Palliative Care in Oncology
Understanding the Discordance About Prognosis Between Clinicians and Terminally Ill Patients and Their Surrogates
Jo Cavallo
Research shows that about half of adults near the end of life in the United States are too ill to participate in decisions about whether to accept life-prolonging treatment,1 requiring family members and other proxies to serve as surrogate decision-makers for their critically ill loved ones. However...
Understanding the Link Between Prognostic Perception and Patient-Oncologist Prognostic Discordance in the Advanced Cancer Setting
Studies have shown that although patients with advanced cancer want their oncologists to give them an honest assessment of their prognosis, most patients still perceive their illness as curable.1 And that lack of understanding of their prognosis can lead to reduced use of hospice care and increased ...
How Low-Dose Oral Minoxidil Is Providing Hope for Patients With Later-Stage Alopecia
Jo Cavallo
Chemotherapy-induced hair loss affects 65% of patients with cancer,1 and the psychosocial impact on these patients can be profound; it may include anxiety, depression, a negative body image, lowered self-esteem, and a reduced sense of well-being.2 In some instances, the fear of hair loss from cytoto...
Is Advance Care Planning of Any Value?
An article in The New York Times earlier this year crystallized the dilemma facing health-care providers when they are presented with a patient in a life-threatening situation: Should they rely on advance care directives written years prior to the current medical situation to accurately determine th...
Understanding Oncologists’ Perceptions About Palliative Care and the Barriers Preventing Its Use
Despite studies showing the benefits of early palliative care in improving the quality of life of patients with advanced cancer (including reducing symptoms of depression),1 a recent survey of oncologists found there is broad variation in the appropriate utilization of this care.2 Conducted by Cardi...
Managing Long-Term Toxicity From Pelvic Radiation Therapy
Advances over the past 3 decades in improvements in cancer prevention and screening strategies and more effective diagnostics and therapies in cancer care have led to unprecedented declines in death rates from all cancers, including prostate, gynecologic, and colorectal/anal cancers. The fastest dec...
The Role of Spirituality in Palliative Care
Jo Cavallo
National surveys consistently show that spirituality and religion are important components in the lives of most Americans, with more than 90% of adults expressing a belief in God and more than 70% identifying religion as one of the most important influences in their lives.1 Studies also show that pa...
How COVID-19 Is Spotlighting the Role of Palliative Medicine
Jo Cavallo
The COVID-19 pandemic has exposed the tragedy of patients dying in isolation, separated from family and friends to limit infection in hospital settings. The process has altered the experience of serious illness for patients and their loved ones, including their ability to grieve, share important wor...
Bringing Palliative Care to Native American Patients With Cancer
Native Americans are among the most underserved minority populations in the United States and are disproportionately affected by cancer. They have the lowest survival rates for nearly all types of cancer of any minority population and much higher rates of certain types of cancer, including lung, col...
Machine Learning–Based Algorithm May Predict Short-Term Mortality in Patients With Cancer and Prompt Serious Illness Conversations
Although most patients with terminal cancer, 87%, have end-of-life conversations with clinicians about their goals and preferences for care, on average, these discussions happen just 1 month before death and most often occur in acute care settings with clinicians who are not their treating oncologis...
Reducing the Risk of Lymphedema in Patients With Cancer
Jo Cavallo
Although the exact incidence of treatment-related lymphedema among cancer survivors is unknown—most likely due to its prolonged latency period—it can be a lifelong chronic side effect that negatively impacts survivors’ quality of life. Although the condition is often linked to treatment for breast c...
How Anxiety, Depression, and Low Social Support Impact the Intensity of Cancer Pain
Pain is one of the most common byproducts of cancer and its treatment. Tumors, surgery, intravenous chemotherapy, radiation therapy, targeted therapy, supportive care therapies (such as bisphosphonates), and diagnostic procedures can all cause pain in patients and may contribute to symptoms of psych...
Reevaluating the Delivery of Palliative Care in the Era of COVID-19
Jo Cavallo
Palliative care services are so crucial to the well-being of patients with cancer that, in 2017, ASCO updated its clinical practice guideline on the integration of palliative care into standard oncology care.1 The updated guideline recommends that all patients with advanced cancer receive dedicated ...
Overcoming the Challenges of Improving Psychosocial Care for Patients With Cancer
Although the United States spends billions of dollars each year on cancer research, very little of that funding is dedicated to mental health research in patients with cancer, despite the fact that cancer survivors have a six-time higher risk for psychological disability than people without cancer.1...
Understanding the Underlying Mechanisms of Pain in Patients With Cancer
Pain is among the most difficult medical issues for oncologists to confront, said Tony L. Yaksh, PhD, Professor of Anesthesiology and Pharmacology at the University of California, San Diego, during his keynote address at the 2019 Supportive Care in Oncology Symposium. Failure to adequately manage th...
Using Machine Learning to Prompt Serious Illness Conversations
Jo Cavallo
Despite research showing that among patients with cancer, early advance care planning conversations lead to care that is in alliance with patients’ goals and wishes, especially at the end of life,1 most patients die without having discussions about their treatment goals and end-of-life p...
Supportive Care in Oncology Symposium Emphasized Caring for the Whole Patient From Diagnosis to End of Life
The 2019 Supportive Care in Oncology Symposium: Advancing Palliative Research Across the Care Continuum, held this past October in San Francisco, marked the fifth anniversary of its inauguration and its last as a stand-alone ASCO thematic meeting. Since its launch in 2014 as the Palliative Care in O...
Is Implicit Bias Contributing to Time Disparities in Goals-of-Care Conversations With Minority Patients?
GUEST EDITOR Addressing the evolving needs of cancer survivors at various stages of their illness and care, Palliative Care in Oncology is guest edited by Jamie H. Von Roenn, MD, FASCO. Dr. Von Roenn is ASCO’s Vice President of Education, Science, and Professional Development. It has been well d...
How an Innovative AI-Based Smartphone Application Is Addressing Patients’ Palliative Care Needs
GUEST EDITOR Addressing the evolving needs of cancer survivors at various stages of their illness and care, Palliative Care in Oncology is guest edited by Jamie H. Von Roenn, MD, FASCO. Dr. Von Roenn is ASCO’s Vice President of Education, Science, and Professional Development. During the 2019...
Innovative Research to Improve the Supportive Care Needs of Cancer Survivors
First launched in 2014, the Palliative Care in Oncology Symposium introduced a nascent interdisciplinary approach to the treatment of both the physical and psychological symptoms of cancer to improve disease outcome and quality of life for patients. Today, it has evolved into a leading forum for the...
Working Together to Help Pediatric Patients With Cancer Live and Live Well
While many patients with cancer can benefit from palliative care to ease symptoms from the disease or its treatment, for children with cancer, especially critically ill children, palliative care can provide an additional layer of medical and emotional support for both young patients and their parent...
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 i...
One Doctor’s Road to Palliative Care Services in the Inner City
Ronald Piana
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 ...
The Need for a Multidisciplinary Approach to Combating Cancer-Related Pain
The statistics are staggering. Despite the development of novel analgesics and the increasing awareness of the importance of adequately controlling pain from cancer or its treatment, up to 50% of patients undergoing treatment and between 70% and 90% of patients with advanced disease experience some ...
Improving Management of Cancer-Related Pain
Jamie H. Von Roenn, MD
Despite multiple guidelines from national and international organizations,1,2 the quality of current cancer pain management remains inadequate. The World Health Organization’s three-step analgesic dosing ladder forms the foundation of these guidelines.3 Yet, as noted by William S. Rosenberg, MD, FAA...
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, nonpharmacolo...
Practicing the Humanistic and Holistic Approach to End-of-Life Care
Jo Cavallo
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 acci...
How Effective Communication Can Improve Patient Care—and Reduce Physician Burnout
Surveys conducted between 1950 and 1970 show that most physicians considered it inhumane to give patients with a poor cancer prognosis the bad news.1,2 Since then, it has been well established that open communication between physician and patient is an essential part of effective cancer care and can...
How Cancer and Its Treatments Affect Cognitive Function
Jo Cavallo
Although chemotherapy is often cited as the main culprit for diminishing cognitive function in patients with cancer, ushering the term “chemobrain” into the vernacular, research by Tim A. Ahles, PhD, and his colleagues is showing that multiple factors may contribute to the condition.1 Using breast c...
Tackling the Symptoms of Long-Term Fatigue and Insomnia in Cancer Survivors
Fatigue and sleep disruption are common occurrences for most patients diagnosed with cancer. Simply having a serious physical illness like cancer along with its associated pain, hospitalization, and treatment, as well as the attendant psychological impact, all contribute to the onset of fatigue an...
Guidelines to Assess and Manage the Symptoms of Fatigue and Insomnia
In 2014, ASCO developed a clinical practice guideline to provide a mechanism for physicians to screen, assess, and manage the persistent symptoms of fatigue in adult cancer survivors.1 As summarized below, the guideline calls for regular screening, assessment, laboratory evaluation, and patient educ...
Integrating Early Palliative Medicine Into Oncology Care to Improve Patients’ Quality of Life
At the 2015 Palliative Care in Oncology Symposium in Boston, Vicki Jackson, MD, MPH, Chief in the Division of Palliative Care and Geriatrics at Massachusetts General Hospital, Co-Director of the Harvard Center for Palliative Care, and Associate Professor of Medicine at Harvard Medical Sc...
Using Pharmacogenetics to Predict Cancer Prognosis, Response to Treatment, and Toxicity
Although clinical trials are helpful in determining the effectiveness of a specific drug across a patient population, they are not as reliable at pinpointing how well a particular patient will respond to the drug or dosing regimen or how the drug may impact the patient’s quality of life from tre...
How Video Support Tools Help Patients Make Informed Decisions About End-of-Life Care
Jo Cavallo
A relatively recent study by Areej El-Jawahri, MD, and her colleagues is showing how the use of visual media can empower patients with advanced cancer, as well as other life-threatening illnesses, to make more informed decisions about their end-of-life care.1 The aim of Dr. El-Jawahri’s study wa...
Weighing the Benefits and Risks of Medical Marijuana
Jo Cavallo
Despite the fact that 28 states and the District of Columbia have enacted laws to permit the use of cannabis and cannabinoid-based drugs to treat medical conditions, including cancer and symptoms from its treatment, federal law prohibits physicians from prescribing marijuana to their patients, ...
Examining the Impact of ‘Death With Dignity’ Legislation
Despite the controversy surrounding “Death With Dignity” laws, which allow physicians to prescribe life-ending drugs to terminally ill patients, they have a long history of majority support from Americans. According to a Gallup poll taken in 2015, nearly 7 in 10 Americans (68%) agreed that phys...
Understanding the Cultural Differences Among Ethnic Minorities in Palliative and End-of-Life Care
GUEST EDITOR Addressing the evolving needs of cancer survivors at various stages of their illness and care, Palliative Care in Oncology is guest edited by Jamie H. Von Roenn, MD. Dr. Von Roenn is ASCO’s Vice President of Education, Science, and Professional Development. Because cultural origi...
Advance Care Planning: Ensuring Patients’ End-of-Life Wishes Are Honored
When Amy Berman, BSN, LHD (aged 58), stood in front of the mirror to perform a routine breast self-exam and saw redness and dimpling on her right breast, she feared they were the telltale signs of inflammatory breast cancer. “I have never self-diagnosed myself before, but I had recently read an ar...
How Early Palliative Care May Benefit Patients With Incurable Cancer
Jo Cavallo
Palliative care provided soon after a patient is diagnosed with incurable cancer not only helps improve the patient’s overall quality of life but also improves communication about the patient’s wishes for end-of-life care, according to a study by Jennifer S. Temel, MD, Clinical Director of Thoracic ...
How Effective Communication Is Integral to Patient-Centered Care
Jo Cavallo
Communicating effectively with patients with advanced cancer not only helps patients and their family members successfully transition to palliative and end-of-life care, it can prevent physicians from experiencing professional burnout, according to Robert M. Arnold, MD, Distinguished Service Profe...
Helping Patients With Advanced Disease Transition From Focused to Intrinsic Hope
Jo Cavallo
While hope for a cure after a cancer diagnosis is a feeling both patients and oncologists rightly cling to during treatment, when too much emphasis is placed on this type of “focused” hope, it can make it more difficult for patients to face their mortality. Moreover, such a focus can deny patients...
Balancing Opioid Use to Relieve Cancer-Related Pain and Protecting Patients From Addiction and Death
Jo Cavallo
According to the Centers for Disease Control and Prevention (CDC), from 1999 to 2015, more than 183,000 people have died in the United States from overdoses related to prescription opioids, including methadone, oxycodone, and hydrocodone.1 To stem the epidemic in prescription opioid–related use and ...
The Challenge of Prognostication in the Era of Immunotherapy
GUEST EDITOR Addressing the evolving needs of cancer survivors at various stages of their illness and care, Palliative Care in Oncology is guest edited by Jamie H. Von Roenn, MD. Dr. Von Roenn is ASCO’s Vice President of Education, Science, and Professional Development. Although advances in s...
Using Video Decision-Support Tools to Facilitate End-of-Life Discussions With Patients
GUEST EDITOR Addressing the evolving needs of cancer survivors at various stages of their illness and care, Palliative Care in Oncology is guest edited by Jamie H. Von Roenn, MD. Dr. Von Roenn is ASCO’s Vice President of Education, Science, and Professional Development. Research shows that altho...
How Learning What’s on Your Patient’s Bucket List May Improve Care
It may sound too good to be true, but asking patients a simple question about what is on their bucket list can actually spark a dialogue about how best to make their cancer care and survivorship fit into their life plans, as well as be an effective way to identify their end-of-life care goals, accor...
Meeting the Challenges of Immunotherapy-Related Toxicities
In 2011, the U.S. Food and Drug Administration (FDA) approved ipilimumab (Yervoy), an anticytotoxic T-lymphocyte– associated antigen 4 (CTLA-4), the first checkpoint inhibitor for the treatment of advanced melanoma.1 Since then, several more checkpoint inhibitors directed at both the programmed cell...
Closing the Gender Divide in Preference for Palliative Care
Eight years ago, a survey of the preferences of Dutch patients with cancer for health care found that while gender was one aspect influencing how men and women approach cancer care, it was the most important, with men, generally, regarding most care aspects as less important than women. The study co...
Developing Patient-Centered Palliative Care From Diagnosis to End of Life
Jo Cavallo
In December, The University of Texas at Austin Dell Medical School will launch an innovative cancer care model called the CaLM (cancer life re-imagined) Clinic as part of its new cancer center, the Livestrong Cancer Institutes. The goal of the Livestrong Cancer Institutes and the CaLM Clinic is to p...
Improving Palliative Care in Low-Resource Settings
Jo Cavallo
In 2016, ASCO published an update to its Clinical Practice Guideline, “Integration of Palliative Care Into Standard Oncology Care,” which provides evidence-based recommendations for symptom management, clarification of treatment goals, support of coping and distress management, and coordination of c...
