New Research and Education at COSM 2019

AUSTIN, Texas—In May, Triological Society members and other attendees came together for the society’s 122nd Annual Meeting to share research and foster new ideas within the field of otolaryngology. The 2019 Triological Society Annual Meeting, held in conjunction with the Combined Otolaryngology Spring Meetings (COSM), welcomed 470 attendees plus residents and medical students, who joined discussions, heard panelists debate, and viewed an extensive array of scientific posters.

Nearly 900 residents and medical students attended COSM, many of whom were offered the opportunity to present clinical and research papers and posters during the society meetings. “I attended the conference to learn about the newest developments in otology and to support the excellent work of some of the medical students and residents with whom I work,” said Aaron Moberly, MD, an assistant professor in the division of otology, neurotology, and cranial base surgery in the department of otolaryngology–head and neck surgery at  The Ohio State University Wexner Medical Center in Columbus.

During the Triological Society’s scientific sessions, 65 podium presentations and seven panels were given. More than 160 posters were presented as a part of a combined poster session. The Triological Society again funded travel grants to fellows, residents, and medical students selected to present oral and poster presentations during the Society’s scientific sessions.

Presidential Address: A Patient’s Perspective on HNC

Sigsbee Duck, RPh, MD, said that he has had an incredible year as the president of the Triological Society. His presidential speech was made “to simply remind all otolaryngologists how important empathy and caring are for our cancer patients. I am just laying out the stark and personal reality of being a head and neck cancer patient first hand and the feelings associated with the treatment process.” He went on to thank all of his head and neck surgery colleagues who selflessly care for patients like him on a daily basis.

Dr. Duck definitely understands the importance of empathy and caring for cancer patients, as he himself is a head and neck cancer survivor. “On the morning of March 9, 2015, I was getting ready for work, shaving actually, when I felt a mass in my right upper neck. Denial set in and I convinced myself that it was an infection.” He put himself on antibiotics and after a few doses he realized it was not going down and seemed to be larger. Becoming quite concerned, he called the Huntsman Cancer in Salt Lake City and drove three hours from Wyoming the same Thursday for a biopsy. The physician told him the ultrasound characteristics appeared benign and to come back in one month if the mass was still present for a FNA. He responded, “I’m here now, so please proceed.” He did and the next Monday the endocrinologist called to inform him “you have metastatic epidermoid carcinoma.” Reality quickly set in.

“This couldn’t be happening to me,” Dr. Duck thought. He was asked to be back at the Huntsman on Wednesday for a PET scan, but as he had NCAA basketball tournament tickets in Kentucky the following weekend, he opted to wait a week and meet his family to let the reality of a totally surrealistic situation settle in. The next week the PET scan was completed. With his surgeon, Dr. Jason Hunt’s hand on his shoulder, he was informed he had a “large tonsillar carcinoma with neck metastasis.”

Dr. Duck underwent a radical tonsillectomy and a modified RND the next day. “I was still in denial,” he said. “Five hours later reality took hold when I awakened to find an NG tube, a Foley, a JP drain, an IV between the toes on my right foot, an inability to swallow and complete anesthesia from my mid cheek to my clavicle. When I finally woke up, reality once again hit and I sat up with a very kind nurse and cried for about three hours. Then came swallowing therapy and ultimately tubes were removed one at a time as my wife and I waited for the pathology reports to assure clear margins and positive testing for HPV and P-16.” He was blessed to have these findings. The day he left the hospital, a Basset Hound therapy dog came by to visit and he realized that “it’s the small things that really mean the most to patients.”

As physicians, we must take extra time with our cancer patients. We must show genuine empathy. —Sigsbee W. Duck, MD

“Emotions run amuck while going through cancer treatment and they are very difficult to control,” Dr. Duck found out. “When I finally returned to work in Wyoming prior to radiation therapy, I was not successful—or nice. I was curt and downright rude. I had not realized the emotional toll cancer takes on patients.”

Radiation therapy was next. “Despite having sent hundreds of patients for these treatments, it was at this point that I realized that I really didn’t know anything about it. Now, more than ever, I genuinely admire my cancer patients, particularly the ones without the financial means or family support like I was blessed to have who must complete this therapy.” Dr. Duck recalled an older man who sat next to him before his first radiation treatment. “He had been told his radiation was palliative and to get his affairs in order. He asked why I was there and I told him and he said good luck. The next day, he was not there and I never saw him again. It is sad and disconcerting to see all these patients every day, and suddenly they are not there anymore.”

On his last day of radiation, the waiting room was full and he was informed that the machine was down. “I figured my options were to get mad, sulk, or cry. Well, I’m a crier,” he said. The other patients with whom he had bonded huddled around him for support, the machine was ultimately repaired and with radiation therapy completed, he finally left the Huntsman.

Dr. Duck’s long and emotionally difficult experience with surgery and radiation were not only grueling, but also educational. “The post-traumatic effects of surgery and radiation therapy, especially as radiation is over-utilized to treat this disease, particularly when used in conjunction with chemotherapy, are very real,” Dr. Duck stated. “And radiation is definitely the gift that keeps on giving—for the rest of your life. Your taste is permanently altered, you have pain and cramping with exercise, and you can never taste or swallow effectively.”

“And there is a stigma associated with HPV H&N cancer. Even my colleagues make jokes about sexual transmission. I had been married for 33 years, and I found no humor in their jokes,” he said. “Frankly, who knows what  bacteria any of us are harboring as otolaryngologists? My entire family has been tested and cleared and we have received the HPV vaccine including the P-16 and P-18 strains.

“No matter how many H&N cancer patients  you have cared for, always remember the absolute feelings of fear and helplessness that your patients experience. As physicians, we must take extra time with our cancer patients. We must show genuine empathy. Sit down by the bed as if you are not busy. These days, I share my experience with my patients and it reassures them in a positive way.” Dr. Duck added. “Most importantly, an opportunity to convey information to a patient’s family and exude a feeling of optimism and trust as to the care we are taking of their loved ones, is one of the greatest opportunities we have as physicians—to demonstrate compassion and caring through simple communication and basic kindness.”

Dr. Duck’s hard-earned message is this: “As cancer patients we are always looking over our shoulders; fear, anxiety, and reality are always lurking. More than ever [these patients] need a physician who is sensitive to that reality and who can show genuine empathy and caring.” 

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Elizabeth Hofheinz is a freelance medical writer based in Louisiana.