Upstream Palliative Care and Dissecting Hope From Hype in Oncology

by Christian SinclairWorking in an outpatient cancer center, I frequently encounter the conversation about whether the next cancer treatment regimen is ‘worth it.’ Patients and families consider may interpretations of worth; financial being one of course, but also physical side effects, the emotional toll of investing faith into ‘one more treatment’ and hoping that it works. These conversations are challenging as they weigh biological, medi cal, spiritual, social, personal, emotional and other issues, so there is no neat equation which can easily tell you if the benefits or the risks are greater.These struggles were nicely summarized by Liz Szabo (@LizSzabo) in her article “Widespread Hype Gives False Hope to Many Cancer Patients. ” From hospital billboards that emphasize eliminating cancer, to multitudes of ads for new drugs with new indications are we entering a hype boom in cancer care or have we really reached the next level? Szabo has this amazing quote form the CMO of the American Cancer Society:“I’m starting to hear more and more that we are better than I think we really are,” said Dr. Otis Brawley, chief medical officer at the American Cancer Society. “We’re starting to believe our own bullshit.”(A quick aside, I appreciate his frank assessment and swearing. This is not some vanilla, focused-group response. Also, thank you Kaiser Health News (and CNN) for actually publishing it without asteri...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: sinclair tweetchat Source Type: blogs

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Conditions:   Metastatic GI Cancers;   Locally Advanced GI Cancers Interventions:   Behavioral: Expectations Survey (CanCORS);   Behavioral: Values Survey (Serious Illness Care Program);   Behavioral: Functional Assessment of Cancer Therapy-General (FACT-G);   Behavioral: NCCN Distress Thermometer;   Behavioral: Hospital Anxiety and Depression Scale (HADS);   Behavio ral: Quality of Communication (QOC);   Behavioral: visits with a supportive care clinician Sponsor:   Memorial Sloan Ketterin...
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
The objective of this pilot study is to evaluate the (1) applicability of a 15-hour attending-taught psychoeducational intervention in a retrospective cohort and (2) feasibility of a trainee-taught intervention in a prospective cohort of patients with gynecologic cancer to help manage cancer-related cognitive impairment (CRCI). METHODS: Adults with any stage gynecologic cancer who completed chemotherapy and reported cognitive complaints were eligible. Additionally, the screening criteria of Functional Assessment of Cancer Therapy-Cognition (FACT-Cog) perceived cognitive impairment (PCI) subscale score
Source: Journal of Palliative Care - Category: Palliative Care Tags: J Palliat Care Source Type: research
AbstractGenomic medicine provides opportunities to personalize cancer therapy for an individual patient. Although novel targeted therapies prolong survival, most patients with cancer continue to suffer from burdensome symptoms including pain, depression, neuropathy, nausea and vomiting, and infections, which significantly impair quality of life. Suboptimal management of these symptoms can negatively affect response to cancer treatment and overall prognosis. The effect of genetic variation on drug response—otherwise known as pharmacogenomics—is well documented and directly influences an individual patient's resp...
Source: The Oncologist - Category: Cancer & Oncology Authors: Tags: Symptom Management and Supportive Care, Precision Medicine Source Type: research
Conclusion: In spite of the rapid development of external beam radiation therapy brachytherapy continues to remain an important mode of therapy and is often a default treatment when external beam radiation option is limited.
Source: Current Cancer Therapy Reviews - Category: Cancer & Oncology Source Type: research
Palliation may be the goal of care for some patients with intra-thoracic lung cancer. Factors such as the extent of disease, comorbidities, performance status, or symptom burden, may indicate that patients are unsuitable for more aggressive approaches with a curative intent. A palliative treatment plan implies a focus on the effective relief and control of symptoms, while preserving both the quality and quantity of life. Therapeutic measures may include palliative radiotherapy, palliative chemotherapy, or other forms of systemic treatment. In addition, certain interventional procedures may be used to achieve symptom pallia...
Source: Current Cancer Therapy Reviews - Category: Cancer & Oncology Source Type: research
In Asia, North America and Europe, lung cancer remains one of the top contributors to cancer-related death. Oncology training programs span 4-5 years and palliative care fellowship is around 2 years. However, the multi-disciplinary conference is increasingly viewed as preferable to assist with decision making in most modern centers. Palliative care for lung cancer likewise differs between regions.
Source: Current Cancer Therapy Reviews - Category: Cancer & Oncology Source Type: research
Conclusion: Different Canadian hospitals developed practical guidelines and procedures by 2017 already. Ramifications of MAID will be discussed in this review.
Source: Current Cancer Therapy Reviews - Category: Cancer & Oncology Source Type: research
This study aims to report radiotherapy utilization and fractionation patterns during the first course of cancer treatment.MethodsWe extracted all solid tumor cases from 2004 to 2014 in the National Cancer Data Base, which captures only the first course of treatment. Patients were subcategorized by disease site: breast, central nervous system (CNS), gastrointestinal, genitourinary, gynecologic, head and neck (HN), musculoskeletal, skin, or thoracic. Receipt of therapy was identified (systemic, surgical, or radiation therapy). Radiotherapy was subcategorized as external beam radiation therapy (EBRT) (conventional and stereot...
Source: Journal of the American College of Radiology - Category: Radiology Source Type: research
Conclusion Baseline HRQoL scores were independently prognostic for survival, supporting their importance. Compared to full dose, reduced dose capecitabine has previously demonstrated equivalent efficacy and reduced toxicity. We have reported dose reduced capecitabine improves quality of life in older or frail patients with aCRC, further supporting its use in the management of aCRC.
Source: Journal of Geriatric Oncology - Category: Cancer & Oncology Source Type: research
Conclusion We found a steady decrease in the percent of patients receiving radiotherapy in their first course of treatment, and a global decline in the mean number of fractions delivered per patient receiving EBRT, compared with an increase in systemic therapy and stable surgery utilization. These results illustrate the changing use of radiotherapy and fractionation during first-line therapy in contemporary US cancer care.
Source: Journal of the American College of Radiology - Category: Radiology Source Type: research
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