Introduction
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xxv Introduction by Michael R. Bishop, MD There is nothing that prepares an individual for the diagnosis of lymphoma —or any cancer, for that matter. When a new diagnosis of lymphoma is shared with patient, family, or friends, the response varies with each person who is hearing it. The perspective that matters the most, of course, is that of the person who is diagnosed with the lymphoma. The perspective of the treating physician is generally limited to technical facts and the physician’s professional experience. Usually the physician can only imagine what patients and their families are going through—although a few of my colleagues either have had someone close to them experience or have themselves experienced being diagnosed and treated for cancer. All of them bring those experiences into their practice, but they are only a small minority of treating physicians. In lymphoma, the treating physicians are usually medical oncologists and hematologists. They attempt to educate the patient and recommend an individualized treatment plan in a manner that they feel most comfortable with. This manner varies from physician to physician. Some physicians are very businesslike; they present just the minimal facts with a clear, straightforward treatment plan. I know many patients who prefer not to know statistics , prognosis, or other options. They just want someone to take control. Then there are physicians who provide detailed information relative to both prognosis and all available treatment options and, after having informed the patient of the treatment options and their relative efficacy and toxicities, leave the decision to the patient. Most often the physician’s approach is somewhere in the middle. He or she wants to provide enough information about the patient’s diagnosis to permit the patient to make an informed decision about treatment options, but not so much information that it is over- U xxvi Introduction whelming. The physician will make a treatment recommendation that he or she thinks will provide the best chance of benefiting the patient, taking into account the patient’s diagnosis, prognostic features, and overall physical condition, as well as the physician’s perception of how much risk the patient is willing to accept relative to each treatment available and appropriate for that individual. No matter which approach is taken and how much time is spent at the initial visit, this experience is nearly always overwhelming. No one can take in all the information provided by the physician, despite the best attempts to explain it in the clearest, simplest, and most direct way possible. Even if the patient has the most compassionate and articulate physician in the world, it is almost impossible for the patient to come away feeling that she knows everything there is to know about her disease, that all her questions have been answered, and that she is fully confident she completely understands the risks and benefits of the treatment plan presented to her. I often start my second visit with a patient by asking him to review with me what we talked about at our first visit. It is not uncommon for a patient to say, “It was so much information and so overwhelming, I barely took in half of what you told me.” Despite the physician’s best efforts, there is never enough time to discuss everything that is important to an individual. In addition, because this initial experience can often be intimidating, it is often difficult for the patient to grasp what is being said. Finally, some patients are reluctant to ask questions of their physicians, not wanting to sound unintelligent or to risk insulting the person who is about to treat them. For all these reasons, patients wanting to know what it is like to be diagnosed and go through treatment for lymphoma do the logical thing and turn to the true authorities: other patients with lymphomas. There are wonderful patient-derived resources available on lymphoma, such as newsletters, support groups, chat rooms. There are even a number of books written by patients providing essential information relative to the diagnosis and treatment of cancer. However, this book by Elizabeth Adler is unique in several ways. First, it deals solely with the diagnosis of lymphoma. Second, it provides comprehensive information about biology, diagnosis, staging, and treatment. Third, the organization is different from that of other scientific texts. Fourth, and most important, it comes from Elizabeth’s perspective as a lymphoma patient and survivor. Introduction xxvii V Lymphoma is not a single disease but a heterogeneous group of disorders that are...


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