Hematology-Oncology W1D1

Today was our first day at the Taipei Hospital and I started out with the Hematology-oncology rotation. Our preceptor for this rotation was Dr. Chen, who was the only physician in the hematology-oncology department. Dr. Chen welcomed us briefly and immediately took us on rounds with him along with another physician, Dr. Luo.

Dr. Chen mentioned that there are very few patients under his care currently so there might not be that many cases for us to observe. We saw a total of four cases today with patients that have breast cancer, colon cancer, gastric cancer, and multiple myeloma. The first patient was a middle aged female outpatient with breast cancer who was being treated with chemotherapy regimen that included drugs such as 5-Flourouracil. The meeting was very short as Dr. Chen simply instructed her to continue with her treatment and return a few days later for a check up.  The second patient we saw was an elderly female inpatient with colon cancer that had metastasized to the liver. She was unresponsive so Dr. Chen communicated with her caretaker. This particular patient has a mass that was too large to remove so she was only on supportive care with no future plans of further treatment.

After seeing the second patient, we went down to the fifth floor where Dr. Chen showed us a lateral radiograph of a skull and asked us to identify the abnormality. It was a skull X-ray of a patient in his 50s that showed punched out lesions that are characteristic of multiple myeloma.  Dr. Chen explained that this patient was referred from the nephrology department where he first went to due to renal insufficiencies. The patient was found to have high blood calcium levels and Ig light chain in his urine, which indicated his symptoms may be more associated with a hematologic origin rather than the originally suspected renal source. Dr. Chen explained to the patient’s nephew and daughter that his condition is incurable and his best option may be to undergo autologous stem cell transplant. Since the Taipei Hospital is not equipped to perform such procedures, Dr. Chen suggested that the patient go to a bigger hospital where he could get more thoroughly examined and possibly receive the transplant. The one thing that really stood out to me was how blunt Dr. Chen was when he was telling the patient’s family about the patient’s condition. He said repeatedly that his condition cannot be cured and it is up to him to choose what kind of treatment, if any at all, he wanted to receive. It was interesting to see the difference in how he deliver bad news as opposed to the way we were taught to deliver bad news. There was no initial set up at all to prepare the patient and his family of the grim prognosis and the time spent with the patient was very short.

The last case we saw of the day was an elderly female with gastric cancer who was on supportive care. This particular case was interesting because the patient had deferred her treatment plan to her six children who could not agree on one treatment to proceed with. As a result of her children’s inability to agree on a treatment option, the patient’s only option was to remain on supportive care. Dr. Chen showed some frustration in this case because the patient is not only not receiving the proper treatment she needs, her children are all directing their misguided anger at him. Dr. Chen spent a good amount of time speaking with some members of the family, suggesting them get together ASAP to come up with a plan in regards to their mother’s treatment.

Overall, it was a short but interesting day. It was definitely difficult to hear or understand some of the information Dr. Chen was telling us, but he was very patient in answering our questions. He explained that due to the high immigrant population in the area, the most prevalent cancers seen at the hospital are oropharyngeal cancer, liver cancer and esophageal cancer (likely due to lifestyle influences such as smoking and drinking). Dr. Chen mentioned the up to 50% of patients forgo treatment if told the cancer has likely metastasized because they believe the costs will not outweigh the benefits.