Jamie Hayden Von Roenn, MD

In this article, we present or review the evidence for providing palliative care concurrently with oncologic care, guideline-based recommendations for screening and incorporation of palliative care, and a case-based discussion to demonstrate palliative care across the continuum of cancer care.

This article will review the overlap between palliative care and oncology and discuss the available evidence that true integration of palliative and oncology care provides patients with optimal oncology care.

Dr. Von Roenn, from the Robert H. Lurie Comprehensive Cancer Center at Northwestern University in Chicago, commented that “this is a well-conceived and well-implemented trial.”

Despite major advances in cancerbiology and therapeutics,cancer and its treatment continueto cause devastating suffering,not only for the more than half a millionpatients who will die this yearfrom cancer, but also for many ofthose who will be successfully treated.[1] Symptom burden has a profoundimpact on the quality of life ofcancer patients across all stages of disease.Routine screening of ambulatorycancer patients identifies an average of7 to 10 distressing physical and psychologicalsymptoms per patient.[2]Even patients with a good performancestatus have a median of nine or moresymptoms.[3,4] Not surprisingly, theseverity and burden of symptoms nearthe end of life is even greater.[4]

Advances in antiretroviral therapy have dramatically improved human immunodeficiency virus (HIV)-associated morbidity and mortality. The use of highly active antiretroviral therapy (HAART) has led to a decrease in the incidence of opportunistic diseases, including some malignancies. Moreover, increased use of effective antiretroviral therapy may alter the incidence, presentation, prognosis, and therapeutic recommendations for patients with acquired immunodeficiency syndrome (AIDS)-related non-Hodgkin’s lymphoma.

Kaposi’s sarcoma (KS) is the most common malignancy associated with human immunodeficiency virus-1 (HIV-1) infection and can result in significant morbidity. The clinical course of KS is quite variable, although for the

Since the first cases of AIDS-associated Kaposi’s sarcoma (AIDS/KS) were described in the medical literature in 1981,[1] various local and systemic therapies have been used in efforts to control this most common HIV-associated neoplasm. Many reviews have been published about the treatment of AIDS/KS, but almost all of them have been written by authors representing a single medical specialty, whether it be medical oncology, dermatology, or radiation oncology.

Kaposi’s sarcoma (KS) is an AIDS-defining neoplasm characterized by the development of lesions that histologically consist of proliferating spindle cells, vascular channels, and inflammatory cells.[1] The typical early presentation consists of painless pink, red, or purple macules or nodules on the skin surface or in the oral cavity. Although the presence of a few skin lesions is not life-threatening, even limited cutaneous KS can have an enormous psychosocial impact, particularly when the lesions occur on exposed areas.

Early intervention and attention to nutritional status are essential in patients with cachexia. Identification of reversible causes of decreased energy intake and/or weight loss is the first step in treatment. When such factors