Pink Cricket 2018

Last weekend, Tony and I were invited to go to the Pink Cricket at the Wanderers.  Every year, one of the T50 games raises funds for a breast cancer project. Over the last few years, the money has gone to  Pink Drive.  This year, the money went to Charlotte Maxeke Hospital in Johannesburg with a third being apportioned to research and out reach programmes.  The Breast Course for Nurses is one of the outreach programmes run from Charlotte Maxeke Hospital.

The team inside the Wanderers
The team outside the Wanderers
 South Africa have done badly against the Indian team in the ODI series.  I don't know enough about cricket to know whether the Indians have been brilliant or RSA poor.  Virat Kholi has repeatedly shown why he is known as one of the best batters in the world. (He is the only batsman to currently hold an average of >50 in all 3 forms of the game).  It was a privilege to watch him bat.  South Africa, however, found a renewed energy.  The new members of the team had a chance to shine.  Ngiti with the ball, Klaasen and Phehlukwayo with the bat.  It was the only ODI that South Africa won.

The real winner are the patients who will be treated at the improved breast unit at the Charlotte Maxeke Hospital.  Breast cancer requires a multidisciplinary approach and many members of the diagnostic and treatment teams were there.  Sarah Nietz (surgeon) has been the public face of the team at the hospital and gave an excellent speech at the event.  In total, over R1.6m was raised and will go to both structural and logistical problems in the unit.

Thank you to cricket SA and all of you who gave so generously.


Regaining confidence after the diagnosis and treatment for breast cancer

I recently had the privilege of listening to a short story on BBC radio 4 called "chemo brain" written by Susmita Bhattacharya.  Susmita is a writer and a teacher and she developed breast cancer and like many people found life difficult afterwards. (Interestingly, in her "about me section" on her blog page, her diagnosis of breast cancer isn't mentioned).

The short story is well worth listening to and describes how she, like many other people, found the non physical side effects of chemotherapy difficult to cope with:

"the physical side effects of chemo had been spelt out...but what about the mind?..What would happen to my mind as the drugs entered my body....I became a writer who could not write"

Chemo brain caused her to loose her confidence.  She ended up writing notes to herself.  In the classroom, she had to rely on her years of experience to get her through her lessons.

She talks about the loneliness after the diagnosis of breast cancer.  She wanted to get on with her life as usual but life had changed for her and her family.  They have had to accept a new normal.

Susmita recalls how she regained her confidence.  She edited her novel and spent time with her local cancer support group.  She set up a writing workshop.  This gave her the confidence to write again.

It is now 2 years since she finished her treatment.  Writing about her experience has helped her come to terms with what has happened.  As a result of being a cancer survivor she has attended dance workshops, has had tea in the mayors house and has even visited Buckingham Palace.

She has learned to accept days as they come.

There are many reasons why breast cancer and its management can cause problems with confidence.  This year, at our annual CBMH October activity we have invited breast cancer survivors to discuss ways they have regained their confidence after the diagnosis and treatment of breast cancer.

If you are in Cape Town on 18/10/17, please come and join us.  For further details, contact Michelle Norris: Michelle.Norris@netcare.co.za.

Hope to see you there.


Survivorship or comprehensive care programmes

A second part of our meeting last month dealt with the topic of survivorship programmes for women who have been diagnosed with breast cancer.  What do we mean by a survivorship programme?  Should we not amalgamate all into a comprehensive care programme?

Linda Greef with Oliver Hart
Dr Heide Hart ran the session.  She was ably assisted her youngest son: Oliver Hart.  She started by defining the need as stated by the American Cancer Society: cancer patients face particular physical, psychosocial, practical and spiritual challenges.

What would a survivorship programme for women who have had breast cancer aim to do?  Ideally, it would coordinate care providing a multidisciplinary approach to cater for the needs of the individual.  These differ and are dependent on the age of the individual, the type of cancer and the treatment given.

Broadly, the following should be offered:
Information about screening programmes for other cancers (e.g. ovarian cancer)
Cardiac assessment post chemotherapy
Exercise programmes
Dietary advice                              
Lymphoedema management
Psychiatric help and assessment of cognitive function
Sexual advice
Pain assessment.
Dr Heide Hart

How should the programmes be run? In some centres, a survivorship specialist runs ongoing programmes and refers individuals to specialists as necessary.  Alternatively, each person could be discussed by a multidisciplinary team and an appropriate programme offered.  When possible, the shift should be for the majority of care to be provided by the primary care physician rather than the specialist.

However, the notion of "survivorship" is complex. What happens to women who develop metastatic disease?  Do they "fail" a survivorship programme?  We were fortunate to have Dr Rene Krause (a palliative care specialist) to add her perspective.  She suggested that rather than think in terms of a survivorship programme, each individual should be referred for comprehensive care.  This includes input from palliative care specialists.

When should a palliative care team be involved? The WHO have recommended that they should be involved from the time of diagnosis.  Dr Krause feels that they should be involved as soon as metastatic disease has developed.  Others argued that as many women with systemic breast cancer live for many years, it is too early.  We didn't reach a consensus.

Ideally, comprehensive care should be offered to any person who has been diagnosed with cancer. This should be from the time of diagnosis with the relevant specialists adding to broad based care as appropriate.

Please share your experience.


Medical data sharing

The move to the new hospital building has brought challenges and opportunities.  For example, provision has been made for an oncology centre. As a result, a new group of us will be working together.  Most of us have electronic notes but we use different systems.  How can we share our data? What are the regulations that govern us?  We held a workshop on the issue of data sharing.  Jean Claude Smith, the founder of DigIt, ran the workshop and we discussed several topics.

Safety of Data:
Last month, about 100 000 organisation were attacked by Wannacry.  In simple terms, it is a worm that manages to gain access to a computer through emails.  By opening an unsolicited email, the worm gains access to the computer, encrypts the files and demands payment in bitcoin to regain access to the data.  Amongst other organisations, the NHS was attacked.  I am sure individual doctors around the world were also targetted.  Jean gave us the following advice:
1. Prevention is the best method of defence
2. Don't open unsolicited emails or download suspicious files
3. Regular backup
4. Install anti ransomeware engine on your computer
5. Turn on Windows firewall

POPPIAct: how does it affect us?
In 2013, South Africa passed legislation known as the POPPIAct.  The aim of the act is to ensure all South Africans store, share and use data responsibly.  As health practitioners we:
1. Must give consent before our data is shared
2. Need a valid reason for collecting data
3. Are responsible for ensuring the data is used correctly
4. Must know who has access to the data
5. Must maintain the safety of the data
6. Must collect data accurately

So, as a group of individual doctors, can we legitimately share our data, adhere to the POPPIAct and still use our own electronic notes?  The answer is probably "no".  The problem is not unique to us.  In 2011, the NHS scrapped an attempt to merge notes having spent £12bn

For us, it looks as though sharing will not be possible so we will have to start again

 Contact Dig IT