Podcasts about advanced cancer

Send us a textCancer staging is very important to guide treatment decisions and eligibility in studies. When an oncologist delivers a diagnosis it will include stage, but what does that mean? After an agonizing period of tests, waits for results, and finally an answer, many people go numb as soon as they hear the word "cancer" and fail to ask for clarification about terminology. Learn what you need to know to be an active participant in your care. Show Notes: https://bit.ly/41q519XIn this Episode:01:45 - Recipe: Alabama Lane Cake, featured in "To Kill a Mockingbird"03:13 - A Short Guide to a Happy Life by Anna Quindlen07:23 - What You Need to Know About Cancer Staging09:48 -  The Exceptions to Staging11:02 - Understanding Staging with a Stomach Cancer Example18:11 - Cancer Staging Sub-Categories20:44 - TNM Categories24:15 - Discussion - Thoughts About Stage 430:22 - A Letter Attributed to David Bowie, Who Died from Liver Cancer32:57 - OutroWhat is Cancer Staging?Our focus today is to help you understand the cancer staging system. The stage of disease measures if the cancer has spread, and how far is has spread from where it started.  Cancer staging is a way to communicate the extent of cancer in the body so that everyone involved is speaking the same language.Cancer Staging Example: Stomach CancerDr. Matzo used stomach cancer as a way to understand staging. Visit our show notes for an image and detailed explanations.Marianne also shared about cancer sub-categories, such as 1a, 2c, etc. This further refines the definition of how far the cancer has spread.Cancer Staging with TNM CategoriesThe Tumor-Node-Metastasis notation is an even more refined way to define the extent of cancer spread. TNM helps to establish the anatomic extent of the disease, and the combination of the 3 factors can define the overall tumor stage. This method allows for simplification, with cancers staged from I-IV, with stage IV being the most severe stage. Related Episodes:S5E45: Why Does Cancer Exist? Empower Yourself With UnderstandingS5E46: “Why Do I Have Cancer?” Kismet, Chastisement or Coincidence?S5E47: MythBusters – Cancer Edition; Clarifying Common Cancer Myths & MisconceptionsS5E48: How to Read a CT Scan Report – Learn the Sections Relevant to Your DiagnosisS5E49: Are there Miracle Cures for Cancer? With Dr. Jeanna FordS4E46: What You Need to Know about Stomach Cancer – Part 1S4E47: What You Need To Know About Stomach Cancer, Part 2Support the showGet show notes and resources at our website: every1dies.org. Facebook | Instagram | YouTube | mail@every1dies.org

Helping people with advanced cancer is facilitated by having them fill out symptom questionnaires for their medical team, who can then intervene promptly, a new study demonstrates. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, applauds the … Patients with advanced cancer can help in their own care, Elizabeth Tracey reports Read More »

Imagine you have advanced cancer and your doctor asks you to report your symptoms electronically, so that intervention is possible before things like pain or breathing difficulties become especially troublesome. Kimmel Cancer Center director William Nelson at Johns Hopkins describes … Is it helpful for people with advanced cancer to report their symptoms regularly? Elizabeth Tracey reports Read More »

This episode features Moyke Versluis (Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands Graduate school of Social and behavioral sciences, Tilburg University, Tilburg, The Netherlands).   What is already known about the topic? Patients who are aware of their limited prognosis are more likely to be actively involved in advance care planning. Many patients with advanced cancer are unaware of their limited prognosis.   What this paper adds? More patients with advanced cancer become aware of their limited prognosis during their last year of life. Some patients do not want to know their prognosis, and their wish to not know their prognosis is persistent during their last year of life.   Implications for practice, theory, or policy It is important for physicians to recognise that the patients' perception of prognosis may change as the disease progresses and to invite patients to discuss their needs and wishes regularly. Although some patients may prefer not to know their prognosis, it remains important to respectfully explore their preferences and wishes for end-of-life care.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241301220   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

In this inspiring episode, we sit down with Georges Cordoba, author of Beating the Odds: My Journey through Holistic Health to Overcome Advanced Cancer. Georges shares his incredible story of resilience, faith, and transformation. From his Catholic upbringing in Venezuela to battling advanced cancer with a holistic approach after enduring ten surgeries, Georges reveals how his faith and a change in perspective were pivotal in his recovery. Join us as we explore his remarkable journey and the lessons he learned about health, spirituality, and the human spirit.

Dr. Francisco Contreras, Director of Oasis of Hope Hospital, shares his insights on maintaining miracles in cancer care. His holistic philosophy prioritizes non-harmful therapies and the power of diet. Move beyond the traditional and embrace the compassionate approach demonstrated by Oasis of Hope, which is inspired by medical principles like "first, do no harm." He discusses his book, "The Art and Science of Undermining Cancer," and its intent to equip patients with the wisdom to make informed treatment choices.Discover how drugs like Abdevo have sparked hope and healing, even as we acknowledge the diverse responses and financial challenges linked with targeted therapies. The conversation covers things like dendritic cell-based immunotherapy and the strategic use of low-dose chemotherapy to enhance alternative treatments, offering an insightful perspective on how to tackle advanced cancers.In a world where mindset matters, the power of spiritual and emotional support in cancer treatment is undeniable. Experience the healing journey that intertwines faith and physical care, inspiring miraculous recoveries. Learn how the HealingStrong organization empowers individuals battling cancer to rejuvenate body and soul, fostering a community where hope and healing are within reach.Learn more about Oasis of Hope here:Oasis of HopeWill you be receiving treatment there? Oasis of Hope has offered a grant to our community, so please email us at help@healingstrong.org to receive information on the grant. HealingStrong's mission is to educate, equip and empower our group leaders and group participants through their journey with cancer or other chronic illnesses, and know there is HOPE. We bring this hope through educational materials, webinars, guest speakers, conferences, community small group support and more.Please consider supporting our mission by becoming a part of our Membership Program, as a monthly donor.When you do, you will receive additional resources such as: webinars, access to ALL our past and most recent conference videos, downloadables and more, as a bonus.To learn more, head to the HealingStrong Membership Program link below: Membership Program

Dr Austin Duffy, Director of the new Clinical Trial Unit at the Mater Hospital in Dublin discusses the scope of treatment open to patients with advanced cancer.

Dr. Shannon Westin and her guest, Dr. Patrick Stone, discuss the article, Methylphenidate Versus Placebo for Treating Fatigue in People with Advanced Cancer, a Randomized, Double-Blind, Multicenter Placebo-Controlled Trial, recently published in JCO. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we go in depth on manuscripts and research published in the Journal of Clinical Oncology. I am your host, Shannon Westin, Social Media Editor for JCO and a Gynecologic Oncologist by trade. I am thrilled today to present Methylphenidate Versus Placebo for Treating Fatigue in People with Advanced Cancer, a Randomized, Double-Blind, Multicenter Placebo-Controlled Trial. This manuscript is a dual publication in the Journal of Clinical Oncology and presentation at the European Association of Palliative Care Congress here on May 17, 2024.   And to review this incredible research with us will be Professor Patrick Stone, the Head of Department of Marie Curie Palliative Care Research Department, Division of Psychiatry at University College London. Welcome, Dr. Stone. Dr. Patrick Stone: Thank you very much. Thank you. Shannon Westin: Let's get right to it, we'll level set. Can you speak a bit about the definition of cancer-related fatigue and how common it is in people with advanced cancer? Dr. Patrick Stone: Sure. I think fatigue is a difficult thing to nail down really and define it clearly, and there are lots of definitions out there. In many ways, the simplest definition is the EAPC, the European Association of Palliative Care's definition of just a subjective sensation of weakness, feeling tired, and exhaustion. The reality is that that symptom is very common in the general population. And so if you really want to get a handle on it, I think a good way to do it is to think about taking an operational definition and say, “Look, if fatigue is normally distributed approximately in the general population, then we should consider severe fatigue or pathological fatigue could be defined as fatigue that is worse than 95% of the general population. And if you think that definition, then prevalence of fatigue in patients with newly diagnosed breast or prostate cancer, for instance, is around 15%, so three times as common as the most severe fatigue in the general population. If you come to patients with newly diagnosed non-small cell lung cancer, it's up to about 50%. And if you come to my area, which is palliative care and you go to a hospice and you ask people to complete a fatigue questionnaire, 78-80% of people complain of fatigue that is more severe than 95% of the general population. So that I think gives us a good handle on sort of the severity of this problem in cancer patients and how it progresses as disease progresses. Shannon Westin: I love this because I think we always struggle with exactly how to nail down the definition and exactly how to treat it. So I think that it's a really nice transition to existing treatment options for this issue and exactly how they might work. Dr. Patrick Stone: The first thing to say is in medicine if you can find a cause then you give a treatment directed at the cause and obviously that applies to fatigue as well. So the first thing is to do a thorough assessment of your patient, and if you can find an easily remediable cause such as anemia, hypocalcemia, or hypomagnesemia, or maybe other things like depression, which might manifest as fatigue, then you should try and give a treatment directed at that cause. But, for many patients, there won't be a single clearly identifiable cause you can target. And then people use more broad spectrum approaches if you like. The most well-studied I think is exercise. And exercise, there have been lots of randomized controlled trials in different types of exercise and it's a well attested treatment, which I think has good evidence of effectiveness, certainly in patients who are on treatment and in disease-free survivors. There is less evidence in advanced cancer because the trials are fewer. I would still say that there's moderate quality evidence that exercise is effective in advanced cancer.  The other group of treatments, broadly speaking, would be psychological therapies, cognitive behavioral therapy and psychoeducational approaches, mindfulness based stress reduction, that sort of thing. And again, in earlier stage disease and in patients on treatment and in survivors, there's more quality evidence that that sort of approach can help, if not alleviate fatigue, allow people to cope better with fatigue. But the evidence in advanced cancer is weaker than for exercise. So I think the evidence for the effectiveness of those psychological therapies is not so strong.  And then you come on to pharmacological therapies and there have been lots of trials of different agents. I won't list them all because most of them are negative and don't show any benefit. A few things which perhaps still show promise from previous trials, there have been, for instance, a few trials looking at ginseng as a herbal therapy. One very good quality trial showed benefit. Although another trial in advanced cancer didn't replicate that finding, so that ginseng is out there. Steroids, widely used in advanced cancer for general relief of many symptoms like fatigue, lack of energy, low moods, appetite. But although widely used, surprisingly little hard evidence or effectiveness, specifically for fatigue, but one relatively recent, well conducted randomized control trial, provides us with some firm evidence, also, that dexamethasone can help in the short term in advanced cancer patients. It obviously wouldn't be a recommended treatment longer term because of its side effects.   And then we really come on to the crux of this study which is probably the most widely studied single agent beyond that, is methylphenidate, which is a psychostimulant agent, raises central dopamine catecholamine levels in the brain. And there's probably a thousand or so randomized control trials sort of being conducted looking at that prior to prize of this study that we're talking about. Shannon Westin: I would love to hear a summary of the data that were pre-existing in this study. So how well does methylphenidate seem to work, or what were the conflicting results that were seen prior? Dr. Patrick Stone: I think the rationale for this study was that it was the perfect background to justify another randomized controlled trial, which there have been– Well, I can't remember exactly how many there were in existence before my trial started, but when I last looked, there were 10 studies, 10 randomized controlled trials in cancer patients. Most of those trials have been neutral. They've shown no benefit over placebo, so most of the individual trials are negative. But meta-analyses always tend to show a positive result. So when you count the trials together, it gets you over the finishing line and you can see a positive benefit. But individually, the trials were quite heterogeneous, they're quite different. There were only four trials prior to the publication of this one that were done specifically in advanced cancer patients. One of them was published only a couple of years ago while my study was going on. And of those four trials, three of those have also been neutral, not showing a benefit over placebo. One study involving 28 patients and using a PRN as required dosing schedule showed some benefit. But the other studies with a total of about 330 odd patients have been neutral.   Shannon Westin: I think that brings us to a great transition, just to talk a little bit about the design and objectives of your current study. Dr. Patrick Stone: Well, what we wanted to do was take the best bits, if you like, of the previous studies, and try to give ourselves the best chance of finding a clinically meaningful improvement in fatigue in patients with advanced cancer. And I was focusing on advanced cancer, principally because I'm a specialist in palliative medicine. That's the group of patients I'm most working with, whereas a lot of the studies have involved mixed groups of cancer patients or patient's disease-free or on treatment. But we looked at patients who were under the care of palliative care services, with incurable cancer, with a prognosis estimated to be less than a year or around a year.  We wanted to try to get the dose of the medication up to a good level because some of the other studies which have shown benefit have got up to quite high levels of methylphenidate, approximating to about 40 to 60 milligrams of methylphenidate a day or equivalent. And we wanted to give the drug in an individually titrated dose because that would reflect the way it is used in clinical practice. You would adjust the dose like you might with morphine for pain relief. You would expect to adjust the dose of this medication up to get a therapeutic benefit. So we had this titration period where we adjusted the dose of the drug every week. We reviewed whether patients were feeling better, worse, or the same. We asked about side effects. And on the basis of the response to those questions, we either went up with the drug or kept the dose the same, or, if necessary, would come down. The primary endpoint was designed to be fatigue after six weeks of dose titration, plus or minus a window of two weeks, accepting the fact that we might miss a few patients at the six-week mark, for whatever reason. So we had a little window around that. That's what we were looking to do.  Shannon Westin: And why did you choose the six-week time point? Dr. Patrick Stone: Well, there was no obvious time point to choose. One of the biggest positive studies previously was by Lower and colleagues back in 2009, and they had found their maximum benefit at around four weeks, or it took rather four weeks to reach the maximum benefit. So we wanted to give the patients in our trial every chance of demonstrating the benefit, and they'd also escalated the doses in their study up to above 40 milligrams or equivalent. And so we wanted to go up as high as we could, and we didn't feel that if we were adjusting the dose every week, that we could get up to a sufficiently high dose in any shorter time span. So six weeks sort of fitted, allowing us to titrate the dose up to a maximum of 60 milligrams a day, which is where we wanted to get up to. Shannon Westin: And what about a little bit more detail on the population you included, and maybe give us a sense of how well you think that represents your general population affected by fatigue in the setting of advanced cancer? Dr. Patrick Stone: We recruited patients from hospices, so that's inpatient palliative care units in the UK, but also from hospital palliative care services, from oncology outpatient services as well, oncology patients who are under the care of palliative care services, and we also recruited from some community palliative care services. So we had quite a good spread of settings, and all of our patients had advanced incurable cancer under the care of palliative care services. But I would say, I think by the nature of doing this randomized controlled trial, inevitably we ended up with quite a selected population, just because of the inclusion and the exclusion criteria that we had to apply. And the regulators were quite clear about who we shouldn't be putting on the drugs. And I think by the time you've excluded all the potential adverse consequences of using methylphenidate, we probably have ended up with a group of patients who were relatively fit compared to the general run-of-the-mill palliative care population, I would say. So I think that that is a limitation with regards to the generalizability of our result. Shannon Westin: How did you measure fatigue in this study? What was the mechanism for that objective? Dr. Patrick Stone: It's a subjective rating scale. We use a very well-established and well-validated measurement instrument. It's the Functional Assessment of Chronic Illness Therapy FACIT-F which is the fatigue subscale of their anemia subscale, which is a 13-item questionnaire, very well validated and widely used in lots of previous studies. Higher scores represent better quality of life and, therefore, lower levels of fatigue. So that's the scale that we used. Shannon Westin: Got it. So let's get to it. How well did methylphenidate work to impact fatigue compared to placebo? And were there any groups that seemed to have a bigger impact? Dr. Patrick Stone: Well, the bottom line, of course, is that at six weeks, plus or minus two weeks, there was no statistically significant benefit for methylphenidate over placebo. There was a two-point improvement in fatigue scores, but it wasn't statistically significant. And two points on the FACIT-F did not reach our predetermined five-point difference that we regarded as representing a minimally clinically important difference. We looked at lots of secondary fatigue endpoints. We measured fatigue every week over the whole course of the study. And actually, at weeks 2, 3, 4, 5, and 6, there was indeed a statistically, nominally statistically significant difference in fatigue scores. But I really would not want anybody to read anything over much into that finding because it was not a pre-stated hypothesis of our study. It wasn't a pre-stated endpoint, it was a secondary outcome. And moreover, even if this was regarded as a statistically significant finding, and as I say, it was only nominally statistically significant finding, the magnitude of the change was still not sufficiently large that I think it would want to influence your clinical decision making. With other groups just to say, we did look specifically at whether patients with the most severe fatigue would experience benefit over and above other patients, because in a previous study, that looked at modafinil, an agent that promotes vigilance, although the overall finding was neutral in a subgroup of patients with the most severe fatigue, modafinil seemed to work. So we thought we better check in this study whether patients with the most severe fatigue had a differential benefit. But we found no such effect. We found no difference in patients who were on or off treatment or indeed among the patients who scored highest with the depression subscale on the hospital anxiety and depression scale. None of these subgroups showed any benefit over placebo. Shannon Westin: How did patients tolerate methylphenidate? Was it tolerable? Dr. Patrick Stone: That was the thing I think that I was most relieved about. I am a cautious and anxious investigator, and the last thing I wanted to do was to put palliative care patients at risk by giving them a drug which might cause some harm. So I was very relieved when we analyzed the results to confirm that methylphenidate was very well tolerated. There was no real pattern of evidence for any increase in adverse effects over placebo. In fact, when we looked at just people who self-reported severe adverse effects, we found a higher rate in the placebo group than in the methylphenidate group in fact. And in terms of serious adverse events, there were 25 serious adverse events in both groups, so there was, again, no pattern that suggested methylphenidate was causing harm. So, yes, it was well tolerated, but did not result in a clinically important improvement in fatigue. Shannon Westin: Were you surprised by the results?  Dr. Patrick Stone: I honestly went into this with an open mind. I didn't come in with a real fixed agenda that I want to prove that this thing works. In fact, although methylphenidate was being used by some of my colleagues around the country and I know it's used by some colleagues internationally, personally I was not using it because I didn't feel the evidence was strong enough to justify using it. So I was waiting for the results of my own trial before making my decision. And I don't plan now to be using it on the basis of the results of the study. Shannon Westin: Sounds pretty definitive. It's always frustrating, and I know our patients, when we tell them to exercise when they're exhausted, they're like, “Are you kidding me?” Right? So it would be wonderful if there is like the perfect pill that we can give them. It's certainly disappointing. What do you think we should be exploring next for the resolution of fatigue in this patient population?  Dr. Patrick Stone: Well, I think one thing. Going back to your very first question to me about defining fatigue, I think one problem is we don't really have a mechanistic understanding of what we're talking about here necessarily with cancer related fatigue. And it's a bit of an umbrella term, I suspect, for a lot of different things, and may have a common endpoint in terms of the symptom. But maybe if we could better define, if you like, for want of a better word, the phenotype of fatigue, it may be that we could actually target a treatment in certain subgroups of patients that may be of more benefit. So maybe some greater basic science pinpointing what is causing fatigue, so that we can design the treatments, rather than just try repurposing existing drugs on the off chance that they work. And the other thing is okay, maybe we can't pinpoint a particular cause, we think it's multi factorial. If we think it's multifactorial, then perhaps we ought to be using a multimodal treatment approach and maybe it's actually exercise, psychological therapies, and diet, plus or minus a drug, and that's the approach if we can't pinpoint a specific cause. Shannon Westin: I love the idea of incorporating the  translational work to really try to understand the etiology better and then use something more targeted. It's that version of precision medicine but for palliative care as well. I really like that.   Well, this has been awesome. Thank you so much, Dr. Stone. I think that your insight is so much appreciated, and thank you for putting together this definitive work to help us treat our patients better every day. I really appreciate the time you took.  Dr. Patrick Stone: Thank you very much. Shannon Westin: You're so welcome.  And thank you to our listeners. This has been methylphenidate versus placebo for treating fatigue in people with advanced cancer, randomized, double-blind, multicenter, placebo-controlled clinical trial. And again, this is a dual publication in the JCO as well as a presentation at the European Association of Palliative Care Congress on 5/17/24. And we are so thrilled that you could join JCO After Hours and we hope you will check out our other offerings wherever you get your podcasts. Have an awesome day.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

What are some common signs that suggest a cancer patient may be developing delirium? In this episode, we explore the complex issue of delirium in advanced cancer patients. We discuss important considerations regarding medication management, the importance of distinguishing terminal from reversible delirium, and the role of antipsychotics and benzodiazepines in treatment. Faculty: Jaroslava Salman, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Depression, Anxiety, and Delirium in Patients With Cancer Management of Delirium in Patients With Cancer

Dr Timothy Cripe, Dr Joshua Palmer, and Kayla Young visit the studio as we explore proton therapy as a treatment for pediatric cancer. Discover how this technology delivers precise radiation with fewer side effects. We hope you can join us!

This episode features an interview with Carlos Doti, MD, Vice President, US Medical Affairs Oncology, AstraZeneca, about new breast cancer treatments.Dr. Doti is a hematologist by training and is passionate about developing treatments that have a real impact for people living with cancer across every aspect of their disease. Dr. Doti has worked in industry for the last 14 years, including seven years at AstraZeneca in various roles, and in small markets like Argentina as well as larger global markets. Since 2022, Dr. Doti has been focusing on the US market in hematology and oncology, working in breast, lung, GI and gynecological cancers among others.Dr. Doti has previously served in medical affairs roles at Novo Nordisk A/S and Pfizer. His work is supported by more than 70 congress presentations and several peer-reviewed publications. He has also served as an investigator in more than 25 clinical trials in hemostasis, onco-hematology and infectious disease.Recently, AstraZeneca won approval for the company's AKT inhibitor Truqap (capivasertib) in combination with Faslodex (fulvestrant) for the treatment of hormone receptor (HR)-positive, HER2-negative locally advanced or metastatic breast cancer with one or more biomarker alterations (PIK3CA, AKT1, or PTEN). The approval of Truqap was the first-in-class approval for AstraZeneca.Tune into the episode to hear more about the milestone approval of the new combination breast cancer treatment, which has been a much-needed treatment option for the nearly 50 percent of patients with advanced HR-positive breast cancer who have PIK3CA and AKT1 mutations or PTEN alterations, and experience resistance to first-line treatments such as endocrine therapies and CDK 4/6 inhibitors. For more life science and medical device content, visit the Xtalks Vitals homepage.Follow Us on Social MediaTwitter: @Xtalks Instagram: @Xtalks Facebook: https://www.facebook.com/Xtalks.Webinars/ LinkedIn: https://www.linkedin.com/company/xtalks-webconferences YouTube: https://www.youtube.com/c/XtalksWebinars/featured

Meet our guestsDon Wood was a caregiver for his late wife Sherry who battled Stage 4 metastatic colon cancer for 3 years. He also lost his only brother Ken to leukemia as a young adult. Don focuses his time now when not golfing or skiing working and volunteering his time primarily in cancer research for several provincial and national health care organizations including the Canadian Cancer Society. He recently co-authored “Co-Creation of a patient engagement strategy in cancer research funding” with the Canadian Cancer Society.Judit Takacs (she/her) is the senior manager for partnerships and engagement in research at the Canadian Cancer Society. She was the staff lead in co-creating the patient engagement in research strategy and works to diversify voices in research and research funding. She holds a PhD from the University of British Columbia and a coffee from the local coffee shop – though the latter is not yet a formal degree.Dr. Michael S. Taccone is the proud Founder and CEO of Childhood Cancer Survivor Canada, Canada's first survivor-led organization which aims to unify and empower the growing childhood cancer survivor community through awareness, education, access to care and peer-support. By training, Michael is a senior resident of neurological surgery at the University of Ottawa and completed his PhD in the Surgeon-Scientist Training Program at the University of Toronto. Himself a survivor of childhood cancer, Michael merges his experiences as a patient advocate, cancer researcher and junior physician to influence policy, research and practice for children and young people living with and beyond cancer in Canada. As a patient partner and co-investigator, Michael contributes to several CIHR-funded AYA and childhood cancer national research programs, is an acting co-chair of the Integrated AfterCare Advisory Council with the Pediatric Oncology Group of Ontario, and informs strategic development and capacity building for patient-engagement initiatives at Sick Kids Hospital, the Canadian Cancer Society and Ontario Health.Suzanne Bays has been the caregiver for her father and husband, both of whom died from metastatic colon cancer. She spent 2019 as a Fellow at Harvard's Advanced Leadership Initiative, where her Capstone Project focused on improving the lives of those with Advanced Cancer. She continues this work with the Canadian Cancer Society as a Patient Advocate, helping create action-oriented strategies to impact the lives of those touched by cancer. She is a co-author of the articles “Co-Creation of a Patient Engagement Strategy in Cancer Research Funding” as well as “Supporting People and their Caregivers Living with Advanced Cancer: From Individual Experience to a National Interdisciplinary Program”. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit asperusual.substack.com

In this episode of the third Eye Awakening podcast, I'm so excited to have Lauren Meadowsweet on the show! Lauren Meadowsweet is currently healing herself from Advanced Stage 3 Cancer - without the medical system. Using a combination of diet, lifestyle, & spiritual practices, she has already overcome record-breaking pesticide toxicity, lyme disease, liver damage, & being housebound + bedridden. She is a Certified Nutritional Therapy Practitioner & specializes in the Gut and Psychology/ Physiology Syndrome Protocol - also referred to as GAPS. In this episode, Lauren and I chat about: -Lauren's diagnoses (yes, plural!) + her cancer journey-healing holistically, and without the medical system-GAPS: Gut and Psychology Syndrome-bodily autonomy-Quantum Leaping… and so much more! CONNECT WITH LAUREN ⁠Youtube⁠ ⁠Instagram.com⁠ ⁠Website ⁠ GET INTO THE COSMIC ORACLE WORLD! ⁠⁠FREE Weekly Tarot & Akashic Readings⁠⁠ ⁠⁠Create Your Own Spiritual Biz⁠⁠ ⁠⁠Galactic Gateway⁠⁠ ⁠Into the Akasha⁠ ⁠⁠The Avatar⁠⁠ Akashic Soul Mission Alignment Group Mentorship 90 powerful days together Weekly Multidimensional transmissions for inspiration, motivation and activation to clarify & align you to your Soul Mission Biweekly group calls for integration & support Includes a private Akashic Reading with Amy Starts January 2024  ⁠⁠Accelerated Ascension All Access Pass⁠⁠ GET IT ALL!!! ALL of my prerecorded programs and ALL of my LIVE programs for a whole year!! HUGE SAVINGS! A total value of $8800 at a fraction of the price (and the value will go up as I add new things all year long!!) A total of 16 programs (with more to come )!!! Includes: Into the Akasha Live Round 5!! and The Avatar: Group Mentorship!!! YOU GET: Into the Akasha Heart Star Creator Who TF Am I? Magic in the Dark Psychic Activation 5D Magic and Manifestation Timeline Shifting & Manifestation Mastery Understanding Entities The New Earth Lightcodes of Money & Wealth Oracle of Light AND Create Your Own Spiritual Biz Galactic Gateway Spirit Guides Workshop The Avatar all in 2024! ⁠Get in now!!⁠

In this episode of the third Eye Awakening podcast, I'm so excited to have Lauren Meadowsweet on the show! Lauren Meadowsweet is currently healing herself from Advanced Stage 3 Cancer - without the medical system. Using a combination of diet, lifestyle, & spiritual practices, she has already overcome record-breaking pesticide toxicity, lyme disease, liver damage, & being housebound + bedridden. She is a Certified Nutritional Therapy Practitioner & specializes in the Gut and Psychology/ Physiology Syndrome Protocol - also referred to as GAPS. In this episode, Lauren and I chat about: -Lauren's diagnoses (yes, plural!) + her cancer journey-healing holistically, and without the medical system-GAPS: Gut and Psychology Syndrome-bodily autonomy-Quantum Leaping… and so much more! CONNECT WITH LAUREN Youtube Instagram.com Website GET INTO THE COSMIC ORACLE WORLD! ⁠FREE Weekly Tarot & Akashic Readings⁠ ⁠Create Your Own Spiritual Biz⁠ ⁠Galactic Gateway⁠ Into the Akasha ⁠The Avatar⁠ Akashic Soul Mission Alignment Group Mentorship 90 powerful days together Weekly Multidimensional transmissions for inspiration, motivation and activation to clarify & align you to your Soul Mission Biweekly group calls for integration & support Includes a private Akashic Reading with Amy Starts January 2024 ⁠Accelerated Ascension All Access Pass⁠ GET IT ALL!!! ALL of my prerecorded programs and ALL of my LIVE programs for a whole year!! HUGE SAVINGS! A total value of $8800 at a fraction of the price (and the value will go up as I add new things all year long!!) A total of 16 programs (with more to come )!!! Includes: Into the Akasha Live Round 5!! and The Avatar: Group Mentorship!!! YOU GET: Into the Akasha Heart Star Creator Who TF Am I? Magic in the Dark Psychic Activation 5D Magic and Manifestation Timeline Shifting & Manifestation Mastery Understanding Entities The New Earth Lightcodes of Money & Wealth Oracle of Light AND Create Your Own Spiritual Biz Galactic Gateway Spirit Guides Workshop The Avatar all in 2024! Get in now!!

Connie Baker - co-creator of the Wong-Baker pain scale (the one with the faces) - has had her own journey with breast cancer and now her father's advanced cancer. Learn about her experience with palliative care and how people have a voice in their care.We also are rebroadcasting one of our very first episodes: "What is Palliative Care?" This is one of our most foundational podcasts - we discuss the concept of palliative care, how it integrates with medical care, and the differences between palliative care and hospice care. Please take a listen and see how this can help you in your life and those around you. Follow us on Facebook | Instagram | Email us at mail@every1dies.orgClick on this link to Rate and Review our podcast!

In this episode, host Shikha Jain, MD, speaks with Laura Petrillo, MD, about navigating patients through changes and goals in palliative care, understanding patients living with and surviving advanced cancer and more. •    Welcome to another exciting episode of Oncology Overdrive :58 •    About Petrillo 1:03 •    The interview 1:40 •    How did you find yourself in medicine, specifically in palliative care and geriatrics? 2:04 •    How has the evolution of cancer care and technology impacted the way you engage and deliver palliative care? 6:46 •    Jain and Petrillo on the effect changes in palliative care can have on patients. 12:47  •    How do you communicate the distinctions between palliative care and hospice care to patients and physicians? 17:19 •    Do you think that there are ways for people outside of palliative care can incorporate intentional communication with patients in their care? … When should you refer someone to palliative care? 23:45 •    Petrillo and Jain on advanced cancer survivorship and living with advanced cancer.  30:54 •    Jain and Reynolds on the progress made in this space and the road ahead. 29:43 •    If someone could only listen to the last two minutes of this episode, what would you want them to take away? 36:41 •    How to contact Petrillo 38:30 •    Thanks for listening 38:58 Laura Petrillo, MD, is a palliative care physician-investigator in the Division of Palliative Care and Geriatrics at MGH and an assistant professor of medicine at Harvard Medical School. We'd love to hear from you! Send your comments/questions to Dr. Jain at oncologyoverdrive@healio.com. Follow Healio on X, formerly known as Twitter, and LinkedIn: @HemOncToday and https://www.linkedin.com/company/hemonctoday/. Follow Dr. Jain on X, formerly known as Twitter: @ShikhaJainMD. Petrillo can be reached on X, formerly known as Twitter, @lpetrillz.  Disclosures:  Jain and Petrillo report no relevant financial disclosures.

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this Meaningful Conversations podcast, Dr. Richard Lee talks to Dr. Tara Sanft and Dr. Biren Saraiya about what people with advanced cancer should know, including the value of palliative and supportive care and ways to talk with their families and healthcare teams about their health care wishes. Meaningful Conversations is a Cancer.Net blog and podcast series that describes the important discussions people may need to have with their providers, caregivers, and loved ones during cancer and offers ways to help navigate these conversations. Dr. Lee is a Clinical Professor in the Departments of Supportive Care Medicine and Medical Oncology at City of Hope Comprehensive Cancer Center and serves as the Medical Director of the Integrative Medicine Program. He is also the 2023 Cancer.Net Associate Editor for Palliative Care. Dr. Sanft is a medical oncologist and Chief Patient Experience Officer at Smilow Cancer Hospital, the Medical Director of the Yale Survivorship Clinic, and Associate Professor of Medicine in Medical Oncology at Yale School of Medicine. Dr. Saraiya is a medical oncologist at Rutgers Cancer Institute and Associate Professor of Medicine in the Division of Medical Oncology, Solid Tumor Section at the Rutgers Robert Wood Johnson Medical School. Both Dr. Sanft and Dr. Biren are members of the 2023 Cancer.Net Advisory Panel for Palliative and Supportive Care. View disclosures for Dr. Lee, Dr. Sanft, and Dr. Saraiya at Cancer.Net. Dr. Lee: Hi, my name is Richard Lee. I'm a clinical professor here at City of Hope and also the Cherng Family Director's Chair for the Center for Integrative Oncology. I'm really happy to be here today and talking about the topic of advanced care planning. And I'll have Dr. Tara Sanft and also Dr. Biren Saraiya introduce themselves as well. Dr. Sanft: Thanks, Dr. Lee. I'm Tara Sanft. I'm a breast medical oncologist at Yale Cancer Center and Smilow Cancer Hospital in New Haven, Connecticut. I am board certified in medical oncology and hospice and palliative medicine. I do direct the survivorship clinic, which is an appropriate place for advanced care planning that we can touch on today. I'm really happy to be here. Dr. Saraiya: Hi, my name is Biren Saraiya. I'm a medical oncologist focused on GU medical oncology and also a board-certified palliative care physician. I'm at Rutgers Cancer Institute of New Jersey. My focus is on decision-making. My research interest in decision-making and end-of-life planning for patients with serious medical illnesses. And I do a lot of teaching on this topic at our medical school. And I'm also glad to be here, and I do not have any relevant financial disclosures. Dr. Lee: Thank you so much for both of you for being here. I should also add, I don't have any relevant financial or disclosures, conflicts of interest. Dr. Sanft: Thank you. I'd like to add that I do not either. Thanks for the reminder. Dr. Lee: Yes. Thank you both. And so this is a really important topic that we deal with when we see patients, especially those with more advanced cancer. Could you talk about when we say advanced cancer, what does that really mean? Dr. Saraiya: When I think of advanced cancer, it is either cancer that has come back, recurred, or that is no longer curable, no longer something that we can't completely get rid of. So many times, it is what we call stage four cancer. Each cancer is a bit different. So it's a general rule of thumb, but not necessarily intelligible for every single cancer. But that's what I mean when I say advanced cancers to my patients. Dr. Lee: How about yourself, Dr. Sanft? Do you use a similar concept, or is it a little bit different? Dr. Sanft: I agree with all that's been said. Advanced cancer typically involves the spread of the cancer to other sites outside of the primary site. And the strategy tends to be a chronic long-term management strategy rather than curative treatment, although not always. And as our science becomes more advanced and sophisticated, these terms can apply to people with all different tumor types and locations of involvement, and that's really exciting. But in general, advanced cancer is very serious and can often be life-threatening and needs to be dealt with always. Dr. Lee: And that leads into the next question, which is, if it's not possible to completely cure the cancer, does that mean there's no treatment available for these patients? Dr. Sanft: Absolutely not. Does it mean that there is no treatment? Even when anti-cancer treatment may not help the situation, there is treatment. And I think as palliative care professionals, in addition to being medical oncologists, treating symptoms and treating suffering that comes with symptoms from cancer is always on the table from the time of diagnosis through the balance of life. And when a diagnosis comes through that is life-threatening or advanced or stage four, it is very common to pursue anti-cancer treatment, sometimes many different types of treatment. And it's very rare that someone with a new diagnosis of advanced cancer would not qualify for any anti-cancer treatment. Dr. Lee: Thank you. And moving along with that same concept, Dr. Saraiya, could you talk about what are the kinds of treatment options available to patients with advanced cancer? And then could you comment a little bit what Dr. Sanft was talking about, which is also there's anti-cancer treatments, but then there's also these treatments that help with quality of life and symptoms. And can they be coordinated together? Are we choosing one or the other? Dr. Saraiya: That's a great question. The way I think about this is I always want to focus on what's important for the person in front of me, what's important for the patient. And so even when there is no cure for the cancer, it is certainly treatable. And as Dr. Sanft pointed out, we have many treatments, many types of treatments. So they are delivered by someone like me or Dr. Sanft who are medical oncologists, but also by our colleagues in radiation and surgery and our colleagues in palliative medicine. So it depends on what the symptoms are; we can discuss how to best address it. And sometimes it requires radiation, short course of radiation. Sometimes that's the most effective thing. Sometimes it requires medicines that are by mouth or chemotherapy that are intravenous or by mouth or immunotherapy or different kinds of newer agents that we are using these days. So they can be delivered under the care of a medical oncologist. We can also have sometimes something that's very painful, and the surgeon can remove it. And that is also just as good of an option. So what we choose to do depends on what the objective is, what we are trying to accomplish. And to me, at any point in time I see a patient, every single person I meet with, my goal is how do I help them live better? What's important for the quality of life? And many times is what I do as a medical oncologist, many times it's just listening to them and talking to them and providing support, either myself or my staff or social work. And many times, it's my colleagues in palliative medicine who are helping me care for their symptoms such as pain, other symptoms that I may have a hard time addressing by myself. And so we call on their help when we can't address it. Dr. Lee: We've touched upon the topic of palliative care and supportive care, that terminology. And I'm wondering if you could expand on that so we have a common understanding. And how is that different than hospice care? Dr. Saraiya: This is how I explain to my patients and my students, which is to say, when I went to medicine and I asked my students this question, how many times do we actually cure cancer or cure anything, forget cancer, just anything? And the fact is that most times we don't cure many diseases. So things like high blood pressure, diabetes, high cholesterol, heart disease, liver disease. We don't cure things outside cancer as well. But what we do is we help patients live long and well for long periods of time. We focus on quality of life. And in essence, we are providing palliative care. So I define palliative care anything that helps patients live better or live well. Sometimes we can cure things as well. So many cancers are curable. But let's say you have extensive surgery for a cure of the cancer, but you have pain from the surgery. We certainly help give you pain medicines. That's palliative care. And so for me, palliative care is anything that we do to help alleviate patient's symptoms. It can be delivered by the surgeon who prescribes pain medicine postop, by radiation doctor, who helps with palliative radiation, by medical oncologists like myself and Dr. Sanft, who give medicines for nausea, vomiting, or other symptoms that either the treatments or the cancer itself is causing. When we need help of our colleagues who specialize in this is specialized palliative care. And some just call it supportive care. It's just a naming terminology. As long as we are helping patients live better, any intervention we make to me is palliative and supportive care. At a time when we agree, both patients and we agree that look, our focus is just on comfort. We are not going to focus on cancer anymore. And we're going to focus on just quality of life. That can be dealt with palliative care and hospice care. Hospice care is a very specific defined insurance benefit that requires certain certification. And that's the difference. So palliative is something required from day one, I meet a patient. It doesn't matter what they have until the end of their life. And sometimes even after that, caring for their loved ones after the patient has died is also palliation. Hospice care is a very small piece of that when we are just focused on end-of-life care. Dr. Lee: I appreciate that understanding. And I think it's a great point that you make that anyone can be providing palliative and supportive care. It doesn't take necessarily specialists, but different types of oncologists and other clinicians can be providing in addition to specialists. And Dr. Sanft, could you talk a little bit about this concept about after kind of after a patient may pass through hospice? Dr. Saraiya was mentioning about emotional and spiritual support. How can we help patients find that kind of support from diagnosis through the whole journey? Dr. Sanft: Yeah. I really think of palliative care as taking care of the whole patient. So not just treating the disease, but really addressing the emotional, spiritual, and other physical aspects that cancer and its treatment can impact on a human being that's undergoing this. And then, of course, the entire family unit. So the importance of addressing all of these aspects has been shown in so many different ways. And getting palliative care involved early can really impact how that individual does with their disease course. But it can also provide the structures around that spiritual and emotional health for the patient and their family from diagnosis throughout. And as Dr. Saraiya mentioned, when the time gets short and the end-of-life time is near, palliative care and hospice care in particular can really provide a lot of that bereavement support or that anticipation of loss. And then, of course, all the grief that comes after the loss. Dr. Lee: And could you expand a little bit in terms of if patients are starting to feel some emotional spiritual needs, how do they find help? Or what should they be doing in terms of connecting with their clinical team to get that type of support? Dr. Sanft: I would like to say first that I think part of it is on the medical team ourselves to ask patients. Our culture in general is not one that often openly discusses emotions. So what I teach the medical students is, for every visit, how are you doing with all of this emotionally? And that is a very open-ended question that patients can reflect on and share what they're comfortable sharing with their providers. Now, not all of us who are practicing learned these techniques when we were going through medical school. So your doctor and medical team might not automatically ask about your emotional health. So it is within a patient's right to say, "I would like to discuss with you how this is impacting me emotionally. Could I share that with you?" And really, I think most healthcare professionals come into this profession to help. And this is a very rewarding conversation to understand how this is impacting you and your family emotionally and then trying to get the support that is needed. Most cancer teams have social workers that are highly trained in assessing and counseling and helping patients get triaged into the help that they need, whether it be a support group or a psychologist or a psychiatrist or all of the above. Usually, social workers are embedded in many cancer teams. And if it's not a social worker, it may be another trained professional who can deal with this. But certainly, the medical team is the place to start and to really raise emotional health and spiritual health issues, even though we might not routinely be asking at every visit. Dr. Lee: Great points. And as we think about the journey and we talked a little bit about hospice care and kind of the end phases, sometimes patients fear losing their capacity or ability to really think clearly and maybe even make their own decisions. How can patients in these situations who are concerned about making their wishes known, how can they make sure that's communicated if there is a situation, maybe temporary, maybe longer lasting, which they have trouble with making medical decisions on their own? Dr. Saraiya? Dr. Saraiya: So I think, hopefully, all adults, all of us, have sort of thought about what-if scenarios in our lives, right? I think the thing I tell my patients that maybe there are three or four people in the room, and it's entirely possible, I'm not the one here tomorrow morning because accidents happen. And we certainly have seen that in our daily lives that suddenly things happen. So hopefully, every adult has thought about it. I always prompt my patients to tell me what they have thoughts about, what thoughts they have had. And I ensure that they have some sort of documentation. This is what we call advanced care planning documentation. Sometimes it's a living will, healthcare proxy. Different states might have different documentation. And many of them may have had it as part of their normal will or their sort of lawyers have drawn it up. I always ask them to sort of just tell me or discuss with me what they have written down. If they have not, I encourage them to have that conversation with their loved one. And there are two points. One, at least have had that thought, and the second, have the conversation. At no point in time do I want my patients' family, their loved ones, whether it's a spouse, whether it's a child, to have to answer the question, "What do you want for your loved one?" It's always about, "What will your loved one want for themselves?" And so that is my responsibility to facilitate the conversation to make sure that the patient and the family has had that discussion. Once they've had it, document it, whether it's an advanced care planning or many states like my state of New Jersey have specific forms for-- it's called Physician Orders For Life-Sustaining Therapies [POLST]. So especially in a setting with advanced care and we know we had the conversation. We can't cure this. It's about their quality of life, how they want to live. And patients have the absolute right to tell us and guide our decisions in what kind of treatments are acceptable and not acceptable. And that can only happen if you had the conversation. We have discussed things that are important for them. Are they okay being in a situation where they are not able to communicate? And whatever the what-if scenarios are for themselves, let's help figure those things out and make sure that we value their opinion, their autonomy at every single point by completing this advanced care planning documentation, and more importantly, having the conversation with loved ones so they can ask the question, what would your loved one want in the situation? Dr. Lee: Those are really good points. And I imagine a lot of individuals, a lot of patients, may not have had that conversation. And so what suggestions do you have for patients who are maybe newly diagnosed? They're just totally surprised by the diagnosis. Unfortunately, it may be, in some cases, it's advanced. Dr. Sanft, how would you suggest patients discuss this topic with their family and friends? Are there certain types of questions to be thinking about or certain topics? Dr. Sanft: Oftentimes, in the midst of a new diagnosis, the whirlwind of having that upside-down feeling is so strong that it's very difficult to then think out into the future. However, once the treatment plan is in place, that tends to be a time where things could sort of be evaluated and the horizon might seem a little bit more stable. And I think most patients are willing to admit that the gravity and the seriousness of the situation that's facing them, yet it's very difficult to really reflect on what might happen in the future or what you might want. I think it's really important from a patient perspective to think, "What are your most important priorities?" And that could be a good framework to start to think about if you aren't able to do these priorities, then what else would you want? So if being able to walk around your yard and enjoy the garden is a very high priority, even identifying that and understanding that can give you some framework, or talking about that with your loved one can give you some framework down the line if that becomes an impossibility. If interacting and talking with your children or your grandchildren is one of the highest priorities, if that ever became impaired, then how would that influence what you would want? So again, it doesn't have to be yes/no questions that you're answering, but it can really be an understanding of what brings you joy, what are the most important parts of your life, and if those were threatened, then how would you reevaluate the quality of your life? Dr. Lee: I think that's a good way of framing the priorities and thinking through that with your loved ones. And for Dr. Saraiya, next after they've had some of these discussions, what should they be asking you and Dr. Sanft as the healthcare providers and helping to guide along these important conversations around advanced care planning? Dr. Saraiya: I will answer that question, but I just want to sort of highlight what Dr. Sanft said is so important, which is really prioritizing and framing. And I think framing is so important. And to sort of put some of the other things Dr. Sanft talked about, the emotional and spiritual support, when someone walks into our office, many times they're really scared. And I take this opportunity to really sort of ask them important questions like, "What are your worries?" Which allows for them to emote a bit about what their worries are. And sometimes it's uncomfortable, right, because they're crying. They're worried about death and dying and what it means for the family. It's hard for the family. It makes a lot of us uncomfortable. But I think it's also very important. So I do take the opportunity early in my interaction with patients just to allow them to emote and just to process their worries. And sometimes I'm acknowledging their worries. Sometimes I'm telling them that those worries are maybe not reasonable, right? Sometimes people say, "Well, I'm going to die next month." And they know that's not the expectation. So they have worries that may be unreasonable. So I can help talk and address specific worries at that point in time. So we do have to-- and again, this is why we have a team. Many times, patients are not comfortable talking to me about some of their worries, but they are much more apt to talk to my social worker or my nurse or my infusion nurse where they spend hours at times. And they will tell them things that they may not tell me. They will talk about some of the side effects that they have that they won't tell me because they worry. This is my hypothesis and what the research shows. They worry that because I hold that key to that chemotherapy or that key to that treatment, that if this is something that I may not like, I might hold it. And so patients have this natural tendency to not tell me absolutely everything. That's why we have a team. We gather all the information to make sure that we sort of make the right decisions. Sometimes we do have to help patients and families facilitate their conversations to make sure that we address their worries, their fears, their emotions. And it can be done, as I said before, just by us as the primary oncology team or our palliative care team or our social workers or nurses. All of us provide a different role for each patient. And in some patient cases, it is me, and some patients sometimes it's my nurse or sometimes it's my infusion nurse, or sometimes my social worker. And sometimes I do need the help of my palliative care and hospice colleagues. Dr. Lee: And, Dr. Saraiya, coming back in terms of just guiding patients, are there certain questions you wish your patients might ask you in terms of helping to kind of navigate these difficult conversations? Dr. Saraiya: I think many patients have this one question, that they have a hard time asking, which is, what's the treatment goal? And many times, we talk about is this something that's treatable. And the answer is yes. That was one of the first questions we're asked. Is it treatable? But many times patients have a question is it curable? And if the answer is no, then what does that mean? Or even if the answer is yes. What does that mean? I think most of us in our lives think about what-if scenarios, but it's really hard to ask those questions. So what I advise and sometimes I facilitate this, but I encourage if you're listening to this, you're a patient, ask your oncologist, "Well, what does this actually mean for me?" And if you have those questions, ask them, "What if this happens? This is my worry. Can I just tell you what my worries are and address them?" And with the worries, also come my hopes. Here's what I'm hoping for. How can I get there? How can you help me get there? And as Dr. Sanft sort of talked about before, if I have a situation where someone tells me, "This is my hope”, but I can't do it, it's not likely, I will tell them. But I will also tell them what we can accomplish, what we can do. And so I think having that honest conversation and patients and families can talk amongst themselves, but also with us as clinical teams to just make sure that we, at all points in time, address and put them and their needs in the center of focus. Dr. Lee: Great questions. And Dr. Sanft, do you have any other questions you wish your patients would ask you in terms of helping to guide these challenging conversations? Dr. Sanft: It's helpful for patients to come at questions about what to expect directly with us. I think it's most helpful when patients say, "Here's the deal. I'm feeling fine right now, and I want to keep going as long as I feel fine. And I want you to offer me every line of treatment until I don't feel like it's going to be worth it anymore. And we can continue to talk about that. And we'll do this together. I will let you know when I'm ready." And that allows me to say, "Okay. I appreciate what you're saying, and I agree with this plan, and we're on the same page. And when I see signs that things aren't going well, I will tell you." And it sort of sets these expectations upfront that we are all on the same page. We all want the same things. And we commit to each other, "You're going to tell me when this gets too hard, and I'm going to tell you when I think that this isn't helping anymore." And so it allows for this open dialogue to continue throughout. Dr. Lee: Well, this has been a great conversation, and learned a lot and think about priorities. And I think you make a very good point. This is an ongoing discussion. It's not a single discussion you have, and then it's done. It's really an ongoing process through the whole journey. Do either of you have anything else to add in terms of helping patients who are addressing advanced care planning? Dr. Saraiya: My biggest ask or sort of consideration is all of us, as Dr. Sanft said in the beginning, all of us came into this to really sort of help. And that is still our primary goal. And good communication really facilitates that. And we have, as a medical team, have to sort of do, as Dr. Sanft pointed out, sort of explore a bit more and really address the concerns. At the same time, you also have to develop a language that we can all understand, both understand, patients and doctors. And I think that's the key work. And I think it's so important to have that partnership with our patients and our families to make sure that we are doing the attentive care that they deserve and they need. So I think having an honest conversation. One thing I always reflect on is for my patients, they may start in the beginning saying what's most important for me is-- and we are in Jersey so going to the casino on the weekends in Atlantic City. And that's the most important thing for me. But there comes a time when they say, "No, I've changed my mind. Most important thing is having the Friday night dinner with my family." And a few months later, maybe, “I've changed my mind. You know what's really important? If I can just sit in the patio on my rocking chair and enjoy that. Can you help me make those things happen?” I think having those conversations, being aware that we can change our minds, I think is absolutely fine. It's encouraged. And I think that's what we expect. Dr. Lee: Dr. Sanft? Dr. Sanft: Oh, I love that. I think I love that. I'm so glad that you brought that up. And the only thing I would add to that is if there are things that you know in your heart you absolutely would not want, telling it to someone, your partner, your family, your decision-makers, and your medical team will really help make sure that that does not come to fruition. So it can be scary to voice those things, but most of us have an idea of what we would never want to have happen. And saying that out loud and making sure that someone close to you, ideally, also your medical team, but certainly someone who's close to you understands what that line is. That can help decisions that need to be made in difficult times make sure that they honor, that they know that that was not what you ever wanted to have, and we can help make sure that that doesn't happen. Dr. Lee: Well, I want to thank both Dr. Saraiya and Dr. Sanft. This has been fantastic. I learned a lot myself in terms of communication and addressing advanced care planning. And I hope all of you listening also were able to learn some pearls of wisdom from both of them. I think your patients are very lucky to have both of you. Feel free to look at Cancer.Net if there's more questions and a lot of information around advanced cancer and treatments and advanced care planning and having these discussions. So thank you both again. And stay tuned for more podcasts on these important topics. ASCO: Thank you, Dr. Lee, Dr. Sanft, and Dr. Saraiya. Find more podcasts and blog posts in the Meaningful Conversations series at www.cancer.net/meaningfulconversations. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

Georges is a stage IV melanoma with metastasis in the brain cancer survivor. He fought the disease for ten years and had ten surgeries. Pharmaceuticals nearly destroyed his body, so he took the natural holistic route to heal himself, and here he is. This July 12th, was his eleventh year, free of cancer. This experience has radically changed his life! And it became his mission and passion to share his story and inspire and help others to do the same. In 2017, Georges shifted careers from being a Chief Technology Officer to a Holistic Transformational Health coach, Functional Nutritionist, Professional Speaker, Reiki Teacher, and best-selling for the book Beating the Odds, about his holistic journey to conquer advanced cancer. "I see my advanced cancer experience as a blessing because surviving it gave me a chance to sing the song I was born to sing... which is Helping People Transform Their Health and Vitality." He is completing his Rapid Transformation Therapist diploma to add value to his clients. ✨Highlights from the show:  [00:02:09] Holistic journey to conquer cancer. [00:07:02] Malignant melanoma and its treatment. [00:11:05] 10-years of surgeries. [00:16:14] Cancer is not hereditary. [00:19:42] Disease starts from emotional clutter. [00:21:44] Digestion and eating habits. [00:26:01] Scars and decision to stop. [00:40:31] Overcoming self-imposed stress. [00:47:37] Overcoming skepticism and doubts. [00:53:50] Rapid healing and transformation.

 Why do I need two different medications for cancer pain? We explain their different roles and how using them as prescribed can improve your quality of life. In this Episode: 01:18 - Pumpkin Spice Muffins02:14 - Angel's Share and Devil's Cut05:26 - A Swan Song - History of the Phrase13:08 - Managing Breakthough Cancer Pain24:24 -  Ask the Ethicist: "I'm Dying of Cancer. Do I have to Tell Anyone?" Follow us on Facebook | Instagram | Email us at mail@every1dies.orgClick on this link to Rate and Review our podcast!

This episode features Caitlin Spooner (Marie Curie Palliative Care Research Department, University College London, London, UK).  What is already known about the topic? - Currently, there is no gold standard for evaluating how different methods of prognosticating in advanced cancer impact on patient care. - Prognostic models are principally evaluated by their statistical performance, determining their discrimination and calibration. However, before any prognostic model can be recommended for use in clinical practice, it is necessary to demonstrate whether or not it has a beneficial impact on patient care. - There is a lack of consensus among stakeholders about how to assess the impact of prognostication in advanced cancer, with prognostic studies varying in the outcomes they select.  What this paper adds? - We identified a wide variety of outcomes and measures used in published studies, which makes inter-study comparability problematic. - Our findings highlight the widespread effect that prognostication in advanced cancer has on patients and informal caregivers. - The lived experiences of patients and informal caregivers regarding prognostication in advanced cancer are not always represented in the outcomes quantitative prognostic studies measure.  Implications for practice, theory, or policy - Further research is needed to identify and prioritise outcomes to measure the impact of prognostication in advanced cancer. - Patients' and informal caregivers' experiences and perspectives should always be incorporated when evaluating the impact of prognostication. - Outcome selection in prognostication studies needs to be more consistent and standardised.  Full paper available from:    https://journals.sagepub.com/doi/full/10.1177/02692163231191148  If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

AP correspondent Jackie Quinn reports on Biden Cancer Research.

Welcome to Integrative Cancer Solutions with Dr. Karlfeldt, where we delve into the world of holistic health practices for managing stress and overcoming advanced cancer. In this powerful episode, we have an exclusive interview with Georges Cordoba, a true warrior who triumphed over stage four melanoma. Prepare to be inspired as Georges takes us on his emotional roller coaster journey, from the initial denial of his diagnosis to his ultimate shift in mindset. With five young children relying on him, Georges transformed his battle with cancer into a fierce opponent to defeat, drawing strength from his athletic background. But this episode goes beyond Georges' personal story. It delves into the importance of seeking integrative and holistic approaches to cancer treatment. Georges firmly believes that traditional therapies are just the tip of the iceberg, and there are additional solutions waiting to be explored. Our aim is to provide hope and inspire you to take charge of your own cancer journey. Join us as we discuss the root causes of cancer, the power of forgiveness and healing from within, and the transformative impact of spirituality. Discover the importance of visualization and positive thinking, as well as the healing power of service and giving back. We explore the significance of taking action on intentions and making lifestyle changes, from dietary shifts to connecting with nature. Learn how self-reflection, self-care, and maintaining a positive attitude can pave the way to healing. We'll also uncover the role of complementary therapies, proper digestion, and good sleep in achieving overall well-being. Don't miss out on this episode packed with insights and practical advice. Tune in to Integrative Cancer Solutions with Dr. Karlfeldt and embark on a journey to holistic health practices for managing stress and overcoming advanced cancer. Visit our website for more information on our center's offerings, and stay tuned for our upcoming live consultation with another cancer patient, discussing integrative cancer solutions. Together, let's explore the limitless possibilities of healing and hope. - Georges battle with stage four melanoma- Importance of integrative and holistic approaches- Addressing the root cause of cancer- Power of spirituality in healing- Personal journey of overcoming advanced cancer- Power of visualization and positive thinking- Healing through giving back and serving others- Taking action on intentions and making lifestyle changes- Importance of self-care emotionally, mentally, and spiritually- Maintaining a positive attitude and complementary therapies- Importance of good sleep and digestion- Connection between chakras and energy- Managing stress and sensual eating- Georges book and available consultations- Disclaimer and invitation to visit host's websiteIntegrative Cancer Solutions was created to instill hope and empowerment. Other people have been where you are right now and have already done the research for you. Listen to their stories and journeys and apply what they learned to achieve similar outcomes as they have, cancer remission and an even more fullness of life than before the diagnosis. Guests will discuss what therapies, supplements, and practitioners they relied on to beat cancer. Once diagnosed, time is of the essence. This podcast will dramatically reduce your learning curve as you search for your own solution to cancer. For more information about products and services discussed in this podcast, please visit www.integrativecancersolutions.com. To learn more about the cutting-edge integrative cancer therapies Dr. Karlfeldt offer at his center, please visit www.TheKarlfeldtCenter.com.

Margaret Rosenzweig, PhD, CRNP-C, AOCNP, FAAN, spoke with CancerNetwork® about findings from the CONNECT study (NCT02712229), a study she authored that aimed to assess the benefit of palliative care intervention in patients with advanced cancer. Rosenzweig, the distinguished service professor of nursing and a professor of medicine at the Hillman Cancer Center Acute & Tertiary Care, University of Pittsburgh, described the potential benefits of more frequently involving oncology nurses in discussions on advanced care planning, and helping patients make decisions on what treatment options best suit them. She also addressed some of the logistical challenges, including provider shortages and implementing training for infusion room nurses. Don't forget to subscribe to the “Oncology On-The-Go” podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

Commentary by Dr. Valentin Fuster

What are the racial inequities in access to opioids among older patients dying of cancer? Find out this and more in today's PVRoundup podcast.

This episode focuses on making treatment decisions when you or your loved one has been diagnosed with an advanced cancer. There are a lot of issues that a person has to navigate - financial concerns, legal documents, communicating with the care team, and the emotions that come with caring for a loved one with an advanced cancer diagnosis. With us today is hospice and palliative medicine physician Dr. BJ Miller.

This episode focuses on making treatment decisions when you or your loved one has been diagnosed with an advanced cancer. There are a lot of issues that a person has to navigate - financial concerns, legal documents, communicating with the care team, and the emotions that come with caring for a loved one with an advanced cancer diagnosis. With us today is hospice and palliative medicine physician Dr. BJ Miller.

Dr. Patrick Vickers is a chiropractor by training and founder of the Advanced Gerson Therapy Clinic in Rosarito, Mexico. The Gerson Therapy is one of the most heavily censored cancer treatments in the world. A therapy based in nutrition, it challenges many core assumptions of conventional medicine. Cheryl received treatment at Dr. Vickers clinic in 2016 and followed the Gerson protocol for a long time after. She encorporates many Gerson principles into her healing journey to this day. Dr. Vickers would like to offer free access to six informational videos listed privately on his website. Go to www.gersonclinic.com and enter the password “podcast” to watch! You can learn more about The Gerson Clinic at gersonclinic.com Gerson Reading List: 1. Death Be Not Proud by John Gunther 2. A Cancer Therapy: Results of Fifty Cases and the Cure of Advanced Cancer by Diet Therapy by Max Gerson 3. Film: Dying to Have Known directed by Steve Kroschel

Dr. Andrew Hertler, chief medical officer at New Century Health, discusses what healthcare organizations can do to catch up on patients' missed cancer screenings. He also shares new developments in oncology that could see patients receiving treatment at home or doing virtual follow-up care.   Also in this episode, HFMA's Katie Gilfillan talks about the upcoming Annual Conference in Denver.   Mentioned in this episode: Telehealth opportunities in oncology, and Stever Robbins shares the secret to tackling email overload Hospital-at-home promises to reshape care delivery in the United States Have hospital-at-home programs finally come of age? Practices grapple with an aging oncology workforce  

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. Greg Guthrie: Hi, everyone. I'm Greg Guthrie, and I'm a member of the Cancer.Net content team, and I'll be your host for today's Cancer.Net podcast. Cancer.Net is the patient information website of ASCO, the American Society of Clinical Oncology. Today, we're going to be talking about the ASCO provisional clinical opinion, “Somatic Genomic Testing in Patients With Metastatic or Advanced Cancer.” Our guests today are the co-chairs of the team that wrote these recommendations. Dr. Funda Meric-Bernstam from the University of Texas MD Anderson Cancer Center in Houston, Texas. Thank you for joining us today, Dr. Meric-Bernstam. Dr. Meric-Bernstam: Thank you for having us. Greg Guthrie: And our second guest today is Dr. Mark Robson from Memorial Sloan Kettering Cancer Center in New York City. Dr. Robson, thank you for joining us today, too. Dr. Robson: Thank you for having me. Greg Guthrie: So before we begin, I should mention that Dr. Meric-Bernstam does not have any relationships to disclose related to this podcast. Dr. Robson has led clinical trials in PARP inhibitors but has not received any personal compensation for this research. Full disclosures for this podcast can be found on Cancer.Net. So, Dr. Robson, let's begin by discussing what a provisional clinical opinion is and why they are important. Dr. Robson: So there are times when there are sea changes or incredibly important changes taking place in oncology practice. And sometimes these are clinical trial data, and sometimes they are more global. And this is a situation where it's one of those global challenges. And what ASCO does in situations like this is pull together a group of experts to provide guidance for the membership through a process of discussion and informal consensus rather than necessarily direct evaluation of clinical studies. And this is important because it allows the membership to benefit from these expert opinions. Greg Guthrie: Now, Dr. Meric-Bernstam, this provisional clinical opinion discusses somatic genomic testing in metastatic or advanced cancer. What is somatic genetic testing, and how is it used in cancer treatment? Dr. Meric-Bernstam: Oh, thank you. This is a really exciting time in the last decade. We have a lot more tools to understand cancer biology. And cancer is a genomically-driven phenomena, where there's alterations in the DNA, in the tumor, that confers the cancer cells a competitive growth and survival advantage. And only 10 years ago, we had the capability of doing this 1 gene at a time, to sequence a gene to see what is different, but now we have technologies where we can look at several hundred genes at a time. We are referring to these as multigene panels. And we're talking about genomic testing or somatic genomic testing. These are tests that look at several hundred genes, either looking at the tumor sequence alone or looking at the tumor sequence and comparing it to the normal sequence so we can see what has differed in the tumor that may give it a competitive advantage. We're doing this to be able to identify if there are genes that are altered that are therapeutically actionable. What we mean by that is, is there an alteration that we think confers the cancer cell an advantage for which we have a drug that either directly or indirectly we can use to help inhibit the cancer cell growth or preferably cause the cancer cell death? Greg Guthrie: Great. And so how is somatic testing different from germline testing? Dr. Robson: So somatic testing is testing the DNA or the nucleic acids, if you will, in the tumor itself, and germline testing is testing the DNA in normal tissue. And so the DNA in the normal tissue is what people are born with, and of course, most of the DNA in the tumor is the same as what people were born with. But there are specific changes that develop as the cancer arises, and it's those specific changes that are called somatic alterations. Dr. Meric-Bernstam: This is actually a really interesting point though because some tests report out germline alterations as well because only the tumor is sequenced, while some tests report the tumor, only subtracting what was in the germline. Thus, unless the germline result is specifically reported, a patient that has a known germline alteration may be surprised to see that it's not in the tumor report. And on the flip side, a tumor-only test may find a germline alteration, and thus it's important that physicians and patients are aware of that. That needs to be further pursued with the genetic testing. Greg Guthrie: Wow, just a wealth of information coming from this testing now. Sometimes I hear the term next-generation sequencing mentioned in regard to cancer. Does this provisional clinical opinion also touch on that? Dr. Meric-Bernstam: Yes. When we are referring to genomic testing panels or multigene panels, we are talking about the next-generation sequencing technology that has the ability now to use a small amount of tumor to be able to report out the sequence of several hundred genes. We have, of course, broader panels also coming, such as whole exome sequencing, whole genomic sequencing. Although, majority of our provisional clinical opinion is talking about the use of these in several hundred gene panels. Greg Guthrie: Amazing. Alright. Dr. Meric-Bernstam, so what should people with cancer and their loved ones know about this opinion? Dr. Meric-Bernstam: This has been a really complicated time because the introduction of next-generation sequencing made genomic testing available, but to be fair, not widely available initially. Only more recently is it more broadly available, and there's been some confusion about which patients with which diseases should get or can get genomic testing or would benefit from genomic testing. So we wanted to frame this by first highlighting that if a patient has a metastatic or advanced cellular tumor type and there is a genomic biomarker that is linked to a therapy approved for a regulatory agency, or they have a tumor type where there's a drug that's approved but there's a known genomic resistance marker, these are scenarios where we feel patients should get genomic testing. Now, the more complicated area, a little more controversial, has been scenarios where the patient has a disease that is not one of those diseases that has a disease-specific approval for a drug. And in that scenario, we believe there's still value in genomic testing for several reasons. There's been several new drug approvals for what we call tumor-agnostic drugs. That means if you have an alteration that gives you sensitivity to immunotherapy because you have what we call microsatellite instability, and some next-generation sequencing panels can report that out, then, regardless of your tumor type, you may be able to get offered immunotherapy. If you have multiple mutations in your tumor, something we call the increased tumor mutation burden, that is now linked to immunotherapy approval. So irrespective of tumor type, if a patient is eligible for immunotherapy, they benefit from getting genomic testing. And then on top of that, we now are seeing more and more that patients may have a genomic alteration that we think is a compelling target. But they may have it-- they may have it in a disease where that drug was not approved. And we're now starting to see that in many clinical trials. We're seeing activity by targeting those alterations. So there may be additional opportunities, especially for clinical trial enrollment, by identifying these potentially actionable alterations in other diseases. So taking this together, we believe multigene testing will provide both additional approved indications and clinical trial indications. And in addition, fusion testing can identify TRK fusions, a fusion type that's found commonly in some uncommon cancers and uncommonly in some common cancers. But when it's found, it is a very compelling target. So again, because patients would be eligible for TRK inhibitors, irrespective of their tumor type, that's another scenario where next-generation sequencing may be beneficial for patients with advanced and metastatic disease, irrespective of tumor type. Greg Guthrie: Wow, that's just an amazing overview right there. And one question that occurs to me is, is all of this genetic testing done from a biopsy sample? Or are there other ways a patient may experience this testing? Dr. Meric-Bernstam: The traditional tumor-based testing is usually done either from a surgical sample or a biopsy sample. And again, it could be tumor-only testing or tumor plus a normal. Usually, normal would be something like blood as a comparator. However, there are times where a patient doesn't have a tumor accessible for a biopsy. In that scenario, there is now the opportunity to look at circulating free DNA to do panel testing on circulating free DNA for some of the more common actionable alterations. So there's a lot of momentum in using that approach, and this is what we often refer to as a liquid biopsy. And the liquid biopsy strategy is also very interesting because it's another way to pick up what changes of the tumor with treatment as well. So there's a lot of research going into using liquid biopsies when the patient also progresses on targeted therapy to see what has changed and how we need to change our therapy to address the tumor's evolution. Greg Guthrie: Wow. Thanks for that, Dr. Meric-Bernstam. Dr. Robson, what are the emerging ways that genetic testing may be used to help people with cancer? Dr. Robson: I think there are many, many ways. I was reflecting on this question, and I think it's important to kind of separate, as we did earlier, what we mean by genetic testing, again, because I think there's a lot of confusion. And there's certainly a lot of work going on in terms of testing of inherited DNA, so germline testing, to identify risks for cancer and potentially therapeutic targets. And that's not something that was discussed in this particular opinion, but it is an important way that genetics is being used to help people. On the side of the folks who already have cancer, the application of genetic technologies, as Dr. Meric-Bernstam said earlier, is identifying more and more targets. In other words, more and more alterations that are driving the cancers and for which we can test new drugs and hopefully achieve successes in a much more focused and less toxic way. And that work is going on at an exponential pace, and indeed, perhaps most of the new drugs that are entering the development pathway right now are indeed targeted therapies, not conventional broad-spectrum chemotherapies. The genetic technologies are also being used as, again, Dr. Meric-Bernstam said, to look at DNA from the tumors that are circulating in the bloodstream. And one way is the liquid biopsy, which is for characterization. But another way that's coming online is just simply to look for the presence or absence of circulating DNA in people who are, for instance, post-op and don't have any evidence of disease to see whether or not they might, in fact, have some cancer that hasn't been detected by imaging. And then the hope is that we could then intervene earlier in that setting and perhaps prevent those circulating DNA from representing true metastasis, detectable metastasis. And again, a lot of work going on there. And there's a diagnostic and prognostic component to what's happening as well. There are, unfortunately, a number of people who present with metastatic cancer, and it's not obvious at all where that started. And work is being done now to use testing of the tumor DNA to help categorize the tumors, to direct the correct therapies, instead of just doing something generic and empiric. And there are many, many other ways that genetic technologies are being applied. It's really 1 of the 2 big frontiers in cancer therapy right now. The other one, of course, being immunotherapy. But it is an exciting time, and I think it's just going to continue to grow as the technologies become more and more innovative. Greg Guthrie: That's really exciting. And thank you for sharing all of that perspective. I really wonder if helping with this somatic testing can help increase enrollment in clinical trials, too, to advance progress in other rare cancers? Dr. Robson: I think it did, not necessarily just in rare cancers. I mean, people are— Greg Guthrie: Agreed. Dr. Robson: —certainly doing testing in common diseases and identifying these new targets. And you're exactly right. The only way we're going to be able to develop new therapies in that setting is through clinical trials. And so, for the appropriate people, genetic testing or testing of the tumor or somatic testing could very well identify clinical trial opportunities for them, and that's the way we're going to move forward. Greg Guthrie: Outstanding. And again, I really love this distinction between somatic and germline testing and clarifying that for our listeners today. Dr. Meric-Bernstam and Dr. Robson, thanks so much for your time today and for sharing your expertise on these ASCO recommendations. It's been great having you and chatting with you today. Dr. Robson: Thanks. Dr. Meric-Bernstam: Thank you for having us. Greg Guthrie: And for our listeners, if you'd like to learn more about genetics, genetic testing, and cancer, visit www.cancer.net/genetics. Thanks so much for joining us today, and be well. ASCO: If this podcast was useful, please take a minute to subscribe, rate, and review the show wherever you listen to podcasts. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

An interview with Dr. Funda Meric-Bernstam and Dr. Amber Johnson from the University of Texas MD Anderson Cancer Center in Houston, Texas, and Dr. Mark Robson and Dr. Debyani Chakravarty from Memorial Sloan Kettering Cancer Center in New York, New York, authors on “Somatic Genomic Testing in Patients with Metastatic or Advanced Cancer: ASCO Provisional Clinical Opinion.” They discuss the key statements of the provisional clinical opinion, including the topics: multigene panel-based genomic sequencing with disease-specific approved markers, assessment of mismatch repair deficiency and/or microsatellite instability-high status and tumor mutational burden, testing for gene fusions and exon skipping variants, decision making for panel tests with no approved disease-specific markers, and elements to consider while reviewing genomic testing results. Read the full PCO at www.asco.org/assays-and-predictive-markers-guidelines.

When a cancer patient has a serious diagnosis, clinicians and families can struggle with how patients experience hope. Three distinguished palliative care physicians and researchers joined the podcast for a conversation about their recent paper in JAMA titled, “Holding Hope for Patients with Serious Illness” (https://jamanetwork.com/journals/jama/article-abstract/2784454). Drs. Abby Rosenberg, Robert Arnold, and Yael Schenker shared their own experiences treating seriously ill patients and talked about how we can navigate the tension between appreciating the potential therapeutic benefit of hope and being concerned about perceived unrealistic hopes: “Rather than being concerned that hope is either so fragile that it can be lost, or so powerful that it can overwhelm decision making, clinicians should remember that hope is protective, if not necessary, for managing serious illness. Holding complex, flexible, and diverse hopes enables patients to believe in the unlikely while simultaneously accepting the inevitable. The role of clinicians is to support both.” Abby Rosenberg, MD, MS, MA, is a pediatric oncologist and palliative care physician and researcher at the University of Washington, where she directs the pediatrics component of the Cambia Palliative Care Center, and Seattle Children's Research Institute, where she directs the Palliative Care and Resilience Lab. She has an American Cancer Society Research Scholar Grant to study “Resilience Outcomes Among Adolescents and Young Adults with Advanced Cancer.” Robert M. Arnold, MD, is a palliative care physician, Distinguished Professor of Medicine, and Chief of the Palliative Care Section at the University of Pittsburgh. He previously served as a member of the American Cancer Society's palliative care peer review committee. Yael Schenker, MD, MAS, is a palliative care physician, Professor of Medicine, and Director of the Palliative Research Center (PaRC) at the University of Pittsburgh. She is a past recipient of American Cancer Society research funding, which supported her study of “Primary Palliative Care for Patients with Advanced Hematologic Malignancies.” 3:27 - The therapeutic benefit of hope and why it's helpful to patients and caregivers 5:12 – Why clinicians sometimes feel the need to “correct” a patient's hope 8:56 – How physicians can address the tension of appreciating the potential therapeutic value of hope but being concerned about perceived unrealistic hopes 10:50 – On how physicians can help patients diversify and increase their hopes 6:24 – How they became interested in this topic and decided to explore this topic in a broader way 17:35 – Advice they would share with someone in medical school who might someday treat patients with a poor prognosis 19:03 – A message for caregivers of a patient with a terminal illness

Barbara Powers, DVM, DACVP, worked as a pathologist and researcher in cancer and radiation pathology at Colorado State University before becoming Director of CSU's Veterinary Diagnostic Laboratories. At CSU, she and her colleagues validated an ELISA for Chronic Wasting Disease (CWD) in cervids and established one of the country's largest CWD testing centers. During the more than 30-year stint at CSU, she was also president of Colorado Veterinary Medical Association from 2003-2004 and president of the American Association of Veterinary Laboratory Diagnosticians (AAVLD) from 2006-2007.  Barbara E. Kitchell, DVM, PhD, DACVIM, graduated from Purdue University School of Veterinary Medicine in 1979.  Dr. Kitchell completed an internship at the University of Minnesota, then residencies in Small Animal Medicine and Oncology at UC Davis from 1981-1985. She received her PhD (emphasis in Cancer Biology) from the Department of Comparative Pathology at UC Davis in 1994.  She is the Director of Residency Training Programs for VCA, as well as staff oncologist at Vet Care. Kitchell is an ACVIM Diplomate in the specialties of Internal Medicine and Oncology. She is past president of the Veterinary Cancer Society and Past Chair of the Board of Regents of the American College of Veterinary Internal Medicine.  

Welcome back to the VTE Dublin Podcast where you'll find all the recent talks from the VTE Dublin Conference. Be sure to subscribe to the VTE Dublin Podcast Video: Audio:  

The Oncology Journal Club - Delivering Oncology News DifferentlyThe Oncology Podcast, brought to you by Oncology News Australia, is proud to present Episode 46 in our series The Oncology Journal Club.This week Eva Segelov talks us through an early detection test using an independent validation set. Craig Underhill looks at systematic barriers to participation in cancer treatment trials by Aboriginal and Torres Strait Islander cancer patients.Hans Prenen is still MIA this episode but he'll be back soon. In the meantime, Eva also has a great selection of Quick Bites including a paper on COVID and burnout - which is a great moment to mention that in the coming weeks we'll have a new series out on Mindful Leadership and strategies to address Burnout with Fran Boyle. So keep your ears out for that one!Don't miss this week's Amazing Article of the Week… you'll never look at a subway sandwich in the same way.We wrap up with a fabulous interview with Belinda Kiley on cancer survival rates. As ever, you'll find links to all the papers, bios and twitter handles in the notes on our website.With the usual top quality banter, papers you won't hear of anywhere else and expert analysis from our Hosts, you are in for another great episode of The Oncology Journal Club!Full bios and the list of all papers discussed are available on our website.For the latest oncology news visit www.oncologynews.com.au and for regular oncology updates for healthcare professionals, subscribe for free to get the weekly The Oncology Newsletter.The Oncology Podcast - An Australian Oncology Perspective

[include file=get-in-itunes.html]If you have cancer or even advanced cancer, I would encourage you to listen to this interview and/or pass it on to you people you know. Dr. John Apsley has been doing amazing work in the field of cancer research for over 30 years. His 4 pillar approach to healing cancer is not only cutting edge but groundbreaking and unique yet simple and fundamental at the same time. After you listen, comment below and tell us what you think! We discuss the following and so much more: Why drinking structured water is critical The importance of detoxification at a cellular level How to increase the proteins inside the cell Why pancreatic enzymes used to work better for cancer than they do now The role of minerals and cancer And much more! Dr. John Apsley uses a 4 pillar approach to heal advanced cancers... - Click to tweet this! - Get Notified:[ois skin="Show Page2"] - Please Subscribe: Subscribe To Our Radio Show For Updates! - Other Shows:[include file=show-links.html] | All Shows With This Guest - Show Date:11/5/2012 - Show Guest:Dr. John Apsley - Guest Info:Dr. Apsley is a physician and researcher specializing in cellular regeneration (healing advanced illnesses) and accelerated wound repair for the past 30 years. Dr. Apsley holds degrees in medicine – MD(E)*, chiropractic – DC, and nutrition – BS. Board certifications included: Acupuncture and Meridian Therapy, Spinal Disability Evaluator (CSDE), and Insurance Claims Reviewer (IRC). He is also aqualified instructor of Electrodermal Scanning as well as Darkfield Microscopy. Read More... - Topic:Advanced cancer - Guest Website(s): http://www.drapsley.com (Guest Social Links Below. Please Follow Them!) Facebook https://www.facebook.com/john.apsley.5 Twitter N/A Youtube N/A - Guest Product(s):Click Below To Checkout The Products While Listening! :) - Items Mentioned: Find A Spring - Connect:Discuss This Episode With Others - Duration/Size:01:00:20 / 57.96 MB - Rate: Rate This Guest! - Rate This Show:[ratings] - Download:Right Click To Download - Donate: (Opens in a new window - Every bit helps us to keep delivering even better shows that help you heal & thrive!) - Support & Share :) Copy and paste the following HTML code into any web page. Or you can grab a badge! Interview with Dr. John Apsley on healing advanced cancers - Video Version:Full Youtube Interview (Opens in a new window) Youtube Time - Follow Us!:Please consider ReTweeting the following update to share this episode...Dr. John Apsley teaches us how to heal from advanced cancer naturally with a 4 pillar approach.extremehealthradio.com/31— Extreme Health Radio (@ehrshow) November 6, 2012 - Watch a very helpful video [video_lightbox_youtube video_id=kNTs_YgKivw width=640 height=480 anchor=tutorial] for this page. - Subscribe to iTunes or Leave a Review Subscribe to iTunes podcast Click Here to Subscribe via RSS (non-iTunes feed) Leave a review Thank you so much for your support, and if you have yet to leave a rating or review, please leave me an honest one on iTunes by clicking here. It will help the show and its ranking in iTunes immensely! I appreciate it! - Podcast Transcript: Coming soon. Thanks for your patience!

Full show notes @ https://thesternmethod.com/mark-simon/ Mark Simon, CN, CHCC, CPBN Mark Simon established the Nutritional Oncology Research Institute (NORI) in 2011 as an organization focused on advancing cancer care through optimization of diet and application of targeted nutraceuticals. Mark Simon's background and interests are in diverse fields including clinical nutrition, biomedical engineering, plant-based nutrition, naturopathic medicine and neuroscience. ***Resources Mentioned*** Nutritional Oncology Research Institute  Cancer Schmancer Can Dietary Methionine Restriction Increase the Effectiveness of Chemotherapy in Treatment of Advanced Cancer? NORI PROTOCOL - methionine video by Dr. Mark Gregor Fruit, The Lymphatic System & Cancer: Dr. Robert Morse Book: Fit for Life by Harvey Diamond Scientific papers on Methionine, Sodium Selenite, Vit E, Melatonin AntibioticWatchdog Nutritional Oncology Research Institute - Cbd, Hemp CBD, Hemp NORI CBD - Cbd, Cbd, Alternative Health Products, Cbd Oil Nutritional Oncology Research Institute - Home Pure Organic Super-Greens Powder Algae Omega-3 Oil, 400 mg DHA per ml  https://norinutraceuticals.com/shop/ols/products/selenium Zinc Chelate, 15 mg, 90 tablets  Vitamin D3, 2,000 IU, 360 tablets Iodine, 1.8 mg/drop Sublingual Vitamin B12, 500 micrograms Methylcobalamin, 120 Tablets 1 oz. Organic Broccoli and Radish Sprout Powder (High Sulforaphane Content) Vitamin E Delta, Gamma Tocotrienols, Annatto Derived (DeltaGold), 60 ml, 21,000 mg  Melatonin, 50 mg, 360 Tablets  Glucosamine HCl Powder, 8 oz., 227 grams Sodium Selenite, 2 mg, 180 Slow Release Tablets   *Use code STERN at checkout to receive a discount     The Stern Method Website - What We Use: Top Anti-Cancer Supplements Essential Oils We Use Including Our Targeted Blends Cancer Fighting Tools for Detox and Cancer Fighting My Kid Cures Cancer Anti-Cancer, Non-Toxic, Healthy Lifestyle Products We Use           *** In This Episode: Our guest today, Mark Simon, talks about how eating a low methionine diet can lead to better health and cancer cell death (apoptosis).  In this episode, Mark and Ryan discuss the benefits of a plant-based diet which is high in fruits and berries, moderate in vegetables and void of animal products. Through his work at the Nutritional Oncology Research Institute, Mark has developed the NORI protocol, based on the two core concepts of restricting methionine intake and using high doses of sodium selenite (selenium salts) and other targeted nutraceuticals to reduce tumor cell growth. In-vivo studies and clinical experience affirm the effectiveness of this type of diet. The concept of using pro-oxidants versus anti-oxidants is discussed as is the mechanism of sodium selenite and the relationship between methionine and cancer. This conversation may challenge the way you currently view your nutritional protocol. We encourage you to keep an open mind. Be prepared to stretch your current point of view and perhaps gain some new insight and ideas. Please enjoy this next installment of the Anti-cancer Revolution! Be sure to let us know what you think below.   0:41 Fruit or no fruit – That is the million dollar question Mark promotes a methionine restricted diet - high fruit, moderate vegetables, no animal products Utilizes Vitamin E, tocotrienol, selenium, iodine 2:30 Overview of the NORI protocol Based on two core ideas -  methionine restricted diet &  high dose selenium (sodium selenite) Mark started the diet based on personal experience after his wife was diagnosed with stage 3 breast cancer Diet plays a huge role as a tool in cancer prevention Sodium selenite is a form of selenium studied for over 40 years Is a selective chemo-therapeutic agent Can kill cancer cells without causing harm to other cells High bio-availability Can be administered intravenously or orally 6:00 Relationship between methionine and cancer cells Mark discover the work of Dr. Daniel E. Epner, MD - clinical studies using methionine restricted diet Video by Dr. Mark Gregor on Mark’s website describing methionine and what it does Methionine is an amino acid If methionine is restricted, cancer cells die Could potentially work as stand-alone therapy 8:30 How do you reduce methionine in the body and what is the end goal? Through the diet methionine levels can be brought quite low All whole foods contain some level of methionine Fruits contain the least amount of methionine Grains, nuts, beans, seeds, animal products contain the most Best to cycle methionine levels on and off In the future hope is to be able to bring methionine levels to zero 10:05 What do cancer cells do with methionine? Cancer cells use methionine as a building block  Methionine is not needed for normal cell growth- not an essential amino acid MTOR pathway is stimulated less with methionine restriction Methionine restriction makes cancer cells more sensitive to treatment NORI diet is a platform to slow down tumor growth and make cancer more sensitive to treatment 13:50 What are your thoughts on eating fruit? Fruit is not the same thing as table sugar Most fruits are low glycemic Fruitarian diet does not cause high blood sugar 80-10-10 diet (80% fruit, 10% protein, 10% fat) Sugar does not encourage tumor growth, insulin does Ketogenic diet doesn’t work long term because glutamine is not cut out of diet 18:00 NORI diet restricts other cancer-dependent amino acids besides methionine Glutamine Phenylalanine Isoleucine Tryptophan Asparagine 18:30 NORI diet is an alkaline diet Alkaline diet helps neutralize acidity around tumors Anti-inflammatory Anti-angiogenesis Dr. Robert Morse recommends a similar program 20:05 Where do you stand on juicing fruit? Is there a difference between eating fruit and vegetables with or without fiber? A little bit of freshly squeezed citrus juice is fine Bottled juices - no Believes juicing is counter-productive More antioxidants flooding the system makes it harder to fight cancer Hasn’t seen data showing success with juicing and stage 4 cancer Plant based diet is a good idea Cancers are crazier today than years ago Gerson’s original diet involved orange juice and lower protein (lower methionine) Juicing probably doesn’t get phytochemicals up to appropriate levels 23:45 Can you elaborate on antioxidants and cancer? Study with animals on low-antioxidant diet slowed tumor progression Normal cells operate on a low level of oxidative stress Cancer cells operate at a high level of oxidative stress because of altered metabolism Adding oxidative stress will push cancer cells over the edge Cancer cells are dependent on anti-oxidant systems like: Glutathione Thioredoxin Catalyse Superoxide dismutase If you block glutathione synthesis, cancer cells die off Putting anti-oxidants into the system aids cancer survival such as: Vitamin E (alpha-tocopherol form) Vitamin C NAC (N-Acetyl Cysteine) Vitamin A NORI program is careful not to incorporate juicing or other antioxidant supplements NORI program utilizes pro-oxidants which increase oxidative stress Sodium selenite Generates hydrogen peroxide Generates ROS (reactive oxygen species) Triggers cell apoptosis 28:30 What are your thoughts on using antioxidants to increase chemotherapy and drug success? Oncologists tell patients no antioxidant supplements because they know they will interfere with treatment Antioxidants protect cancer cells Mark hasn’t seen any research showing antioxidants make chemo work better Research shows pro-oxidant therapy helps chemo work better  Sodium selenite Ozone therapy Sulforaphane (need 10-20 grams or more) - not too efficient 32:30 Can you give us a breakdown of the different levels of methionine within food groups? Foods highest in methionine: Chicken and fish Next: other animal products- beef, dairy, eggs Mark has been vegan for 30 years (supplements with B12 occasionally) Caution: B-12 can be used by cancer cells for protein synthesis Soy, sesame seeds, and brazil nuts are high in methionine Lowest: apple, most fruits  Dark green veggies are fairly high Hard part is getting enough calories on a low methionine diet Potatoes and rice work to bring up weight 38:40 Cycling on and off low-methionine foods Encourage fruit-only breakfast (easily digested, full of enzymes, fiber, water, cleansing, detoxifying, extends a fast) Book: Harvey Diamond, Fit for Life  Food combining Methionine restriction is anti-aging Ketosis is not necessarily a healthy state -  not natural/normal  Not a proponent of fasting for cancer patients - too stressful Recommends a fruit-only diet instead of fasting Super-charge your system by eating raw, high-energy, plant-based foods 44:30 What is the distinction between nutraceuticals and supplements? Use supplements to fill in gaps Recommends supplementing with iodine, selenium, vitamin D, zinc, B12 Nutraceuticals can be used to lower inflammation Sodium selenite is used as an anticancer nutraceutical  Vitamin E delta tocotrienol- high dose kills cancer cells Glucosamine alters cancer cells High-dose zinc is effective in killing cancer cells Melatonin effective in fighting cancer (300 mg)  Curcumin - plant derived medicine - not very bioavailable Medicines work because of toxic effects on system/system modulation 50:20 How did selenium and tocotrienols stand out to you?   High index of therapeutic value High bioavailability Water solubility ADME Absorption, Distribution, Metabolism and Excretion - nutraceuticals are analyzed according to this standard Sodium selenite has reached animal and human clinical studies (in-vivo) Methionine restriction is being used in ongoing human clinical studies   55:20 What is the mechanism of action of sodium selenite?   Selective pro-oxidant Study which shows it inhibits glutamine metabolism Natural high uptake into tumor tissue Radioactive sodium selenite (SE-75) was used in the 1960s to highlight cancer cells on imaging tests Relatively small amount of sodium selenite (10-20 mg) is typically needed at therapeutic threshold levels 9 hour half-life Cells need to be exposed 24 to 72 hours or more - the longer the better Lower doses can be sustained for longer periods of time .3 mg/kg of body weight is dosage for IV sodium selenite IVs are used for pulsing in addition to oral dosage IVs can become cost-prohibitive   1:01:30  Hazards of buying sodium selenite online   Can be risky - might be over a toxic dose or too weak Mark sells some on his website Might not be pharmaceutical dose Signs of overdose Hair loss Brittle nails Use under supervision   1:03:00  Is this an extract of selenium versus a whole compound?    Sodium selenite is a mineral salt - inorganic form of selenium- trace mineral Chemical formula Na 2 Se0 3 Body needs it all the time Organic forms vary in the level of anti-cancer activity 100% water soluble- easily crosses blood-brain barrier Vitamin E used is extracted from annatto seed - delta tocotrienol Pro-oxidant  Looks and behaves like unsaturated fatty acid Initiates lipid peroxidase chain reaction Ends up in mitochondrial membrane Interacts with and generates more ROS Triggers cancer cells to die - apoptosis Mitochondria are dysfunctional in cancer cells Breaks the positive feedback loop of the mitochondria so cells can die   1:09:39  You mentioned DHA. Where do you get yours?   Mark uses an algae oil Studies show DHA can be used therapeutically in cancer (6g/day) DHA will become incorporated into the cancer cell membranes and will undergo lipid peroxidase reactions Algae oil is unstable and oxidizes easily  Antioxidants are added to maintain stability and this can be enough to interfere with NORI protocol   1:11:20  Budwig diet - similarities and differences   Fruit, berries, no animal products Cottage cheese and flax oil mixture Flax contains ALA, a polyunsaturated fat Studies show ALA can trigger cancer cells to die Flaxseed oil must be freshly pressed (15-30g) Cottage cheese/quark works as an emulsifying agent to break up the oil for bioavailability Theoretically based on the science, it should work Not in favor of it right now because there are better methods Tocotrienol does the same thing only with more efficiency   1:15:30 Lithium Chloride   Still under study Has a favorable effect on cancer pathways Used as treatment booster Studies with lithium chloride used in conjunction with 5FU in animals   1:17:07 NORI protocol is currently using 6 agents   3 core agents make up the cytotoxic cocktail Vit E tocotrienol (1200mg), sodium selenite, Vit K3 3 other agents working around the cocktail Glucosamine (8g), zinc citrate (150mg), melatonin (300mg) Used in conjunction with methionine-restricted diet Protocol is continually evolving based on clinical experience Simple, low-cost   1:19:10 Where can we find you?   https://antibioticwatchdog.com/ Website covering relationship between antibiotics and cancer Free ebook https://norinutraceuticals.com/ (store)  https://noricbd.com/ https://nutritionaloncology.net/ Info on program and protocol Mailing list CBD products and nutraceuticals - Use code STERN Free consultations (30-60 min)   1:22:00 Closing remarks   Please check out the podcast links and the links on our website (“What We Use” section). Your patronage is greatly appreciated and helps keep the lights on.  For more info about fruit in the diet and to view our most popular video, see Ryan’s podcast with Dr. Robert Morse. Link Below. Use your intuition and try different options if a current protocol is not working. There are many paths to wellness. Future podcast idea: feature two experts on opposite sides of a topic and let them discuss the pros and cons of each Please send your ideas for future speakers to info@anticancerrevolution.com As always, if you are going through cancer….just keep going!     Related Podcasts Fruit, The Lymphatic System & Cancer: Dr. Robert Morse     If you have a question or comment about this episode let us know below!!

An interview with Dr. David Hui from MD Anderson Cancer Center and Dr. Margaret L. Campbell from Wayne State University, co-chairs on “Management of Dyspnea in Advanced Cancer: ASCO Guideline.” This guideline outlines a hierarchical approach to dyspnea management, beginning with identifying and managing potentially reversible causes, followed by the use of non-pharmacologic interventions, and then pharmacologic interventions. Read the full guideline at www.asco.org/supportive-care-guidelines TRANSCRIPT SPEAKER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines Podcast Series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at podcast.asco.org. My name is Brittany Harvey, and today I'm interviewing Dr. David Hui from MD Anderson Cancer Center in Houston, Texas, and Dr. Margaret Campbell from Wayne State University in Detroit, Michigan, co-chairs on "Management of Dyspnea in Advanced Cancer: ASCO Guideline." Thank you for being here, Dr. Hui and Dr. Campbell. DR. DAVID HUI: Thank you. It's wonderful to be here. DR. MARGARET CAMPBELL: Yeah, it's my pleasure. BRITTANY HARVEY: First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Hui, do you have any relevant disclosures that are directly related to this guideline topic? DR. DAVID HUI: I have no relevant disclosures. BRITTANY HARVEY: Thank you. And Dr. Campbell, do you have any relevant disclosures that are related to this guideline topic? DR. MARGARET CAMPBELL: No, I do not have any relevant disclosures. BRITTANY HARVEY: Thank you. Then let's get into some of the guideline content. So first, Dr. Hui, can you give us a general overview of the purpose of this clinical practice guideline? DR. DAVID HUI: Yeah. This clinical practice guideline is on dyspnea in patients with advanced cancer. And this symptom of shortness of breath, or dyspnea, is very common in our patients and extremely distressing. And the evidence base is rapidly evolving, so the purpose of this guideline is then to summarize the up-to-date information and provide some recommendations for clinical practice to help alleviate this very challenging symptom. BRITTANY HARVEY: Great. Then let's review some of those key recommendations of this guideline. So Dr. Campbell, what is recommended for screening and assessment of dyspnea in patients with advanced cancer? DR. MARGARET CAMPBELL: Well, as David mentioned, this is a highly prevalent symptom. But we know that in clinical practice, sometimes patients won't disclose their symptom unless they're asked. And it gives us an opportunity to be certain that we don't overlook the symptom, particularly when it's in the early stages, mild or moderate stages, where we can intervene rapidly. So in order to treat a symptom, we have to know that the symptom exists. So in the guideline, we recommend at every clinical encounter that there be an assessment for dyspnea. So every clinical encounter could be every time the patient presents in the outpatient clinic, or it could be every day if the patient is an inpatient. Every day on rounds, or every time vital signs are obtained, there would be an assessment of the patient's dyspnea. BRITTANY HARVEY: Great. Then, reading through this guideline, it takes a hierarchical approach to the management of dyspnea, addressing first potentially reversible causes, then the use of non-pharmacologic interventions, and finally pharmacologic interventions. So first, what does the guideline state regarding addressing those potentially reversible causes of dyspnea? DR. DAVID HUI: Yeah, well, this is a very important aspect that you highlighted is that we really want clinicians to remember that it's not just about treating this symptom. It's ideally identifying what are the causes of shortness of breath that we could reverse. And in many patients, there may be multiple factors contributing to the shortness of breath. Some patients may have some effusion, perifusion contributing to it. They may also have underlying emphysema. And other times they may have some complications, such as blood clots. And so it's important to kind of identify the issues that may be at stake. And some of them are very treatable, and patients may have significant improvement in their shortness of breath right away. So I think it's a combination of identifying the complications and comorbidities in those patients. And of course that along with treating the cancer if the cancer is the cause of the dyspnea as well. BRITTANY HARVEY: Great. Then so after addressing those potentially reversible causes, Dr. Campbell, what are the recommended non-pharmacologic interventions? DR. MARGARET CAMPBELL: Well, in the case of a patient whose dyspnea is not severe but is a difficult to tolerate symptom, we propose that the clinician begin with a hierarchical approach from the easiest, simplest interventions that are non-pharmacologic that may actually help improve the symptom experience. So that might be as simple as changing the patient's position. And depending on where their cancer is located, they may find that they are more comfortable sitting up straight propped with pillows, for example. In addition, circulating air around the face has a fairly strong evidence base. And that can be accomplished, weather permitting, by putting the patient's chair near an open window. Or it can be accomplished with a small handheld fan blowing on the face. For some patients whose blood oxygen levels are low, then the application of supplemental oxygen may be helpful to correct the low blood oxygen. Those are the major interventions that we would suggest, but there could be others. If the patient is still ambulatory, then perhaps a walking aid, avoiding stairs. And some of that comes back to our comprehensive assessment. If we could determine what triggers the patient's shortness of breath, then perhaps we can suggest interventions to minimize that, like pacing activity. So similarly, if the patient's in the hospital but has dyspnea, we would want to pace their clinical activity. We wouldn't want them to have their bed, bath, their breakfast, their linen change, their physical therapy all in the same short period of time. We would want to see those interventions staggered through the day. BRITTANY HARVEY: Definitely. That makes a lot of sense. So then, Dr. Hui, what pharmacologic interventions are recommended for patients with advanced cancer and dyspnea? DR. DAVID HUI: Yeah, and so building on Dr. Campbell's discussion of the non-pharmacologic interventions, sometimes patients will continue to have quite a bit of shortness of breath. Or it's a very acute or severe presentation, such as in the hospital setting, then we do recommend some pharmacologic interventions. So the front line measure for that would be systemic opioids. And I recognize that, nowadays, opioids, there's still a lot of stigma around the use of it and concerns. But it is after careful review by the committee and based on the existing evidence that we do recommend this as the main pharmacologic agent. For patients, of course, the use of opioids need to be carefully monitored, and patients should be educated very carefully on how to use them properly for shortness of breath. There are a number of other pharmacologic agents that may be considered for selected populations, other than opioids. So if patients have a higher level of anxiety, then a short-acting benzodiazepine may be considered for those individuals. And for patients with more structural causes of shortness of breath, such as airway obstruction, systemic corticosteroids may be considered. And for patients with airway obstruction, then bronchodilators may be helpful as well, although the evidence around that is still on the weaker side. And there are some patients who, despite very active intervention with many of these non-pharmacologic and pharmacologic measures, who continue to have very severe shortness of breath. And for those who are, let's say, in a palliative care unit setting and have refractory dyspnea, palliative sedation is mentioned as an option for patients as a last resort. BRITTANY HARVEY: OK, thank you both for reviewing those interventions for patients. So Dr. Campbell, in your view, why is this guideline important? And how will it change practice? DR. MARGARET CAMPBELL: Well, for a busy oncologic clinician who may not have a lot of time to search the literature because of a busy practice, what this puts in one place is an opportunity to do a quick guideline that could suggest a treatment course. For a palliative care provider, who may have more experience with non-cancer diagnoses, this guideline focuses on the patient with advanced cancer. So I think there's an opportunity for clinicians in both of those fields who would be taking care of advanced cancer patients to find a benefit. BRITTANY HARVEY: Definitely. And then finally, Dr. Hui, how will these guideline recommendations impact patients with advanced cancer? DR. DAVID HUI: Yeah, well, I'd like to echo what Dr. Campbell said. I would also say that perhaps one of the strongest recommendations of this guideline is actually for patients with dyspnea and advanced cancer to be referred to palliative care. Because dyspnea is such a multi-dimensional symptom and often just the tip of the iceberg in terms of what patients are going through. So just the very presence of it really highlights that there is likely a high supportive care burden, and it would be a good idea for a team specializing in relieving of this symptom to be there to work with the oncology team to help patients. So we hope that with this guideline, that there will be more patients who will have access to palliative care teams. And I think that will be one important impact. And there is a lot of evidence that palliative care can help our patients. And other, maybe, impacts, I think, down the road for maybe future patients would be that we highlighted that more research is really needed in this field. The guideline clearly highlighted some areas we need to work on for further research. And it is not easy to do research in dyspnea and cancer patients because these patients are so sick. And yet these are the very patients who need to have better interventions. And so with this guideline, we hope that it can stimulate further research and to support some patients in the future as well. BRITTANY HARVEY: Great. Well, it definitely sounds like these will have a positive impact for both researchers and for patients with advanced cancer. So I want to thank you both for your work on these guidelines. And thank you for taking the time to talk with me today, Dr. Campbell, and Dr. Hui. DR. DAVID HUI: It's my pleasure. DR. MARGARET CAMPBELL: Mine also. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline, go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast. And be sure to subscribe so you never miss an episode.

If someone you care about dies from cancer, the grief can be intense and long-lasting. So how can you tell if what you are feeling is normal and when should you think about seeking extra support? Julie McCrossin explores these questions with bereavement counsellor Nathan MacArthur. **We'd love to know what you think of this episode. Start our quick survey now.** Find links and more information about this topic at cancercouncil.com.au/podcasts.  See omnystudio.com/listener for privacy information.

Everyone says that if you're caring for someone in their last months, you need to look after yourself, but how exactly do you do that? What are some practical day-to-day strategies? How can you manage feelings of guilt about self-care? What are your options if you need a break and how can you recognise the signs of burnout? Julie McCrossin discusses these questions and more with Professor Liz Lobb. **We'd love to know what you think of this episode. Start our quick survey now.** Find links and more information about this topic at cancercouncil.com.au/podcasts. See omnystudio.com/listener for privacy information.

Caring for someone with advanced cancer can affect every aspect of your life, including your relationships with family and friends. And as the carer, you're often the one who needs to manage people's reactions and work through any conflict that comes up – and that can take its toll on your emotional reserves. How can carers navigate this tricky territory and cope with all the shifting dynamics? Julie McCrossin tackles these issues with clinical psychologist Cath Adams. **We'd love to know what you think of this episode. Start our quick survey now.** Find links and more information about this topic at cancercouncil.com.au/podcasts. See omnystudio.com/listener for privacy information.

Bereaved carers often feel very isolated after the death and may experience a wide range of emotions. How does grief change over time, and how can carers come to terms with their loss? Julie McCrossin talks about grief and loss with bereavement counsellor Nathan MacArthur. **We'd love to know what you think of this episode. Start our quick survey now.** Find links and more information about this topic at cancercouncil.com.au/podcasts.  See omnystudio.com/listener for privacy information.

3 big ideas discussed in this episode: #1 CANCER and how it impacts people #2 Owning your disease #3 Holistic Lifestyle reset and balance Get the show notes and more resources related to this episode here: https://AskJeremyJones.com/210

Editor in Chief Fred Rivara and Deputy Editor Steve Fihn discuss research published in JAMA Network Open in November 2020 Related Articles: Effect of Vitamin D Supplements on Development of Advanced Cancer: A Secondary Analysis of the VITAL Randomized Clinical Trial Effect of Pod e-Cigarettes vs Cigarettes on Carcinogen Exposure Among African American and Latinx Smokers: A Randomized Clinical Trial

Dr. Pennell and Dr. Jennifer Tsui discuss the processes that lead to suboptimal EOL care within Medicaid populations and among racial/ethnic minority groups.     Hello, and welcome to the latest JCO Oncology Practice podcast, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all recordings, including this one, at podcast.asco.org. My name is Dr. Nate Pennell, medical oncologist at the Cleveland Clinic and consultant editor for the JCO OP. I have no conflicts of interest related to this podcast, and a complete list of disclosures is available at the end of the podcast. Aggressive care at the end of life for cancer patients is widely recognized as poor-quality care. And by aggressive care, I don't mean aggressive supportive care or hospice, but rather inappropriate interventions, like chemotherapy or hospital and ICU admissions, near the end of life that rarely improve outcomes and often actually worsen quality of life. Efforts are being made to educate physicians and cancer patients to try to minimize aggressive treatments near the end of life and to help as many patients as possible benefit from things like hospice benefits and appropriate end-of-life care. However, not all patients receive high-quality end-of-life care, and there may be differences in end-of-life care in various populations. For example, how do race and things like Medicaid status impact aggressive care at the end of life? With me today to discuss this topic is Dr. Jennifer Tsui, Assistant Professor in the Division of Population Science at Rutgers Cancer Institute of New Jersey. We'll be discussing her paper "Racial Disparities in Health Care Utilization at the End of Life Among New Jersey Medicaid Beneficiaries With Advanced Cancer," currently in press for the JCO OP. Welcome, Dr. Tsui, and thank you for joining me on the podcast. Thanks so much. Thanks for having me. I have no conflicts of interest with this study whatsoever. Dr. Tsui, can you please tell me a little bit about what exactly constitutes high or low-quality end-of-life care? Sure. I mean, I think that, in this study in particular, we wanted to focus on guideline-related end-of-life care. So we wanted to see if it was possible to take a look at patterns at the end of life for breast and colorectal cancer and stage cancer cases and see sort of what the patterns were in relation to adherence to guideline adherence and what they should be receiving at the end of life. And so that included a set of measures around aggressive care related to hospitalization in the last 30 days, emergency department visits in the last 30 days of life, an ICU admission in the last 30 days of life, and chemotherapy in the last 14 days of life. These are guidelines that have been discussed and published by national organizations. And we also looked at hospice enrollment. So we looked at whether there was any hospice enrollment and whether there was hospice enrollment in the last 30 days of life, I'm sorry. Are there already data existing for various disparities in end-of-life care among different racial groups or patients of different socioeconomic status? There are. So there have been a few prior publications before our study that have shown that Medicaid patients frequently-- not just for end-of-life care, but cancer care in general-- that Medicaid patients receive lower quality of care. And there were studies done prior to ours that did show, I think, in New York, for example, that Medicaid patients had lower-quality end-of-life care compared to Medicaid and privately insured patients. We have seen other studies also mentioning disparities by race in terms of quality of end-of-life care. However, I don't think-- some of these studies have focused on different populations and cancer sites. So some of the studies I mentioned looked at AYA, adolescent and young adult cancer survivors. Other studies have focused on other cancer sites. And also, these were studies that were conducted in earlier time period. And what we know is that, given all that's happened since the Affordable Care Act and Medicaid expansion in several states, sort of the Medicaid population has changed, but sort of health care delivery has been redesigned in different ways. And so that was really why we wanted to look at this issue sort of in more recent years and during a period that spanned Medicaid expansion within New Jersey. You know, that's helpful to understand what sort of prompted you to do this. So why don't you tell our listeners basically how you designed your study. Sure. So this was a large data linkage that we established within the state of New Jersey to better understand cancer care quality for breast and colorectal cancer patients in general, so beyond just the stage IV cancer patients, the patient's diagnosis at stage IV, but breast and colorectal cancer patients in general. So we worked with our New Jersey State Cancer Registry, identified all our breast and colorectal cancer cases that were diagnosed between 2011 and 2015, and then we linked those with our New Jersey Medicaid enrollment and claims files. So this was a study that was done in partnership with our Rutgers Center for State Health Policy. It was conducted sort of with ongoing input and feedback from both our State Cancer Registry as well as our Medicaid program. They've seen sort of findings related to this and other research questions we've had throughout the process. And what we really ended up with was a very rich data set that not only gave us all the tumor characteristics that are available in the cancer registry, but also the health care utilization patterns and Medicaid enrollment characteristics that are available on the Medicaid claims and Medicaid program data side. And how well did this database capture all of these measures of aggressive end-of-life care, so ED visits and chemotherapy and such? Since we did focus on those who were continuously enrolled in our state Medicaid program, we were able to go through our claims data and be able to, using billing codes, identify things like ED visits, et cetera. This data set only includes cancer cases up to age 64. So we didn't include people who may be dual enrolled in Medicare or have Medicare claims. We also tried to create some other restrictions so that we can get at just the people where we had a definitive diagnosis month and year and follow them through their death. And so we did use the prior studies that I mentioned earlier to see what kind of codes were used there. We have quite a multidisciplinary team of collaborators. I worked with quite closely the first author here, Annie Yang. Soon-to-be Dr. Annie Yang is in medical school here at the New Jersey Medical School. And so we did try to be as comprehensive as we could with the codes we used to identify those utilization patterns. OK, so why don't you tell us some of your findings? So I would say that the overall finding is that 62% of these stage IV breast and colorectal cancer patients received at least one measure of aggressive end-of-life care. So out of those four individual measures, 2/3 received at least one, which seems quite high. They ranged from 27% having at least one hospitalization to 34% receiving chemotherapy within the last 14 days of life. What we found is alarming, and it's sort of a call to action for addressing racial and ethnic disparities in health care, is that we found that our non-Hispanic Black patients had a higher odds of receiving any one of those aggressive end-of-life care measures after controlling for other factors. So we did find this racial/ethnic disparity in non-Hispanic Black patients having more aggressive end-of-life care compared to our non-Hispanic white patients, even though these are all the same Medicaid program. This is within one state. And so it did point to some need to better understand what is going on within the health care system, within the health care encounter between patients and physicians towards the end of life and what needs to be done to address these disproportionate rates in end-of-life care among racial/ethnic minority patients. When you talk about these numbers, like 2/3 of patients having aggressive end-of-life care and 39% enrolling in hospice, how does that compare to what would be considered a more appropriate level, say, the private insured patients? So we didn't compare it to privately insured in our state, but we did look at what was published in other states. In New York, for example, I think we had a slightly higher proportion of Medicaid enrollees with stage IV breast and colorectal cancer having more aggressive care. So we did see higher rates. So while we can't compare within our state alone, we do see that the rates are slightly higher than other published studies. Well, I guess I'm just trying to figure out, is aggressive end-of-life care something that commonly happens to all Americans in general, or is this vastly more in this population than what we would expect? In the general population? Yeah, in the general-- You know, I don't-- yeah, I don't have those rates and what our bar should be at baseline, to be honest. I do think that what we see in the end-of-life hospice literature is that there is suboptimal use of hospice care. And what we found was, again, here also sort of suboptimal use of hospice care in this diverse, low-income, Medicaid population. No, clearly, clearly, definitely so. What are some reasons why Medicaid patients would be more likely to have aggressive end-of-life care, do you think? I think Medicaid patients sort of broadly often have higher rates of comorbid conditions when they're diagnosed with cancer. There are complex social factors related to the Medicaid population in terms of being low-income, in terms of other social determinants of health and social needs that increase barriers to care or barriers to high-quality care or continuity of care. In another paper that we published that focuses on this data linkage in the population and this data linkage, there was a lack of primary care utilization prior to cancer diagnosis as well as a lot of the cancer patients in Medicaid enrolling in Medicaid upon diagnosis, right? So I think that there are sort of just several multi-level factors that contribute to why there may be higher rates of aggressive end-of-life care. I think, from a patient perspective, there is a literature out there on the need for communication tools and sort of interaction and inclusion of caregivers that are a part of the decision-making in end-of-life care. Certainly, we've seen in the literature for a while the issue of providers and providers not only being sort of culturally competent or racial and ethnic concordant, but having the tools that they need, both for the physician or the health care team, to have these end-of-life discussions. So I think it's very multi-level and certainly not just either on the patient or the physician. Even within the Medicaid population, so independent just of the, say, the financial pressures that would lead one to enroll in Medicaid, what you showed was that non-Hispanic Black patients had a much higher rate of aggressive end-of-life care even than the overall Medicaid population. And why do you think that would be true? Yeah, so after we finished the analysis for this, we definitely did reach out to other colleagues who have worked in the communities more closely within New Jersey, within the non-Hispanic Black population across New Jersey. We've also talked to our state Medicaid program to, one, think of sort of action items for how to better understand what we're seeing in the quantitative administrative data here, and then two, how to engage communities to understand what to do next about this. So from the literature and from sort of racial/ethnic disparities literature, we do know that there is often mistrust of the medical system. There's underutilization of preventive screenings, and there are physician biases and structural biases that occur along the way, so again, the multi-level factors that impact why there may be disproportionate aggressive end-of-life care in the non-Hispanic Black population. You know, we can't answer those questions with Medicaid claims and enrollment files. We can identify these patterns. And I think what our research team has been in communication with our state Medicaid program to do next is then figure out, how do we talk with some of these communities across the state to figure out what the appropriate community-level education tools might be needed to improve an understanding of what end-of-life options are, but also to focus on the hospitals and health care systems that may be disproportionately seeing some of the-- that may be seeing higher proportions of non-Hispanic Black patients, and how can we engage the health care teams within those settings to figure out what can be done at the health care delivery level? Do you think we have enough information to make interventions now? I mean, are there-- how do you think, aside from further study and trying to understand it better, we might, in the short term, improve rates of quality end-of-life care in these high-risk patients? We've seen-- and we've talked about this, I think, in this field somewhat-- is, one, there are guidelines. And just having health care teams, providers, hospitals understand where they are, sort of tracking where they are in rates of aggressive end-of-life care and in hospice enrollment, and having that feedback and audit loop to kind of look introspectively within the health care delivery setting, I think is one option that we've seen in terms of trying to increase quality and increase adherence to guidelines for other things. And then I certainly think that there might be a need for community-level interventions around, what are the barriers to hospice enrollment? Or where is the lack of awareness and knowledge around end-of-life care options? And what does it mean to reduce interventional care, right? And what does it mean for communities? I think that targeting those aspects and having a dialogue that is responsive to the community-level needs are probably ways that we can start. I think that makes sense. I mean, as an oncologist, a city with a high minority population, I think improving the cultural competence and being able to establish a level of trust with patients who may have an inherent distrust of the medical system, especially when you're talking about something like that's as counterintuitive as trying to recommend not doing more aggressive care, it's certainly a complex conversation and definitely would require a level of trust and communication in order to do that properly. So I completely agree with you that I think, on the community level, the interventions will have to involve that if it's going to be effective. So Dr. Tsui, thanks so much for joining me on the podcast today. Thank you for having me. And until next time, thank you to our listeners for listening to this JCO Oncology Practice podcast. If you enjoyed what you heard today, don't forget to give us a rating or a review on Apple podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO OP podcasts are just one of ASCO's many podcasts programs. You can find all the recordings at podcast.asco.org. The full text of this paper will be available online at ascopubs.org/journal/op. This is Dr. Nate Pennell for the JCO Oncology Practice, signing off.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. For more original research, editorials, and review articles, please visit us online at jco.org. This production is copyrighted to the American Society of Clinical Oncology. Thank you for listening.

In this episode, Dr. Cohen sits down at AACU with Dr Benjamin Lowentritt, Director of the Prostate Cancer Care Program at Chesapeake Urology to talk about his experience setting up advanced prostate cancer clinics. Dr. Lowentritt also talks at length about the collaborative model he and his partners are using to develop processes for delivering new levels of patient care. New treatments and advanced therapies for the treatment of metastatic disease are discussed at length and how the use of genetic markers are being implemented to personalize treatment. 

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