc@galegroup.com
680557 - ..
680558 - HWRC Document
680560 - ..
680561 - Genentech, Inc. (Phase 3). Applied Clinical Trials. Oct 2002
680562 - v11 i10 p16(1).
680564 - ..
680565 - A Phase 3 study of Avastin (Genentech, Inc., South San
680566 - Francisco, CA, bevacizumab, rhuMAb-VEGF) in relapsed metastatic
680567 - breast cancer subjects did not meet its primary efficacy
680568 - endpoint of progression-free survival. The study randomized 462
680569 - women with metastatic breast cancer, who had previously
680570 - received treatment with both anthracycline and taxane-based
680571 - chemotherapy regimens, to receive the study drug with Xeloda,
680572 - or Xeloda alone. One of the secondary endpoints, overall
680573 - response rate, did achieve statistical significance, but this
680574 - did not translate into benefit in progression-free survival or
680575 - 12-month survival.
680577 - ..
680578 - This appears to be a parallel study in 2002 with Avastin and Xeloda,
680579 - which is, also, different from Taxol.
680581 - ..
680582 - Above, ask the doctor about potential significance of "response rate"
680583 - success reported in the study? ref SDS 0 516F Does not sound very
680584 - promising.
680586 - ..
680587 - Record Number: A93070486
680588 -
680590 - ..
680591 - 12. HWRC Documents: Cancer Drug Avastin Use Increases
680592 - Risk of Stroke
680593 - hwrc@galegroup.com
680595 - ..
680596 - Duplicates prior report on risk taking Avastin from blood
680597 - clots. ref SDS 0 XU4I
680598 -
680600 - ..
680601 - 13. This was an Avastin trial that said there is no data, and no
680602 - evident relationship to IBC.
680603 -
680604 -
680605 -
680606 -
680607 -
680608 -
680609 -
680610 -
680611 -
680612 -
680613 -
680614 -
680615 -
680616 -
680617 -
680618 -
6807 -