Cancer may be the same disease worldwide, but the way physicians and patients approach it can be worlds apart, a visiting Israeli oncologist is learning.

"Everything is so different, you wouldn't believe it," said Ayala Hubert, a medical oncologist and radiotherapist in practice at Hadassah Hospital in Jerusalem. "The patient-doctor relationship is so different here. Patients are given the whole truth," Hubert said.

"In Israel, we don't lie, but we are under a lot of pressure from families not to tell everything," she said. "I think most patients would like to know the truth and can handle it."

During a two-week tour in California, Hubert visited the UCSF/Mount Zion Cancer Center and Stanford Medical Center as part of the Billie Zemel UCSF/Mount Zion Oncology Fellowship. She is also spending the first two weeks of this month visiting Memorial Sloan-Kettering Cancer Center in New York City.

While she doesn't dismiss innovations in the Israeli system, Hubert said she has learned new diagnostic and treatment options from her American counterparts at UCSF and Stanford. American physicians, for example, are making more use of monoclonal antibodies, including the HER2/neu antibody, now being used in clinical trials at UCSF in women with advanced cancer. Hubert also was interested to learn about innovations in radiation therapy, particularly research by Mack Roach III, MD, UCSF associate professor in radiation oncology and medicine, in which high-dose radiation is targeted to a localized area in prostate cancer patients.

Israel, Hubert said, has made major advances in establishing genetic testing and counseling for Ashkenazy women who may be more likely to inherit an altered copy of the BRCA1 and BRCA2 genes linked to breast cancer. Special clinics have been established for carriers of the genes, she said. She also was impressed with the variety of emotional and psychological support and resources available in the United States.

"Meditation, yoga, music. I have a whole load of information to take back with me," she said. While on the West Coast, Hubert was a guest of Ernest Rosenbaum, MD, clinical professor of medicine at UCSF/Mount Zion, and his wife, Isadora.

The Billie Zemel Fellowship has been given annually for more than 11 years to allow Israeli physicians an opportunity to study American health care. The fellowship was named in honor of the late wife of Arthur Zemel, a Peninsula businessman.

By Dale Martin

1st appeared 11/06/97

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