The Journal of Community and Supportive Oncology

Background Patient understanding of advanced metastatic disease is central to decisions about care near death. Prior studies have focused on gender differences in communication style rather than on illness understanding.

Objectives To evaluate gender differences in terminal illness acknowledgement (TIA), understanding that the disease is incurable and the advanced stage of the disease. To evaluate gender differences in patients’ reports of discussions of life expectancy with oncology providers and its effect on differences in illness understanding.

Methods Coping with Cancer 2 patients (N 68) were interviewed before and after a visit with their oncology providers to discuss scan results.

Results At the prescan interview, there were no statistically significant gender differences in patient measures of illness understanding. At the postscan interview, women were more likely than men to recognize that their illness was incurable (Adjusted Odds Ratio, [AOR] 5.29; P .038), know that their cancer was at an advanced stage (AOR, 6.38; P, .013), and report having had discussions of life expectancy with their oncologist (AOR, 4.77; P, .021). Controlling discussions of life expectancy, women were more likely than men to report that their cancer was at an advanced stage (AOR, 9.53; P .050). Controlling for gender, discussions of life expectancy were associated with higher rates of TIA (AOR, 4.65; P, .036) and higher rates of understanding that the cancer was incurable (AOR, 4.09;  P .085).

Conclusions Due largely to gender differences in communication, women over time have a better understanding of their illness than men. More frequent discussions of life expectancy should enhance illness understanding and reduce gender differences.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Patient understanding of advanced metastatic disease is central to decisions about care near death. Prior studies have focused on gender differences in communication style rather than on illness understanding.

Objectives To evaluate gender differences in terminal illness acknowledgement (TIA), understanding that the disease is incurable and the advanced stage of the disease. To evaluate gender differences in patients’ reports of discussions of life expectancy with oncology providers and its effect on differences in illness understanding.

Methods Coping with Cancer 2 patients (N 68) were interviewed before and after a visit with their oncology providers to discuss scan results.

Results At the prescan interview, there were no statistically significant gender differences in patient measures of illness understanding. At the postscan interview, women were more likely than men to recognize that their illness was incurable (Adjusted Odds Ratio, [AOR] 5.29; P .038), know that their cancer was at an advanced stage (AOR, 6.38; P, .013), and report having had discussions of life expectancy with their oncologist (AOR, 4.77; P, .021). Controlling discussions of life expectancy, women were more likely than men to report that their cancer was at an advanced stage (AOR, 9.53; P .050). Controlling for gender, discussions of life expectancy were associated with higher rates of TIA (AOR, 4.65; P, .036) and higher rates of understanding that the cancer was incurable (AOR, 4.09;  P .085).

Conclusions Due largely to gender differences in communication, women over time have a better understanding of their illness than men. More frequent discussions of life expectancy should enhance illness understanding and reduce gender differences.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Patient understanding of advanced metastatic disease is central to decisions about care near death. Prior studies have focused on gender differences in communication style rather than on illness understanding.

Objectives To evaluate gender differences in terminal illness acknowledgement (TIA), understanding that the disease is incurable and the advanced stage of the disease. To evaluate gender differences in patients’ reports of discussions of life expectancy with oncology providers and its effect on differences in illness understanding.

Methods Coping with Cancer 2 patients (N 68) were interviewed before and after a visit with their oncology providers to discuss scan results.

Results At the prescan interview, there were no statistically significant gender differences in patient measures of illness understanding. At the postscan interview, women were more likely than men to recognize that their illness was incurable (Adjusted Odds Ratio, [AOR] 5.29; P .038), know that their cancer was at an advanced stage (AOR, 6.38; P, .013), and report having had discussions of life expectancy with their oncologist (AOR, 4.77; P, .021). Controlling discussions of life expectancy, women were more likely than men to report that their cancer was at an advanced stage (AOR, 9.53; P .050). Controlling for gender, discussions of life expectancy were associated with higher rates of TIA (AOR, 4.65; P, .036) and higher rates of understanding that the cancer was incurable (AOR, 4.09;  P .085).

Conclusions Due largely to gender differences in communication, women over time have a better understanding of their illness than men. More frequent discussions of life expectancy should enhance illness understanding and reduce gender differences.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Symptom management medications are often compounded into topical gel formulations providing an alternative route of administration for hospice and palliative care patients. Though commonly used, transdermal absorption and bioavailability studies of these gel products are lacking. Chlorpromazine was studied because it is FDA approved for treatment of nausea and vomiting and is used off-label for treatment of agitation and delirium.

Objective The objective of this study is to determine the transdermal absorption of chlorpromazine PLO gel in healthy adults.

Methods Twenty-five milligrams of chlorpromazine in PLO gel was applied to 10 subjects’ wrists and 100 mg was applied to 1 subject’s wrist. Blood draws were completed preapplication and 1, 2, and 4 hours postapplication. This single-center unblinded study recruited healthy adults between 18 and 70 years of age. Participants were not pregnant, did not have an allergy to any component of the study medication, and were not taking a phenothiazine medication.

Results Chlorpromazine was undetected in any of the 11 subjects’ blood samples.

Limitations There is an assumption of equivalent medication absorption in healthy patients and palliative care or hospice patients.

Conclusion Rapid relief of symptoms at end of life is essential. Chlorpromazine in PLO gel may not be an effective treatment option since blood levels were undetectable at 1, 2, and 4 hours after topical application.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Symptom management medications are often compounded into topical gel formulations providing an alternative route of administration for hospice and palliative care patients. Though commonly used, transdermal absorption and bioavailability studies of these gel products are lacking. Chlorpromazine was studied because it is FDA approved for treatment of nausea and vomiting and is used off-label for treatment of agitation and delirium.

Objective The objective of this study is to determine the transdermal absorption of chlorpromazine PLO gel in healthy adults.

Methods Twenty-five milligrams of chlorpromazine in PLO gel was applied to 10 subjects’ wrists and 100 mg was applied to 1 subject’s wrist. Blood draws were completed preapplication and 1, 2, and 4 hours postapplication. This single-center unblinded study recruited healthy adults between 18 and 70 years of age. Participants were not pregnant, did not have an allergy to any component of the study medication, and were not taking a phenothiazine medication.

Results Chlorpromazine was undetected in any of the 11 subjects’ blood samples.

Limitations There is an assumption of equivalent medication absorption in healthy patients and palliative care or hospice patients.

Conclusion Rapid relief of symptoms at end of life is essential. Chlorpromazine in PLO gel may not be an effective treatment option since blood levels were undetectable at 1, 2, and 4 hours after topical application.

*For a PDF of the full article, click on the link to the left of this introduction.

Background Symptom management medications are often compounded into topical gel formulations providing an alternative route of administration for hospice and palliative care patients. Though commonly used, transdermal absorption and bioavailability studies of these gel products are lacking. Chlorpromazine was studied because it is FDA approved for treatment of nausea and vomiting and is used off-label for treatment of agitation and delirium.

Objective The objective of this study is to determine the transdermal absorption of chlorpromazine PLO gel in healthy adults.

Methods Twenty-five milligrams of chlorpromazine in PLO gel was applied to 10 subjects’ wrists and 100 mg was applied to 1 subject’s wrist. Blood draws were completed preapplication and 1, 2, and 4 hours postapplication. This single-center unblinded study recruited healthy adults between 18 and 70 years of age. Participants were not pregnant, did not have an allergy to any component of the study medication, and were not taking a phenothiazine medication.

Results Chlorpromazine was undetected in any of the 11 subjects’ blood samples.

Limitations There is an assumption of equivalent medication absorption in healthy patients and palliative care or hospice patients.

Conclusion Rapid relief of symptoms at end of life is essential. Chlorpromazine in PLO gel may not be an effective treatment option since blood levels were undetectable at 1, 2, and 4 hours after topical application.

*For a PDF of the full article, click on the link to the left of this introduction.

This systematic review synthesizes knowledge about the use of complementary and alternative medicine (CAM) among advanced cancer patients. EBSCO and Ovid databases were searched using core concepts, including advanced cancer, CAM, integrative medicine, and decision-making. Articles included in the final review were analyzed using narrative synthesis methods, including thematic analysis, concept mapping, and critical reflection on the synthesis process. Results demonstrate that advanced cancer patients who are younger, female, more educated, have longer duration of disease, and have previously used CAM are more likely to use CAM during this stage of illness. Key themes identified include patterns of and reasons for use; and barriers and facilitators to informed CAM decision-making. Knowledge regarding the use of CAM in advanced cancer remains in its nascent stages. Findings suggest a need for more research on understanding the dynamic process of CAM decision-making in the advanced cancer population from the patients’ perspective.

*For a PDF of the full article, click on the link to the left of this introduction.

This systematic review synthesizes knowledge about the use of complementary and alternative medicine (CAM) among advanced cancer patients. EBSCO and Ovid databases were searched using core concepts, including advanced cancer, CAM, integrative medicine, and decision-making. Articles included in the final review were analyzed using narrative synthesis methods, including thematic analysis, concept mapping, and critical reflection on the synthesis process. Results demonstrate that advanced cancer patients who are younger, female, more educated, have longer duration of disease, and have previously used CAM are more likely to use CAM during this stage of illness. Key themes identified include patterns of and reasons for use; and barriers and facilitators to informed CAM decision-making. Knowledge regarding the use of CAM in advanced cancer remains in its nascent stages. Findings suggest a need for more research on understanding the dynamic process of CAM decision-making in the advanced cancer population from the patients’ perspective.

*For a PDF of the full article, click on the link to the left of this introduction.

This systematic review synthesizes knowledge about the use of complementary and alternative medicine (CAM) among advanced cancer patients. EBSCO and Ovid databases were searched using core concepts, including advanced cancer, CAM, integrative medicine, and decision-making. Articles included in the final review were analyzed using narrative synthesis methods, including thematic analysis, concept mapping, and critical reflection on the synthesis process. Results demonstrate that advanced cancer patients who are younger, female, more educated, have longer duration of disease, and have previously used CAM are more likely to use CAM during this stage of illness. Key themes identified include patterns of and reasons for use; and barriers and facilitators to informed CAM decision-making. Knowledge regarding the use of CAM in advanced cancer remains in its nascent stages. Findings suggest a need for more research on understanding the dynamic process of CAM decision-making in the advanced cancer population from the patients’ perspective.

*For a PDF of the full article, click on the link to the left of this introduction.

Cancer is the leading cause of disease-related death in children and adolescents. Pediatric patients with cancer suffer greatly at the end of life. However, palliative care interventions can reduce suffering and significantly improve the care of these patients and their families. A large percentage of pediatric deaths occur outside of the hospital setting where pediatric palliative resources may not be readily available. This review focuses on the principles of best practice in the provision of palliative care for children and adolescents with cancer.

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

Cancer is the leading cause of disease-related death in children and adolescents. Pediatric patients with cancer suffer greatly at the end of life. However, palliative care interventions can reduce suffering and significantly improve the care of these patients and their families. A large percentage of pediatric deaths occur outside of the hospital setting where pediatric palliative resources may not be readily available. This review focuses on the principles of best practice in the provision of palliative care for children and adolescents with cancer.

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

Cancer is the leading cause of disease-related death in children and adolescents. Pediatric patients with cancer suffer greatly at the end of life. However, palliative care interventions can reduce suffering and significantly improve the care of these patients and their families. A large percentage of pediatric deaths occur outside of the hospital setting where pediatric palliative resources may not be readily available. This review focuses on the principles of best practice in the provision of palliative care for children and adolescents with cancer.

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

The ATLAS trial¹
For decades, 5 years of tamoxifen has been the standard of care for the adjuvant therapy of women with estrogen receptor positive breast cancer, although in recent years for postmenopausal women this treatment has been largely replaced with aromatase inhibitors (AIs). Would extending tamoxifen therapy to 10 years provide further benefit or merely increase toxicity? Do the results of the ATLAS trial, in which nearly 13,000 women were recruited and randomized to receive 5 more years of tamoxifen or to stop tamoxifen at 5 years, provide us with a new standard of care for premenopausal women?

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

The ATLAS trial¹
For decades, 5 years of tamoxifen has been the standard of care for the adjuvant therapy of women with estrogen receptor positive breast cancer, although in recent years for postmenopausal women this treatment has been largely replaced with aromatase inhibitors (AIs). Would extending tamoxifen therapy to 10 years provide further benefit or merely increase toxicity? Do the results of the ATLAS trial, in which nearly 13,000 women were recruited and randomized to receive 5 more years of tamoxifen or to stop tamoxifen at 5 years, provide us with a new standard of care for premenopausal women?

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

The ATLAS trial¹
For decades, 5 years of tamoxifen has been the standard of care for the adjuvant therapy of women with estrogen receptor positive breast cancer, although in recent years for postmenopausal women this treatment has been largely replaced with aromatase inhibitors (AIs). Would extending tamoxifen therapy to 10 years provide further benefit or merely increase toxicity? Do the results of the ATLAS trial, in which nearly 13,000 women were recruited and randomized to receive 5 more years of tamoxifen or to stop tamoxifen at 5 years, provide us with a new standard of care for premenopausal women?

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

Rhabdomyosarcomas are a rare group of soft tissue neoplasms of mesenchymal origin. RMS is common among childhood cancers, but it is among the rarest of adult tumors. They account for about 5% of all childhood cancers.1 Soft-tissue sarcomas account for less than 1% of adult malignancies, and RMS account for only 3% of those sarcomas.2 Here, we report a case of RMS in the neck, which led to dysphagia due to external compression of the esophagus.

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

Rhabdomyosarcomas are a rare group of soft tissue neoplasms of mesenchymal origin. RMS is common among childhood cancers, but it is among the rarest of adult tumors. They account for about 5% of all childhood cancers.1 Soft-tissue sarcomas account for less than 1% of adult malignancies, and RMS account for only 3% of those sarcomas.2 Here, we report a case of RMS in the neck, which led to dysphagia due to external compression of the esophagus.

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

Rhabdomyosarcomas are a rare group of soft tissue neoplasms of mesenchymal origin. RMS is common among childhood cancers, but it is among the rarest of adult tumors. They account for about 5% of all childhood cancers.1 Soft-tissue sarcomas account for less than 1% of adult malignancies, and RMS account for only 3% of those sarcomas.2 Here, we report a case of RMS in the neck, which led to dysphagia due to external compression of the esophagus.

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

Since President Richard Nixon declared war on cancer more than 40 years ago, there have been significant increases in the number of people who survive cancer. Alongside advances in screening, detection, and diagnosis, the development of targeted anticancer agents has been a major contributory factor to this success. We highlight some of the key developments that have shaped oncological practice in recent decades and those that will likely have a significant impact in the near future.

*Click on the link to the left for a PDF of the full article.  
 

Since President Richard Nixon declared war on cancer more than 40 years ago, there have been significant increases in the number of people who survive cancer. Alongside advances in screening, detection, and diagnosis, the development of targeted anticancer agents has been a major contributory factor to this success. We highlight some of the key developments that have shaped oncological practice in recent decades and those that will likely have a significant impact in the near future.

*Click on the link to the left for a PDF of the full article.  
 

Since President Richard Nixon declared war on cancer more than 40 years ago, there have been significant increases in the number of people who survive cancer. Alongside advances in screening, detection, and diagnosis, the development of targeted anticancer agents has been a major contributory factor to this success. We highlight some of the key developments that have shaped oncological practice in recent decades and those that will likely have a significant impact in the near future.

*Click on the link to the left for a PDF of the full article.  
 

Patients with gastrointestinal stromal tumors (GIST) used to have a poor prognosis due to the very low response rate of these tumors to conventional chemotherapy and radiation therapy. However, following the introduction of imatinib as a targeted therapeutic agent with efficacy in GIST, survival outcomes have improved remarkably for patients in the advanced/metastatic and adjuvant settings. Imatinib is now approved for both indications and has become the standard of care for patients with GIST. Despite the mounting evidence demonstrating the clinical benefits of extending imatinib treatment beyond 1 year, the optimal duration of imatinib therapy has not yet been determined. Similarly, whether chronic or extended adjuvant imatinib therapy can further improve clinical outcomes in patients with GIST remains to be determined. In this review, we present recent findings from various clinical trials which indicate that prolonged, uninterrupted imatinib treatment can have durable clinical benefits in patients who underwent resection of primary, operable GIST, as well as patients with advanced, unresectable, or metastatic GIST. We also summarize data showing that treatment interruption can result in disease progression in both the adjuvant and advanced/metastatic settings. Finally, we present evidence from different trials that long-term imatinib therapy is feasible and safe (ie, without cumulative toxicities) in patients with GIST.

*Click on the link to the left for a PDF of the full article.   

Patients with gastrointestinal stromal tumors (GIST) used to have a poor prognosis due to the very low response rate of these tumors to conventional chemotherapy and radiation therapy. However, following the introduction of imatinib as a targeted therapeutic agent with efficacy in GIST, survival outcomes have improved remarkably for patients in the advanced/metastatic and adjuvant settings. Imatinib is now approved for both indications and has become the standard of care for patients with GIST. Despite the mounting evidence demonstrating the clinical benefits of extending imatinib treatment beyond 1 year, the optimal duration of imatinib therapy has not yet been determined. Similarly, whether chronic or extended adjuvant imatinib therapy can further improve clinical outcomes in patients with GIST remains to be determined. In this review, we present recent findings from various clinical trials which indicate that prolonged, uninterrupted imatinib treatment can have durable clinical benefits in patients who underwent resection of primary, operable GIST, as well as patients with advanced, unresectable, or metastatic GIST. We also summarize data showing that treatment interruption can result in disease progression in both the adjuvant and advanced/metastatic settings. Finally, we present evidence from different trials that long-term imatinib therapy is feasible and safe (ie, without cumulative toxicities) in patients with GIST.

*Click on the link to the left for a PDF of the full article.   

Patients with gastrointestinal stromal tumors (GIST) used to have a poor prognosis due to the very low response rate of these tumors to conventional chemotherapy and radiation therapy. However, following the introduction of imatinib as a targeted therapeutic agent with efficacy in GIST, survival outcomes have improved remarkably for patients in the advanced/metastatic and adjuvant settings. Imatinib is now approved for both indications and has become the standard of care for patients with GIST. Despite the mounting evidence demonstrating the clinical benefits of extending imatinib treatment beyond 1 year, the optimal duration of imatinib therapy has not yet been determined. Similarly, whether chronic or extended adjuvant imatinib therapy can further improve clinical outcomes in patients with GIST remains to be determined. In this review, we present recent findings from various clinical trials which indicate that prolonged, uninterrupted imatinib treatment can have durable clinical benefits in patients who underwent resection of primary, operable GIST, as well as patients with advanced, unresectable, or metastatic GIST. We also summarize data showing that treatment interruption can result in disease progression in both the adjuvant and advanced/metastatic settings. Finally, we present evidence from different trials that long-term imatinib therapy is feasible and safe (ie, without cumulative toxicities) in patients with GIST.

*Click on the link to the left for a PDF of the full article.