Fourth Session

Wednesday, November 14, 2012

The Emperor of All Maladies: Patient Care Implications

Possible Discussion Questions

  1. Mukherjee frames the book around the story of his patient, Carla Reed, a teacher who is diagnosed with leukemia. What did you find interesting or important about Carla’s experience? How do you think she shaped the author’s life and thoughts?
  2. “The stories of my patients consumed me, and the decisions that I made haunted me,” Mukherjee says about working in a cancer clinic (page 5). But in the 1970s, during the height of aggressive combination chemotherapy trials, Mukherjee paints a different picture of doctor-patient interaction: “The language of suffering had parted, with the ‘smiling oncologist’ on one side and his patients on the other.” How have the relationships between doctors and patients evolved along with cancer treatments? What could be done to restore some of the lapses in this relationship?
  3. Review the case of Nelene Fox (pages 322-324), whose HMO, Health Net, refused in 1991 to pay for an expensive bone marrow transplant to treat her diagnosis of advanced breast cancer, citing the procedure as “investigational.” In your view, was it appropriate for Health Net to refuse reimbursement? Should patients pay for expensive experimental treatments out of their own pockets? What if these experimental treatments turn out not to extend survival – as with Fox’s transplant?
  4. The author says that he was motivated to write this book after a patient asked him, “What is cancer?” Mukherjee could not think of a book that would answer her question. So he wrote it. Does “knowing your enemy” – knowing cancer – bring some kind of comfort?
  5. On page 459, Mukherjee writes, “AS the fraction of those affected by cancer creeps inexorably in some nations from one in four to one in three to one in two, cancer, will indeed, be the normal – an inevitability.” Mukherjee makes this assessment despite the approval of oncogene-targeting drugs like Herceptin, which has given new hope to cancer patients, as well as promising efforts to sequence the cancer genome. At the end of The Emperor of All Maladies, do you come away with optimism about science’s efforts to combat cancer? Why or why not?

1 Comment (+add yours?)

  1. Jena Hallenbeck
    Nov 20, 2012 @ 01:32:36

    1.Carla’s story made this book more “human” than history to me. It was interesting to see her story developed and intertwined with the history of cancer. Her experience was important because it showed the other side of the history of cancer, the personal human experience. As a healthcare professional it is important to realize that every patient is a person with their own needs- these needs are not only regarding their health or physical wellbeing. It is important to realize a patient’s social, psychological, and spiritual needs along with any others they may present.

    2. During the 1970’s cancer treatment was still widely investigational. Oncologists were merely attempting different doses and combinations hoping for a treatment. With their focus so driven by a cure for cancer the oncologist sometimes lost sight of the real reason for treatment, the patient. As described in the book many patients felt as if they had ‘no answers’ and that even if they asked their oncologist could not provide them with the answer. Because of oncology’s ever changing nature it is a difficult medical world to navigate for both patients and doctors. Restoring lapses in this relationship must begin with building the relationship between the doctor and medical staff and their patient.

    3.Although treatment in the form of a bone marrow transplant was considered “investigational” by the insurance company it was considered highly effective in the medical community. This leads me to wonder who is dictating the course of patient’s treatment, the doctor or the insurance company? Ms. Fox had gone through conventional treatment without success and the bone marrow transplant was suggested by her doctor. Her health insurance had a responsibility to Ms. Fox to provide coverage related to her health care as directed by her doctor but they chose not to. It was understood that if she did not receive this treatment thyat death was almost certain. Yet, the insurance company decided financially that Ms. Fox’s treatment was not their responsibility. If experimental treatments turn out to be failures than I believe at that point insurance companies can refuse coverage; until this point I believe it is their responsibility to provide health coverage as promised.

    4. Knowing your enemy is half the battle. I believe that we as humans have the responsibility to apply the knowledge gained thorough cancer’s history to our lives. This is not to say that cancer cannot sneak its way into our lives without our permission but understanding what carcinogens are and how to avoid them, maintaining a healthy lifestyle, taking advantage of preventative medicine and tests, and seeking early medical attention when abnormalities are recognized is our responsibility as humans attempting to win the“war” on cancer.

    5. I am optimistic about the future of cancer diagnosis, treatment, and care. Although I think many people will continue to be affected by cancer I believe there is hope to lessen the numbers. Significant advances have been made as described in this book which leads me to believe that more will be made. Increasing technology along with medical advancement will play a tremendous role in the future of cancer.


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