Michelle Shayne, MD
Requests for Single Reprints: Michelle Shayne, MD, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642; e-mail, firstname.lastname@example.org.
Shayne M.; Prognosis. Ann Intern Med. 2011;155:645. doi: 10.7326/0003-4819-155-9-201111010-00019
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Published: Ann Intern Med. 2011;155(9):645.
I didn't expect the telephone conversation to take such a turn. I was returning a call to report the results of tumor markers that were still pending at the time of my patient's clinic visit. I told her the results, and along with them came implications I knew she wouldn't want to hear. The tumor marker values, instead of declining in a manner consistent with a good response to treatment, were increasing. I sensed the tension in her voice as she asked, “That's not good, is it?”
I told her that we'd need to see what the overall trend of the numbers was before we could say for certain that the disease was not responding to treatment. I told her that the magnitude of the increase was relatively slight and explained that the imaging studies—CT and nuclear bone scans—would give us far more information. I stated that her sense of well-being was far more important than numbers. Then I admitted that we indeed would have liked to have seen the numbers decline rather than increase.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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