“You have cancer.”

How terrible that sounds.
A million thoughts race through your mind.
You have so many questions, but you can’t get them out;
your brain freezes.
The specialists talk of stage, grade, mutations, CT, MRI, PET, risks, benefits, side-effects, survival curves.
You worry about your family, your kids.
Will there be pain?
Will you die?

Test after test ensues, but finally it is time to treat.
You pray the cancer is not incurable, and any prescription
In the past, your doctor chose the treatment plan for you,
without even a whisper of the word
Now patients make their own decisions, provided their payer agrees.
Pathways, established by computers, expert panels, government, hospitals, and insurance companies are killing doctor-patient decision-making.
Only when you pay the bill yourself, do you have

I’ve been counseling cancer patients for almost 30 years;
they still want to know what I would do, what I would recommend for my wife or
my mother.
When a “representative” of some sort on the phone or the computer
replaces your private doctor,
be on the lookout for times when the standard pathway may not be the best option,
when you should jump off the trail to find a personalized solution to your problem.

In Cancer Stories, we explore paradigms of cancer treatment highlighted by true patient histories. Some situations reflect conflicts between individual goals and medical norms or between my patient’s desires and my recommendations.

Faced with a fatal disease, do you take a treatment that has only a 10% chance of success?
What about 5%? or 2%?
How do you define “success?”
What about cancers that are not curable? What about toxicity and the risk of
dying from the treatment?

Does age matter?
Does cost matter?
How do we measure
quality of life?

Cancer Stories tackles these issues, not from the macro perspective of
hospitals, payers, government, and society,
but from the micro perspective.

How do elderly patients and their doctors make decisions?

What would you do?

What you'll find on this site

Stories - with each vignette, I highlight a challenge we faced. The stories are mostly about individuals older than 75,  unless there is a particular point I want to make      

Survey -  I'd like to know what most individuals think about cancer treatment in older individuals

Contact us - join our mailing list, ask a question, send in your story, make an observation, or register your support for n of 1 studies

Cancer Biology and Concepts  If you must confront cancer, arm yourself with knowledge; I decided not to re-create the wheel, but I've tried to find the best references available

Book -  An outline of what I plan to include in the book

About the author  - my credentials and experience

A word about privacy

Help support this project

What's the book about?

What? It  isn't finished yet?

These are true stories about some amazing people who fought cancer in different ways. Some won, some lost. All had some difficult decisions to make.

Read the story for each of these patients that I took care of, then think of what you would do if you were the patient, or what you would recommend if you were the doctor, the nurse, a family member, or the administrator.

Should older patients get the same treatment as younger patients?

Does cost matter?

Click below to send me your email to be notified when the book is ready to ship.

Please notify me when the book is available

Please click here to take the survey
It’s only 6 questions long:

How old are you?

At what age are people too old for cancer treatment?

What is the most important factor in whether an older person should receive cancer treatment?

Have you ever had cancer?

Have you ever had a good friend or family member with cancer?

Do you work in the health care field?

A word about privacy

I have struggled to protect my patient's privacy while also maintaining the non-fiction contract according to Tilar Mazzeo, PhD.  She writes: "Nonfiction writers have a sort of contract with readers: We are not allowed to make anything up. We must be rigorous reporters of lived experience. True stories teach us something about what it means to be human and what it means to struggle and triumph in life. True stories introduce us to amazing characters, characters who are all the more amazing for being real." 

I drew these cases from my experience across the United States and over 30 years.  Professor Mazzeo also writes:  "Especially in memoir and autobiography, the line between our lives and the lives of other people is not always clear." These are my stories too, especially as they record my dilemmas about how to treat and my anxieties about being wrong. 

I feel compelled to tell these stories because a discussion about cancer care for older individuals cannot take place wholly in the abstract, but only with reference to specific patient situations. I have decided to tell true stories. Even if the ages are inexact and some of the details have been changed or amalgamated, all of the medical events and treatment outcomes are factual.

Check my blog post here for a further discussion about patient privacy and the Health Insurance Portability and Accountability Act.

About the author

Dr. Mitchell has been practicing Hematology, Oncology, and Internal Medicine in Virginia since 1992. For 7 years he was Assistant Professor of Medicine at VCU and since then has been in private practice. He served on the managment team of a 20-physician single specialty group for 10 years, including 3 years as managing partner.

He has worked continuously over that time developing ways to make medical record keeping more accurate, concise, and to the point, providing benefits to all who might need to access or understand a patient's medical records.

He has participated extensively in review of a variety of cases, including standard of care, causation, and liablity questions. He is expert at analyzing complex and manifold medical issues, boiling them down, providing, whether for medical, personal, or legal purposes, a coherent and concise solution.
In 2017, Dr. Mitchell was recognized as one of the top 8 physicians in metropolitan Richmond by the readers of the Richmond Times-Dispatch.

Since finishing medical school in 1985, Dr. Mitchell has held medical licenses in Maryland, Illinois,Virginina, Montana, Wisconsin, Nebraska, and Michigan.

Support for this project

Thanks for visiting this website!

I've intentionally kept advertising on the site to a minimum. Instead of a bunch of pop-up ads and videos that slow down the site, there are just a few unobtrusive ads. Check out the items below to show your support.

NCI Dictionary of cancer terms                               NCI Drug Dictionary

NCI guide to cancer  (start with the patient version, then move on to the Health Professional Version for more details.

If you want to know where all the rules and pathways come from that determine if your insurer will cover your treatment, check out the NCCN Guidelines

UpToDate - a comprehensive medical source

Cancer Biology and Concepts specific to Cancer Stories

Send us a message

UpToDate - a comprehensive medical source

The best review of any medical topic, not just cancer, can be found on the UpToDate website.

You have to pay for quality, though. Save up your quesitons, then sign up for one week of access for $20. Keep open your NCI Dictionary of cancer terms.

Use this site if you want to know what your doctor knows. Many topics have less complicated patient education sections called: "Basic" and "Beyond the Basics".