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palliative care

Using Patient-Reported Outcome Measures in Palliative Care Clinical Practice

Incorporating patient-reported outcomes into the palliative care clinical setting can improve patients’ symptom management, quality of life, and overall communication with their oncologists, according to Ethan Basch, MD. Dr. Basch is Director of the Cancer Outcomes Research Program and Associate...

Gastroesophageal Cancer
Palliative Care

No Overall Survival Improvement but Some Palliative Benefit With Gefitinib in Esophageal Cancer Progressing Postchemotherapy

In what may be the first randomized trial of systemic therapy in this setting, Susan J. Dutton, MSc, of University of Oxford, United Kingdom, and colleagues evaluated the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor gefitinib vs placebo in patients with esophageal cancer...

palliative care

The Role of Integrated Palliative Care in Radiation Oncology

Three years ago, Dana-Farber Cancer Institute and Brigham and Women’s Hospital in Boston, launched a Supportive and Palliative Radiation Oncology (SPRO) program to integrate generalist palliative oncology services, including the physical, psychosocial, and spiritual aspects of care, into radiation...

palliative care

Timing and Meaning of Do-Not-Resuscitate Orders in the Palliative Care Setting

Although a do-not-resuscitate (DNR) order does not mean “do not treat,” that is how it is often interpreted, according to a study examining the level of care oncology inpatients at a tertiary care hospital received.1 The study found that the interpretation of DNR orders among oncology nurses and...

issues in oncology
palliative care

Helping Patients Talk to Their Children About Cancer

Although the focus of an oncologist’s attention is understandably attuned to the needs of the patient, when a patient is a parent, quality oncology care should also include attention to the patient’s role as a parent and to the needs of the patient’s children, according to Paula K. Rauch, MD,...

gastroesophageal cancer
palliative care

Radiation Alone Is as Effective as and Less Toxic Than Chemoradiation for Advanced Esophageal Cancer

Radiation therapy alone was found to be as effective as chemoradiation in reducing dysphagia associated with advanced esophageal cancer in the palliative setting and was less toxic, according to results of a multinational phase III trial called the Trans-Tasman Radiation Oncology Group (TROG) 03.01 ...

lung cancer
palliative care

Novel Oral Agent Treats Cachexia in Patients With Non–Small Cell Lung Cancer

For the first time, studies show that a drug is effective in treating several domains of cancer-related cachexia. Oral anamorelin increased lean body mass, achieved weight gain, and improved quality of life in patients with cancer-related cachexia in two pivotal phase III studies presented together ...

palliative care

Dying in America: Ensuring High-Quality Care at the End of Life

In September, the Institute of Medicine (IOM) released its report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The report argues that the U.S. health-care system subjects patients to too many—and often futile—interventions near the end of life, often ...

palliative care

Recipients of the 2014 Conquer Cancer Foundation of ASCO Merit Awards in Palliative Care Honored

The following seven recipients of the 2014 Conquer Cancer Foundation of ASCO Merit Awards in Palliative Care were honored at the 2014 Palliative Care in Oncology Symposium for their work in improving the care of people living with cancer around the world. Erin Alexi, MD, Virginia Commonwealth...

supportive care
palliative care

Experts Stress the Need for Integrating Palliative Care Into Standard Oncology Care

The overriding consensus from the 2014 Palliative Care in Oncology Symposium: Patient-Centered Care Across the Cancer Continuum held in Boston was that achieving optimal high-quality cancer care requires both state-of-the-art cancer therapy and the integration of palliative care principles...

palliative care

How the Earlier Introduction of Palliative Care Improves Quality of Life for Patients With Advanced Cancer

A 4-year study1 involving 461 patients with advanced stages of lung, gastrointestinal, genitourinary, breast, and gynecologic cancers has found that providing early outpatient palliative care vs standard oncology care alone improved quality of life and patient satisfaction. The study participants...

palliative care

Use of Hospice Care by Medicare Patients Associated With Lower Rate of Hospitalization, ICU Admission, Invasive Procedures, and Costs

Medicare patients with poor­prognosis cancers who received hospice care had significantly lower rates of hospitalization, intensive care unit (ICU) admissions and invasive procedures at the end of life, along with significantly lower health care expenditures during the last year of life, according...

palliative care

Debate Over Legalizing Physician-Assisted Death for the Terminally Ill

On November 1, 2014, 29-year-old Brittany Maynard ended her life through physician-assisted death, reigniting the controversy surrounding Death With Dignity laws, which allow physicians to prescribe life-ending drugs to terminally ill patients. Diagnosed with glioblastoma multiforme in January, Ms. ...

palliative care

Palliative Care in 2014

Palliative care expert Diane E. Meier, MD, is the Director of the Center to Advance Palliative Care (CAPC), a national organization devoted to enhancing the number and quality of palliative care programs across the nation. Under her leadership, the number of palliative care programs in the United...

palliative care

Cancer Care Incomplete Without Palliative Care Integration

ASCO recognizes that an array of efforts are needed to fully integrate palliative care into the cancer care continuum, and the Society is committed to facilitating the integration of palliative cancer care into existing health-care systems worldwide in order to realize the vision of comprehensive...

palliative care

Private Payer and Academic Center Data Capture Inappropriate Use of End-of-Life Care

Data sharing between a comprehensive cancer center and a private insurer appears to be a novel way to capture practice patterns that can point to potential quality improvements. A study that combined data from Dana-Farber Cancer Institute and Blue Cross Blue Shield of Massachusetts showed that some ...

palliative care

Better Studies Needed to Dispel Confusion Over When to Refer a Patient to Hospice

I read the article on “Private Payer and Academic Center Data Capture Inappropriate Use of End-of Life Care” (The ASCO Post, December 15, 2014, page 11). The data highlight Dr. Deborah Schrag’s notion that there is “ample evidence of overuse of intensive care at the end of life.” However, there is...

palliative care

Incorporating Physical Medicine and Rehabilitation Into Palliative Care

Although cancer rehabilitation has been a part of oncology clinical practice for several decades, it has largely gone unrecognized as an integral part of palliative medicine and survivorship care. Now, the role of physical medicine and rehabilitation in oncology care may increase as patients with...

issues in oncology
palliative care

What It Means to Be Mortal

“I learned a lot of things in medical school, but mortality wasn’t one of them,” writes Atul Gawande, MD, MPH, in his new book on the medicalization of aging and dying, Being Mortal: Medicine and What Matters in the End (Metropolitan Books, 2014). In the book, Dr. Gawande critiques the American...

palliative care

Palliative Care in the Middle East

While some seek peace in the Middle East through political means, others are looking to help patients with cancer find peace through palliative care. This endeavor is bringing oncology professionals together across the region’s national borders and cultural boundaries to implement solutions and...

palliative care

Improving the Quality of Palliative Care in Oncology

Two years ago, ASCO collaborated with the American Academy of Hospice and Palliative Medicine to develop the Virtual Learning Collaborative, a virtual quality improvement program intended to address the complex care needs of patients with advanced cancer and the care quality for all patients with...

palliative care

AAHPM Unveils List of Inspiring Hospice and Palliative Medicine Leaders Under 40

The American Academy of Hospice and Palliative Medicine (AAHPM) has released a list of Inspiring Leaders Under 40 in the field. Eligible candidates were evaluated on involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, mentoring of...

Palliative Care

Highlights From the 2014 Palliative Care in Oncology Symposium

The inaugural 2014 Palliative Care in Oncology Symposium was held October 24 to 25 in Boston. Over 200 abstracts were presented, covering topics such as the integration of palliative care into treatment and the financial hardships facing people living with cancer. The following abstracts were among ...

palliative care

Recognizing Physical Signs Associated With Impending Death Can Assist Clinicians, Patients, and Caregivers With Complex Decisions

In a recently published study of patients with advanced cancer whose status was systematically documented twice a day, from the time of admission to a palliative care unit until death or discharge, investigators identified eight physical signs associated with death within 3 days. Taken together...

palliative care

Helping Patients Understand Palliative Care

The booklet Palliative Care: Improving Quality of Life for Patients and Families is one of the latest additions to the ASCO Answers collection of patient education materials developed by ASCO for people with cancer and their caregivers. These materials provide oncologist-approved information in a...

issues in oncology
palliative care

Why Just Having ‘Good’ Communication Skills Is Not Enough for Talking With Seriously Ill Patients

In the Institute of Medicine’s 2014 report Dying in America,1 the report’s authors found that while frequent clinician-patient conversations about end-of-life care, goals, and preferences are necessary to avoid unwanted treatment, most patients do not have those conversations with their physicians. ...

integrative oncology
palliative care

Escalation of Oncology Services at End of Life May Be Moderated by Coordinated Care

“Use of oncology-related services is increasingly scrutinized, yet precisely which services are actually rendered to patients, particularly at the end of life, is unknown,” noted an article in the Journal of Oncology Practice. To address this knowledge gap, Eijean Wu, MD, of the Los Angeles County...

palliative care

The Mechanisms Driving Cancer Pain

For over a decade, Patrick W. ­Mantyh, PhD, JD, has been investigating the molecular and cellular mechanisms that are involved in cancer-related pain, especially bone pain caused by advanced breast, prostate, and lung cancers. His early laboratory work using mouse models of bone cancer led to an...

Palliative Care

The Importance of Including Adolescents and Young Adults With Cancer in Their Advance Care Planning

Three years ago, a study of adolescents and young adults aged 16 to 28 with metastatic or recurrent cancer or HIV/AIDS compared the usefulness of two previously developed advance care planning guides—one prepared specifically for adolescents and young adults and one specifically for adults. The...

Issues in Oncology
Palliative Care

Using Gene Analytics to Identify Patients at Risk for Treatment Toxicity

Genomic applications are now an accepted part of oncologic science and practice. Differences in gene expression have been used to understand and predict tumor behaviors and response to treatment. And now it seems likely that genomics may also play a pivotal role in guiding treatment preferences by...

Supportive Care
Pain Management
Palliative Care
Symptom Management

Managing Cancer Pain at the End of Life

Cancer-related pain does not exist in a vacuum. To effectively treat it, clinicians should understand the contributing factors. Proper assessment and management of cancer pain at the end of life can significantly alleviate patient suffering, according to Eduardo Bruera, MD, FAAHPM, Department Chair ...

Head and Neck Cancer
Supportive Care
Palliative Care
Symptom Management

Dispelling the Myths Associated With Osteonecrosis of the Jaw

Osteonecrosis of the jaw associated with cancer treatment is frequently misunderstood, according to Cesar ­Augusto Migliorati, DDS, MS, PhD, who delivered an update on its proper recognition and management at the 2015 Multinational Association of Supportive Care in Cancer/International Society of...

Palliative Care

One Doctor’s Road to Palliative Care Services in the Inner City

St. Barnabas Hospital is located in the heart of Bronx, New York, and as such, it has a culturally diverse, largely poor, patient population. The backbone of successful palliative care services is the doctor-patient communication bonding process. However, many of the patients with late-stage cancer ...

Palliative Care

Important Research in the Palliative Care of Patients With Cancer

The emphasis at this year’s Palliative Care in Oncology Symposium, held earlier this month in Boston, was on patient-centered care throughout the cancer continuum. The meeting attracted more than 650 attendees and included six general sessions featuring best practices in communication,...

Palliative Care

End-of-Life Clinical Decisions Still Need Conversations About Improving Care

In 2014, the Institute of Medicine report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life called for more conversations about improving care for those who are dying. Improving the care of the imminently dying is an important issue in the oncology...

Prostate Cancer
Palliative Care

Aggressive End-of-Life Care More Frequent Among Black Men With End-Stage Prostate Cancer

A study to examine end-of-life care among black and white patients dying of prostate cancer found that “significant racial disparities in end-of-life care” do exist. “Although diagnostic and therapeutic interventions are less frequent in black patients with end-stage prostate cancer, the rate of...

integrative oncology
palliative care

ASCO University® Offers Resources for Palliative and Team-Based Care

ASCO University®, ASCO’s eLearning center, offers an array of courses and programs relevant to palliative care and multidisciplinary team–based cancer care. Below are descriptions of just a few of these offerings. Pain Management Released in March 2015, ASCO University’s “Pain Management Program”...

Integrative Oncology
Palliative Care

Integrating Spirituality Into Palliative Care Services

Over the past couple of decades, the oncology community has made great strides in mediating the psychosocial needs of our patients. However, a patient’s spirituality is a subjective and uncomfortable issue for many oncologists, which leaves a gap in the continuum of care. To reach a better...

Palliative Care

A Swiss Psychotherapist Gives Her Perspective on Optimal Palliative Care

Over the past few decades, the oncology community has incorporated new evidence-based therapies to address the psychosocial needs of patients with cancer, especially those with advanced disease. To bring a global perspective to this evolving discipline, The ASCO Post recently spoke with Monika...

Palliative Care

Practicing the Humanistic and Holistic Approach to End-of-Life Care

In 1990, when Bruce (B.J.) ­Miller, MD, was an undergraduate at Princeton University, the practice of medicine was far from his mind. Then a student in Chinese and Asian studies and later an art history major, Dr. Miller would come to pursue a career specializing in palliative medicine after an...

Palliative Care

Evidence-Based Practice Needed in End-of-Life Care

Evidence-based oncology practice is a systematic approach to problem solving for cancer care providers, characterized by the use of the best evidence currently available for clinical decision-making. Over the past several decades, the oncology community, led by its major organizations such as ASCO...

Lung Cancer
Palliative Care

‘Substantial Number’ of Patients Requiring Palliative Radiotherapy for Stage IV NSCLC Are Overtreated

An analysis of data from 46,803 patients with stage IV non–small cell lung cancer (NSCLC) who received palliative chest radiation therapy found that 49% received radiotherapy for longer than 15 fractions, and 28% received more than 25 fractions. This treatment pattern “is inconsistent with the...

Palliative Care

Perceptions of End-of-Life Care Differ Sharply Between African Americans and White Americans

Studies demonstrate that patients with advanced cancer who are not actively engaged in planning their end-of-life care often receive overly aggressive, physically taxing, costly and unnecessary treatment toward life’s end. Recent findings indicate that African Americans appear to be more apt to...

Palliative Care

More, Earlier, and Better Goals-of-Care Conversations at the End of Life Are Feasible

An intervention called the Serious Illness Care Program helps clinicians to conduct more, earlier, and better conversations about goals of care with their seriously ill patients, according to ­Rachelle E. Bernacki, MD, MS, who presented the preliminary results of a study using this approach at the...

Palliative Care

ASCO and AAHPM Define Primary Palliative Care in Oncology

A new guidance statement from ASCO and the American Academy of Hospice and Palliative Medicine (AAHPM) could potentially lead to more standardized primary palliative care delivery across oncology settings, according to Kathleen E. Bickel, MD, MPhil, who presented the study findings at the 2015...

symptom management
palliative care
pain management

Samuel Chao, MD, on Improving the Consistency of Radiation Oncology Processes

Samuel Chao, MD, of Cleveland Clinic, discusses the QMAP program and data-driven management, which offer ways to improve consistency and drive quality in radiation oncology departments (Abstract 39).

palliative care
pain management
symptom management

Alysa M. Fairchild, MD, on Preventing Radiation-Induced Pain Flare

Alysa M. Fairchild, MD, of the Cross Cancer Institute and the University of Alberta, discusses her study on the use of dexamethasone to reduce pain flare in patients receiving palliative radiotherapy for bone metastases (Abstract LBA6663).

palliative care

More Than One-Third of Patients With Metastatic Cancer Continue to Work

A new analysis indicated that many patients continue working after being diagnosed with metastatic cancer, but a heavy burden of symptoms may prevent them from doing so. Published by Tevaarwerk et al in Cancer, the study illustrates the need to treat difficult symptoms so that patients can maintain ...

palliative care
breast cancer
issues in oncology

SABCS 2015: Phase III BELLE-2 Trial Meets Primary Endpoint of Progression-Free Survival

Among women with locally advanced or metastatic hormone receptor–positive breast cancer that was resistant to hormone therapy, those who had mutated PIK3CA detected in their blood benefited from a combination of the investigational PI3K inhibitor buparlisib and fulvestrant (Faslodex),...

palliative care
leukemia

ASH 2015: Combination Therapy With Idelalisib Improves Progression-Free Survival vs Bendamustine/Rituximab Alone in Relapsed/Refractory CLL

In a phase III study to be presented by Zelenetz et al at the 57th American Society of Hematology Annual Meeting, idelalisib (Zydelig) plus bendamustine (Treanda) and rituximab (Rituxan), or BR, proved superior to BR alone in patients with relapsed/refractory chronic lymphocytic leukemia (CLL)...

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