Palliative and Supportive Care

Locally advanced or metastatic adenocarcinoma of the stomach still carries a poor prognosis, with 5-year survival rates of < 15%. Palliative chemotherapeutic regimens for this disease are largely 5-FU–based. We

Because most patients now want to know the truth about their diagnosis and prognosis, the ability to discuss the cancer diagnosis, disease recurrence, or treatment failure, and to solicit patients’ views about resuscitation

To determine whether a shorter course of radiation treatment may be associated with an improvement in quality of life (QOL), investigators at William Beaumont Hospital, Royal Oak, Michigan, compared the QOL of women with early-

The VA Cancer of the Prostate Outcomes Study (VA CaPOS) is collecting quality-of-life (QOL) information from prostate cancer patients, spouses, and physicians at six VA medical centers. Currently, 601 men with prostate

Problem: Several million women worldwide have survived breast cancer but are currently advised against the use of estrogen for the management of menopausal symptoms and for the prevention of early cardiovascular death and osteoporosis.

CLEVELAND-Delirium, although common in patients with advanced cancer, is poorly understood, Donna S. Zhukovsky, MD, said at a conference on palliative medicine held at the Cleveland Clinic Foundation. Properly identifying delirium can be difficult, and the literature shows that it frequently goes unrecognized by physicians and nurses, said Dr. Zhukovsky, of the Cleveland Clinic Foundation’s Harry R. Horvitz Center for Palliative Medicine.

CLEVELAND, Ohio-Decisions involving patients with advanced cancer must take place within a conceptual framework that takes into account quality of care, quality of life, and quality of death, Declan Walsh, MD, MSc, said at a conference on palliative medicine held at the Cleveland Clinic Foundation.

Since sadness and anxiety are normal reactions to serious illness such as cancer, the challenge for the physician becomes determining which symptoms are appropriate to the situation and which are pathologic and require treatment, Susan J. Stagno, MD, said at a conference on palliative medicine at the Cleveland Clinic Foundation.

Pain due to malignancy can be controlled through simple means in most patients. In certain refractory cases, however, the chronic delivery of analgesics to the epidural or subarachnoid space may be appropriate. This review

There are several million breast cancer survivors worldwide. In the United States, 180,000 women were

Integrating spirituality into oncology social work practice is appropriate, feasible, and necessary, said Mary Ellen

CLEVELAND-A comprehensive evaluation of acute and chronic pain in the cancer patient is essential in order to choose the appropriate therapy, detect the progression of disease, and optimize quality of life, Donna S. Zhukovsky, MD, of the Harry R. Horvitz Center for Palliative Medicine at the Cleveland Clinic Foundation, said at a conference on palliative medicine sponsored by the Cleveland Clinic Foundation.

CLEVELAND-Common respiratory symptoms of advanced cancer include dyspnea, wheezing and broncho-spasm, cough, and pleural effusion. Shortness of breath is the symptom cancer patients fear most, with the exception of pain, Susan B. LeGrand, MD, said at a conference on Palliative Medicine held at the Cleveland Clinic Foundation.

CLEVELAND-Standard respiratory therapy often must be modified for the palliative care patient, David Haney, RRT, said at a conference on palliative medicine held at the Cleveland Clinic Foundation.

Approximately 50% of cancer patients develop anemia. In the past, the only available treatment option for these patients was transfusion. Since the late 1980s, recombinant human erythropoietin (rHuEPO, epoetin alfa

There are several million breast cancer survivors worldwide. In the United States, 180,000 women were diagnosed

CLEVELAND, Ohio-When cancer is diagnosed, most patients fear pain more than any other symptom, Victoria Lipnickey, PA-C, said at a symposium on palliative medicine, sponsored by the Cleveland Clinic Foundation.

There are several million breast cancer survivors worldwide. In the United States, 180,000 women were diagnosed with breast cancer in 1997, and approximately 97,000 of these women have an extremely low chance of a suffering a recurrence of their cancer. With an average age at diagnosis of 60 years and a 25-year expected duration of survival, the current number of breast cancer survivors in the United States may approach 2.5 million women. Since breast cancer is now being detected at an earlier stage than previously and since adjuvant chemotherapy may cause ovarian failure, an increasing number of women are becoming postmenopausal at a younger age after breast cancer treatment. This conference was convened in September 1997 to consider how menopausal breast cancer survivors should be treated at the present time and what future studies are needed to develop improved therapeutic strategies. A total of 47 breast cancer experts and 13 patient advocates participated. The proceedings of the conference are being published in six installments in successive issues of oncology. This third part focuses on the prevention of osteoporosis and the cardiovascular effects of estrogens and antiestrogens. [ONCOLOGY 13(3):397-432, 1999]

The 1999 Asia Pacific Hospice Conference, “New Horizons in Hospice Care,” will take place in Hong Kong on June 2-4, 1999. An estimated 600 attendees are expected.

CLEVELAND, Ohio-Nearly half of the symptoms associated with cancer are gastrointestinal (GI), including anorexia, weight loss, dry mouth, constipation, early satiety, nausea and vomiting, taste change, and dysphagia. Yet these symptoms are among the most difficult to treat because their pathophysiology is not well understood, available drugs are not always effective, and multiple symptoms may occur together, Kristine A. Nelson, MD, said at a symposium on palliative medicine held at the Cleveland Clinic Foundation.

CLEVELAND, Ohio-Pain is the most common symptom of patients with advanced cancer, followed by fatigue. Other common symptoms, in order of frequency, are anorexia, dry mouth, constipation, early satiety, dyspnea, weight loss, sleep problems, and depression, Kristine A. Nelson, MD, said at a symposium on palliative medicine held at the Cleveland Clinic Foundation.

Findings released from a national survey underscore what cancer patients already know: The fatigue following chemotherapy treatment has a sweeping impact on patients’ physical and emotional health, as well as their economic well-being.

CLEVELAND, Ohio-The importance of the spiritual domain in comprehensive patient care was emphasized during the care of Mrs. S, a 64-year-old woman with renal cell carcinoma with bone metastasis, Cathy Palcisco, LISW, said at a symposium on palliative medicine held at the Cleveland Clinic Foundation.

Although the optimal route of administration of opioids is by mouth, some patients may require alternative routes during the course of their illnesses for several reasons. These include bowel obstruction, severe emesis, or severe

BETHESDA, Md-Studies in end-of-life care must be introduced into the standard medical school curriculum, David E. Weissman, MD, of the Medical College of Wisconsin, said at the First International Conference on Research in Palliative Care, sponsored by the National Institutes of Health (NIH) and the US Cancer Pain Relief Committee. “They don’t know what they don’t know,” Dr. Weissman said in his presentation on the need to change palliative care practice in academic medical centers.

There are several million breast cancer survivors worldwide. In the United States, 180,000 women were diagnosed with breast cancer in 1997, and approximately 97,000 of these women have an extremely low chance of suffering a recurrence of their cancer. With an average age at diagnosis of 60 years and a 25-year expected duration of survival, the current number of breast cancer survivors in the United States may approach 2.5 million women. Since breast cancer is now being detected at an earlier stage than previously and since adjuvant chemotherapy may cause ovarian failure, an increasing number of women are becoming postmenopausal at a younger age after breast cancer treatment. This conference was convened in September 1997 to consider how menopausal breast cancer survivors should be treated at the present time and what future studies are needed to develop improved therapeutic strategies. A total of 47 breast cancer experts and 13 patient advocates participated. The proceedings of the conference will be published in six installments in successive issues of oncology. This first part defines the problem and explores its magnitude and ramifications for patient management. [ONCOLOGY 1(13):109-136, 1999]

Amifostine (Ethyol) is an analog of cysteamine that selectively protects normal tissues in multiple organ systems against the toxic effects of radiation and various cytotoxic drugs while preserving the antitumor effects of these

BETHESDA, Md-Children and elderly people with pain present special problems in assessing the presence and causes of pain and other symptoms, as well as determining treatment efficacy, two pain specialists said at the 1st International Conference on Research in Palliative Care, held at the NIH.

LOS ANGELES-City of Hope National Medical Center’s Nursing Research and Education Department has received a grant from the National Cancer Institute to provide palliative care training for home care professionals at 10 Los Angeles area home care agencies and 50 agencies across the country. Called HOPE (Home care Outreach for Palliative care Education), the program’s goal is to help dying patients achieve the best quality of life while maximizing comfort and maintaining dignity.

NEW YORK-The Comprehensive Breast Center of St. Luke’s Roosevelt Hospital in Manhattan joined forces with the Vidal Sassoon Salon to kick off National Breast Cancer Awareness Month in October with free beauty makeovers for breast cancer patients.