Palliative and Supportive Care

The Clinical Trials Referral Resource that appeared in the April issue of ONCOLOGY began a series on health-related quality of life (HRQOL). Part I of this series, which concludes this month, focuses on HRQOL questions in cancer treatment trials. Part II (on investigator-initiated HRQOL research) and part III (on HRQOL research as part of cancer prevention trials) will appear in upcoming issues. Information about these studies can be obtained from the contacts listed for each trial or from Edward L. Trimble, MD, MPH, at the Cancer Therapy Evaluation Program (CTEP), trimble@ctep.nci.nih.gov or (301) 496-1196

According to a study conducted at Emory University, the prophylactic use of antidepressants is successful in preventing depression, anxiety, and physical distress in cancer patients. The study, published in the New England Journal of Medicine

Over the past 15 years, research into the health-related quality of life (HRQOL) of cancer patients has expanded dramatically. We have seen the development of a variety of instruments to assess both global HRQOL as well as cancer-specific symptoms. These instruments have been validated in a variety of populations. Many of the instruments have been translated into multiple languages. We have also seen the development of instruments to evaluate HRQOL in children and in adults with low literacy levels. We have learned how to integrate HRQOL questions into cancer clinical trials and how to facilitate the collection of QOL data from patients and their families. We are now beginning to evaluate interventions to maintain and enhance HRQOL among cancer patients and cancer survivors.

Amgen has announced that a prefilled syringe containing a more concentrated formulation of the white blood-cell booster, granulocyte colony stimulating factor (G-CSF, Neupogen) is now available to hospitals and health-care providers. Neupogen

Loss of appetite and weight predict a poor prognosis for cancer patients. Although caloric supplementation might benefit subgroups of patients-specifically, perioperative, severely malnourished cancer patients, stem cell and

The impact of anticancer therapy on quality of life has been receiving increasing attention, particularly with diseases such as low-grade non-Hodgkin’s lymphoma (NHL), where palliation rather than cure is the primary objective of therapy. The

One of the major challenges facing oncologists today is invasive fungal infection. Difficult to diagnose and deadly when missed, invasive fungal infection-primarily by Candida and Aspergillus organisms-is the major infectious cause of death associated with chemotherapy-induced myelosuppression. In this review, the problem will be described and evidence-based approaches to management, including assessment for risk factors and empiric antifungal therapy, will be discussed. Finally, the future of diagnostic and therapeutic strategies for protecting the immunocompromised patient will be considered. [ONCOLOGY 15(3):351-369, 2001]

Although bone pain from osteoblastic metastases can be ameliorated 50% to 80% of the time by use of intravenously or orally administered radiopharmaceuticals, we cannot accurately predict who will or will not

Despite the fact that there are only a few controlled trials demonstrating the benefits associated with the use of corticosteroids in specific situations, these agents are administered frequently to patients with advanced cancer. Corticosteroids may be used alone or as adjuvants in combination with other palliative or antineoplastic treatments. For example, corticosteroids may help prevent nausea, vomiting, and hypersensitivity reactions to treatment with chemotherapy or radiation. They are also commonly used as appetite stimulants in patients with advanced cancer. In the adjuvant setting, corticosteroids help to alleviate pain in advanced cancer patients, including specific situations such as back pain related to epidural compression. This article reviews the evidence supporting the use of corticosteroids in a broad range of situations seen in patients with advanced cancer. [ONCOLOGY 15(2):225-236, 2001]

The optimal management of opioid-related side effects is hampered by a lack of comparative studies of management strategies. The prevalence of such side effects is influenced by the extent of disease, the patient’s

PHILADELPHIA-Pancreatic cancer patients usually lose 25% of their body mass within 4 months of diagnosis and die within 6 months. But early work from Scotland on supplementation with eicosapentaenoic acid (EPA) seems to suggest that the fatty acid may stabilize weight and add months to the lives of pancreatic cancer patients.

BETHESDA, Md-The National Cancer Institute has released a summary of published data derived so far from the Prostate Cancer Outcomes Study (PCOS), which seeks to determine the effect of various therapies for primary invasive prostate cancer on patients’ quality of life.

PHILADELPHIA-For too long, the nutritional needs of cachectic cancer patients have been ignored, Stanley J. Dudrick, MD, said at the 5th International Congress of the Society for Nutritional Oncology Adjuvant Therapy.

Among the serious complications associated with bone marrow transplantation are invasive fungal infections caused by organisms such as Candida and Aspergillus species and end-organ disease caused by

The fastest growing segment of the US population is the group over the age of 65 years. In the next 30 years, this group will comprise over 20% of the population. Because 60% of all cancers occur in this age group, there will be an expected rise in the total cancer burden.

LONDON-A prospective survey of cancer patients admitted to a hospice shows that breakthrough pain is “frequent, short lasting, often unpredictable, and not necessarily related to chronic pain, making treatment difficult,” said Giovambattista Zeppetella, BSc, MRCGP, of the Palliative Medicine Service, St. Joseph’s Hospice, London.

Research suggests that a drug used to relieve nausea in cancer patients can help the most difficult-to-treat alcoholics significantly reduce their drinking. Success with the drug ondansetron (Zofran) comes amid growing search for new medications to help treat a disease that affects some 14 million Americans.

The cachexia of malignancy is considered mediated through excess production of tumor necrosis factor–alpha and other cytokines. Thalidomide (Thalomid), a sedative/hypnotic, has been shown to inhibit tumor necrosis factor–alpha production.

The prevention and treatment of invasive fungal infections is being improved by the relatively recent introduction of new antifungal agents. While some of these agents offer better efficacy, others are proving their value more in improved tolerability, said John R.

NASHVILLE, Tennessee-‘‘Historically, chemotherapy was only palliative in head and neck cancers, but chemotherapy regimens now in use actually do cure some patients,” Barbara A Murphy, MD, told a clinical investigators’ workshop. Dr. Murphy is Assistant Professor of Medicine at Vanderbilt-Ingram Cancer Center in Nashville, Tennessee. The workshop was sponsored by the University of Texas M. D. Anderson Cancer Center and Pharmacia Oncology.

Weekly administration of taxanes as palliative treatment in metastatic breast cancer has been reported with significantly reduced hematologic toxicity and comparable efficacy to standard every-3-week protocols. This study update provides mature results with weekly docetaxel (Taxotere) in a larger patient population.

This concise review by Drs. Wexner and Hwang examines the issues surrounding the use of laparoscopy in the management of gastrointestinal (GI) malignancies. The authors believe, and most of us would agree, that in palliative cases, a minimally invasive surgical approach has much to offer the patient in terms of reduced morbidity and mortality and improved quality of life. However, the role of this technology in potentially curative resectional therapy remains controversial.

Laparoscopic procedures have become standard surgical techniques for several benign abdominal diseases. Laparoscopic cholecystectomy, appendectomy, Nissen fundoplication, splenectomy, adrenalectomy, and palliative intestinal bypass procedures are widely accepted as standards of care. It was believed that the success of these laparoscopic procedures would soon transform colorectal surgery for neoplastic diseases. This enthusiasm is evident in many early publications cited in the article by Drs. Wexner and Hwang. The article offers a balanced and thorough review of laparoscopy in the management of colorectal neoplasms and emphasizes the significant controversy surrounding this topic.

Nosocomial bloodstream infections across the United States and in Europe are increasingly attributable to gram-positive species- a trend that represents a reversal of the gram-negative predominance of the previous

Cancer treatment–related fatigue, the most prevalent and debilitating side effect of chemotherapy, has a significant impact on the economic well-being of patients and their caregivers, according to a national survey of more than 300 cancer patients. The

FT. LAUDERDALE, Fla-Palliative care, broadly defined, can benefit cancer patients who are newly diagnosed and who are in active treatment, as well as those who are near death. In creating guidelines for palliative care, the National Comprehensive Cancer Network (NCCN) Palliative Care Panel members found agreement on this point.

The US Food and Drug Administration has approved ALZA Corporation’s new drug application for a

NEW YORK-Four major themes important to dying patients emerged from a study of people with end-stage cancer: Performing rituals to create memories for survivors; finding meaning in life as well as death; continuing therapy, including alternative therapies; and feelings of a persistent sense of loss, said Sherry Schachter, PhD, RN, certified grief therapist in the Pain & Palliative Care Service at Memorial Sloan-Kettering Cancer Center.

The inadequate treatment of pain associated with malignancy remains a significant clinical problem.[1-4] Despite published guidelines on the appropriate management of cancer pain, 50% of dying patients experience moderate to severe pain.[1,5-8] One of the greatest barriers to the proper treatment of cancer pain remains health care professionals’ lack of knowledge regarding the appropriate use of analgesic medications.[9-11] The failure to refer to and limited availability of knowledgeable specialists in pain and palliative care also contribute to this pervasive problem.[12]

Many cancer patients are undermedicated and inappropriately managed for pain, leading to a diminished quality of life. Patients with moderate to severe pain often require opioid analgesics. Recently published guidelines