When Should Palliative Care Be Integrated into Cancer Care?

“Palliative care should be integrated into cancer care during any cancer stage and in patients at any age.

“Palliative care is commonly confused with end-of-life care, but it is initiated at the time of a cancer diagnosis to relieve suffering throughout the duration of the disease.

“In a 2010 study published in The New England Journal of Medicine, researchers found that the early initiation of palliative care among patients with advanced lung cancer was not only associated with improvements in quality of life for patients, but that palliative care also decreased the need for aggressive care at the end of life and even increased survival in some cases.

“Yet, according to a 2014 study published in Journal of Clinical Oncology, patients are not always referred to a palliative care team or they are referred late during the course of illness.  According to the paper, feasible service delivery models are lacking in both the inpatient and outpatient setting.”


Surgery for Terminal Cancer Patients Still Common

“The number of surgeries performed on terminally ill cancer patients has not dropped in recent years­, despite more attention to the importance of less invasive care for these patients to relieve symptoms and improve quality of life. But new research from UC Davis also finds that the morbidity and mortality among patients with terminal cancer has declined because surgeons are selecting to operate on healthier patients.

“The study, ‘Current Perioperative Outcomes for Patients with Disseminated Care Undergoing Surgery’ was published online this week in the Journal of Surgical Research.

“ ‘Surgeons are becoming wiser,’ said study lead author Sarah Bateni, a UC Davis resident surgeon. ‘Our research suggests that surgeons may be operating on healthier patients who are more likely to recover well from an operation. These are patients who can perform activities of daily living without assistance, for example.’

“Bateni’s interest in the appropriate surgical care of people with late-stage cancer grew from observing terminally ill patients whose acute problems were addressed through surgery, and who then suffered complications resulting in lengthy stays in intensive care units, and even in death.

“ ‘It is common that patients end up dying in the intensive care unit instead of being managed with medication with hopes of returning home with their families, including with hospice care,’ she said.”


Living With Cancer: In and Out of the Closet

“In a memoir, ‘The Summer of Her Baldness,’ the visual artist and theorist Catherine Lord finds ‘the cancer closet . . . at least as complicated as the sexuality closet’: ‘You can never get entirely out and you can never get entirely back in.’

“Does my deployment of careful costumes to conceal scars, hair loss, an ostomy bag, a port and other signs of treatment put me in a closet like the one in which many lesbians and gay men once felt they needed to be confined?

“Only a few decades ago, both homosexuals and cancer patients frequently needed to lie about their lives — to keep their jobs and their social standing. Happily, physicians today no longer define homosexuality as a sickness. But cancer is a disease that continues to afflict one of four Americans. And it can still be accompanied by a sense of shame and with economic as well as physical and emotional liabilities.

“While coping with cancer, I often feel like an impersonator of my former self. In a number of contexts and for various reasons, I am a sick person trying to appear healthy. While the contest between destructive cells and aggressive therapies persists, it seems strategic to pretend to be normal. All sorts of props — a wig, make-up, hats, billowing pants and shirts — provide a semblance of what I used to look like.”


“Why Did This Happen to Me?”

“That question is perhaps the most common one raised by patients facing a diagnosis of cancer for the first time. There are so many campaigns about how to ‘avoid’ cancer: no white sugar, no chemicals, all-plant diets, regular exercise, don’t smoke, don’t drink. I can see how one can get the impression that if one does all of it, cancer will never touch him or her. Yet, every once in a while, someone comes to my office who drives home the message that all most people can do—and all most clinicians can advise—is risk reduction, not prevention. Such was the case with Laurie*.

“Laurie was in her early fifties, the mom of twin girls. She had prided herself on being a health nut—aerobic exercise in the morning, yoga in the evening. She did not eat red meat and didn’t drink alcohol. Her family adopted an organic diet; she even grew her own vegetables. She was proud of her reputation as the ‘healthiest mom on the block.’ She had told me that others in her little town often sought her counsel about how to get healthier.

“Then, she found a mass in her breast. At first, she couldn’t believe it, thinking it must have been a blocked duct. However, it grew with time, and eventually, a mass appeared under her axilla.

“By the time she was diagnosed she had a 5cm breast mass and at least two sonographically suspicious nodes. A biopsy confirmed triple-negative breast cancer. She was devastated. Even more, she just couldn’t understand how this happened to her.”


After Prostate Cancer, Start Walking: Walking Routine Improves Health-Related Quality of Life

“Walking at an easy pace for about three hours every week may be just enough physical activity to help prostate cancer survivors reduce damaging side effects of their treatment, according to a new Northwestern Medicine study.

” ‘Non-vigorous walking for three hours per week seems to improve the fatigue, depression and body weight issues that affect many men post-treatment,’ said Siobhan Phillips, lead author of the study. ‘If you walk even more briskly, for only 90 minutes a week, you could also see similar benefits in these areas.’

“Phillips is a kinesiologist and an assistant professor in the department of preventive medicine at Northwestern University Feinberg School of Medicine. The paper will be published April 16, 2015 in the Journal of Cancer Survivorship: Research and Practice.

“This is one of the first papers to investigate how different intensities and types of physical activity affect the health-related quality of life of men after prostate cancer treatment.

” ‘This study shows that you don’t have to engage in high-impact, vigorous activities to improve your quality of life after a prostate cancer diagnosis,’ Phillips said. ‘Since many prostate cancer survivors might find vigorous activities hard to stick with, the good news is that simply focusing on walking more may be enough to make them feel better.’ “


ADT Affects Long-Term Quality of Life in Patients with Prostate Cancer

“The physical adverse effects associated with continuous androgen deprivation therapy persisted long-term in patients with nonmetastatic prostate cancer, according to study results.

“Approximately 50% of men with prostate cancer will receive ADT, and most of those men will undergo the treatment for 2 to 3 years, according to study background. ADT is associated with several adverse effects that affect the quality of life in patients, such as sexual dysfunction, fatigue, anemia, osteoporosis and muscle loss.

“Shabbir M.H. Alibhai, MD, MSc, FRCPC, of the department of medicine at the University Health Network in Toronto, and colleagues previously evaluated the physical effects of ADT after 12 months. Researchers evaluated data from the same cohort for an additional 2 years to examine long-term adverse effects of the therapy.

“The analysis included 87 men with nonmetastatic prostate cancer who received continuous ADT and two age- and education-matched control groups, one composed of 86 men with prostate cancer who did not receive ADT and one composed of 86 healthy men. The mean age of all participants in the population was 69 years…

“ ‘A reasonable interpretation of our findings is that most of the deleterious effects of ADT on physical function in middle-aged and older men is seen with 6 months of ADT use,’ the researchers wrote. ‘An additional 12 to 30 months of ADT does not appear to lead to much additional decline. …This may be particularly relevant to clinicians who are debating the merits of shorter or longer courses of ADT because it provides more information about physical toxicities of ADT.’ ”


Melanoma Surgery Delays Are Common for Medicare Patients

“One in five Medicare patients with melanoma experience delays in getting surgery, a Yale study found. The research was published April 8 in JAMA Dermatology.

“Melanoma, a type of skin cancer, is a leading cause of new cancer diagnoses in the United States. A delay between diagnosis and surgery to remove melanomas may cause patients psychological harm and affect health-care quality. Using the national Surveillance, Epidemiology, and End Result-Medicare database, the Yale team conducted the first population-based analysis of delay of surgery among Medicare patients with melanoma.

“The researchers reviewed data on more than 32,000 Medicare patients diagnosed with melanoma. They found that 22% of patients waited longer than 1.5 months for melanoma surgery, and 8% were delayed more than 3 months. Although no gold standard exists, a timeframe of less than six weeks between diagnosis and surgery has been recommended.

” ‘Delay for melanoma surgery in this population is more common than we expected,’ said Jason Lott, M.D., who was first author of the study as postdoctoral fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at Yale School of Medicine.”


Dying Patients' Choices Not Always Aligned to Caregivers'

“Patients with advanced cancer or other life limiting illnesses often have to consider how much money they are willing to spend on high cost treatments that result in only moderate improvements in length or quality of life. These decisions are very difficult for patients to make, and in some cases the decision is entirely deferred to a family caregiver.

“Past research has shown that in addition to extending life, being free of pain and dying at home are important considerations for people nearing the end of their lives. However, the value that patients place on these considerations or their willingness to pay for either was not previously known.

“A team led by Professor Eric Finkelstein and Assistant Professor Chetna Malhotra from the LCPC in Duke-NUS Graduate Medical School (Duke-NUS) administered surveys to 211 patients with stage IV cancer and their informal caregivers to find out more about their end-of-life preferences.”


Physical Activity Benefits Lung Cancer Patients and Survivors

“Exercise and physical activity should be considered as therapeutic options for lung cancer as they have been shown to reduce symptoms, increase exercise tolerance, improve quality of life, and potentially reduce length of hospital stay and complications following surgery for lung cancer.

“Lung cancer is the leading cause of cancer deaths in the United States with an estimated 160,000 deaths each year and worldwide there are 1.4 million deaths. In the last two decades lung cancer therapy has improved, but the overall 5-year survival rate is still quite low at 17%. Lung cancer patients experience many debilitating symptoms including difficulty breathing, cough, fatigue, anxiety, depression, insomnia, and pain. A third of long term survivors, those >5 years from diagnosis, experience reduced quality of life and report lower physical and health scores compared to healthy patients. Given the incidence of lung cancer and the associated costs An inexpensive and relatively easy cancer therapy to reduce symptoms and improve quality of life, like physical activity, could be beneficial, especially for therapy, but clinicians underutilize exercise as a therapy, in part due to the lack of evidence-based consensus as to how and when to implement increasing physical activity.

“Dr. Gerard A. Silvestri, Dr. Brett Bade, and colleagues at Medical University of South Carolina have reviewed the safety, benefits, and application of increasing physical activity and exercise in lung cancer with the goal to summarize the effect on improved lung cancer outcomes. Their results are published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC).”