Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How long after prostate radiation do you recommend waiting for routine screening colonoscopy?
Good question. In this regard, I would say that the timing would depend on the nature of the acute reaction in the area of the rectum adjacent to the prostate. This may be patient dependent. Further, the local reaction erythema can last for weeks to months depending on the reaction. Also, if it's >1...
Which criteria do you follow to recommend low-dose CT screening in patients at high risk for lung cancer?
At this time, I still follow the USPSTF/NLST guidelines, but believe the criteria for screening should be updated to include more patients. The current recommendations from the USPSTF based on the National Lung Screening Trial demonstrating an improvement in lung cancer and all cause mortality inclu...
How do you decide whether to obtain dental evaluation to reduce the risk of medication-related osteonecrosis of the jaw prior to initiating non-urgent bone-modifying agent therapy?
I have a practice that I send all patients, even edentulous patients, for a dental screening examination if they have a non-emergent need bone-modifying agents (BMAs). That recommendation comes from osteonecrosis guidelines published in J Clin Oncol 2019. The reason for this recommendation is when s...
Is it safe for a patient to breastfeed during their course of EBRT?
Not aware of any concerns. In our pregnancy-associated breast cancer patients, I encourage women to breastfeed on the side I am not treating as long as med onc has cleared them. We work with pediatricians to ensure that the infant is reaching normal weight/growth milestones, but may need to suppleme...
Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?
As per FAQ’s posted by ASTRO: There is no reason to do so at this time. Be vigilant re: hand hygiene and wiping down any equipment that touches the patient (stethoscope, etc.). Additionally, any equipment that touches mucosa/secretions of the patient must be sterilized (rhinolaryngoscope, etc.). For...
What oral alternatives would you recommend as opposed to injectable GnRH agonists for those who do not wish to come to clinic due to COVID-19?
Casodex is an option. Due to liver toxicity, they would need LFTs checked before and at a future interval, effectively requiring them 3 visits to a health care facility—labs, pharmacy, labs. A single 6 month injection seems like a better proposition.
Should patients with bleeding disorders increase their home supplies of clotting factors foreseeing a possible shortage of product availability due to COVID-19?
No. The Medical and Scientific Advisory Council (MASAC) for the World Federation of Hemophilia recommends against increasing the already recommended home supply of clotting factors: One month worth of regular prophylaxis doses if on a prophylactic regimen; and one major correction dose, and two mino...
What lifestyle changes (if any) do you recommend to patients and caregivers regarding the bodily fluids of patients receiving systemic therapy?
For recommendations related to reproduction (both genders) and lactation, the USPI (a.k.a. FDA label) is a great place to start. Specifically, I refer to subsections 8.1 Pregnancy, 8.2 Lactation, and 8.3 Females and Males of Reproductive Potential of the "Use in Specific Populations" section. These ...
Do you adjust PSA for finasteride use when determining prostate cancer stage and risk category?
We generally use the rule of 50% (real PSA is twice the lab value when on Finasteride).
How long after discontinuation of TKI (for complete remission) would you feel it is safe for a patient with CML to consider pregnancy?
Tyrosine kinase inhibitors have been demonstrated, in animal models, to be teratogenic when utilized early in pregnancy. In retrospective studies in humans, congenital anomalies similar to what was identified in animal studies have been reported. Since spermatogenesis takes several weeks, some have ...