In a captivating and elegant 3-page memoir, primary care physician Gene Bishop describes his gradual understanding of radiation late-effects from his 1965 treatment for childhood Hodgkin lymphoma (2019 Bishop, MD Arc of Therapy):
Both my oncologist and I are living with the reminder that no treatment
does only what we want it to do and that one year’s miracles
may have serious consequences even 50 years later.
In 1997 I rejoiced when my oncologist suggested that surgery and radiation might cure the cancer in my throat. Like Bishop, my therapy worked. But also like Bishop, my oncologist was silent about the long-term effects and the late-effects of radiation.
It was my skilled and compassionate prosthodontist, Dr. Paul Marischen, who predicted the entire parade of impairments that I have experienced over the last 24 years, from dental demolition to age-related difficulties with speaking, drinking, and swallowing.
Only my dental prosthodontist warned me that I should keep watch
for symptoms associated with heart damage that might develop from
the impact of radiation scatter during my 1997 treatment.
If I had seen a cancer rehabilitation therapist in 1997 when I was making treatment decisions, I would have learned the most predictable treatment outcomes, and how best to prepare for negative side-effects that I would likely experience. Part of a prehabilitation assessment would have likely included a referral to a prosthesis specialist who could have created a pre-surgery model of my throat to ensure the accurate fit of a prosthetic palate.
Instead I learned about a prosthetic palate after I complained to my oncologist about my problems with liquids and swallowing. My oncologist gave me a referral but the consultation was over quickly. The prosthesis specialist apologized and explained it was too late to be fitted. I should have seen him before the surgery.
It has been 24 years and most of the survivors I meet as a cancer advocate
are unaware of the benefits they could gain from cancer rehabilitation.
My passion is changing that narrative. We have abundant research that cancer rehabilitation services can lead to an improved quality of life, reduced risk of recurrence, and decreased mortality. Cancer rehabilitation makes economic sense too, by reducing unanticipated emergency room visits, and by addressing impairments early when treatment is least invasive and most effective.
Implementation science can contribute to better outcomes
by translating the benefits of cancer rehabilitation
from the world of clinical research into the real-world of survivors.
Bishop article online: DOI: 10.1200/JCO.19.00666 Journal of Clinical Oncology 37, no. 34 (December 01, 2019) 3320-3322.
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