Sickle Cell Treatment, Part II

Thursday, March 28, 2019

Blood & Cancer Episode 09:

John J. Strouse, MD, PhD, and Julie Kanter, MD, join guest host Ify Osunkwo, MD, of Levine Cancer Institute/Atrium Health in Charlotte, N.C., take a look at some of the thornier issues in sickle cell disease treatment, from caring for young adults to prescribing opioids for pain.

Clinical Correlation:
Ilana Yurkiewicz, MD, explores the tight rope cancer patients must walk when they are told to “hope for the best, but prepare for the worst.” Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford University and is a columnist for Hematology News.

SHOW NOTES:
BY EMILY BRYER, DO
Resident in the department of internal medicine, University of Pennsylvania Health System.

What is the role of the community hematologist-oncologist or the primary care physician in supporting their disease management?

  • Utilize resources, including consults with hematologists, as well as guidelines from the American Society of Hematology and National Heart, Lung, and Blood Institute.

Pain is one of the most disabling symptoms of sickle cell disease.

  • Lack of objective criteria for pain poses a challenge to clinicians
  • IV opioids are the gold standard for acute sickle cell pain crises

While patients with sickle cell disease have the same condition, they are each affected by it differently. Every individual with sickle cell disease needs to be assessed and treated as an individual.

Providers should look beyond the sickle cell diagnosis when treating pain.

  • It is important to differentiate if presenting pain is distinct from typical sickle cell pain
  • Ask patients: “Is this pain like your usual pain?”

Psychosocial and emotional status are important components of treating and supporting patients with sickle cell disease.

It is important to establish pain management strategies for patients with sickle cell disease, as well as to clarify pain management strategy and access to care.

Podcast Participants

David Henry, MD
David Henry, MD, FACP, is a clinical professor of medicine at the University of Pennsylvania and vice chairman of the department of medicine at Pennsylvania Hospital in Philadelphia. He received his bachelor’s degree from Princeton University and his MD from the University of Pennsylvania, then completed his internship, residency, and fellowship at the Hospital of the University of Pennsylvania. After 2 years as an attending in the U.S. Air Force, he was drawn to practicing as a hem-onc because of the close patient contact and interaction, and his belief that, win or lose with each patient, one can always make a difference in their care and lives. Follow Dr. Henry on Twitter: @davidhenrymd.
Ilana Yurkiewicz, MD
Ilana Yurkiewicz, MD, is a fellow in hematology and oncology at Stanford University, where she also completed her internal medicine residency. Dr. Yurkiewicz holds an MD from Harvard Medical School and a BS from Yale University. She went into hematology and oncology because of the high-stakes decision-making, meaningful relationships with patients, and opportunity to help people through some of the toughest challenges of their lives. Dr. Yurkiewicz is also a medical journalist. She is a former AAAS Mass Media Fellow and Scientific American blog columnist, and her writing has appeared in numerous media outlets including Hematology News, where she writes the monthly column Hard Questions. Dr. Yurkiewicz is on Twitter: @ilanayurkiewicz.