When you died from cancer at 28, the light went out for me. You were going to change the world with your brilliance. My plans (wife, artist, mother) had to change. We were always a team, so now 11 yrs later I'm a cancer doctor... trying to change the world.
#ShareAStoryInOneTweet
🔥Hot take: A phrase I never want to hear again in medicine, "VIP Patient".
If there is a better, more efficient, more patient-centered way of treating people we should be doing it for all of our patients.
"To have and to hold..."
On September 2nd, 2006 I married the love of my life. Every anniversary I recommit myself to his memory and to trying to live a life that I hope he would be proud of.
It does not get easier. We move forward but we never move on.🖤
💡Many cancers develop despite excellent "life long health decisions". I spent all day telling my patients that
#cancer
is NOT their fault.
Can we reduce cancer risk? Yes.
Can we PREVENT cancer? No.
So sweet. 6 person family walking down the street.
Hand in hand.
6 people. Mom, dad, son, son, daughter, son.
👩🤝👨🤝👦🤝👦🤝👧🤝🧒
So sweet. Hand in hand. Walking down the street.
In New York.
Hand in Hand.
😡🤬
ABSOLUTELY NOT. This man was a pillar of strength for a whole community; we should not designate him a loser. He TRIUMPHED in a life cut short too soon. I refuse to make cancer the winner in this imaginary war. Chadwick Boseman won hearts and minds and cancer won nothing.
Simple
#TipsforNewDocs
:
1) Introduce yourself & your role to everyone in room
2) never assume relationships, (verify spouse, kid, friend)
3) SIT DOWN (no chair? GET A CHAIR)
4) Speak in plain language (oncologist = cancer doctor)
5) “what ?s do you have” is better than “any ?s”
I have fielded insults (“Really? This is what you consider research? No better ideas?”) for doing this study. Physicians make fun that
@JAMAOnc
felt it was important enough to publish. But parking costs have real negative effects on patients & families.👇
Franklin Chino (2006-2023) died peacefully today surrounded by his people. He brought years of joy to his family. He predeceased by Andrew who adopted him with Fumiko somehow knowing that a cat would help her grief & help support her transition from cancer widow to researcher. 🖤
We have a
#cancerbell
but I also privately give my patients a hand folded origami crane (symbol of hope & healing) at their last status check with me. I include a short note to acknowledge that the end of treatment can be both a triumphant & paradoxically scary time.
Many patients love the
#CancerBell
(rung at the end of
#cancer
treatment); however, some can be hurt by this “celebratory” ritual. Are we helping some & harming others? If so, what do we do with the bell?
This
@ASTRO_org
podcast discusses this phenomena.
My favorite books of the decade:
1. I didn’t
2. Barely read
3. Any books
4. Because I was
5. In Med school
6. And then residency
7. Trying to cram
8. All cancer knowledge
9. Into my brain
10.
#whenbreathbecomesair
Saw a dear patient in follow up today and she showed me her new tattoo. I cried. ❤️😭🙏 Never say this job is a one way street. My patients lift me up.
(picture with permission)
We have a
#cancerbell
but I also privately give my patients a hand folded origami crane (symbol of hope & healing) at their last status check with me. I include a short note to acknowledge that the end of treatment can be both a triumphant & paradoxically scary time.
1,000+ comments about our
@JAMAOnc
study about the costs of parking for patients w/
#cancer
.
People feel very passionately about this topic. I do too... I paid $15+/day for parking when my husband was treated. It seemed so cruel.
#financialtoxicity
#ASCO22
highlights: coordinating my outfit to my
@GoHealio
#DisruptiveInnovator
award for “The Patient Voice”.
But seriously… I become an oncologist bc my experiences as a
#cancerCaregiver
highlighted large flaws in health care in the US. I wanted to try and help fix them. 🙏
If you’re the praying type or just the kind to send good wishes into the universe, I need your help. Both my parents (and my aunt & uncle) have
#covid19
. Currently quarantined, doing okay with low grade temps & mild symptoms. Both with PMH that put them at risk. I’m so scared.
March 4th. The only date that is also a command:
My husband was diagnosed at age 27 as having aggressive neuroendocrine cancer. 14 months, 27 kg, & 3 hospitalizations later, Andrew died. On March 4, 2007, the life we had planned together was over before it had really even begun.
Trying something new... I've seen others put the photo of trainees that they've worked with in the corner of the slide to acknowledge who led the work. Always thought it was cool but finally pulled the trigger to add to my slides. What do we think? 🤔
#RestInPower
Chadwick Boseman, this one really got me. I know all people with cancer are secretly superheroes. I just didn’t know that some superheroes secretly had cancer.
#wakandaForever
#crcsm
Finally hung my
@ASCO
award in my office. 🤩 I am grateful and privileged to do research in affordability, access, and equity. I am standing on the shoulders of giants; make no mistake that this work has a long history primarily done by those who do not have awards (or offices).
@StephenGrantMD
I'm so sorry for this cruelty. Your son deserves better from his community, school, and from those purporting to be part of his education.
Police shining flashlight in my eyes: Where are you going?
Me (returning at 10pm bc, well, 👩🏻⚕️🩺 ): Home
Police: Where are you coming from?
Me (glancing down at scrubs & hospital badge): Work
Police: Don’t you know there’s a curfew?
Me: 🤷🏻♀️ I stay at work until the work is done.
This beautiful photograph is in my office. It is from my best friend’s wedding. I love the layered humanity and the captured intimacy of me and my husband. This is before he got sick. We were young, healthy, and in love.
#NationalCaregiversMonth
@marklewismd
I’m beginning to think this is all a scam perpetrated by “big grocery” to keep us complacent and dependent on our next meal. I’m going to do my own research on this.
A patient I met for the first time today brought in the
@sloan_kettering
article that she had just read. She thought I might need a copy. And I did!! First time I saw the story in print. ❤️
This is my periodic alert that
@costplusdrugs
has
#Ondansetron
#Zofran
at $13 for 90 tabs.
I was spending $35 PER PILL out of pocket & having to ration when my husband was puking his guts out from
#cancer
related nausea. 🤢🤮 Zofran caused significant
#FinancialToxicity
for us.
My beloved Franklin has a leg sarcoma with ?lung mets. I have cancelled my
#ASTRO23
travel plans to stay with the guy who got me thru dark times. I’d welcome suggestions for vet palliative radiation venues in NY/NJ.
Read how Franklin saved my life:
Honored that our small study on parking fees for patients with
#cancer
really struck a cord. It was the
#1
most viewed/downloaded article in
@JAMAOnc
in 2020.
#FinancialToxicity
is driven by both small and large costs, we have alot of work to do!
Happy Mother’s Day! My mom grew up in a trailer in Tennessee, worked throughout school to support her family, & lived in the YMCA. She ultimately went to Med school in the 1960s & become a
#RadOnc
in the 1970s. Along the way, she had 5 kids while building a successful career!
Mourning the loss of my collaborator & friend Dr
@TarlieTownsend
. The best way I can honor her phenomenal resilience and keen intellect is to share her powerful words from
#ASCOQLTY21
. Her talk in the
#Metavivors
panel outlined her strength and her message to oncologists. 🧵1/
This tweet was 2 yrs ago and now I'm at
@sloan_kettering
doing research on 1) how to improve the patient experience during
#cancer
treatment and 2) how to improve equity in all aspects of health care delivery. It's been 13 yrs since Andrew died & I still think about him every day
When you died from cancer at 28, the light went out for me. You were going to change the world with your brilliance. My plans (wife, artist, mother) had to change. We were always a team, so now 11 yrs later I'm a cancer doctor... trying to change the world.
#ShareAStoryInOneTweet
I was beyond honored to receive two different awards yesterday at
#ASCO22
. The
@ASCO
Excellent in Equity Award and the
@GoHealio
The Patient Voice Award, both for work that I have been privileged to do in the field of
#financialToxicity
and health care
#affordability
. 1/3
"The stress & overwhelming crushing defeat of these bills that would come in every week —it had an effect on our quality of life."
After keeping it secret for over a decade, I went public in 2017 on how
#financialtoxicity
had affected me & my late husband
Clinicians HATE
#priorAuth
.
How do patients feel?
We asked... their experience is also bad.
Most experienced a delay in recommended oncology care leading to:
1⃣ increased anxiety
2⃣ decreased TRUST
3⃣ patient administrative burden
@JAMANetworkOpen
:
| ̄ ̄ ̄ ̄ ̄ ̄ ̄ ̄ ̄ ̄|
ASK PATIENTS.
ASK THEM ABOUT
THEIR FEARS. ASK
THEM ABOUT THEIR
SUPPORT SYSTEM.
ASK THEM ABOUT
THEIR COSTS.
THEN LISTEN.
|______���___|
(\__/) ||
(•ㅅ•) ||
/ づ
I'm not sure why it just hit me that none of my old life's plans are true today.
I am not a wife nor an artist or a mother.
Those dreams are gone, lost, erased.
I am happy as an oncologist but wow, this hit me like a tonne of bricks today.
#beforeAndafterCANCER
When you died from cancer at 28, the light went out for me. You were going to change the world with your brilliance. My plans (wife, artist, mother) had to change. We were always a team, so now 11 yrs later I'm a cancer doctor... trying to change the world.
#ShareAStoryInOneTweet
Walked out from my 12 hr day (not bad right? I’m usually 14hrs on Weds) into sunshine & this ❤️ message at
@sloan_kettering
Monmouth. 100% started crying. The days are getting longer, the sun is shining brighter, & we’re going to beat this thing, together.
#Covid19NJ
#COVID19nyc
☝️I actually counsel students looking at residency programs to evaluate the research output of the department. The majority of manuscripts should have trainee or junior faculty first authors. Otherwise it’s a signal that senior members of the dept don’t know how mentorship works.
As I scroll major journals, I sometimes wonder: why’re long tenured full profs still first authoring major publications? What’s the driver?
#MedTwitter
#radonc
🧐This week I had another paper accepted but a hard look makes me realize that I am failing at life. My car is impounded due to expired registration, I feel overwhelmed constantly, and I haven't seen a dentist in 3 years. I need to do a ROS/review of systems on my life.
#WomenWhoCurie
are so ready for this!! “From the 1870s to the modern era,
#Radioactive
is a journey through
#MarieCurie
's enduring legacies – her passionate relationships, scientific breakthroughs, & the consequences that followed for her & for the world”
#radoncwomen
1⃣Overcoming adversity is a huge success.
2⃣Pulling oneself out of a big hole is a big accomplishment.
3⃣Acheiving a normal life after everything goes sideways is an incredible win.
🙏
@fosslien
Whenever Andrew thought something was funny or amazing he would always grab his head as if his brain couldn't handle the information. Words cannot really explain how much I miss this guy. We move forward but we don't move on.
#MarchForth
"My husband would not be defined by his cancer and I will not be defined by being a cancer widow. I am physician, an oncologist, and I am on a mission to improve cancer care in America."
@endwellproject
#Take10
: today 12/10/2020
Patients w/
#metastatic
#pancreaticCancer
are spending 10% of their remaining time alive on doctors appointments (including >half spent commuting or in waiting rooms).
When time is limited, is THIS how we want to spend our last days?
#pancsm
#pallonc
#hpm
Every week I fold cranes for my patients who complete their radiation for cancer. It no longer surprises me when patients cry as it’s an emotional time, however what still surprises me is how many times *I cry*. Thousands of patients later I hope I never stop feeling this bond.❤️
We have a
#cancerbell
but I also privately give my patients a hand folded origami crane (symbol of hope & healing) at their last status check with me. I include a short note to acknowledge that the end of treatment can be both a triumphant & paradoxically scary time.
Celebrating
#DoctorsDay
by printing out a physical reminder for myself that it is OKAY to pass on some “opportunities” and to protect myself and my time.
#burnoutMitigation
#selfcare
IT👏IS👏OKAY👏TO👏SAY👏“NO”
It's the classic American story:
Boy meets girl.
Boy is dx with
#cancer
.
Boy reaches insurance cap & starts paying out of pocket.
Girl quits job to take care of boy.
Boy dies anyway.
Girl is left grieving and threatened by debt collectors.
Treatment for cancer should not bankrupt families.
Treatment for cancer should not bankrupt families.
Treatment for cancer should not bankrupt families.
Treatment for cancer should not bankrupt families.
Treatment for cancer should not bankrupt families.
Palliative care and hospice is not “giving up.”
Palliative care and hospice is not “giving up.”
Palliative care and hospice is not “giving up.”
Palliative care and hospice is not “giving up.”
Palliative care and hospice is not “giving up.”
How many successful women have been labeled
#TooAmbitious
like it is a problem? From now on I’m considering it a compliment.
#KamalaHarrisForVP
“
#AmbitiousWomen
have always been a problem for those who have wanted to maintain the status quo”
Happy Mother’s Day to my
#radoncMom
☢️⚡️🧬. She went to medical school in the 1960s, did residency in the 70s, raised 7 kids in the 80s and retired in the 2010s.
#womenWhoCurie
#weWhoCurie
💪🩺🩻
Got this from a patient & hung it in my office. If you were to ask me what I value more, it’s not AOA or honors on a diploma. It’s that my patients trust me with their life, during their darkest hours, in their triumphs, & with their greatest fears. 🙏
#IAmARadiationOncologist
Preparing a talk: "Shared Decision Making:An Opportunity to Improve Patient Centered Care" I made this graphic to represent my biggest learning curve as a physician.
🤍🖤 It is truly rare that a decision is 100% cut & dry, black & white. So much of what I do is in the grey.
“Fumiko Chino, MD, a radiation oncologist at
@MSKCancerCenter
, and the first recipient of the Excellence in Equity Award at the 2022
@ASCO
Annual Meeting, doesn't just understand the harrowing financial shock of a cancer diagnosis: she has lived it."
My most anticipated session from
#ASCOQLTY20
: "The Patient is a Member of the Care team".
Say it louder for the people in the back!!
THE PATIENT IS A MEMBER OF THE CARE TEAM
#patientadvocates
@ASCO
I learned about the lifesaving power of
#radiation
from an early age. I was the youngest of 7 kids, and my mother was one of the first female radiation oncologists in Indiana. Her dedication to her patients has been the model for me in my practice.
#WomenWhoCurie
#RadOncWomen
A bit saddened by the
#ageDiscrimination
of this grant call requiring applicants be born ≥1980. I understand (and applaud) the desire to fund those establishing careers but an age limit punishes those (like me) who came late to academia but are still early in our faculty career.
Good morning Washington DC from some of the women of
@asco
. We’re passionate about improving cancer care in America and we’ve got something to say.
#ASCOAdvocacySummit
My husband was diagnosed with a
#NET
in his 20s. It took his life & left me a cancer widow besieged by debt collectors.
Grief galvanized me become a physician & to do research on access, affordability, & equity. 🙏My prayers are with you
@JoaquinCastrotx
.
12 days, $126k
That was the cost for surgery prep, surgery and ten days in the hospital.
It’s easy to see how that could bankrupt someone without insurance or without enough insurance.
With very good insurance I got billed several thousand dollars. 17.5/
🚨
@Oncoalert
: Providing hospital funded rideshare transportation for resource-limited pts with
#cancer
increased their
#radiation
completion rates & was a net benefit for the hospital.
🚗Turns out that helping pts get necessary care is good for business.
@eugenegu
Last year in clinic an older white male patient told me with glee that he had the right to grab my ass if he wanted to. [I asked him politely not to and then proceeded to make a plan to treat his cancer.]
And, yes, he was wearing a large Trump pin (I wish I was kidding).
#medToo
“People don’t quite understand how an animal is a therapeutic agent for people with cancer. It’s more effective for some of my patients than an anti-nausea pill or a pain pill...And yet, sometimes we don’t respect that, as clinicians.” 🐱🐶
@TheCancerLetter
We are in a different
#covid19
world today than 3 yrs ago, but masking when practical and taking a rapid today is not a burden on me. I know I’m in the minority now. We used to judge people for not wearing masks and now we do the same for those who continue to wear them. 🤷🏻♀️
Excited to start this
#survivorship
project for those treated for
#cancer
as young adults.
#FinancialToxicity
can be a lingering side effect of tx, limit education/career growth, and leave lasting financial burden. I am working w/ the amazing Bridgette Thom, PhD
@sloan_kettering
Congrats to PI Dr
@fumikochino
for her 2019 Chanel Endowment to Fund Survivorship Research Award for her project: “Running
on Empty”: Financial Literacy, Financial Capacity and Enduring Financial
Toxicity in Young Adult Cancer Survivors.
#ayacsm
#financialtoxicity
#survivorship
👏How many patients:
1) were denied an appt bc of insurance issues?
2) had their appt cancelled bc they were 40 min late due to public transit?
3) couldn’t afford gas or parking?
5) couldn’t find childcare?
6) had to work instead?
7) budgeted for groceries instead of a co-pay?
Your patient can have a PD-L1 expression of 90% but if he/she doesn't have a way to get to treatment (transportation)- The response rate is 0% !!
Social determinants of health are an essential part of oncology care.
Ask! Inquire!
@dsmithgraz
@fumikochino
@DrWinkfield
"At a certain point, if your dying husband wants a cat … you get a cat, right?"
Before the pandemic I wrote a piece about how my cat saved my life. It's still true.
#CatMedTwitter
For the record, I posted a screen shot bc I felt confident that
@CDC_Cancer
would immediately post a correction with the intended statement “Cancer is the 2nd leading cause of death in the US.” But now we’re >24 hours and they appear to just be leaning in. 🤷🏻♀️🤦🏻♀️
Continuing to mask at meetings & test during travel. 😷 I know that “mask optional” meetings mean most will omit masks; I literally just saw this at my last meeting as one of the few masked MDs.
@ASCO
: There’s still time to change
#ASCO22
policies. We’re in it for patient health.
Let me clear why this is important to me & to millions who grieve their loved ones daily: My husband DID NOT “lose his battle” —he WON the good days he had after his cancer dx. He was taken too soon by a horrible disease. His life was a TRIUMPH; it’s the world’s loss not his.
“We will all die 1 day; perhaps the winner here is the person who does it under his/her own terms; the person who dies peacefully & not at war. Let us ...remember them as victors in life, not losers in death. Let us stop letting cancer appear to be the winner.”
#endthebattle
Sometimes you need to take a midday break back to your room to take an hour to eat chips and gummiworms and drink a Coke Zero in blessed silence before returning to the conference.
👀 I see you introverts.
#ASCOQLTY22
I have worn lipstick <20 times in my lifetime but I got a new bug when I turned 45 last week so I’m trying out a new stain. So far so good & no transfer to my mask thus far today. I’ll keep you posted since clearly this is a Twitter worthy transformation of my status quo. 😅😂🤣
@arghavan_salles
YES. This is on my formal, academic CV:
"Cancer Caregiver and Subsequent Cancer Widow,Ann Arbor MI and Houston TX,08/2006-08/2008"
To "explain the gap". Is this really necessary?
Scientists NEED to become better communicators.
Proud of this manuscript highlighting HOW to present your research to diverse audiences, WHY it matters, and some Do's & Don'ts.
With: Drs
@aaronecarroll
@DusetzinaS
@yzafar
& Ms.
@sangerkatz
in
@JNCI_Now
Delighted to speak tomorrow AM for
@sloan_kettering
Surgery Grand Rounds on
#FinancialToxicity
. The
#costsofcare
have only been rising and the negative effects on our patients can be catastrophic. Solutions require government, health systems, provider, and interpersonal changes.
🚨The 1st, 2nd, & 3rd symptom of
#cancer
are IGNORED by physicians for those under 40. My husband was told he had IBS but got no real testing for why he was sick for 6 MONTHS. He lost 30lbs before he was taken seriosly & a CT scan showed cancer compressing his pancreas.
#ayacsm
As a gastrointestinal oncologist I cannot begin to tell you how many young patients I’ve seen with incurable
#coloncancer
after being told they had hemorrhoids without a rectal exam, or irritable bowel syndrome without a colonoscopy
#ripChadwick
& may we learn from this
#crcsm
"Each person who walks through my door is an individual, with hopes, fears, and a personal history that is much larger than just a cancer diagnosis."
My
@sloan_kettering
profile is up! Proud to practice high-quality, patient-centered care
@MSK_RadOnc
It was my parents 41st anniversary recently. They raised 7 kids in small town Indiana who are now: 3 radiation oncologists, 1 NASA engineer, 1 marketing executive, 1 lawyer, and a teacher.
#blendedFamily
This
#NationalDoctorsDay
I’m celebrating the amazing physicians in NYC who are working long hrs to provide the best care for their patients in an impossible situation. I am proud to be a
@sloan_kettering
doctor & proud to serve this amazing city full of grit, heart, & resilience.