Showing posts with label cancer treatment. Show all posts
Showing posts with label cancer treatment. Show all posts

Monday, March 21, 2011

A Day in the Life of an Oncologist: “How Do You What You Do?” | GRACE :: Coping with Cancer / Social Work

On the rare occasion I’m in a social situation with people who aren’t in medicine (yes, I’m sure you know I don’t get out much, so this is largely from remote memory), the most common question that follows my answer to what I do for a living is, “How can you do what you do?”.   People imagine the obvious low points of telling people about a new cancer, about delivering bad news and discussing people’s difficult cancer-related symptoms and potential to decline despite our best efforts.  It’s fair to wonder what keeps us going.  So I thought I’d provide a brief sketch of a day in my clinic, which offers several ups along with the downs everyone might envision as dominating life in the oncology clinic.

   Work starts at about 7AM. At least the drive in avoids the big traffic.  I review my schedule, briefly reviewing the recent records of the people coming in that day, including a more detailed review of the records of new patients, including reviewing their scans that are usually delivered in anticipation of their arrival in my clinic.  Check e-mail, sign head shots in response to fan mail*, etc. (*in truth, it is perhaps technically more accurate to say that I sign dozens of orders for prescription refills and lab orders).

   Before clinic starts, I head to the hospital to round on inpatients of mine in the hospital.  One is a young man with testicular cancer who is doing fine on his chemo, though he’s grown weary of the hospital food after three admissions lasting 5 days each for inpatient chemo.  Fortunately, this is his last planned round of chemo, so the end is in sight.  And he knows I’m not responsible for the food.  At least his nausea is so well controlled that he’s interested in eating.

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Friday, February 4, 2011

Jeffrey L. Sturchio: The Global Burden of Cancer

Most of us in developed countries have dwelled in the shadow of cancer. We've anxiously awaited a test result, become intimate with chemotherapy for ourselves or a loved one or held vigil at a bedside.

During those intense and often tragic periods, we usually have options -- education, treatment, pain relief and sometimes, blessedly, remission and recovery -- that is, if we happen to reside in a wealthy country. Not so for millions of others, adults and children alike, in poorer countries where more than 70 percent of all cancer deaths occur yet five percent or less of cancer resources are allocated to the people living there, despite the growing cancer burden.

Cancer is the leading cause of death worldwide, killing more people than AIDS, tuberculosis and malaria combined. The cancer burden in low- and middle-income countries is increasingly disproportionate. Globally in 2009, there were an estimated 12.9 million cases of cancer, a number expected to double by 2020, with 60 percent of new cases occurring in low- and middle-income countries.

Not only do these countries carry more than half the disease burden, they lack the resources for cancer awareness and prevention, early detection, treatment or palliative options to relieve the staggering pain and human suffering if the disease is untreated -- an unthinkable outcome for people who have cancer in rich nations.

Cancer also has the most devastating economic impact of any cause of death in the world, according to the recent landmark report, "The Global Economic Cost of Cancer," released by the American Cancer Society and Livestrong. Premature deaths and disability from cancer cost the global economy nearly 1 trillion dollars a year. The data from this study provides compelling evidence that balancing the world's global health agenda to address cancer more effectively will save not only millions of lives, but also billions of dollars.

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Saturday, January 1, 2011

Discussing cancer treatment with the terminal patient, KevinMD.com

“Are you giving up on me?” My patient looks at me severely. “There must be other treatment options! Aren’t there some experimental drugs out there? I have beaten this cancer twice before. Are you saying that I can’t beat it again?”

No one can ever know with absolute certainty whether my patient’s newly recurrent cancer might miraculously disappear with one more treatment. His recurrence, however, has developed very quickly and is growing very rapidly. New cancer nodules are developing weekly. I have never seen a patient with a cancer this aggressive have a meaningful, sustained response to further treatment. The research literature confirms my impression.

It is always difficult to know what to recommend. Although “no further treatment” is always an alternative, I routinely run through all of the options, reviewing whatever is available, and hoping that we land on the combination that offers that improbable, one-in-a-thousand cure. However unlikely, we sometimes set up appointments and hope for the best.

Today, though, my sense is that it is time to focus on new goals.

The decision not to pursue more studies and more treatment can be very, very difficult. Surgeon and journalist Atul Gawande in an essay in The New Yorker entitled “Letting Go,” writes about how difficult it can be for physicians and patients to halt cancer treatment as the end of life draws near. The dilemma, he concludes, “arises from a still unresolved argument about what the function of medicine really is — what, in other words, we should and should not be paying for doctors to do.” In Gawande’s view, the profession should equip and supply doctors and nurses “who are willing to have the hard discussions and say what they have seen …”

Article continues at KevinMD.com
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Wednesday, December 15, 2010

Cancer patients die too often in hospitals, study says - The Boston Globe

Researchers at the Dartmouth Atlas Project in Lebanon, N.H., analyzed the records of 235,821 Medicare patients ages 65 and older who died between 2003 and 2007. Overall, the researchers found that one-third of patients spent their last days in hospitals and intensive-care units. But there was a big range. At one end was Manhattan, where 46.7 percent died in the hospital. In contrast, 7 percent of cancer patients died in the hospital in Mason City, Iowa.

While chemotherapy and other aggressive procedures can prolong life and enable some cancer patients to return home and to work, studies have shown that these treatments have little or no value for frail elderly patients and those with advanced cancer. But 6 percent of patients received chemotherapy in their last two weeks of life, and the rate was much higher — more than 10 percent — in some places, the researchers found.

Similarly, more than 18 percent of cancer patients were placed on a feeding tube or received cardiopulmonary resuscitation in their last two weeks of life in Manhattan, compared with less than 4 percent in Minneapolis.

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Andrew Lopez, RN
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Sunday, November 14, 2010

Music Therapy, American Cancer Society

Music Therapy

Other common name(s): none

Scientific/medical name(s): none

Description

Music therapy is the use of music by health care professionals to promote healing and enhance quality of life for their patients. Music therapy may be used to encourage emotional expression, promote social interaction, relieve symptoms, and for other purposes. Music therapists may use active or passive methods with patients, depending on the individual patient’s needs and abilities.

Overview

There is some evidence that, when used with conventional treatment, music therapy can help to reduce pain and relieve chemotherapy-induced nausea and vomiting. It may also relieve stress and provide an overall sense of well-being. Some studies have found that music therapy can lower heart rate, blood pressure, and breathing rate.

How is it promoted for use?

Music therapists work with a variety of physical, emotional, and psychological symptoms. Music therapy is often used in cancer treatment to help reduce pain, anxiety, and nausea caused by chemotherapy. Some people believe music therapy may be a beneficial addition to the health care of children with cancer by promoting social interaction and cooperation.

There is evidence that music therapy can reduce high blood pressure, rapid heart beat, depression, and sleeplessness. There are no claims music therapy can cure cancer or other diseases, but medical experts do believe it can reduce some symptoms, aid healing, improve physical movement, and enrich a patient’s quality of life.

What does it involve?

Music therapists design music sessions for individuals and groups based on their needs and tastes. Some aspects of music therapy include making music, listening to music, writing songs, and talking about lyrics. Music therapy may also involve imagery and learning through music. It can be done in different places such as hospitals, cancer centers, hospices, at home, or anywhere people can benefit from its calming or stimulating effects. The patient does not need to have any musical ability to benefit from music therapy.

A related practice called music thanatology is sometimes used at the end of a patient’s life to ease the person’s passing. It is practiced in homes, hospices, or nursing homes.

What is the history behind it?

Music has been used in medicine for thousands of years. Ancient Greek philosophers believed that music could heal both the body and the soul. Native Americans have used singing and chanting as part of their healing rituals for millennia. The more formal approach to music therapy began in World War II, when U.S. Veterans Administration hospitals began to use music to help treat soldiers suffering from shell shock. In 1944, Michigan State University established the first music therapy degree program in the world.

Today, more than seventy colleges and universities have degree programs that are approved by the American Music Therapy Association. Music therapists must have at least a bachelor’s degree, 1,200 hours of clinical training, and one or more internships before they can be certified. There are thousands of professional music therapists working in health care settings in the United States today. They serve as part of cancer-management teams in many hospitals and cancer centers, helping to plan and evaluate treatment. Some music therapy services are covered by health insurance.

What is the evidence?

Scientific studies have shown the value of music therapy on the body, mind, and spirit of children and adults. Researchers have found that music therapy, when used with anti-nausea drugs for patients receiving high-dose chemotherapy, can help ease nausea and vomiting. A number of clinical trials have shown the benefit of music therapy for short-term pain, including pain from cancer. Some studies have suggested that music may help decrease the overall intensity of the patient’s experience of pain when used with pain-relieving drugs. Music therapy can also result in a decreased need for pain medicine in some patients, although studies on this topic have shown mixed results.

In hospice patients, one study found that music therapy improved comfort, relaxation, and pain control. Another study found that quality of life improved in cancer patients who received music therapy, even as it declined in those who did not. No differences were seen in survival between the 2 groups.

A more recent clinical trial looked at the effects of music during the course of several weeks of radiation treatments. The researchers found that while emotional distress (such as anxiety) seemed to be helped at the beginning of treatment, the patients reported that this effect gradually decreased. Music did not appear to help such symptoms as pain, fatigue, and depression over the long term.

Other clinical trials have revealed a reduction in heart rate, blood pressure, breathing rate, insomnia, depression, and anxiety with music therapy. No one knows all the ways music can benefit the body, but studies have shown that music can affect brain waves, brain circulation, and stress hormones. These effects are usually seen during and shortly after the music therapy.

Studies have shown that students who take music lessons have improved IQ levels, and show improvement in nonmusical abilities as well. Other studies have shown that listening to music composed by Mozart produces a short-term improvement in tasks that use spatial abilities. Studies of brain circulation have shown that people listening to Mozart have more activity in certain areas of the brain. This has been called the “Mozart effect.” Although the reasons for this effect are not completely clear, this kind of information supports the idea that music can be used in many helpful ways.

Some clinical trials that involve listening to music have shown no benefit on anxiety during surgical procedures, although one study that allowed patients to choose their own music showed improved anxiety levels. One recent review of studies looked at the effect of music on all types of pain and found a wide variation in its effects. The study authors observed that the best effects were on short-term pain after surgery. It is important to note that not all studies of music use music therapists, who assess the patient’s needs, circumstances, and preferences, as well as the different effects of certain types of music. This may account for some differences in clinical trial results.

Are there any possible problems or complications?

In general, music therapy done under the care of a professionally trained therapist has a helpful effect and is considered safe when used with standard treatment. Musical intervention by untrained people can be ineffective or can even cause increased stress and discomfort. Relying on this type of treatment alone and avoiding or delaying conventional medical care for cancer may have serious health consequences.

Additional resources

More information from your American Cancer Society

The following information on complementary and alternative therapies may also be helpful to you. These materials may be found on our Web site (www.cancer.org) or ordered from our toll-free number (1-800-ACS-2345).

Guidelines for Using Complementary and Alternative Therapies

Dietary Supplements: How to Know What Is Safe

The ACS Operational Statement on Complementary and Alternative Methods of Cancer Management

Complementary and Alternative Methods for Cancer Management

Placebo Effect

Learning About New Ways to Treat Cancer

Learning About New Ways to Prevent Cancer

References

Bodner M, Muftuler LT, Nalcioglu O, Shaw GL. FMRI study relevant to the Mozart effect: brain areas involved in spatial-temporal reasoning. Neurol Res. 2001;23:683-690.

Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane Database Syst Rev. 2006;(2):CD004843.

Clark M, Isaacks-Downton G, Wells N, et al. Use of preferred music to reduce emotional distress and symptom activity during radiation therapy. J Music Ther. 2006;43:247-265.

Ezzone S, Baker C, Rosselet R, Terepka E. Music as an adjunct to antiemetic therapy. Oncol Nurs Forum. 1998;25:1551-1556.

Hilliard RE. The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. J Music Ther. 2003;40:113-137.

Jausovec N, Habe K. The “Mozart effect”: an electroencephalographic analysis employing the methods of induced event-related desynchronization/synchronization and event-related coherence. Brain Topogr. 2003;16:73-84.

Krout RE. The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients. Am J Hosp Palliat Care. 2001;18:383-390.

Lane D. Music therapy: a gift beyond measure. Oncol Nurs Forum. 1992;19:863-867.

Lane D. Music therapy: gaining an edge in oncology management. J Oncol Manag. 1993;2:42-46.

Pelletier CL. The effect of music on decreasing arousal due to stress: a meta-analysis. J Music Ther. 2004;41:192-214.

Phumdoung S, Good M. Music reduces sensation and distress of labor pain. Pain Manag Nurs. 2003;4:54-61.

Schellenberg EG. Music and nonmusical abilities. Ann N Y Acad Sci. 2001;930:355-371.

Schellenberg EG. Music lessons enhance IQ. Psychol Sci. 2004;15:511-514.

Watkins GR. Music therapy: proposed physiological mechanisms and clinical implications. Clin Nurse Spec. 1997;11:43-50.

What is music therapy? American Music Therapy Association Web site. Accessed at www.musictherapy.org/ on May 23, 2008.

Note: This information may not cover all possible claims, uses, actions, precautions, side effects or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for consultation with your doctor, who is familiar with your medical situation.

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Thursday, November 11, 2010

Prevent Cancer Foundation-About Us

Our mission is to advocate and support the prevention and early detection of cancer through research, education and community outreach to all populations, including children and the underserved. We envision a future where cancer incidence and mortality will be significantly reduced through preventive measures. We carry out our mission in three main ways:

  1. by funding research that helps us better understand how to prevent cancer;
  2. by educating people about how they can prevent cancer; and
  3. by reaching out to communities across the country through our resources, events and partnerships with other organizations

Since 1985, we have provided more than $120 million in support of cancer prevention research, education and outreach programs nationwide and have played a pivotal role in developing a body of knowledge that is the basis for important prevention and early detection strategies. We have funded nearly 400 scientists at over 150 leading medical institutions across the country. Our public education programs have applied this scientific knowledge to teach the public on ways they can reduce their cancer risks.

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Cancerwise | Cancer blog from MD Anderson Cancer Center

Learning you have cancer is scary and confusing enough.

Thinking about how you'll manage to keep your job during cancer treatment adds another layer of worry and stress.

A three-part series in Network, MD Anderson's newsletter for patients, survivors and caregivers, is exploring ways to cope with your job after a cancer diagnosis.

From deciding whom to tell (or whether to disclose your diagnosis at all) to making a plan to deal with job responsibilities, to knowing your legal rights, the series aims to be relevant and meaningful.

marisaramirez_network1.jpgThe first article, in Network's summer issue, featured cervical cancer survivor Marisa Ramirez, who found her job a refuge in a time of uncertainty.

"I really didn't know who I was going to be as a cancer patient. But I knew how to go to work Monday through Friday, doing media relations for Interfaith Ministries," she recalls.

"I put my back up against that, and it helped me be more positive."

Ramirez says her coworkers offered prayers and support, but "followed my lead" when it came to dealing with her illness.

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