Dr Giancarlo Moscol, an oncologist from Texas, is thrilled about the many amazing advancements over the past five to 10 years that allow not only to help extend the lives of patients with increased quality of life, but also to potentially offer the possibility to cure some diseases, something unthinkable even five years ago. As a consequence of diverse clinical trials, access to new and more potent drugs, and multiple indications, he observes that doctors are becoming increasingly sub-specialized now, and that this is likely improving patient outcomes and satisfaction. People in the field no longer just talk about breast cancer; they talk about breast cancer that is ER-positive or HER2-negative—not just colon cancer, but RAS-wild type, BRAF-mutated, or MSI-stable colon cancer.
Dr Moscol notes that breakthroughs in colon cancer in recent years have established a central role for different biomarkers such as MSI and MMR status, which were previously used for Stage II colorectal cancer. These biomarkers can now also be used to predict response and benefits from immunotherapy in the metastatic setting, offering prolonged, progression-free survival and minimal toxicity. Still the percentage of population that truly benefit from checkpoint inhibition at this point is minimal (5-8%), which means that for the remaining 90% of patients without this altered biomarker, he believes that more needs to be done.
Dr Giancarlo Moscol is optimistic about the ways that technology is helping patients. In particular, he notes the multiple new ways his patients connect to peers and doctors through online advocacy groups—to learn about diverse issues from clinical trial eligibility to dietary recommendations or age appropriate recommended screenings. He also believes apps and gadgets such as Fitbits® and Apple Watch® are helpful resources to improve general health management.
The one downside Dr Moscol warns about is that in a time where anyone can offer anything on the internet, desperate patients can be scammed into paying for fraudulent treatments online. While he has no issues against homeopathic remedies, he dislikes how some of them are being sold online and the false promises they are sold upon. The frustrating result he has seen is that his patients who go after those types of treatments end up coming back to his clinic with more advanced and more aggressive disease.
When addressing the importance of colon cancer awareness, Dr. Moscol stresses to not assume you are too young to be diagnosed with a disease like colorectal cancer or breast cancer. He believes that there needs to be more awareness about getting preventive colonoscopies done earlier. He’s seeing an increasing number of younger patients being diagnosed and notes that a less-active lifestyle and poor dietary habits are the likely culprits. In his clinic, he’s seen cases of patients under the age of 50 multiply by a factor of two or three over the previous year. He stresses that screening and early detection are fundamental to offer a cure.
In fact, Dr Giancarlo Moscol finds that practicing in the US is unique because while there’s better access to a broad array of medications and clinical trials, likely unavailable to a majority of patients in his native Peru, some of the malignancies he’s treating in the US are more commonly related to the sedentary lifestyle and poor diet seen too frequently as part of the American lifestyle.
What Dr. Moscol finds most rewarding about practicing medicine is building relationships with his patients and their families. He appreciates that even when he can’t cure someone’s family member, they recognize that he always has done what is best for them. It’s difficult for him when he knows he can’t change the outcome, but he feels it’s important to be human and treat those patients with respect and be sure they know he will continue to be there to coach them and oversee their treatment and keep their best interests in mind.
The most frustrating challenge Dr Giancarlo Moscol deals with is trying to build a human relationship with his oncologic patients when his daily schedule only allows for short 15-minute follow-up visits. He acknowledges that each patient who visits his clinic has a different level of complexity and most importantly is a human being who deserves his respect and total attention to be able to solve all pending questions and matters brought to consultation. This is especially important in end-of-life discussions, where he finds his tight schedule can be particularly frustrating.
Another challenge Dr. Moscol notes is that while it’s wonderful that there are always new medications being approved, staying up-todate has become an extremely difficult task. In his specialty, it could be really challenging to be aware of the multiple clinical trials and mechanisms of action being explored for patients with colon cancer.
Dr Giancarlo Moscol would advise medical students entering into the oncology field to be mindful that you are dealing with real human beings and be respectful of your patients and their human dignity; know when to pause, when to handle an issue, and when to simply not say anything out of respect. Additionally, he would counsel them to not become overwhelmed when you know that some patients will not make it, because you are still making a huge impact on their lives by giving your best and supporting them through this difficult time.
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