A woman in medicine. From the 1940s to the 1990s. A personal saga.

The past 50 years through which I have lived as a woman in medicine have been an exciting time. Women in medicine have increased from a small minority to sizeable numbers. It remains for women in medicine to become more active in organizations and to assume more leadership roles. The current leadership of the Medical Society of Virginia is a step in that direction.

Cancer rehabilitation.

An important trend in cancer treatment is an increasing emphasis on the overall outcome, not just on survival or disease-free interval, but also on the functional status and the quality of life of the survivor. Measuring the quality of life as a part of a clinical protocol is not enough. Measures must be aimed at facilitating optimal function and life satisfaction for the patient treated for cancer. The rehabilitation techniques used to enhance the life of the survivor need to be subjected to the same sort of scientific rigor required for other kinds of treatment. To develop data on rehabilitation parameters, we must create and utilize standardized and reliable evaluation techniques and instruments. These evaluation practices can then be utilized in clinical trials, both to assess the effectiveness of the rehabilitation techniques themselves and also to determine the effect of specific antitumor treatments on the patient's physical and psychosocial function. An organized multidisciplinary cancer rehabilitation program as a part of clinical and research facilities may be helpful. The important concept for all of us involved with the care of cancer patients is that of conveying our concern, not only for their survival, but for their function--physical, emotional, social, and vocational.

Future directions in cancer rehabilitation.

Many of the current and future directions in cancer rehabilitation have been briefly discussed; and some of the important areas for development are outlined in Table 1. Implementation of rehabilitation measures may be facilitated by organized and creative multidisciplinary rehabilitation programs. Advances are also dependent on health care policy, particularly in reimbursement for rehabilitation services and in the funding of rehabilitation research. Much progress can be expected in the years ahead.

The cancer patient at work.

The person who has been treated for cancer may have unique problems resuming employment or starting a new job. Cancer represents a spectrum of diseases, and posttreatment impairments may vary from none, in the majority of cases, to major functional disability. Employers understandably have difficulty recognizing the variability that exists, both in terms of functional capacity and prognosis, and they are often unaware of the improved prognosis for many cancers. Today, many patients receive adjuvant chemotherapy or prolonged intermittent treatment and need to adjust their work schedule to allow for this. Some people need job training or vocational counseling; in many states, vocational rehabilitation agencies now have an increased interest in providing services to cancer patients. Discrimination against the cancer patient has been demonstrated; the major problems are in the area of hiring practices. Efforts need to be continued to educate employers and the public and to ensure that the rights of the cancer patient are recognized. We may, however, do our patients a disservice if we overemphasize potential problems to a degree that increases patient fear and insecurity in regard to employment. Instead, we as physicians may be able to help prevent problems by more effective communication with employers on behalf of our patients, as well as by direct patient counseling. The insurance problems of cancer patients, particularly those relating to health insurance, do require major attention. The potential productivity, as well as the quality of life, of the cancer patient are jeopardized when he or she feels unable to change jobs because of fear of loss of insurance coverage. The relatively high number of reported cancellations and changes in insurance benefits that have been reported by cancer patients also represents an area of concern, since some of these appear medically unjustified. The physician's opinion and input may be of importance in preventing or solving individual insurance problems. The physician can also help the cancer patient who has employment problems by providing information about available resources. The above-mentioned employment booklet (#4585-PS), available from the ACS, may be useful and contains information about legal resources. Referral to a vocational rehabilitation agency may be indicated. The best medicine of all may be a positive and optimistic attitude toward the patient's participation in the work force.

Adenocarcinoma of the pancreas associated with hypoglycemia: case report and review of the literature.

The occurrence of profound hypoglycemia in a patient with metastatic adenocarcinoma of the pancreas is reported. In contrast to the four previously reported cases, no suggestion of excess insulin production was found. Metabolic studies in this patient suggest both increased peripheral glucose utilization and decreased hepatic glucose production as contributing factors which promoted the hypoglycemia.