The Journal of Community and Supportive Oncology

Diffuse large B-cell lymphoma of the lung is a rare entity, and although the prognosis is favorable, its biological features, clinical presentation, prognostic markers, and treatment have not been well defined.^1,2 It is the second most common primary pulmonary lymphoma after mucosa-associated lymphoid tissue. PPL itself is very rare; it represents 3%-4% of extranodal non-Hodgkin lymphoma, less than 1% of NHL, and 0.5%-1.0% of primary pulmonary malignancies.^2,3 A review of the literature indicates a lack of data on pulmonary DLBCL. The objective of this case report is to highlight areas in which further research may be pursued to better understand this disease.
 

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Diffuse large B-cell lymphoma of the lung is a rare entity, and although the prognosis is favorable, its biological features, clinical presentation, prognostic markers, and treatment have not been well defined.^1,2 It is the second most common primary pulmonary lymphoma after mucosa-associated lymphoid tissue. PPL itself is very rare; it represents 3%-4% of extranodal non-Hodgkin lymphoma, less than 1% of NHL, and 0.5%-1.0% of primary pulmonary malignancies.^2,3 A review of the literature indicates a lack of data on pulmonary DLBCL. The objective of this case report is to highlight areas in which further research may be pursued to better understand this disease.
 

Click on the PDF icon at the top of this introduction to read the full article.

Diffuse large B-cell lymphoma of the lung is a rare entity, and although the prognosis is favorable, its biological features, clinical presentation, prognostic markers, and treatment have not been well defined.^1,2 It is the second most common primary pulmonary lymphoma after mucosa-associated lymphoid tissue. PPL itself is very rare; it represents 3%-4% of extranodal non-Hodgkin lymphoma, less than 1% of NHL, and 0.5%-1.0% of primary pulmonary malignancies.^2,3 A review of the literature indicates a lack of data on pulmonary DLBCL. The objective of this case report is to highlight areas in which further research may be pursued to better understand this disease.
 

Click on the PDF icon at the top of this introduction to read the full article.

Management-focused scientific evaluation is a useful administrative tool especially when hospitals implement a new technology. This paper describes the components of a scientific evaluation framework and then illustrates the application and the utility of the framework in a hospital-based community oncology setting. The clinical technology, Telesynergy, is an advanced telecommunications and remote medical consultation system which has been developed by the National Cancer Institute to support community hospital-based radiation oncology programs.

Click on the PDF icon at the top of this introduction to read the full article.

Management-focused scientific evaluation is a useful administrative tool especially when hospitals implement a new technology. This paper describes the components of a scientific evaluation framework and then illustrates the application and the utility of the framework in a hospital-based community oncology setting. The clinical technology, Telesynergy, is an advanced telecommunications and remote medical consultation system which has been developed by the National Cancer Institute to support community hospital-based radiation oncology programs.

Click on the PDF icon at the top of this introduction to read the full article.

Management-focused scientific evaluation is a useful administrative tool especially when hospitals implement a new technology. This paper describes the components of a scientific evaluation framework and then illustrates the application and the utility of the framework in a hospital-based community oncology setting. The clinical technology, Telesynergy, is an advanced telecommunications and remote medical consultation system which has been developed by the National Cancer Institute to support community hospital-based radiation oncology programs.

Click on the PDF icon at the top of this introduction to read the full article.

Rapidly increasing volume and complexity of information used for multidisciplinary cancer treatment requires carefully evolving communications with programmatic planning, detailed evaluation, and new methodologies and technical approaches to enhance the impact and efficacy of medical conferencing systems. We designed, implemented, and evaluated cost-effective and appropriate remote learning optimize oncology practice techniques in community hospitals. Our experience over the course of more than 7 years demonstrated simple and inexpensive communication solutions for both professional and lay education, satisfying information-dense needs of multimodality cancer care. We describe how potential complexities may be resolved with inexpensive devices and software programs. Staff teamwork and creativity are always required to implement constantly evolving technologies. We provide both quantitative and qualitative data describing activities and resulting staff responses resulting in 6,520 personnel with more than 391 aggregate credit hours of continuing medical education and continuing education credit activities with enhanced collegial participant satisfaction levels and heightened interactions/professionalism among regional oncology staff. We noted significant cost reductions for communications in all our three partnered hospitals. We demonstrated both increased satisfaction levels and heightened levels of behavioral changes (Impacts) in participants. Always, activities must be cost effective and responsive to changing medical needs. Community focused efforts with regional partners should be similar, assuring evolving successes.

Click on the PDF icon at the top of this introduction to read the full article.

Rapidly increasing volume and complexity of information used for multidisciplinary cancer treatment requires carefully evolving communications with programmatic planning, detailed evaluation, and new methodologies and technical approaches to enhance the impact and efficacy of medical conferencing systems. We designed, implemented, and evaluated cost-effective and appropriate remote learning optimize oncology practice techniques in community hospitals. Our experience over the course of more than 7 years demonstrated simple and inexpensive communication solutions for both professional and lay education, satisfying information-dense needs of multimodality cancer care. We describe how potential complexities may be resolved with inexpensive devices and software programs. Staff teamwork and creativity are always required to implement constantly evolving technologies. We provide both quantitative and qualitative data describing activities and resulting staff responses resulting in 6,520 personnel with more than 391 aggregate credit hours of continuing medical education and continuing education credit activities with enhanced collegial participant satisfaction levels and heightened interactions/professionalism among regional oncology staff. We noted significant cost reductions for communications in all our three partnered hospitals. We demonstrated both increased satisfaction levels and heightened levels of behavioral changes (Impacts) in participants. Always, activities must be cost effective and responsive to changing medical needs. Community focused efforts with regional partners should be similar, assuring evolving successes.

Click on the PDF icon at the top of this introduction to read the full article.

Rapidly increasing volume and complexity of information used for multidisciplinary cancer treatment requires carefully evolving communications with programmatic planning, detailed evaluation, and new methodologies and technical approaches to enhance the impact and efficacy of medical conferencing systems. We designed, implemented, and evaluated cost-effective and appropriate remote learning optimize oncology practice techniques in community hospitals. Our experience over the course of more than 7 years demonstrated simple and inexpensive communication solutions for both professional and lay education, satisfying information-dense needs of multimodality cancer care. We describe how potential complexities may be resolved with inexpensive devices and software programs. Staff teamwork and creativity are always required to implement constantly evolving technologies. We provide both quantitative and qualitative data describing activities and resulting staff responses resulting in 6,520 personnel with more than 391 aggregate credit hours of continuing medical education and continuing education credit activities with enhanced collegial participant satisfaction levels and heightened interactions/professionalism among regional oncology staff. We noted significant cost reductions for communications in all our three partnered hospitals. We demonstrated both increased satisfaction levels and heightened levels of behavioral changes (Impacts) in participants. Always, activities must be cost effective and responsive to changing medical needs. Community focused efforts with regional partners should be similar, assuring evolving successes.

Click on the PDF icon at the top of this introduction to read the full article.

Objective To develop and implement virtual interactive multidisciplinary cancer tumor boards (VTBs), created throughtelemedicine links between the University of California, Davis Cancer Center and community-based cancer care providers. Thegoal of this project was to facilitate communication among community and academic cancer specialists.

Materials and methods Four geographically remote sites were selected to participate with established disease-specific tumorboards of the UC Davis Cancer Center. Telemedicine links were created using dedicated T1 lines, and PolyCom HDX 9000 was used by the center for teleconference hosting. Participants were then surveyed on their perception of the benefit of VTBs.

Results The results across disease-specific virtual tumor boards show that most of the participants reported that the right amountof clinical information on the cases was presented and that new information was discussed that helped providers manage thecare of the patients.

Conclusions Teleconferencing of disease-specific tumor boards allowed providers in a geographically remote group ofproviders to make prospective, case-based treatment decisions that increased their knowledge of treatment options and facilitatedtheir decision making. This transfer of knowledge and experience speeds up the dissemination of rapidly evolving cancer care,which could lead to higher quality patient outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

Objective To develop and implement virtual interactive multidisciplinary cancer tumor boards (VTBs), created throughtelemedicine links between the University of California, Davis Cancer Center and community-based cancer care providers. Thegoal of this project was to facilitate communication among community and academic cancer specialists.

Materials and methods Four geographically remote sites were selected to participate with established disease-specific tumorboards of the UC Davis Cancer Center. Telemedicine links were created using dedicated T1 lines, and PolyCom HDX 9000 was used by the center for teleconference hosting. Participants were then surveyed on their perception of the benefit of VTBs.

Results The results across disease-specific virtual tumor boards show that most of the participants reported that the right amountof clinical information on the cases was presented and that new information was discussed that helped providers manage thecare of the patients.

Conclusions Teleconferencing of disease-specific tumor boards allowed providers in a geographically remote group ofproviders to make prospective, case-based treatment decisions that increased their knowledge of treatment options and facilitatedtheir decision making. This transfer of knowledge and experience speeds up the dissemination of rapidly evolving cancer care,which could lead to higher quality patient outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

Objective To develop and implement virtual interactive multidisciplinary cancer tumor boards (VTBs), created throughtelemedicine links between the University of California, Davis Cancer Center and community-based cancer care providers. Thegoal of this project was to facilitate communication among community and academic cancer specialists.

Materials and methods Four geographically remote sites were selected to participate with established disease-specific tumorboards of the UC Davis Cancer Center. Telemedicine links were created using dedicated T1 lines, and PolyCom HDX 9000 was used by the center for teleconference hosting. Participants were then surveyed on their perception of the benefit of VTBs.

Results The results across disease-specific virtual tumor boards show that most of the participants reported that the right amountof clinical information on the cases was presented and that new information was discussed that helped providers manage thecare of the patients.

Conclusions Teleconferencing of disease-specific tumor boards allowed providers in a geographically remote group ofproviders to make prospective, case-based treatment decisions that increased their knowledge of treatment options and facilitatedtheir decision making. This transfer of knowledge and experience speeds up the dissemination of rapidly evolving cancer care,which could lead to higher quality patient outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

The stories of patients and families, like this one presented by Kimberly Lastinger, offer powerful lessons for health professionals about the human experience of illness and its impact on the person and family. Furthermore, patient narratives present ‘experiential truth and passion’ that compel us to re-examine medical practices and ethical perceptions of care.¹ However much we think we know from our years of medical practice and our observation of many patients and families, we are not ‘in the patient’s shoes’. The content of patient narratives supports ethical decisions by helping us listen and hear what patients say, how they say it, and by clarifying why it matters. The patient story can help us focus healthcare on the patient and to recognize that the patient is the ultimate authority when it comes to the interpretation of his or her illness experience. Until one has been there, it is impossible to imagine the impact of a life-threatening illness. I am reminded of my own surprise at seeing, feeling, and experiencing the loss of a loved one to cancer. I have been a medical oncologist and palliative care physician for more than 25 years, and I thought I understood the experience I could expect when my husband died. Instead, I was stunned to find that I didn’t have a clue! It has taught me to listen more carefully and ask more questions. When listening occurs, understanding increases, and narratives can be jointly constructed by the patient and healthcare provider. This leads to power that is shared and the sharing of power constitutes an important ethical safeguard within the relationship.²

The narrative presented here suggests a remarkably positive experience of a devastating illness and its potential impact on the patient and family. The patient was someone with tremendous resiliency and optimism. She was commited to living on her terms and for caring for her daughter. Her story is an inspiring one. Ms Lastinger recalls her mother’s amazing support system, but also her mother’s fear of dying. The latter learned only years after her mother’s death from reading her journal. I wonder if, as too often happens, we failed to offer adequate psychosocial support. This service is too often not offered.^3,4 This occurs for many reasons including, I suspect, when there is the perception of a supportive social network embracing the patient. It behooves us as healthcare professionals to remember that patients may not want or be able to share some of their deepest fears, the threat of dying or of being dependent, with the people they love. The patients who seem to be doing well emotionally, those with ‘great support’ may also benefit from professional counseling.

The stories of patients and families, like this one presented by Kimberly Lastinger, offer powerful lessons for health professionals about the human experience of illness and its impact on the person and family. Furthermore, patient narratives present ‘experiential truth and passion’ that compel us to re-examine medical practices and ethical perceptions of care.¹ However much we think we know from our years of medical practice and our observation of many patients and families, we are not ‘in the patient’s shoes’. The content of patient narratives supports ethical decisions by helping us listen and hear what patients say, how they say it, and by clarifying why it matters. The patient story can help us focus healthcare on the patient and to recognize that the patient is the ultimate authority when it comes to the interpretation of his or her illness experience. Until one has been there, it is impossible to imagine the impact of a life-threatening illness. I am reminded of my own surprise at seeing, feeling, and experiencing the loss of a loved one to cancer. I have been a medical oncologist and palliative care physician for more than 25 years, and I thought I understood the experience I could expect when my husband died. Instead, I was stunned to find that I didn’t have a clue! It has taught me to listen more carefully and ask more questions. When listening occurs, understanding increases, and narratives can be jointly constructed by the patient and healthcare provider. This leads to power that is shared and the sharing of power constitutes an important ethical safeguard within the relationship.²

The narrative presented here suggests a remarkably positive experience of a devastating illness and its potential impact on the patient and family. The patient was someone with tremendous resiliency and optimism. She was commited to living on her terms and for caring for her daughter. Her story is an inspiring one. Ms Lastinger recalls her mother’s amazing support system, but also her mother’s fear of dying. The latter learned only years after her mother’s death from reading her journal. I wonder if, as too often happens, we failed to offer adequate psychosocial support. This service is too often not offered.^3,4 This occurs for many reasons including, I suspect, when there is the perception of a supportive social network embracing the patient. It behooves us as healthcare professionals to remember that patients may not want or be able to share some of their deepest fears, the threat of dying or of being dependent, with the people they love. The patients who seem to be doing well emotionally, those with ‘great support’ may also benefit from professional counseling.

The stories of patients and families, like this one presented by Kimberly Lastinger, offer powerful lessons for health professionals about the human experience of illness and its impact on the person and family. Furthermore, patient narratives present ‘experiential truth and passion’ that compel us to re-examine medical practices and ethical perceptions of care.¹ However much we think we know from our years of medical practice and our observation of many patients and families, we are not ‘in the patient’s shoes’. The content of patient narratives supports ethical decisions by helping us listen and hear what patients say, how they say it, and by clarifying why it matters. The patient story can help us focus healthcare on the patient and to recognize that the patient is the ultimate authority when it comes to the interpretation of his or her illness experience. Until one has been there, it is impossible to imagine the impact of a life-threatening illness. I am reminded of my own surprise at seeing, feeling, and experiencing the loss of a loved one to cancer. I have been a medical oncologist and palliative care physician for more than 25 years, and I thought I understood the experience I could expect when my husband died. Instead, I was stunned to find that I didn’t have a clue! It has taught me to listen more carefully and ask more questions. When listening occurs, understanding increases, and narratives can be jointly constructed by the patient and healthcare provider. This leads to power that is shared and the sharing of power constitutes an important ethical safeguard within the relationship.²

The narrative presented here suggests a remarkably positive experience of a devastating illness and its potential impact on the patient and family. The patient was someone with tremendous resiliency and optimism. She was commited to living on her terms and for caring for her daughter. Her story is an inspiring one. Ms Lastinger recalls her mother’s amazing support system, but also her mother’s fear of dying. The latter learned only years after her mother’s death from reading her journal. I wonder if, as too often happens, we failed to offer adequate psychosocial support. This service is too often not offered.^3,4 This occurs for many reasons including, I suspect, when there is the perception of a supportive social network embracing the patient. It behooves us as healthcare professionals to remember that patients may not want or be able to share some of their deepest fears, the threat of dying or of being dependent, with the people they love. The patients who seem to be doing well emotionally, those with ‘great support’ may also benefit from professional counseling.

Squamous cell carcinomas of the head and neck account for 3% of all new cancers diagnosed annually within the United States.¹ According to the Surveillance Epidemiology
and Ends Reports (SEER) database, 79% of patients in the US present with local or regional advanced disease and are treated with combinedmodality therapy.² Factors that influence treatment decision making include the following: resectability, function preservation, local patterns of care, and patient characteristics or preferences. In this cohort of patients, disease eradication is the goal of therapy. Conversely, for approximately 16% of patients who are diagnosed with metastatic disease at presentation, or the substantial portion of patients who develop non-curable disease recurrence, the main therapeutic objectives are palliation and prolongation of survival (accessible at http://seer.cancer.gov/statfacts/html/oralcav.html).^2,3 We define patients as having non-curable recurrence if development of metastatic disease or development of local recurrence is not amenable to either surgical resection or re-irradiation therapy. Several changes in the epidemiology and treatment of metastatic and recurrent head and neck cancer (M/RHNC) have resulted in paradigm shifts that effect treatment decision making in this population. First, a combination of standard chemotherapy with cetuximab has demonstrated a survival advantage. This is the first time that any agent or combination of agents has demonstrated superiority in the treatment of M/RHNC.⁴ Second, human papilloma virus (HPV)-associated oropharyngeal cancers are epidemic in many areas of the world. The cohort of HPV-positive patients has an excellent prognosis with currently available primary treatment regimens. The recurrence rate in this population is low; however, data regarding the treatment responsiveness of HPV-associated tumors that recur after primary therapy is lacking. Finally, with the increased use of aggressive combined modality regimens as primary therapy, patients with recurrent disease are often heavily pretreated and suffer from symptoms secondary to their initial therapy. It is important to understand how the evolving epidemiology and treatment paradigms affect decision making for our patients. This requires an understanding of how these changes affect both the benefits and risks to the patient.

Squamous cell carcinomas of the head and neck account for 3% of all new cancers diagnosed annually within the United States.¹ According to the Surveillance Epidemiology
and Ends Reports (SEER) database, 79% of patients in the US present with local or regional advanced disease and are treated with combinedmodality therapy.² Factors that influence treatment decision making include the following: resectability, function preservation, local patterns of care, and patient characteristics or preferences. In this cohort of patients, disease eradication is the goal of therapy. Conversely, for approximately 16% of patients who are diagnosed with metastatic disease at presentation, or the substantial portion of patients who develop non-curable disease recurrence, the main therapeutic objectives are palliation and prolongation of survival (accessible at http://seer.cancer.gov/statfacts/html/oralcav.html).^2,3 We define patients as having non-curable recurrence if development of metastatic disease or development of local recurrence is not amenable to either surgical resection or re-irradiation therapy. Several changes in the epidemiology and treatment of metastatic and recurrent head and neck cancer (M/RHNC) have resulted in paradigm shifts that effect treatment decision making in this population. First, a combination of standard chemotherapy with cetuximab has demonstrated a survival advantage. This is the first time that any agent or combination of agents has demonstrated superiority in the treatment of M/RHNC.⁴ Second, human papilloma virus (HPV)-associated oropharyngeal cancers are epidemic in many areas of the world. The cohort of HPV-positive patients has an excellent prognosis with currently available primary treatment regimens. The recurrence rate in this population is low; however, data regarding the treatment responsiveness of HPV-associated tumors that recur after primary therapy is lacking. Finally, with the increased use of aggressive combined modality regimens as primary therapy, patients with recurrent disease are often heavily pretreated and suffer from symptoms secondary to their initial therapy. It is important to understand how the evolving epidemiology and treatment paradigms affect decision making for our patients. This requires an understanding of how these changes affect both the benefits and risks to the patient.

Squamous cell carcinomas of the head and neck account for 3% of all new cancers diagnosed annually within the United States.¹ According to the Surveillance Epidemiology
and Ends Reports (SEER) database, 79% of patients in the US present with local or regional advanced disease and are treated with combinedmodality therapy.² Factors that influence treatment decision making include the following: resectability, function preservation, local patterns of care, and patient characteristics or preferences. In this cohort of patients, disease eradication is the goal of therapy. Conversely, for approximately 16% of patients who are diagnosed with metastatic disease at presentation, or the substantial portion of patients who develop non-curable disease recurrence, the main therapeutic objectives are palliation and prolongation of survival (accessible at http://seer.cancer.gov/statfacts/html/oralcav.html).^2,3 We define patients as having non-curable recurrence if development of metastatic disease or development of local recurrence is not amenable to either surgical resection or re-irradiation therapy. Several changes in the epidemiology and treatment of metastatic and recurrent head and neck cancer (M/RHNC) have resulted in paradigm shifts that effect treatment decision making in this population. First, a combination of standard chemotherapy with cetuximab has demonstrated a survival advantage. This is the first time that any agent or combination of agents has demonstrated superiority in the treatment of M/RHNC.⁴ Second, human papilloma virus (HPV)-associated oropharyngeal cancers are epidemic in many areas of the world. The cohort of HPV-positive patients has an excellent prognosis with currently available primary treatment regimens. The recurrence rate in this population is low; however, data regarding the treatment responsiveness of HPV-associated tumors that recur after primary therapy is lacking. Finally, with the increased use of aggressive combined modality regimens as primary therapy, patients with recurrent disease are often heavily pretreated and suffer from symptoms secondary to their initial therapy. It is important to understand how the evolving epidemiology and treatment paradigms affect decision making for our patients. This requires an understanding of how these changes affect both the benefits and risks to the patient.

I often daydream that my mom is still here and living cancer free. I like to imagine her teaching art at a prestigious private school in New York City, or maybe retired quilting in a little cottage in Vermont, or at home sketching on her back porch watching her dog playing in the yard. My mother battled cancer for over 20 years; and I find myself wondering what would it have been like to grow up without living under the shadow of the “c” word. How would things have been different? Would my mom still have been the fierce, strong, and passionate woman I remember? She never allowed herself to be a cancer patient. She was a mother, an artist, a friend, a teacher, and a cancer warrior. My mother was diagnosed with Stage II breast cancer in July of 1991. I was 7 years old and my younger sister was 2. She found a pea-sized lump in her left breast by self examination. Her treatment was to be a lumpectomy and radiation. While in surgery, they found numerous lumps in her left breast as well as her right breast and lymph nodes. My father had to make the decision for a radical mastectomy of her left breast and a partial of her right. It was very hard to see her going through all of it. I can remember having to spend a lot of time overnight with friends and family. There was a lot of crying and adults whispering. My mom was in bed most of the time and I remember waking up at night to her vomiting. At 7 years old, I knew words like mastectomy and chemotherapy. One night I couldn’t sleep and I went up stairs to ask my mom if she was dying. How do you answer that? My pediatrician told my mother to give me a journal so I could draw and write my thoughts and emotions. In the afternoons, the two of us would write in our journals. She kept my composition notebook filled with funny round people and lots of “x”s over my mommy’s “bueb”.

I often daydream that my mom is still here and living cancer free. I like to imagine her teaching art at a prestigious private school in New York City, or maybe retired quilting in a little cottage in Vermont, or at home sketching on her back porch watching her dog playing in the yard. My mother battled cancer for over 20 years; and I find myself wondering what would it have been like to grow up without living under the shadow of the “c” word. How would things have been different? Would my mom still have been the fierce, strong, and passionate woman I remember? She never allowed herself to be a cancer patient. She was a mother, an artist, a friend, a teacher, and a cancer warrior. My mother was diagnosed with Stage II breast cancer in July of 1991. I was 7 years old and my younger sister was 2. She found a pea-sized lump in her left breast by self examination. Her treatment was to be a lumpectomy and radiation. While in surgery, they found numerous lumps in her left breast as well as her right breast and lymph nodes. My father had to make the decision for a radical mastectomy of her left breast and a partial of her right. It was very hard to see her going through all of it. I can remember having to spend a lot of time overnight with friends and family. There was a lot of crying and adults whispering. My mom was in bed most of the time and I remember waking up at night to her vomiting. At 7 years old, I knew words like mastectomy and chemotherapy. One night I couldn’t sleep and I went up stairs to ask my mom if she was dying. How do you answer that? My pediatrician told my mother to give me a journal so I could draw and write my thoughts and emotions. In the afternoons, the two of us would write in our journals. She kept my composition notebook filled with funny round people and lots of “x”s over my mommy’s “bueb”.

I often daydream that my mom is still here and living cancer free. I like to imagine her teaching art at a prestigious private school in New York City, or maybe retired quilting in a little cottage in Vermont, or at home sketching on her back porch watching her dog playing in the yard. My mother battled cancer for over 20 years; and I find myself wondering what would it have been like to grow up without living under the shadow of the “c” word. How would things have been different? Would my mom still have been the fierce, strong, and passionate woman I remember? She never allowed herself to be a cancer patient. She was a mother, an artist, a friend, a teacher, and a cancer warrior. My mother was diagnosed with Stage II breast cancer in July of 1991. I was 7 years old and my younger sister was 2. She found a pea-sized lump in her left breast by self examination. Her treatment was to be a lumpectomy and radiation. While in surgery, they found numerous lumps in her left breast as well as her right breast and lymph nodes. My father had to make the decision for a radical mastectomy of her left breast and a partial of her right. It was very hard to see her going through all of it. I can remember having to spend a lot of time overnight with friends and family. There was a lot of crying and adults whispering. My mom was in bed most of the time and I remember waking up at night to her vomiting. At 7 years old, I knew words like mastectomy and chemotherapy. One night I couldn’t sleep and I went up stairs to ask my mom if she was dying. How do you answer that? My pediatrician told my mother to give me a journal so I could draw and write my thoughts and emotions. In the afternoons, the two of us would write in our journals. She kept my composition notebook filled with funny round people and lots of “x”s over my mommy’s “bueb”.

Background Skin reactions and pain are commonly reported side effects of radiation therapy (RT).

Objective To characterize RT-induced symptoms according to treatment site subgroups and identify skin symptoms that correlate with pain.

Methods A self-report survey—adapted from the MD Anderson Symptom Inventory and the McGill Pain Questionnaire—assessed RT-induced skin problems, pain, and specific skin symptoms. Wilcoxon Sign Ranked tests compared mean severity of pre- and post-RT pain and skin problems within each RT-site subgroup. Multiple linear regression (MLR) investigated associations between skin symptoms and pain.

Results Survey respondents (N = 106) were 58% female and on average 64 years old. RT sites included lung, breast, lower abdomen, head/neck/brain, and upper abdomen. Only patients receiving breast RT reported significant increases in treatment site pain and skin problems (P ≤ .007). Patients receiving head/neck/brain RT reported increased skin problems (P < .0009). MLR showed that post-RT skin tenderness and tightness were most strongly associated with post-RT pain (P = .066 and P = .122, respectively).

Limitations Small sample size, exploratory analyses, and nonvalidated measure.

Conclusions Only patients receiving breast RT reported significant increases in pain and skin problems at the RT site while patients receiving head/neck/brain RT had increased skin problems but not pain. These findings suggest that the severity of skin problems is not the only factor that contributes to pain and that interventions should be tailored to specifically target pain at the RT site, possibly by targeting tenderness and tightness. These findings should be confirmed in a larger sampling of RT patients.

Click on the PDF icon at the top of this introduction to read the full article.

Background Skin reactions and pain are commonly reported side effects of radiation therapy (RT).

Objective To characterize RT-induced symptoms according to treatment site subgroups and identify skin symptoms that correlate with pain.

Methods A self-report survey—adapted from the MD Anderson Symptom Inventory and the McGill Pain Questionnaire—assessed RT-induced skin problems, pain, and specific skin symptoms. Wilcoxon Sign Ranked tests compared mean severity of pre- and post-RT pain and skin problems within each RT-site subgroup. Multiple linear regression (MLR) investigated associations between skin symptoms and pain.

Results Survey respondents (N = 106) were 58% female and on average 64 years old. RT sites included lung, breast, lower abdomen, head/neck/brain, and upper abdomen. Only patients receiving breast RT reported significant increases in treatment site pain and skin problems (P ≤ .007). Patients receiving head/neck/brain RT reported increased skin problems (P < .0009). MLR showed that post-RT skin tenderness and tightness were most strongly associated with post-RT pain (P = .066 and P = .122, respectively).

Limitations Small sample size, exploratory analyses, and nonvalidated measure.

Conclusions Only patients receiving breast RT reported significant increases in pain and skin problems at the RT site while patients receiving head/neck/brain RT had increased skin problems but not pain. These findings suggest that the severity of skin problems is not the only factor that contributes to pain and that interventions should be tailored to specifically target pain at the RT site, possibly by targeting tenderness and tightness. These findings should be confirmed in a larger sampling of RT patients.

Click on the PDF icon at the top of this introduction to read the full article.

Background Skin reactions and pain are commonly reported side effects of radiation therapy (RT).

Objective To characterize RT-induced symptoms according to treatment site subgroups and identify skin symptoms that correlate with pain.

Methods A self-report survey—adapted from the MD Anderson Symptom Inventory and the McGill Pain Questionnaire—assessed RT-induced skin problems, pain, and specific skin symptoms. Wilcoxon Sign Ranked tests compared mean severity of pre- and post-RT pain and skin problems within each RT-site subgroup. Multiple linear regression (MLR) investigated associations between skin symptoms and pain.

Results Survey respondents (N = 106) were 58% female and on average 64 years old. RT sites included lung, breast, lower abdomen, head/neck/brain, and upper abdomen. Only patients receiving breast RT reported significant increases in treatment site pain and skin problems (P ≤ .007). Patients receiving head/neck/brain RT reported increased skin problems (P < .0009). MLR showed that post-RT skin tenderness and tightness were most strongly associated with post-RT pain (P = .066 and P = .122, respectively).

Limitations Small sample size, exploratory analyses, and nonvalidated measure.

Conclusions Only patients receiving breast RT reported significant increases in pain and skin problems at the RT site while patients receiving head/neck/brain RT had increased skin problems but not pain. These findings suggest that the severity of skin problems is not the only factor that contributes to pain and that interventions should be tailored to specifically target pain at the RT site, possibly by targeting tenderness and tightness. These findings should be confirmed in a larger sampling of RT patients.

Click on the PDF icon at the top of this introduction to read the full article.