Cancer-related fatigue is a common, albeit complex, symptom experienced by many cancer patients. Identification of fatigue and assessment of its severity should be a part of routine office care and can be performed using simple, one-question screening tools.
Thomas J. Smith, MD
New Practical Approaches to Chemotherapy-Induced Neuropathic Pain: Prevention, Assessment, and Treatment
We review here the recommendations of the American Society of Clinical Oncology, as well as some new and promising approaches to neuropathy, including new neuromodulation techniques.
Advance Care Planning Discussions: Why They Should Happen, Why They Don’t, and How We Can Facilitate the Process
If we can successfully initiate advance care planning discussions with our patients and families, their end-of-life processes will improve, resulting in better care, less use of the hospital, and more honoring of newly discerned choices.
In this podcast we discuss integrating palliative care into standard oncology care with Thomas J. Smith, director of palliative medicine at Sidney Kimmel Comprehensive Cancer Center.
This article addresses the practical application of palliative care (PC) in the outpatient oncology setting.
Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.
The use of the term "futility" in cancer care has been prompted, in part, by increasing requests from patients for treatments thought to be ineffective as well as costly. The appropriate role of chemotherapy near the end of life is a complex issue.
Twenty years of research in controlling symptoms such as pain and
nausea have shown persistent suboptimal performance by the US oncology
system. The data suggest that some of the tools of palliative care
programs can improve physical symptoms of seriously ill patients at a
cost society can afford. To fix these problems will require recognition
of the symptoms or concerns, a system such as an algorithm or care
plan for addressing each, measurement of the change, and accountability
for the change. Symptom assessment scales such as the Edmonton
Symptom Assessment Scale or Rotterdam Symptom Check List work to
make symptoms manifest. Listing symptoms on a problem list is a necessary
step in addressing them. Physical symptoms such as pain can be
improved by use of computer prompts, algorithms, dedicated staff time,
team management, or combinations of these strategies. Less concrete
problems such as medically appropriate goal-setting, integrating palliative
care into anticancer care sooner, and informing patients about
the benefits and risks of chemotherapy near the end of life require more
complex solutions. We review what is known about symptom control in
oncology, how and why some programs do better, and make suggestions
for practice. Finally, we suggest a practical plan for using symptom
assessment scales, listing the problems, and managing them according
to algorithms or other predetermined plans.
The 1992 metaanalysis of adjuvant therapies after surgery in early breast cancer summarizes the most extensively studied of all cancer treatments via randomized controlled trials. This study found overall benefits with use of adjuvant therapies, and their expanded use outside the clinical trial setting was assumed to be effective and implied to be cost effective. Thus, the primary remaining questions are which form of adjuvant therapy to use and how to identify which patients are unlikely to benefit. In British Columbia, the effectiveness of adjuvant therapy outside the clinical trial setting was reassuringly similar to the metaanalysis efficacy. Our decision analysis model of hypothetical cohorts of women with early breast cancer confirmed that the efficacy of adjuvant treatment is the primary determinate of its incremental cost effectiveness. Future cost-effectiveness and quality of life assessments should move from hypothetical cohorts assessed via models to prospective data collected within clinical trials or integrated health delivery system. [ONCOLOGY 9(Suppl):129-134, 1995]