Current Problems in Cancer

Title Page

2011-11-01

Information for Readers

2011-11-01

Author Bio Sketch

2011-11-01

Foreword

Stephen Lutz, Joshua Jones — 2011-11-01

The worldwide incidence of cancer is projected to increase steadily over the next 2 to 3 decades, with many developed countries facing a dramatic increase in the need for end-of-life oncology care as aging populations reach the phase of life when this disease most commonly presents. According to the World Health Organization, “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” The successful provision of palliative care to cancer patients requires an integrated, team-based approach to care for patients and families alike. However, there are few written resources to help educate clinicians and caregivers about the coordination of the efforts of the clinical team members involved in these patients' care. The reviews in this issue of Current Problems in Cancer provide an understanding of the role of each of the health care providers involved in end-of-life care, with special attention given to the means by which communication may be optimized among team members. The authors have done an excellent job both to provide an overview of the current status of palliative oncology care and to provide a springboard for discussion of future trends that will meet the demands created by the aforementioned demographic forces.

The History of Hospice and Palliative Care

Stephen Lutz — 2011-11-01

Although individuals and cultures since prehistoric times have been consistently preoccupied with circumstances after death, devotion to the care of the dying has only recently gained consistent attention in the human consciousness. Religious institutions were the main providers of end-of-life care for centuries, and the recipients of that care were mainly those with limited resources and no family members. The progression of hospice and palliative care from its unorganized origins to its current complex, interdisciplinary approach mirrors the development of health care in society over the past thousand years.

Vital Communication Skills at the End of Life

Jessica Bauman, Jennifer Kapo — 2011-11-01

Excellent communication skills are essential in the many discussions oncologists have with patients over the trajectory of their disease. Research and clinical experience have found that, despite their importance, patient–doctor interactions in the setting of severe illness leave something to be desired. Physicians may have difficulty talking about bad news in general, as well as conveying information about prognosis, advanced care planning, and dying. These communication skills become even more necessary during conversations at the end of life, in particular when the discussion focuses on the transition from treatment directed against their cancer to best supportive care.

Pain Management Principles

Erin McMenamin — 2011-11-01

In 2011, more than 1.5 million Americans are expected to be diagnosed with cancer in the USA. In addition, more than 500,000 people are expected to die from cancer this year. The literature abounds with references to the fact that those diagnosed with cancer experience pain at a rate of one- to two-thirds depending on their disease, treatment, and stage.

Too Much, Too Little, or Just the Right Amount: Finding the Balance in Palliative Radiotherapy

Joshua Jones — 2011-11-01

Since shortly after the discovery of the X-ray in 1896, radiation therapy has been used effectively in the treatment of patients with cancer with two discrete rationales: to palliate symptoms and to eradicate disease. Early on, it was recognized that short courses, even single doses of radiation, could relieve pain, stop bleeding, and alleviate other symptoms of advanced cancer. In the 1930s, the discovery that dividing the dose into small daily fractions delivered over a period of weeks would exploit the differences between normal tissues and malignant cells, allowing high (tumoricidal) doses to be delivered to the tumor while sparing normal tissues from the late effects of radiation therapy, increasing the chance of tumor control in certain malignancies.

Establishing Communication Within the Field of Pediatric Oncology: A Palliative Care Approach

Tamara Vern-Gross — 2011-11-01

Communication is an inherent skill that we refine as we mature, which allows us to maintain survival, connect with humanity, and create meaningful relationships. It is conveyed predominantly by our words, although it may also be projected by touch, expression, and body language. Effective communication is not a novel proposal; however, it continues to be an area where gaps exist, especially when caring for children with life-threatening malignancies. Palliative care physicians have a major role as the patient and family “Ombudsmen” by enhancing communication, comanaging the patient and family with the interdisciplinary team, facilitating goals of care discussions, and providing emotional support and education for the patient, family, and primary team involved in the care of the child.

Palliative Care Nursing

Tami Bornen — 2011-11-01

According to the most recent National Vital Statistics Reports, 2,436,652 deaths occurred in 2009, of which 568,688 were due to cancer, second only to heart disease. In 2009, those 65 years or older constituted 39.6 million and represented 12.9% of the US population. By 2030 they will represent 19.3%, with those 85+ representing 15% of the population as early as 2020. In addition to age, illness, and death statistics of those <65, these numbers bear serious consideration regarding the amount of health care that will be required to care for these future patients. Nurses have always been involved in the front lines of care, ensuring that it is delivered safely, effectively, and compassionately. As our society ages, palliative care nurses will be even more vital to providing expert care in meeting the many needs experienced by oncology patients and their families.

Oncology Social Work in Palliative Care

Tracy Schroepfer — 2011-11-01

With regard to cancer, two facts are clear: cancer is the second leading cause of death in the USA, and the consequences of unmet psychosocial needs for those with terminal cancer have devastating consequences for quality of life experienced. The medical literature on this topic recognizes the importance of addressing these needs and recommends that the education and training for oncologists include skills necessary for assessing and handling psychosocial issues. This body of literature, however, does not address the importance of oncologists understanding the role of the oncology social worker, whose training and experience is focused exclusively on insuring that the psychosocial needs of individuals diagnosed with cancer are addressed. The oncology social worker is an important resource for oncologists, whose time allotted to patients is often focused out of necessity on medical issues and less on psychosocial needs. As the number of palliative care teams continues to grow, oncologists and oncology social workers will increasingly find themselves working together. If the team is to address holistically the needs of individuals with cancer, capitalizing on the social worker's expertise and skills will be crucial.

Spiritual Care for Palliative Patients

George Handzo — 2011-11-01

Despite persistent rumors to the contrary, the USA remains a country where spirituality is centrally important to most people, and most of those people continue to express this spirituality as religious belief and practice. The General Social Survey reported that 98% of adult Americans pray at least once a week; 56% claim to pray every day, and 85% say they read the Bible or Qu'ran at least once a month. In another survey, 94% of Americans describe God as loving and 88% say they feel close to God.

Current Problems in Cancer

Title Page

Information for Readers

Table of Contents

Author Bio Sketch

Foreword

The History of Hospice and Palliative Care

Vital Communication Skills at the End of Life

Pain Management Principles

Too Much, Too Little, or Just the Right Amount: Finding the Balance in Palliative Radiotherapy

Establishing Communication Within the Field of Pediatric Oncology: A Palliative Care Approach

Palliative Care Nursing

Oncology Social Work in Palliative Care

Spiritual Care for Palliative Patients