Palliative and Supportive Care

Two of the most distressing side effects of cancer treatment, nausea and vomiting, cause enough fear in some patients to induce them to delay or abandon potentially curative treatment. Some studies of surgical patients suggest that the fear of

After an almost 40-year search for a primary regulatory of platelet production, thrombopoietin has recently been purified and cloned. Thrombopoietin regulates all stages in the production of platelets by promoting both the

Tumor-induced osteolysis or lytic bone disease is mediated by osteoclast activation. Osteoclasts can be activated directly by products produced by tumors or indirectly through other nonmalignant cells. By reducing

BETHESDA, Md--How important is it to prevent opioid-induced constipation in patients taking opioids for cancer pain? "Some patients have said they would rather live with the pain than suffer with constipation," Joseph F. Foss, MD, assistant professor of anesthesia, University of Chicago, said at the First International Conference on Research in Palliative Care, held at the National Institutes of Health (NIH).

COLUMBUS, Ohio--Cancer pain must be viewed as a "pathogenic agent" in its own right as well as a symptom of cancer or its treatment, said Costantino Benedetti, MD, director of the Palliative Medicine-Hospice Program, Ohio State University, Arthur G. James Cancer Hospital and Research Institute.

NEW YORK--The fear that pain may signal advancing disease often stops patients from telling their physicians about it and getting relief, Nessa Coyle, RN, MS, director of palliative care, Memorial Sloan-Kettering Cancer Center, said in a talk to cancer patients at Cancer Care, Inc. headquarters.

If patients with terminal cancer are to participate in making good treatment choices, their physicians must clearly and honestly

A life with cancer is often a life with pain. But it does not have to be that way.Physicians and award-winning multimedia designers at Michigan State University have developed a new CD-ROM that

Leaders of the American Society of Clinical Oncology (ASCO) discussed the society’s comprehensive position statement calling for the removal of all barriers to high-quality end-of-life care. ASCO’s recommendations include greatly expanded

Patients in pain may soon be better treated with fewer side effects using lower morphine doses combined with newer painkillers, according to a study reported by researchers from the University of California, San Francisco (UCSF), in the

Advanced gastric carcinoma remains an incurable disease with a median survival of 6 to 9 months, and available therapeutic approaches are predominantly palliative. In small controlled trials, systemic chemotherapy has

LOUISVILLE, Kentucky--Photodynamic therapy (PDT) offers a simple and effective alternative to conventional techniques for palliative debridement of endobronchial obstructions in lung cancer patients, data from two clinical trials suggest.

LOS ANGELES--Combined therapy with suramin and hydrocortisone significantly improved palliation over placebo plus hydrocortisone in hormone-refractory prostate cancer. The palliative improvement emerged within 6 weeks, and the difference between the regimens increased to the end of therapy, Eric Small, MD, reported at the ASCO integrated symposium on prostate cancer.

"Breakthrough pain" is a common clinical term that has not been conclusively defined or described. Breakthrough pain is a transitory flare of pain experienced when baseline pain has been reduced to a mild or moderate level.

ORLANDO--Half of the problems of patients who are dying are never reported. "Why?" asked Dr. Derek Doyle, a palliative medicine specialist in Edin-burgh, Scotland, "because doctors are not interested." Or at least that’s how patients feel, he said. "Physicians have not yet learned to communicate with patients about problems beyond their disease and its pain," he said at the 15th Annual International Breast Cancer Conference.

ORLANDO--Those who argue for physician-assisted suicide maintain that it gives terminal patients autonomy to decide when they’ve had enough, when they are through with their life’s work, and when they have made peace with family and friends. They can die where they want with the assistance of a caring physician.

BUFFALO, NY--In January 1998, the Food and Drug Administration approved photodynamic therapy (PDT) using the sensitizer porfimer sodium (Photofrin) for the treatment of early-stage lung cancer. PDT was originally approved in 1995 for the palliative treatment of obstructive esophageal cancer.

Passik and colleagues address an important and badly neglected issue in cancer care. Alcoholism has been reported to occur in 5% to 15% of the North American population, and drug abuse in approximately 5%. In hospitalized patients, the prevalence of alcoholism increases to approximately 20%.[1] In 200 patients admitted to a tertiary palliative care program in a health care system providing universal access, the prevalence of alcoholism was 27%.[2]

NEW YORK--Today’s physician must be aware of the nuances among the terms tolerance, physical dependence, and addiction in order to treat cancer pain effectively, said Russell K. Portenoy, MD, chairman of the Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York.

BUFFALO, NY-Photofrin (porfi-mer sodium), a photosensitizer used in photodynamic therapy (PDT), has received FDA approval for use in early-stage microinvasive lung cancer. The agent, manufactured by QLT Photo-Therapeutics, was approved in 1995 for palliative use in esophageal cancer.

Some bacteria in the environment may already have a natural resistance to certain antibiotics, due only to genetic variation and not to antibiotic exposure. These bacteria could provide a key to the rational design of new antibiotics, say researchers in

Chemotherapy has been shown to prolong survival in patients with stage IV non-small-cell lung cancer (NSCLC). However, traditional cisplatin (Platinol)-containing regimens are associated with significant toxicity.

Cancer researchers, led by Antonio Giordano, MD, PhD, associate professor at Jefferson Medical College, have for the first

SHEFFIELD, England-Sam Ah-medzai, MD, chair of palliative medicine at the University of Sheffield, England, believes that palliative care is an important aspect of cancer treatment right from the time of diagnosis. In the World Health Organization’s cancer treatment model, he said, palliative care is typically reserved for a patient’s final weeks, but he believes that palliative care should underpin all treatment from the start.

NEW YORK--Dying can be a long process, not an isolated event, and much of it happens at home, said Nessa Coyle, RN, director of the supportive care program, Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center. Ms. Coyle suggested some guidelines for the challenging task of caring for the terminally ill at home during a Cancer Care, Inc. teleconference.

The Prostate Cancer Intervention Versus Observation Trial (PIVOT) should prove interesting in that the study design will permit observation of the natural history of a potentially lethal malignant disease, influenced only by palliative treatments. My comments will focus on the concerns raised by this study design. I will not address possible biases of the trial introduced by: (1) enrollment of less than 20% of the eligible population; (2) an enrollment rate per participating center of less than 3 patients per year; (3) a 7-year enrollment period; and (4) a 12-year follow-up (for a total trial duration of 19 years).

The article by Dr. Swift provides an excellent, comprehensive review of malignancies in the setting of HIV and their management with radiation. It is important for clinicians to have an understanding of the current antiviral management of HIV disease, as well as its implications for patient longevity. This information, in the context of an individual patient's history, is crucial in determining whether treatment will be "palliative" or "curative," and therefore, which radiation dose/fractionation schedule will be employed. With improved antiviral therapies and increasing longevity, the late effects of radiotherapy, as well as recall phenomena (recurrent radiation effects), with the subsequent use of chemotherapeutic agents, must now be considered.

NEW YORK--Aggressive new interferon (IFN) treatment strategies aimed at combating chronic hepatitis C virus (HCV) infection are roughly twice as effective as the standard thrice-weekly, six-month IFN regimen.

VIENNA--Although the majority of patients with advanced non-small-cell lung cancer (NSCLC) are too ill to tolerate platinum therapy, the more benign safety profile of gemcitabine (Gemzar) is opening up the possibility of palliative chemotherapy for a wider group of NSCLC patients.

ST. PETERSBURG, Russia--High doses of the investigational antiestrogen toremifene (Fareston) proved safe and effective as palliative therapy in patients with advanced renal cell carcinoma, say Dr. Michael Gershanovich and colleagues, of the Professor N. N. Petrov Research Institute of Oncology, St. Petersburg, and Orion Corporation, Turku, Finland.