Radiation Oncologist Gives Clear Advice to Patients With Cancer

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Title: Cancer: What You Need to Know: Overcome the 10 Common Mistakes Patients Make
Author: Stephen A. Rosenberg, MD
Publisher: Stephen Rosenberg, MD
Year Published: November 2017
Price: $9.99, paperback, 248 pages

Stephen A. Rosenberg, MD, is Chief Resident in Radiation Oncology at the University of Wisconsin. He is also the author of a new book Cancer: What You Need to Know: Overcome the 10 Common Mistakes Patients Make. Dr. Rosenberg’s experience in the clinic left him unsettled by the lack of quality information his cancer patients were obtaining, either from poorly written books laden with unnecessary information or a tsunami of contradictory and often misleading information culled during Web searches.

Simplifying Complexity

The goal of Dr. Rosenberg’s book is “to fill in the who, what, when, where, and why of cancer in an easy-to-read format.” And he does all that and more, in a neat construction that clearly elucidates the dizzying complexity of cancer, making it a valued companion for busy oncologists across the country, especially young fellows who are just getting their feet wet in doctor-patient communication.

Dr. Rosenberg’s book is organized into 17 chapters with an addendum called, “The 10 Common Mistakes Patients Make.” It is above and beyond one of the most accessible books in this genre; all of the scientific terms are defined in reader-friendly language in the book’s glossary. In the opening chapter, “Cancer 101,” Dr. Rosenberg succinctly explains the genetic and biologic drivers of cancer, including age. Yet it is the clarity of his explanations that stands out when he tackles issues that baffle most in the lay public, such as metastases.

Dr. Rosenberg, writes: “Cancer spreads anywhere it needs to go to find an environment with resources to help it grow. It’s clear that different types of cancers tend to spread to certain parts of the body…. Just like there are certain soils that are better for some plants, there are better places in the body for certain cancers to grow. This idea is called the seed in soil hypothesis. These specific patterns happen because cancer cells communicate with (send signals to) other organs.”

Understanding Treatment Options

He digs a bit deeper into cancer biology in the following chapter, where he discusses DNA and heritable cancers, offering an informative segment on cancer risk factors. The nuts and bolts of the book are the chapters dealing with diagnosis and deciding on goals and treatment. Explaining surgery and chemotherapy is fairly straightforward, but wading into radiation—an invisible power that still remains misunderstood and mistakenly feared—requires a careful wordsmith, and once again Dr. Rosenberg reduces the complex into lay-friendly language without ever dumbing down the content.

For example: “Accuracy in setup is essential. The goal of radiation is to treat the cancer while sparing as much normal tissue as possible…. A doctor works with a dosimetrist (someone specializing in how to calculate radiation doses) and a physicist (someone with a master’s degree or PhD in physics) to come up with a patient’s unique radiation plan.”

Chapter 9, “Immunotherapy: Enlisting the Immune System,” does an excellent job of introducing immunotherapy, still a somewhat hazy concept in the public’s mind. Dr. Rosenberg even touches on the abscopal effect, in which local radiation causes tumor cell death, which is followed by an adaptive immune system response that eradicates distant cancer, one of the more intriguing areas of research.

To his credit, Dr. Rosenberg also forewarns patients about cost: “Immunotherapy drugs are costly. In fact, some newer drugs cost more per gram than gold. Keep this in mind if having to pay for out-of-pocket treatment costs is a consideration. These drugs may be available through clinical trials, which we discuss next.”

Confidential Style

Dr. Rosenberg’s ability to drill to the marrow of the message is on display in chapter 11, “Integrative Medicine: Caring for the Whole Person.” Here, in short, information-filled paragraphs, he outlines the most prominently used complementary medicines and explains how they are integrated into traditional care. He ends the chapter with an important caveat about Internet con artists who prey on cancer patients’ fear and anxiety. His tone is never preachy; it’s more of a confidential conversation between a doctor and his patient.

It’s clear, smart, and honest communication that all cancer patients should have taped to their refrigerator door. So should their oncologists.

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The section on nutrition and lifestyle is value-added and straight to the point. Dr. -Rosenberg is well versed on everything from exercise to weight gain to sugar intake, debunking myths and offering sound advice. “A cancer patient undergoing treatment needs to keep up his or her weight. I want to make sure a patient continues to get enough calories. The ideal is a balanced diet (the Mediterranean approach I mentioned earlier), but I wouldn’t be upset if a patient got significant calories from sugar during treatment.”

Research shows that people respond well to enumerated lists, especially on difficult issues for which they may need to continually reference. After fine chapters on sex after cancer and survivorship, Dr. Rosenberg closes with some heartfelt comments for cancer patients and then gives the reader The 10 Common Mistakes Patients Make, with each mistake annotated with a reference page. It’s clear, smart, and honest communication that all cancer patients should have taped to their refrigerator door. So should their oncologists. This book is highly recommended for The ASCO Post readers. ■