Friday, May 15, 2009

What is ‘women’s oncology’? (by Suzie)

          A. Is it the treatment of cancers that occur only in women? (Some people may not know that breast cancer can arise in men. Others might cite gynecologic cancers, not thinking of transmen.)
         B. Does “women’s oncology” refer to cancers that occur predominantly in women?
         C. Is it the study and treatment of any woman with cancer? 
         Answers matter in the allocation of resources.
         Last week, I went to a reception for the new Center for Women’s Oncology at a comprehensive cancer center where I get my care. The center combines the clinics for breast and gynecologic cancers.
         I wore a beautiful outfit in deep pink that I had just gotten from Goodwill. What was I thinking? I had worn the wrong gang colors. Because my cancer arose in my "lady parts," people told me that I should have worn teal, the color for ovarian cancer, which seems to have morphed into the color for all gyn cancers.
         The color for my cancer, leiomyosarcoma, is purple, but few people know that because we are the abject. (I’m sorta, kinda referencing Judith Butler.)
         There was live music, gourmet hors d’oeuvres from a catering staff, and an open bar. One doctor joked that patients might not mind the usual wait time if the waiting room could retain the bar.
         Survivors were given a white rose and a tote bag when we left. (In sarcoma, we don’t even get drugs approved for us; we’ve got to use other people’s drugs off-label.)
         At the women’s center, we won’t keep the bar, but there’s no doubt that women whose cancers arose in their reproductive tracts will get an upgrade in amenities by the merger with the breast clinic. Breast cancer patients tend to have the best.
         I understand that many women have worked hard to raise money for breast cancer. In a system that relies heavily on volunteers and donations, however, you can expect that people with rare diseases will get less.
         As an example: I was amazed to hear that some breast-cancer patients get teddy bears after surgery that they can hold to their chests when they cough, sneeze, etc., to minimize the pain. After major abdominal surgery, I was lucky that someone suggested holding a hospital pillow against my body.
        In the new center, plush bathrobes in a light sage, tied with a ribbon, rested on the exam tables. I asked if those were the gifts we could win in the drawing. No, I was told, patients would be wearing them. WHAT?? We don't have to wear stiff paper drapes or white-with-small-flowers-and-washed-a-zillion-times-in-hot-water gowns?
        Combining the breast and gyn clinics can save money in terms of staffing and space. People I trust also say there's a benefit to more doctors and researchers collaborating. (That's why I wish oncologists in gyn and sarcoma would collaborate more. They rarely go to each other’s conferences, for example.)
        There’s a genetic link between some breast and ovarian cancer. For the women with that genetic profile, it makes sense to join forces. But there are other cancers connected by genetics or treatment, e.g., retinoblastoma and soft-tissue sarcomas. I hope all oncologists and support staff understand the various connections.
        Breast cancer has been marketed as the sexy cancer – save the ta-tas!!!! ® – and as the women’s cancer. Not to be outdone, gyn oncologists have the Women’s Cancer Network. Meanwhile, lung cancer kills more women than breast or gyn cancers.
         I wonder how women with other kinds of cancer feel.