Palliative and Supportive 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.

Patients with advanced progressive cancer require care plans that address their physical, emotional, and psychosocial needs, as well as their goals of care.

In this article, prognostic data are summarized and a suggested approach for discussing hospice enrollment with patients is presented.

Palliative care addresses the symptoms of cancer throughout the course of the disease. Moreover, rather than just improving end-of-life care, palliative care also improves survival.

One in four Americans facing end-of-life is a veteran. Because of their traumatic experiences during combat, including experiences with death, veterans with cancer and other serious illnesses can have complex healthcare needs.

An ethnographic study of palliative care specialists reveals that many of them find dealing with dying patients a gratifying experience. The scant evidence about oncologists on this subject paints a much different picture.

The American Society for Radiation Oncology (ASTRO) has released guidelines for the use of radiation therapy in treating bone metastases; the guidelines are published in the International Journal of Radiation Oncology, Biology, Physics.

ASCO’s QOPI analysis recently found that less than half of all cancer patients are enrolled in hospice care before their death and of those who are enrolled, one-third are not enrolled until the last week of their lives. In response to this and other findings, ASCO published a new policy and guidelines this week, intended to encourage physicians to initiate open dialogue about palliative care and treatment with patients as soon as they are identified as having incurable cancer.

The effectiveness of RT in the palliative setting is sometimes overlooked; however, RT can provide excellent palliation for patients whose disease becomes refractory to other modalities.

In these patients with substantial symptoms and short life expectancy, there's no reason to delay delivery of palliative care.

Stephen Lutz, MD, talks about the evolution of the ASTRO guideline and how it answers vital questions for radiation oncologists.

Th e cancer survivor population in the U.S. is nearing 14 million and is growing at a rate of about 10% each year. Unfortunately, cancer patients who have completed treatment do not always have access to comprehensive, follow-up care.

It is well known that exposure to chemotherapy or radiation therapy can result in long-term complications for childhood cancer survivors. What is less certain is why some children have to contend with these complications while others do not. Researchers at the City of Hope Medical Center in Duarte, Calif., are one step closer to fitting another piece in the survivorship puzzle: They hypothesized that there is some inherent genetic susceptibility that raises this risk.

Physicians must engage and educate patients about significant risk for cardiovascular disease.

Healthcare professionals must do more to address an issue that impacts a patient’s daily life.

The case report by Magnuson and Halligan presents the palliative treatment of a patient with stage IV melanoma, distantly metastatic to several sites, including the lung, pulmonary vein, left atrium, and CNS. The article focuses on the external beam radiotherapy employed to treat the cardiac metastasis and includes a discussion of the role of radiotherapy in treating metastatic melanoma.

Trelstar (22.5 mg triptorelin pamoate) has received FDA marketing approval as a twice-yearly intramuscular gonadotropin-releasing hormone (GnRH) agonist.

Understandably, oncologists are reluctant to tell patients that there is no longer any benefit for them to continue chemotherapy. It is a conversation that alters the doctor/patient relationship, an acknowledgement by the doctor that, despite all the advances of modern medicine, “I can do nothing more to extend your life.” However, according to ongoing research, this difficult conversation is not being had enough, and patients, clinging to false hope, are being given chemotherapy when it should have been discontinued in favor of palliative care.

Early survey results from the Association of Community Cancer Centers indicate that practices are scaling back in some areas but also that their overall financial outlook is healthy.

For quality to become the standard, care delivery must be fundamentally changed and oncologists will need to step up to work with insurance providers.

Acupuncture is an important component of traditional Chinese medicine. The practice originated more than 2,000 years ago. It involves stimulation of one or more predetermined points on the body with sterile, filiform, disposable needles, sometimes with added heat (moxibustion), pressure (acupressure) or electricity to enhance therapeutic effect. The needles are much thinner than the hypodermic needles used for injections.

Dr. McCall is a board-certified internist and the medical editor of Yoga Journal. He is the author of Yoga as Medicine: The Yogic Prescription for Health and Healing (Bantam, 2007). He can be found on the Web at www.DrMcCall.com.

The American Board of Radiology (ABR) has introduced a certificate in hospice and palliative care.

Wyeth Pharmaceuticals, a division of Wyeth, and Progenics Pharmaceuticals, Inc. recently announced the publication of results from a pivotal phase III trial of methylnaltrexone bromide (Relistor) subcutaneous injection in the New England Journal of Medicine. Methylnaltrexone is a newly approved therapy for the treatment of opioid-induced constipation (OIC) in patients with advanced illness who are receiving palliative care, when response to laxative therapy has not been sufficient.

Meaningful pain relief at 10 minutes following dosing with intranasal fentanyl spray among patients with cancer who experience breakthrough pain was reported at the Fifth Research Forum of the European Association for Palliative Care, in Trondheim, Norway. All patients involved in the trial were already receiving effective treatment to control background pain, but still experienced episodes of breakthrough pain everyday. Intranasal fentanyl spray is aimed at managing breakthrough pain in adult patients with cancer who are

The goal of palliative radiotherapy is to treat symptoms as rapidly and efficiently as possible, with the fewest side effects.[1] For many years, pain medication, radiotherapy, and surgery were the only tools available for the treatment of bone metastases. This has changed significantly over the past 15 years. New systemic agents, including bisphosphonates such as zoledronic acid (Reclast, Zometa), are available to prevent the development of new lesions, strengthen the bone, and improve symptoms. In addition, targeted treatments directed at achieving tumor ablation now include radiofrequency ablation and stereotactic body radiation therapy (SBRT).

Important therapeutic innovations within the past several years have resulted in only modest survival benefits for women with metastatic breast cancer. In this setting, cancer remains incurable and treatment is mainly palliative, involving judiciously applied multiple endocrine, chemotherapeutic, or biologic therapies in an attempt to induce a series of remissions and, ultimately, adequate palliation. At present, we lack both a consensus management algorithm and an ideal treatment model of specific subsets of women.

Offering palliative care to pediatric cancer patients markedly reduced their end-of-life suffering, according to research conducted at the Dana-Farber Cancer Institute in Boston.

The Dana-Farber Cancer Institute has been named a consulting hospital for palliative care programs nationwide. The Boston-based center has been designated as a learning lab by the Health Research and Educational Trust (HRET) of the American Hospital Association.