Dr. Hammar: "They Should Not Suffer"

Dr. Sam Hammar is no ordinary pathologist. The prototypical pathologist is a doctor who hunches over a microscope in a hospital basement, far removed from patient contact. Dr. Hammar bridges the gap between sterile academia and hands-on patient care. Richard Hahn of Wenatchee, Washington was recently diagnosed by local pathologists with a pleural based tumor. The pulmonary doctor was convinced the tumor was mesothelioma, but the pathologist was uncertain. The Hahns learned of Dr. Hammar's expertise and had the slides and pathology specimens sent to him.

Normally, that's as far as the contact goes. But Mr. Hahn's wife was not getting satisfactory information regarding treatment options from the local doctors in Wenatchee. So she called Dr. Hammar directly -- not an easy man to contact. Dr. Hammar, who analyzed Mr. Hahn's specimens on a fast track basis and, unfortunately, confirmed the diagnosis of mesothelioma, took Mrs. Hahn's call.

I have found that patients do not necessarily want to hear evasive sounding gobbledygook from doctors. They want to know what the diagnosis is and what the options are. They don't want delay or indecision. Dr. Hammar is a straight shooter. Dr. Hammar basically agreed with the local pulmonary doctor's prognosis. This was not what Mrs. Hahn wanted to hear. The Hahns were holding on to some hope that the tumor was not mesothelioma. In the case of mesothelioma, the truth does not exactly set the patient free. Nobody wants to be the bearer of bad news. But now the Hahns know what they are dealing with and can make plans accordingly. They appreciate Dr. Hammar's frank assessment of their case.

I have reprinted portions of Dr. Hammar's report on the Hahn case. As a pathologist, Dr. Hammar is not directly involved in the management of a cancer patient's treatment. However, his opinions regarding the various treatment options are entitled to respect.

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October 29, 1997

Dear Mr. Worthington:

Please find enclosed my report on Richard R. Hahn. This is an unfortunate case of a 74-year-old man with a history of exposure to asbestos [electrician in the Navy and at Alcoa Aluminum in Wenatchee, among other job sites, from 1942 to 1985]. Mr. Hahn was also stated to have been a previous cigarette smoker and had a history of coronary artery disease, hypertension and hyperlipidemia.

Mr. Hahn was in his usual state of health until about the first week of September, 1997 when he developed progressive dyspnea and pressure sensation in his chest. He was found to have a right pleural effusion and right pleural thickening. Mr. Hahn was evaluated at the Wenatchee Valley Clinic by Dr. McBride. A thoracentesis and pleural biopsy were performed. The thoracentesis contained cells that I thought were highly suspicious for neoplastic mesothelial cells and the pleural biopsy showed what I would have diagnosed as an infiltrating epithelial neoplasm that according to the immunohistochemical studies that were done was consistent with an epithelial mesothelioma. Dr. McBride indicated that the tumor was invasive and that any further surgery would not specifically benefit Mr. Hahn with respect to his treatment. Based on Mr. Hahn's history of occupational exposure to asbestos, I conclude that his right pleural epithelial mesothelioma was caused by asbestos.

I spoke with Mrs. Hahn today before I had reviewed the slides and medical records in this case. I basically agree with Dr. McBride; namely, that there is not a whole lot to offer Mr. Hahn. I talked to Mrs. Hahn about possible therapies that were being done and told her that surgery was probably the best therapy, but that could only be done in a small number of patients that had stage I disease. It is clear the Mr. Hahn's disease is not stage I.

I am not convinced that the gene therapy has any great success in this disease at this point in time and also am not convinced that Onconase or Taxol have any long-term favorable effects. I have seen a couple of individuals have a dramatic response to platinum-based drugs and one patient who had a dramatic response to an analog of Methotrexate. These chemotherapeutic responses, however, are few and far between and from a practical point, only rare patients will show any improvement.

I told Mrs. Hahn that about the best things that one could offer her husband would be to make sure that he was kept pain-free and I think that should be the goal in all patients who have mesotheliomas. They should not suffer.

Sincerely,

Samuel P. Hammar, M.D.

** POSTED NOVEMBER 4, 1997 **