Podcasts about bruera

I always find cachexia in serious illness puzzling. I feel like I recognize it when I see it, but I struggle to give a clear definition or provide effective ways to address it. In today's podcast, we had the opportunity to learn from a renowned expert in palliative care, Eduardo Bruera, about cachexia and anorexia in serious illness. Eduardo established one of the first palliative care programs in 1984, created the Edmonton Symptom Assessment Scale (ESAS), and significantly contributed to the evidence base for palliative care symptoms that many of us rely on daily. During our discussion with Eduardo, we delved into how we can define cachexia and anorexia, why they occur in conditions like cancer, how to assess for them, and explored the interventions that are helpful and those that are not in the treatment of these conditions.

Hoy en #CosaPública2.0 con Rubén Martín y Jesús Estrada 1. Desaparecidos 2. Hernán Gómez Bruera, escritor, periodista y analista político, conductor en La Octava 3. Elecciones + Globales Conducción y producción por: Rubén Martín: https://twitter.com/rmartinmar Jesús Estrada: https://twitter.com/jestradax Asistencia de producción y realización: Alejandro Coronado: https://twitter.com/SoyelCoronado Operador de audio: Emanuel Candelas

En mesa de debate para MVS Noticias con Luis Cárdenas, los analistas políticos Hernán Gómez y Juan Ignacio Zavala, analizaron la respuesta del gobierno ante el impacto del huracán Otis en Guerrero, principalmente en Acapulco. Gómez Bruera, quien es más afín a la izquierda, opinó que “estamos ante un fenómeno de la naturaleza inédito, un comportamiento en la forma en que escala un huracán que no conocíamos”. “Si bien las autoridades pudieron actuar mejor y prever de otra manera las cosas, no había manera de que el Estado no quedara sobrepasado”, destacó. “Fenómenos como este nos terminan mostrando que tenemos un Estado tan débil históricamente que cuando la gente lo necesita, no está”.See omnystudio.com/listener for privacy information.

En mesa de debate para MVS Noticias con Luis Cárdenas, los analistas políticos Hernán Gómez Bruera y Juan Ignacio Zavala, discutieron sobre la paridad de género en las elecciones del 2024 y la cancelación del evento de Claudia Sheinbaum ayer en el Estadio Azul de la Ciudad de México. “Me parece una medida elemental de justicia. Se aprobó paridad en todo, Cámara de Diputados, Senado ya la tienen, alcaldes no, gobernadoras existen, por eso existen las acciones afirmativas, para compensar a un grupo rezagado que no está en paridad”, dijo Hernán Gómez sobre la decisión del Instituto Nacional Electoral (INE) para que cinco de nueve gubernaturas sean para mujeres. El también periodista explicó que, de acuerdo con la Constitución, los congresos estatales debían legislarlo en sus estados, “pero los dueños de partidos se hicieron weyes”.See omnystudio.com/listener for privacy information.

En mesa de discusión con Luis Cárdenas para MVS Noticias, los analistas políticos Hernán Gómez Bruera y Juan Ignacio Zavala profundizaron en la figura del exsecretario de Seguridad Ciudadana de la Ciudad de México, Omar García Harfuch, quien busca la candidatura de Morena a la Jefatura de Gobierno. “Yo creo que, si fuera del PRI, sería mi priista favorito, pero creo que no tiene nada que hacer en Morena”, opinó Gómez. “Fue un muy buen secretario de Seguridad, me parece que eso es en lo que es bueno y en eso debería seguir”. Sin embargo, mencionó que le parece una “desproporción que alguien así pueda ser jefe de Gobierno”.See omnystudio.com/listener for privacy information.

En mesa política para MVS Noticias con Luis Cárdenas, Hernán Gómez Bruera y Juan Ignacio Zavala, analistas políticos, profundizaron sobre la situación actual y el futuro del excanciller Marcelo Ebrard. “Le opacó la victoria a Claudia, le opacó el anuncio de su triunfo, yo no me esperaba que fuera a salir de Morena, pero ahora es lo más probable, pero si es un Monrealazo, ya se excedió. Yo recuerdo el pleito en el 2017 que tuvo Monreal, pero no llegó a tanto”, dijo Hernán Gómez. A esto se une que “hay una serie de expresiones del propio Marcelo que hacen pensar que ya es insalvable”.See omnystudio.com/listener for privacy information.

En mesa de debate para MVS Noticias con Luis Cárdenas, Hernán Gómez Bruera y Juan Ignacio Zavala, analistas políticos, abordaron lo que pasará después de la revelación del coordinador o coordinadora de la Cuarta Transformación esta tarde, quien se terminará convirtiendo en el candidato o candidata de Morena a la presidencia rumbo a 2024.See omnystudio.com/listener for privacy information.

La campaña electoral ya comenzó en México. Tanto Morena, el partido oficialista, como el frente opositor, conformado por el Partido Acción Nacional (PAN), el Partido Revolucionario Institucional (PRI) y el Partido de la Revolución Democrática (PRD), comenzaron los procesos para definir quiénes serán sus candidatos de cara a los comicios de 2024. Carmen Aristegui charla con Alfonso Zárate, presidente de grupo Consultor Interdisciplinario y el analista político Hernán Gómez Bruera.Para conocer sobre cómo CNN protege la privacidad de su audiencia, visite CNN.com/privacidad

En mesa de debate para MVS Noticias con Luis Cárdenas, los analistas políticos Hernán Gómez Bruera y Juan Ignacio Zavala, analizaron el proceso interno del Frente Amplio por México, en el que compiten la priista Beatriz Paredes y la panista Xóchitl Gálvez. Esto a unas horas de que la senadora del PRI haga un anuncio importante sobre su futuro en la contienda, enfocado principalmente en si declinará o no en favor de su compañera del PAN. Para llegar a ese punto fue crucial la declaración del dirigente nacional priista, Alejandro “Alito” Moreno, quien el lunes dijo que las encuestas no favorecen a su aspirante. Sin embargo, ella negó declinar en primer momento.See omnystudio.com/listener for privacy information.

En su colaboración para MVS Noticias con Luis Cárdenas, Hernán Gómez, analista político, habló sobre los finalistas del Frente Amplio por México y cómo se comparan con Claudia Sheinbaum rumbo a las elecciones presidenciales del 2024. El periodista hizo referencia a la más reciente encuesta del periódico El Financiero en la que se compara a los opositores con la corcholata ‘más fuerte' de Morena. “La 4T los aplasta. La encuesta de El Financiero hace un simulacro, comparan con Xóchitl, Santiago y a Beatriz, considerando a Samuel y Claudia. Todo mundo ya da por hecho que Claudia es nuestra señora presidenta”, expresó Gómez Bruera.See omnystudio.com/listener for privacy information.

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 September 2022, ASCO and the Society for Integrative Oncology, or SIO, published a joint guideline on using integrative therapies to manage pain in people with cancer. Integrative therapies are treatments and techniques used in addition to standard cancer treatment to help people cope with the side effects of cancer, including cancer-related pain. In this podcast, Dr. Richard Lee talks to the guideline panel co-chair, Dr. Jun Mao, about these guideline recommendations. They discuss why the guideline was created and the different types of integrative therapies included in these recommendations, including acupuncture, reflexology and acupressure, hypnosis, massage, yoga, guided imagery and progressive muscle relaxation, and music therapy. 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. Dr. Lee is also the 2023 Cancer.Net Associate Editor for Palliative Care. Dr. Mao is chief of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center and holds the Laurance S. Rockefeller Chair in Integrative Medicine at the institution. View disclosures for Dr. Lee and Dr. Mao at Cancer.Net. Dr. Lee: My name is Richard Lee. I'm a clinical professor here at City of Hope Cancer Center. I'm in the Departments of Supportive Care Medicine and Medical Oncology and medical director for the Integrative Medicine Program. I'm honored to be accompanied today by Dr. Jun Mao. He's the chief of the Integrative Medicine Service at Memorial Sloan Kettering and holds the Laurance S. Rockefeller Chair in Integrative Medicine. So we're going to talk about the joint SIO-ASCO guidelines that recently came out in the Journal of Clinical Oncology looking at integrative approaches to cancer pain. And so let me first ask you, Jun, could you talk about what is a clinical practice guideline, and how does it help guide cancer care? Dr. Mao: The clinical practice guideline is a process bringing multidisciplinary experts to look at the evidence from randomized clinical trials or systematic reviews and meta-analysis and to really evaluate the level of the evidence from research and clinical trials, and also incorporate our clinical expertise, consideration for the benefit and risk. Then, making a set of recommendations for doctors and nurses, health care providers to make informed decisions for patients. Dr. Lee: Great. And tell us more, what is integrative medicine for those patients who may not have a full understanding what this field is about? Jun Mao: So integrative medicine is a complex term. Originally, a lot of people may have heard that term of “alternative medicine” or “complementary medicine.” So those terms are referring to using things like herbs or shamanism instead of a conventional cancer treatment. So recognizing the needs of patients who want to explore alternative ways to help them to cope with cancer, and the importance of adhering to conventional surgery, radiation therapy, chemotherapy. So the field of integrative medicine has emerged. Integrative medicine is a field that is based on evidence and acknowledge the patient's wishes to carefully incorporate evidence-based lifestyle interventions, mind-body treatments, and consider for natural products and herbal medicine in a safe and effective way to improve patients' physical, emotional, and spiritual well-being. Also, part of the goal of integrative medicine is to really engage the patient as an active participant to prevent cancer and to really engage in their own care during and beyond their cancer treatment. Dr. Lee: And for patients who are new to this concept of integrative medicine or integrative therapies, why is it important for us to study this for cancer care? Dr. Mao: Richard, this is really important because often when a person gets cancer, you get friends and family who really want to be helpful who say, “Do this, try that, use this herb, or this supplement has been used by that.” So there's a lot of anecdote. There's a lot of sort of people just want to be helpful. But in actuality, some of the treatments, without carefully considering actual evidence and potential risks of drug herbal interaction, can induce harm, not only increase the toxicity of the cancer treatment, but may even shorten the lives of cancer patients. Therefore, we often tell patients don't use these treatments as alternative, but to use in an integrated way. And doing research is going to be helpful to understand in what setting for what condition or symptoms. These are helpful, not helpful, are they safe or unsafe? Dr. Lee: That's really important. That's great to see the research coming along. And so let's talk about ASCO, the American Society for Clinical Oncology, which is the world's leading and largest professional organization for oncologists, as well as Society for Integrative Oncology, SIO. You know, how did they come together to produce this joint guideline on integrative medicine and pain management? Dr. Mao: So, as you know, ASCO is a world-leading conventional oncology society. It's a multi-discipline, you know, surgeons, medical oncologists, radiation oncologists, a lot of psychosocial supportive care folks are part of this society. Society for Integrative Oncology is a relatively new society, but this year we're celebrating 20th year, so it's not so new anymore. You know, a lot of very passionate physicians, nurses, nutritionists, social workers, we joined together to really help to advocate for evidence-based integrative medicine in the context of care delivery. SIO brings that expertise together with ASCO to formulate a set of guidelines that can be readily implemented into the care setting to help patients and families to deal with pain, a very common and disturbing side effect for cancer and cancer treatment. Dr. Lee: It's so great to see 2 leading organizations come together to put these guidelines together. So let's jump into the guidelines a little bit, and one of the areas that they covered is acupuncture. So can you let us know and let patients know what is acupuncture, and what types of cancer-related pain has it been shown to be helpful? Dr. Mao: Acupuncture is a type of therapy that originated from the traditional Chinese medicine. It has been documented over 2,500 years ago. So the way acupuncture works clinically is putting very thin, sterile needles in specific locations of the body to help address symptoms, promote a sense of relaxation and wellness. Often, you need a series between 6 to 10 treatments. I always tell patients it's almost like a physical therapy. You need a few treatments to see the benefit. In animal research, there has been a documented mechanism that acupuncture may help your brain to release endogenous neurotransmitters, like endogenous opiates, serotonin, or dopamine, as a result to reduce pain, increase a sense of relaxation, well-being. So the ASCO-SIO Joint Clinical Guideline looked at clinical trials, found pretty strong evidence that acupuncture can be used for a type of joint pain that is very common in women with breast cancer taking aromatase inhibitors. Aromatase inhibitors are a class of drug that drop the estrogen level in women with breast cancer as a result of preventing the breast cancer from spreading. Unfortunately, about 50% of women do develop very diffuse joint pain. A lot of time it is in the low back and knees and makes a lot of patients stop this life-saving drug. The committee feels strongly like acupuncture should be recommended as one of the options to treat aromatase inhibitor-related joint pain. In other areas, not as strong, but also in general cancer-related joint pain and musculoskeletal pain. And there are also some weak evidence on acupuncture can be helpful for chemotherapy-induced peripheral neuropathy, as well as to be used in post-surgical related pain. So those are the recommendations we would tell a patient who experienced those pains to try acupuncture. Dr. Lee: So Jun, you mentioned about the different recommendations around acupuncture, and you're talking a little bit about levels of evidence. Could you explain to patients what you mean by the levels of evidence and the types of recommendations that were put forward by ASCO and SIO? Dr. Mao: So when experts review evidence from clinical trials, if you have several large clinical trials producing very consistent findings that a therapy is beneficial with very low risk, that will give you a high level, strong quality of evidence with strong recommendation. Unfortunately, in the field of integrative medicine, often there's a lack of funding for this type of research. So what you do see is there are maybe only 1 trial showing that it's very beneficial and maybe there are some smaller trials to show some signal, then we will give an intermediate quality of evidence and moderate strength of recommendation. And then you have therapies that are being used by patients, but there's very little trials or the trials, the sample size are very small. Sample size means how many patients participate. Then you see some promising signals overall, but it's kind of, you know, we don't have a strong confidence in the result. That's where we give low quality of evidence and weak strength of recommendation. Dr. Lee: That's really helpful and it's, I think, important since integrative medicine is really based on evidence-based approaches that we are looking at the levels of evidence. So thank you for explaining that. Let's move on to some other therapies that were mentioned within the guidelines. You talk about reflexology and acupressure. Can you talk about what these types of therapies are and what have they been shown to help? Dr. Mao: So reflexology acupressure, so this is a very similar sort of a principle of treatment, but instead of putting needles, it's actually a therapist will put hands on or teach the patient to press specific acupuncture or pressure points as a result to reduce pain or induce relaxation. So here is where you see some intermediate quality of evidence with moderate strength of recommendation for general cancer pain or musculoskeletal pain as the patient is receiving treatment. One common area you would see that is sometimes when a patient's getting chemotherapy, they will have these muscle aches and joint pain. It's not long lasting, but it's very annoying for a number of days. So in those settings, you can try that.   Dr. Lee: So for patients who might have a needle phobia and are very hesitant, would it be reasonable for them to think about reflexology and acupressure as another modality? Dr. Mao: Oh, absolutely. And also I want to clarify reflexology often is done on the feet. So a lot of patients may not necessarily like general massage. Some people love it, but other people just don't want people to touch their whole body. Then the reflexology just focusing on massaging the feet or lower legs can be a really good option. Dr. Lee: Yeah, great to see there are options for patients, depending on their preferences. Let's move on to another therapy in the guidelines that mention hypnosis. And so a lot of patients may not be familiar with what is hypnosis and where can that be applied for patients with cancer? Dr. Mao: Hypnosis is really about changing a state of awareness and a sense of increased relaxation that often allows for improved focus or concentration. But when you talk about hypnosis in a health care setting, it is often done by a provider with verbal repetition, provided with some mental images. Often during hypnosis, patients can be taken to a different mental place and feel a sense of relaxation and calm. And where you see some evidence is actually for procedural pain. This is derived from a large, randomized trial for biopsy, as well as some interventional procedure showing that hypnosis produces benefit for pain reduction, more of acute pain relief. Again, it makes sense physiologically, right? You take your mind and consciousness to a different place rather than focus on the procedure and pain. So this is where we give intermediate quality of evidence and moderate strengths of recommendation. Dr. Lee: Mm-hmm, good. And let's talk a little bit more about massage. You mentioned that a little bit when you were talking about reflexology. Can you tell us about what situations might massage be helpful for the patients? Dr. Mao: So massage, many people know is really applying pressure in a specific body area. And certainly, for oncology massage, people need to have some specific training to be safe, make sure people don't put pressure in where the tumor is or where there may be fracture risk for bone metastasis as well as in where their medical port is. So I would advise patients work with people who have specialized oncology training. With that said, I think we find really good evidence, particularly in the area of use in palliative care. So there was a large trial with over 300 people randomized to either massage or just gentle touch. Massage reduced pain and improved mental health. So I would say massage to be utilized in patients living with advanced cancer or for patients in a hospice setting can be a really beneficial tool. Where there is a slightly, sort of a weaker evidence I would say, is in the area of a general musculoskeletal pain as the patient is experiencing treatment or in survivorship. There, we give a low quality of evidence, but a moderate strength of recommendation. The reason we give a moderate strength of evidence is the risk is really minimal, right? Like even though we don't have a good amount of research, but even say massage produces some temporary relief, it can still be very beneficial for the patients. Dr. Lee: And let's shift gears a little bit to something called yoga, which many of us may know from your local gym. Can you talk a little bit about yoga and what does that mean for patients who have cancer, and how can that help with cancer-related pain? Dr. Mao: Yoga, as many of you know, originated from India, maybe even as old as 5,000 years ago. So yoga practices, it really combines breath work with meditative work with posture, right, specific postures. So often we know in routine, just health industry, yoga can be really good for physical balance, for flexibility, for induced sense of relaxation. So less is known about the use of that for pain management. So there were some small studies to show that yoga showed really good potential benefit in addressing aromatase inhibitor-related joint pain. The reason we give it a low quality of evidence and weak strength of recommendation is because the research is not as developed in this area. Also, in one of the trials, the pain was the secondary outcome rather than the primary outcome. So it was not the outcome they hypothesized to find, although they did find some benefits. So with that, we do feel like given how yoga is relatively low risk, it's very accessible. So it could be considered for women with breast cancer experiencing aromatase inhibitor-related joint pain. Dr. Lee: And then, Dr. Mao, could you comment a little bit about--there's so many different styles of yoga. Some of them are very physical, like the kind of hot yoga versus other styles might be more gentle. Can you comment a little bit about that and in terms of what style patients might want to consider? Dr. Mao: There's also a national organization to help to train yoga instructors to work with cancer survivors. So as you look out for those programs, you should really look at people who have those experiences. And I would say most of the studies use more of a hatha type of, more gentle yoga rather than the probably rigorous sort of yoga. Particularly, I would say for women with breast cancer on hormonal drugs, there's higher risk for osteoporosis. So it's important to consider the risks. And I would work with highly experienced instructors rather than trying very risky moves that potentially can cause musculoskeletal injuries or fractures. Dr. Lee: Good things to keep in mind as you think about these different therapies. Let's focus more on these kinds of what some consider mind-body techniques: guided imagery, progressive muscle relaxation. Can you talk about these types of therapies, and can the 2 techniques be used in combination to help with cancer pain? Dr. Mao: So these are very common techniques in the realm of mind-body and relaxation technique. Often you will listen to words and the words will guide you to imagine you're on a beach or hiking in the green meadows. And often there's nice music along with the verbal suggestions. And with progressive muscle relaxation, sometimes we'll ask you to squeeze certain muscle and then release, squeeze and release. By doing that, it also causes a sense of relaxation. So where the application for this is where you see in general cancer pain or musculoskeletal pain. So in those settings, this can definitely be elements to help you improve the coping of pain, it's almost in the realm of self-care. So patients can potentially do that at home. However, I would say the evidence still very low. So the quality of evidence we give is a low quality of evidence and weak strength of recommendation. Although this therapy is very intuitive, they cause relaxation, which should help with pain. But I would say they by themselves may not be... the primary mode to manage pain, but rather than improve the coping of pain. Dr. Lee: And let's shift gears a little bit to other techniques. One that was mentioned was music therapy. And of course, a lot of people listen to music on the radio or on the way to work. Can you talk about  what is music therapy? Is that the same as just turning on the radio, and where can that be helpful for pain management?   Dr. Mao: So I'm so glad you're asking this question because music therapy is not just music. Music therapy is working with a specialized trained therapist to use music as an avenue to allow patients to develop a very meaningful therapeutic report to induce relaxation, to manage specific physical and emotional symptoms such as pain, depressive symptoms, anxiety. So often, you know, either through playing an instrument, creating sounds, and sometimes by passive listening and passive relaxation. So it's a very sort of an involved process. Where I think there are currently some weak levels of evidence is music therapy for post-operative for surgical pain. That's where there are some research, but because of the trial, the sample size and the control, so unfortunately we can only give a low quality of evidence and weak strength of recommendation. There's much more knowledge about the use of music therapy to reduce anxiety and depression. So, and often those psychological symptoms go hand in hand with a patient with pain. So I do think when we talk about pain management, we shouldn't be so reductionist to just think of a person with pain. Often you have pain, you have anxiety, then you feel depressed about the pain, right? So I think music therapy can play a role to improve the mental coping with pain. Dr. Lee: I think you bring up a really great point, Dr. Mao, about for patients who are being evaluated for pain to really work with their medical team to explore all the potential factors that might be contributing to the pain. Not only their cancer or the treatment, but their mood or how they're sleeping might play a factor. Dr. Mao: Rich, as you know, I'm an integrative medicine specialist. So when we work with patients, we really take a comprehensive history to really understand what are the symptoms. Often, I have never seen patients just presenting with one symptom, right? So then you'll understand their symptoms and needs and then help them to prioritize what matters the most for them and which therapies potentially have the biggest bang for the buck to improve the things they want to help the most. And then often those therapies will produce some, what I call the “side benefit,” say by improving pain, also improve your sleep, improve your anxiety. So the mechanism may be slightly different, and also patients may have different preference. Some people love yoga, other people would never try it. So you got to really, this is what the beauty is about integrative oncology, to give that choice and control back to the patients. But really, as physicians, we provide them with the evidence to help them to make informed decisions. Dr. Lee: And what do you think are the kind of key takeaway points a patient should think about based on these guidelines? Dr. Mao: I think the key takeaway is when you experience pain, don't just think about drugs. Really think about, there are evidence-based non-pharmacological interventions that can really potentially help you reduce pain, improve your emotional and physical coping with the pain. So talk to your doctors and nurses. Are there those therapies available in your cancer center or clinical practice? Or connect you with the qualified community providers and be a strong advocate for your own health. Dr. Lee: And for patients who really want to dive deep and learn more about these, where would you suggest they go to learn more about integrative therapies for cancer-related pain? Dr. Mao: Yeah, as a patient as well as a family member, it's really important to go to websites that are credible for reliable information. So, ASCO has Cancer.Net. It provides incredibly valuable information for patients and families impacted by cancer. American Cancer Society will be a good resource as well. National Cancer Institute also have monographs for integrative therapy, so those can be really valuable. Other places like a Society for Integrative Oncology website or Memorial Sloan Kettering Cancer Center website also have a lot of information about integrative therapies. Dr. Lee: So this has been wonderful. I really want to thank Dr. Mao for a great overview regarding the ASCO-SIO joint guidelines on pain management. And you mentioned a lot of great websites, including Cancer.Net, in which you can learn more about these guidelines as well as other therapies to help with your care. Dr. Mao: Dr. Lee, thank you so much for doing this really important podcast. I do think as one of the co-chairs for this committee, our group really aspired to use this set of ASCO-SIO clinical guidelines to make integrative therapies part of comprehensive pain management for patients impacted by cancer. And together, we can move closer to allow cancer patients to have lower symptom burden, high quality of life. Dr. Lee: I really congratulate you and Dr. Bruera for a job well done, co-chairing this really large effort. It took a lot of time. We're looking forward to additional guidelines coming out from ASCO and SIO looking at different symptoms. ASCO: Thank you, Dr. Lee and Dr. Mao. Learn more about integrative medicine at www.cancer.net/integrative. 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.

En mesa de debate para MVS Noticias con Luis Cárdenas, Hernán Gómez y Juan Ignacio Zavala, analistas políticos, hablaron sobre la figura de Xóchitl Gálvez como aspirante a la presidencia y lo que representa para Morena. Antes de eso, Gómez Bruera se refirió a la decisión tomada ayer por el Tribunal Electoral del Poder Judicial de la Federación (TEPJF), el cual avaló el proceso interno del partido guinda, sumándose a las medidas implementadas por el Instituto Nacional Electoral (INE). “El INE ya le dijo a Morena que adelante con su proceso interno, están todos como en la simulación”, opinó. “Juegan a la simulación, el INE se presta a esa simulación y ayer el Tribunal Electoral refrenda esa tesis”.See omnystudio.com/listener for privacy information.

En su colaboración para MVS Noticias con Luis Cárdenas, Hernán Gómez Bruera, analista político y periodista, presentó su libro más reciente, “La traición en Palacio: El negocio de la justicia en la 4T”, una investigación que involucra al exconsejero jurídico de la Presidencia, Julio Scherer Ibarra. “Fue un libro muy difícil de escribir porque yo soy simpatizante de la 4T, pero me parece que es una historia que se merece contar”, expresó el también columnista. Añadió que “es importante porque estoy revelando una red de corrupción de un hombre muy cercano al presidente de la República”.See omnystudio.com/listener for privacy information.

En mesa de debate con Luis Cárdenas para la Primera Emisión de MVS Noticias, Juan Ignacio Zavala y Hernán Gómez Bruera, analistas políticos, hablaron sobre las elecciones en el Estado de México y Coahuila.See omnystudio.com/listener for privacy information.

En mesa de debate con Luis Cárdenas, Hernán Gómez Bruera y Juan Ignacio Zavala, analistas políticos, hablaron sobre las reformas aprobadas en el Senado, así como de las ‘corcholatas' presidenciales de Morena rumbo a las elecciones de 2024.See omnystudio.com/listener for privacy information.

En su colaboración con Luis Cárdenas para la Primera Emisión de MVS Noticias, Hernán Gómez Bruera, analista político, habló sobre su investigación alrededor de la consejera del Instituto Nacional Electoral (INE), Norma de la Cruz.See omnystudio.com/listener for privacy information.

Diputada provincial sobre Rosario

Sobre la demencia fronto-temporal

Dr. Judith Paice and Dr. Eduardo Bruera discuss the latest evidence-based recommendations from ASCO on the use of opioids in managing cancer-related pain. They review the safe and effective use of opioids, including when clinicians should offer opioids, which opioids should be offered, how opioids should be initiated and titrated, management of opioid-related adverse events, modifying opioid use for patients with specific comorbidities, management of breakthrough pain, and how opioids should be switched. Additionally, they address barriers to care, considerations of health disparities, cost, and patient-clinician communication in achieving optimal pain management. Read the full guideline, “Use of Opioids for Adults with Pain from Cancer or Cancer Treatment: ASCO Guideline” at www.asco.org/supportive-care-guidelines. TRANSCRIPT 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 asco.org/podcasts. My name is Brittany Harvey, and today, I'm interviewing Dr. Judith Paice from Northwestern University Feinberg School of Medicine in Chicago, Illinois and Dr. Eduardo Bruera from the University of Texas MD Anderson Cancer Center in Houston, Texas, co-chairs on “Use of Opioids for Adults with Pain from Cancer or Cancer Treatment: ASCO Guideline.” Thank you for being here, Dr. Paice and Dr. Bruera. Dr. Judith Paice: Thank you. Dr. Eduardo Bruera: Thank you for having us. 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. Paice, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Judith Paice: I have no relevant disclosures. Brittany Harvey:  Thank you. And then Dr. Bruera, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Eduardo Bruera: Regrettably, I don't. Brittany Harvey: Great. Then getting into the content of this guideline, to start us off, Dr. Paice, can you provide an overview of the purpose and the scope of this guideline? Dr. Judith Paice: The use of opioids has become so complicated, so controversial, and just so associated with so much stigma that we wanted to provide oncology clinicians some guidance about safe and effective use of opioids. We wanted to help people be aware of the current literature, and so we conducted a systematic review and identified randomized controlled clinical trials and other systematic reviews. And we found that there were 31 systematic reviews in 16 RCTs. We carefully reviewed all of these literature and all of these studies, and our expert panel met via the web and via numerous conference calls and emails, and we came to consensus regarding these recommendations related to the use of opioids for people with cancer. Brittany Harvey: Great. Sounds like there was a lot of effort that went into developing this and to tackle an important topic. So, then Dr. Bruera, I'd like to review the key recommendations of this guideline for our listeners. This guideline addresses seven different clinical questions. So, let's review these questions starting with; in what circumstances should opioids be offered? Dr. Eduardo Bruera: That's a very important point because the reality is that although opioids have been around for more than 300 years in different modalities, they continue to be the mainstay of care of patients with severe pain. So, it's very important to try to figure out in the clinical practice why the patient has a pain syndrome. But in the great majority of patients who have pain that is due to the presence of the primary cancer or metastatic disease. And also, in the vast majority of patients who develop severe complications from treatment such as mucositis from radiation and chemotherapy, an opioid will be needed. And the oncologist and the oncology clinician is in perfect conditions to safely prescribe that opioid so the patient can achieve fast relief of their pain. Brittany Harvey: Great. Thank you for that explanation. So, then the next clinical question that the panel addressed, Dr. Paice, which opioids does the panel recommend clinicians should offer? Dr. Judith Paice:  Yeah, thank you. This is a really important question, one that gets asked all of the time, and yet, the data are insufficient to really suggest that there is one preferred opioid over another. So, a patient with moderate to severe cancer-related pain is a candidate for any of the approved medications either approved by the FDA or because our audience also includes international experts, other regulatory agencies for pain treatment. We did call out a couple agents for which there is some concern or for issues where they are less than desirable in some settings. So, one of those drugs is tramadol. And our rationale for identifying tramadol as a potential agent of concern is that it's a prodrug. It has a threshold, a ceiling unlike most of the other opioids, and that threshold is pretty low for neurotoxicity, which is of particular concern in the person with cancer. And it also, has a significant amount of drug-drug interactions. So, we were concerned about tramadol, even though it is an agent that many, many people are using, in part, because it is a lower schedule on the controlled substance scheduling system, and there's a perception that it is less potent, and it is less potent. The other drug that we call out is codeine. And our rationale for identifying it as an agent that may be of difficulty in certain populations of patients, is that it is also a prodrug and it is metabolized through the cytochrome P450 system, particularly through the isoenzyme CYP2D6. And that's what allows codeine to be metabolized to morphine, which allows it to be analgesic. The challenge is there are some individuals who are poor metabolizers, and so they will not receive an analgesic effect. And then there are others who are ultra-rapid metabolizers, and they may actually experience a greater prevalence of adverse effects. So, for those reasons, we call out tramadol and codeine. Now, we don't call out methadone as an agent that we're concerned about in terms of not being desirable. It is an agent that has a role in cancer pain management. However, we do caution clinicians that it is a complex drug to use. And so, as result, people should obtain some guidance either from their palliative care program, their supportive care program, pain experts, or pharmacists, whomever can assist them in the dosing associated with this really important, but somewhat complicated drug to use. Brittany Harvey: Understood. And I appreciate you reviewing where there's a lack of evidence and where there is evidence in identifying those potential agents of concern or where clinicians need to seek other expertise in this area. So, then following those recommendations, after identifying patients who should be offered opioids, Dr. Bruera, how should opioids be initiated and titrated? Dr. Eduardo Bruera: One possible way to do this is to give the patient an immediate release opioid. That could be a combination of hydrocodone with acetaminophen, a combination of other opioids or a straight strong opioid in a low concentration. And ideally, we suggest that you use it as needed for the first few days and see if the patient needs to take it frequently. And there is a magic number around 30 milligrams of morphine equivalent per day. Once the patient needs to take that opioid on a more frequent basis and gets through that threshold of needing about five, six tablets a day of immediate release opioid, then it might be necessary to start a regular opioid that is to stay on top of the pain. And the way we do that are two ways; if the patient can afford it and insurance covers it, an extended release opioid is a wonderful option, because then, the patient can take the opioid a couple of times a day or put a patch for three days and they're going to be comfortable. But if that is not an option, taking the immediate release opioid around the clock, not anymore as needed. But now, around the clock, will maintain that blood level and allow the patient to have less episodes of breakthrough pain. An important thing to remember is that whether we decide to go with the extended release opioid or immediate release, it's nice to tell the patient that there might be moments in which the pain might break through. And so, giving that extra prescription and advice might help if there are moments in which the patient might break through. Brittany Harvey: Understood. And then the next clinical question that the guideline panel addressed, Dr. Paice, how should opioid-related adverse events be prevented or managed? Dr. Judith Paice: So, Brittany, I'm glad you asked me that question because I am called the pain and the poop nurse in the clinic, and it is so important whenever we can to prevent the adverse effects of opioids, and constipation is one where we can implement some preventive measures, and then treat unfortunately if your measures have not been totally effective. But we wanted to address the gamut of potential adverse effects. So, we included not only constipation, but delirium, endocrinopathies, sedation, nausea, vomiting, itching, and urinary retention. And we've included a table with very specific suggestions about how to prevent in some cases, and how to manage these adverse effects. Again, we wanted to make this document of the most use for all oncology clinicians who might be prescribing opioids for people with cancer. Brittany Harvey: Absolutely. And that's key to maintaining quality of life for patients. So, then Dr. Bruera, what does the panel recommend regarding modifying opioid use in patients with either renal or hepatic impairment? Dr. Eduardo Bruera: That's a great question, Brittany, and I think we have some evidence that some opioids are particularly desirable when the patient has renal dysfunction. One of the ones that comes to mind is methadone because it has almost no major renal elimination, and therefore, that might be a wonderful option. One of the challenges is that changing from one opioid to another sometimes is a little bit more complex than maintaining the opioid that is being used. And so, in absence of a major and fast deterioration, one option is to carefully titrate the dose of the opioid we're using to reduce the risk of accumulation in a given patient. There are some opioids that have traditionally been associated with a little bit more accumulation in cases of renal failure and traditionally, morphine is included, but there are other opioid agonists that also produce metabolites that are massively eliminated by urine that might be a little bit less desirable in patients with renal failure. With regards to liver failure, it's very hard to find a complete consensus about the opioids that are less desirable or potentially more desirable. And we could say that careful titration is important. But the one that was so good for renal failure might be the one you might not want to use for liver failure, and that would be methadone, because a vast majority of its metabolism happens in liver. So, I think cautious individualized titration might be a nice recommendation to our patients. And perhaps, the most important thing is that there might be a little bit of renal failure or liver failure, but it's very, very important that we maintain the opioid therapy, that we don't give up on the opioids. Brittany Harvey: Yes, those are important clinical considerations for individualized patient care. So, then Dr. Paice, Dr. Bruera touched on this a little bit earlier, but what are the recommendations regarding management of breakthrough pain? Dr. Judith Paice: So, breakthrough pain is very common in the person with cancer. We see this when the individual has bony metastases and they place pressure on that limb or joint. And the patient who's normally well-controlled with either a regularly scheduled immediate release agent or a long-acting agent, now experiences what we call breakthrough. And that's probably the most common type of breakthrough pain. There are also other breakthrough pains where the short-acting agent that's given regularly doesn't provide the relief that lasts four hours or six hours. Or similarly, if a long-acting agent is given every 12 hours, we may see that the pain breaks through prior to the next dose. But for that patient who requires breakthrough medication, unfortunately, the literature does not reveal that one agent is superior to another. So, any immediate release opioid that's appropriate for that patient can be used for breakthrough-related pain. Now, a common clinical conundrum is - which dose? What's the correct dose for the breakthrough medication? And again, the literature has a wide range of appropriate doses, and our committee established a range of 5 to 20% of the daily regular oral morphine equivalent daily dose. And our rationale for that was that you really cannot come up with one figure. Every patient is different. So, on average it's somewhere around 10%, but the range is five to 20% of the daily regular morphine equivalency. And so, what you need to do as you're examining the patient and exploring their needs is to look at the patient's frailty, the patient's pain, of course, their function when these breakthrough episodes occur. What about the comorbid kinds of organ dysfunction that Eduardo just spoke about? So, all of those other factors need to be considered when selecting the appropriate opioid for the breakthrough as well as the appropriate starting dose. Brittany Harvey: Definitely, it's important to consider all of those factors that you just mentioned. So, then the last clinical question that the panel addressed, Dr. Bruera, when and how should opioids be switched or rotated? Dr. Eduardo Bruera: Thank you, Brittany. This is a hugely important issue because for many, many years, we believe that since opioids stimulated an opioid Mu receptor, and they all had a similar effect, there will be limited rationale for changing. The answer to increasing pain was what we call opioid dose escalation. Just give more of the same. And we realized that that had serious limitations. And one of them is the development of side effects. And a lot of those side effects are neurotoxic side effects. Patients get unduly sedated, get hyperalgesia, paradoxical increase in pain due to active metabolites and changes in their receptors, and they also get sometimes myoclonus, hallucinations, confusion. And so, there are moments in which the side effects require us to say, okay, this opioid has done a good job for a while, but now, we have to change. And so, changing can be done due to side effects. But also, sometimes, since we're all different and there's a lot of interpersonal variation in response — as some patients may just not be controlled, their pain syndrome might not be controlled well-enough with one type of opioid because we know there are multiple sub-Mu receptors, and they might really benefit from another. So, the two main reasons are the development of toxicity to the opioid that so far was working reasonably well. And the second is failure, inability to control the pain, and in that case, going cautiously respecting the fact that there is limited cross-tolerance so that the dose of one opioid is not always exactly equivalent to the dose of the other opioid that you find in the actual tables that are published around is necessary to understand that that's a general guideline. But the most important thing is to go progressively and monitor your patient frequently when you change from one opioid agonist to another opioid agonist. There is limited understanding in the literature about the exact equianalgesic dosing. And because of that, a new guideline is being produced that addresses opioid rotation and deals exactly with trying to find out consensus from all the different existing tables on how to change what is the dose that is most likely to be appropriate when you move from one opioid, for example, morphine to hydromorphone or to fentanyl, or to oxycodone or vice versa. We dealt with great trepidation to give all our oncology clinicians some kind of a fixed table, but the evidence is unfortunately not there at this point. It is sad because these medications are not that new, but the evidence unfortunately, is not there. And that's why I think what we can tell you is go through your guidelines, use in a very careful monitoring of your patient to see if the dose you're giving is clearly not enough or it's a little bit too much. And you will learn that very rapidly — in a couple of days, you'll learn if you're doing okay or if you're doing too much or not enough. And stay tuned because hopefully, very soon, ASCO, together with MASCC and a couple of other organizations will provide you with a little bit more evidence around this. Brittany Harvey: Definitely, we'll look forward to that future guideline on opioid conversion tables as it is a confusing and complicated area, but it sounds like a lot of these recommendations are about providing individualized care for your patients. So, I want to thank you both for reviewing all of those recommendations that the panel came up with. So, then Dr. Paice, what does this guideline mean for both clinicians and for patients with pain from cancer or their cancer treatment? Dr. Judith Paice: Well, speaking on behalf of the panel, our wish is that this will improve the management of cancer-related pain, that people will feel more comfortable in safe and effective use of these agents, and they'll be used more effectively. There are other barriers that we've addressed, in addition to all of these recommendations. We talk about the care of people who have multiple chronic conditions. We address the disparities that we see in cancer pain management, and we talk about cost as another consideration, as one is developing a treatment plan for patients. We also address the patient-clinician communication that is so essential. This is definitely a team effort, and we guide our clinicians and offer for patients the need to have clear communication, open dialogue throughout the development of a treatment plan, and then throughout the course of treatment while we reassess whether the plan has been effective. Brittany Harvey: Absolutely. And it's really key what you just said about the safe and effective use of opioids for patients. So, then finally, Dr. Bruera, you've both mentioned this throughout our conversation today, where the literature is either inconclusive or evidence is insufficient. So, what are the outstanding questions about the use of opioids for pain from cancer or cancer therapies? Dr. Eduardo Bruera: I think there are questions that relate to the relative lack of specificity of the opioids for the different receptor pathways, and there are very likely considerable differences because they're chemically quite different, but they're considerable differences. But we have not done an awful lot of the head on comparisons that would be so wonderful to do. And I think we need more studies comparing the different existing medications, and more importantly, we need a lot of translational work to get to specific areas. Wouldn't it be fantastic if we were able to stimulate the Mu receptor all along the nociceptive pathway to reduce nociceptive input, but avoid completely the limbic system and avoid those Mu receptors in the area where reward is going to happen, an anti-reward and the possibility of developing non-medical use and eventually, opioid use disorder. That would be, to me, the corollary, the ability to dissociate those receptors along the nociceptive pathway from those receptors in the areas where we would like our opioids to not go, but we cannot avoid it because they're a bit dummy drugs. And so, hopefully, getting smarter opioids would be wonderful. Brittany Harvey: Absolutely. Well, I want to thank you both so much for your work developing this guideline, addressing these important questions for optimal pain management in patients with cancer. And thank you for your time today, Dr. Paice and Dr. Bruera. Dr.  Judith Paice: Thank you. Dr. Eduardo Bruera:Thank you so much. 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-cancer-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. Voiceover: 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.  

Imputaciones del día

Luiz Inácio Lula da Silva ganó las elecciones en Brasil y será presidente por tercera vez a sus 77 años. El actual mandatario, Jair Bolsonaro, aún no ha reconocido la derrota de forma pública. Carmen Aristegui charla con la especialista en política Yizbeleni Gallardo y con el periodista Hernán Gómez Bruera sobre el resultado del domingo.Para conocer sobre cómo CNN protege la privacidad de su audiencia, visite CNN.com/privacidad

La diputada justicialista Matilde Bruera, se refirió en Radio EME al aspecto integral de su iniciativa para modificar el régimen sancionatorio de fiscales y defensores.

Seremos Agua: Incendios en Humedales Informe de Jésica Fernández Bruera, referente de la Multisectorial Humedales Noticias : Demanda de Pueblos Amazónicos Sumas y Saldos: Con Tomas Astellara Hablamos de Economía. Lo que viene y Desmonte en Córdoba Ternas Musicales: Anibal Sampayo Músicos en Vivo: Nito Mestre

En mesa de debate con Luis Cárdenas, Juan Ignacio Zavala y Hernán Bruera, analistas políticos hablaron sobre la reunión entre Andrés Manuel López Obrador, presidente de México y el mandatario estadounidense, Joe Biden.

¿AMLO boicoteó la Cumbre de las Américas?; Caso Debanhi "Esto es un feminicidio, a dos meses no hay detenidos"; Conoce "El empresario inconsciente", libro de Hernán Gómez Bruera; Inflación en México no cede: Torreblanca.

En entrevista Hernán Gómez Bruera, analista político y escritor, mencionó que "se genera un fenómeno en el mundo donde la desigualdad es normal".

Plática con Hernán Gómez Bruera, periodista, autor (entre otros muchos) de El Empresariado Inconsciente, libro en el que midió la sensibilidad e ideas de parte del empresariado mexicano en torno a temas como la desigualdad y pobreza. En esta plática hablamos de las impresiones y conclusiones que Hernán tiene después de haber entrevistado a más de 200 empresarios y de la importancia que tienen estos mismos empresarios (grandes, medianos y pequeños) en la creación de polìticas públicas que podrían llevar a disminuir la pobreza y la desigualdad.

La diputada provincial del bloque Justicialista visitó la ciudad de Reconquista y mantuvo reuniones con los sindicatos gremiales del norte santafesino.

En este episodio de Rompiendo el Internet, el analista político y periodista Hernán Gómez Bruera, conductor de El Octágono, en La Octava, habla sobre el arte de provocar y hacer política desde los medios.

FESTRAM denunció cortes en el servicio de IAPOS para afiliados

Nel business ti sarai trovata davanti a difficoltà che spesso molte altre imprenditrici trovano lungo il cammino. Se non sai come riscoprire il tuo talento con il coaching sei capitata nel posto giusto.In questo episodio ti racconteremo come usare il tuo potere femminile per riscoprire il tuo talento con il coaching, grazie a una pink coach formata nella nostra scuola. Lei è Miriam Bruera!===============Trovi questa puntata anche in versione video, su YouTube:https://www.youtube.com/channel/UCMXPcm_0htUbWvyWplmQG4APreferisci leggere? Dai un'occhiata ai miei articoli di blog: https://lunascuoladicoaching.com/blog/Vuoi raggiungerci per i prossimi live? Iscriviti gratis al gruppo Shine you Light su Facebook: https://www.facebook.com/groups/anh.coachE nel frattempo, se il mondo del coaching ti attira e vuoi capire se sei pronta a diventare coach, fai subito il quiz gratuito "LUNA” e scopri se è la strada giusta per te! Lo trovi qui: https://anhcoach.com/lunaquiz===============Mi trovi anche su:Instagram - https://www.instagram.com/anh.coach/Facebook - https://www.facebook.com/anh.coach/Puoi trovare Miriam in questi canali:Sito: www.pinkfactory.itFacebook: www.facebook.com/pinkfactoryInstagram: www.instagram.com/pinkfactoryYouTube: www.youtube.com/pinkfactory

Eduardo Bruera is a well-known passionate advocate and world leader when it comes to the ongoing evolution of comprehensive cancer care to truly address the whole person care needs of the patient. In this engaging conversation, we explore lessons learned and strategies to embed the delivery of integration oncology in cancer care systems. Starting his career in medical oncology in Edmonton he was quick to develop a system to in cancer care, the ESAS to capture the patient voice and embed research and outcome measures into clinical supportive care and IO delivery. For the last 2 decades, he has been the director of the MD Anderson palliative care rehabilitation and integrative medicine program. He is working with SIOs Jun Mao as the ASCO representative for developing the guidelines for Integrative medicine in managing cancer pain.

Luiz Eson Fachin, ministro del Tribunal Supremo Federal de Brasil, anuló todas las condenas que tiene el expresidente Lula da Silva. La decisión supone un fuerte cambio político en Brasil porque esto habilita a Lula a ser nuevamente candidato. Carmen Aristegui charla con Paulo Abrāo, exsecretario ejecutivo de la Comisión Interamericana de Derechos Humanos, y con el analista internacional Hernán Gómez Bruera sobre el futuro de Lula y de Brasil.Para conocer sobre cómo CNN protege la privacidad de su audiencia, visite CNN.com/privacidad

El analista señaló que existe una tendencia a pensar que el racismo es algo que siempre está lejos de nosotros

El analista político Hernán Gómez Bruera explica en entrevista con Aristegui cómo ha llevado a cabo su gestión el presidente de México, Andrés Manuel López Obrador, a dos años de estar en el poder. El también internacionalista asegura que el mandatario “está cambiando” el país con sus acciones gubernamentales. Pero también hay críticas al mandatario. El director editorial de Cuestione, Andrés Pascoe Rippey, habla de las políticas públicas en temas de seguridad durante los dos primeros años del Gobierno de López Obrador. El también escritor asegura que tanto grupos feministas, la comunidad LGBTQ, así como indígenas, sociedad civil y personas con discapacidades, han sido olvidados en el gobierno de AMLO.Para conocer sobre cómo CNN protege la privacidad de su audiencia, visite CNN.com/privacidad

Esta semana se cumplieron 8 meses de la muerte de Carlos "Bocacha" Orellano, cuyo cuerpo fue encontrado en el río Paraná a metros del boliche Ming, lugar donde fue visto por última vez. Para hablar del caso estamos en contacto con la diputada provincial Matilde Bruera, quien está al frente de la Comisión de Seguimiento e Investigación de la causa.

En este nuevo episodio recordando el 17 de Octubre de 1945, Raúl Bigote Acosta mantiene una charla con Hugo Bruera, sobre aquellas jornadas históricas

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez, is joined by Dr. Eduardo Bruera a to discuss updates on palliative care in gynecologic oncology. Dr. Eduardo Bruera is the F.T. McGraw Chair in the Treatment of Cancer, Department of Palliative, Rehabilitation and Integrative Medicine and the The University of Texas MD Anderson Cancer Center. Dr. Bruera’s main areas of interest are program development, comparative effectiveness research, and clinical studies on symptom control in palliative care. He has published more than 1200 publications, given more than 900 major invited lectures, and has received multiple NIH research grants and awards.

In un periodo in cui dobbiamo stare distanti e rinchiusi in casa il più possibile, come cambia il modo di lavorare di chi invece della presenza fisica fa il suo punto di forza? In questo episodio intervisto Miriam Bruera di Pink Factory, una coach che si occupa di imprenditoria femminile, che ha dovuto cambiare il suo modo di lavorare. Ci spiegherà il suo lavoro, come ha dovuto adattarlo alla nuova situazione e cosa ha fatto e sta facendo anche su se stessa.Potete trovare Miriam da queste parti: pinkfactory.it e pinkfactory.academy—Iscriviti al podcast su iTunes o su Spotify. Metti i tuoi like o le stelline su Spreaker e su iTunes e sulle piattaforme che usi. Insomma, datti da fare per far crescere il primo podcast dedicato al vino digitale! ---Per finanziare The Digital Wine puoi andare su patreon.com/thedigitalwine, e per la newsletter basta cliccare sul pulsante del sito thedigitalwine.com. Altre notizie sulla wine tech puoi leggerle naturalmente su http://webinvigna.it---Sigla iniziale: By By Baby by Stefan Kartenberg (c) copyright 2016 CC (3.0) licenseSoundtrack: Funin and Sunin by Kevin MacLeod (incompetech.com) CC (4.0) license

Noi freelance abbiamo spesso un grande difetto: fatichiamo a far percepire il nostro VALORE.Ecco perché occorre avere il mindset giusto. Lo ricordo spesso e su questo punto - e non solo - si trova d'accordo con me Miriam Bruera, business coach al femminile e imprenditrice spirituale. Ho conosciuto Miriam durante la preparazione per il Congresso DonnaOn che si terrà a Marzo a Riccione. Insieme a lei e ad altre splendide donne abbiamo lavorato per apprendere e migliorare nel public speaking e nel marketing, ma anche nella visione imprenditoriale.Chi mi segue da tempo lo sa, mi piace contaminare - in senso positivo - gli ambiti e le professioni per condividere un'opportunità di arricchimento per tutti. Emi piace riscontrare dai vostri messaggi che ciascuno di noi riesce a trarre spunti e nuovi stimoli.Nell'episodio di oggi impareremo che per espanderci dobbiamo ripensarci come imprese, crescere in team e sentire il nostro valore.Buon ascolto!

Esteban Bruera siempre ha estado rodeado de música. Desde muy temprana edad se acercó a la música electrónica y encontró en los reproductores y tornamesas la manera de contagiar su melomanía. Sus espectro musical nos lleva en un viaje que va desde el Hip-Hop hasta el Techno, caracterizando sus sets por tener mucho ritmo y experimentación.

Esteban Bruera siempre ha estado rodeado de música. Desde muy temprana edad se acercó a la música electrónica y encontró en los reproductores y tornamesas la manera de contagiar su melomanía. Sus espectro musical nos lleva en un viaje que va desde el Hip-Hop hasta el Techno, caracterizando sus sets por tener mucho ritmo y experimentación.

Esteban Bruera siempre ha estado rodeado de música. Desde muy temprana edad se acercó a la música electrónica y encontró en los reproductores y tornamesas la manera de contagiar su melomanía. Sus espectro musical nos lleva en un viaje que va desde el Hip-Hop hasta el Techno, caracterizando sus sets por tener mucho ritmo y experimentación.

Se moviliza México en contra de AMLO en la ahora famosa Marcha de los 100 varitos y todo sobre sus lonas, carteles y protagonistas. Hernán Gomez nos acompaña en La Llamada para educarnos sobre política. Guaidó se fue a la guerra, qué dolor qué dolor qué pena y el Tuit de la Semana.

Hello, and welcome to the ASCO Journal of Oncology Practice podcast. This is Dr. Nate Pennell, medical oncologist at the Cleveland Clinic and consultant editor for the JOP. The opioid crisis continues to be a major public health issue, with increasing attention at both the state and national level. Efforts to address this issue are highly relevant to oncologists, because we treat a unique population of cancer patients for which opioid prescriptions are an established standard of care. So how will these efforts to address the opioid crisis impact the care of our patients? And what role can oncologists play on this issue? Today, we're going to be talking about this topic with Dr. Ray Page medical oncologist and hematologist at the Center for Cancer and Blood Disorders in Fort Worth, Texas, who currently serves as chair of ASCO's Clinical Practice Committee, is on the ASCO Government Relations Committee, and is the current ASCO delegate to the AMA House of Delegates, about his new editorial titled, "Opioids and Cancer Pain, Patients' Needs and Access Challenges," which will be published in the April 2019 JOP. Ray, thanks for joining me today. Thank you. So can you start out by giving our listeners a little background on the magnitude of the opioid problem in the US. Sure, Nate. Let me just first say, the opioid epidemic is real and is startling. The CBC reported that in 2017 that over 72,000 in the United States died from drug overdoses. And this included over 47,000 people who involved in drug overdoses of opioids. And most of us have heard from the media that the biggest increase in use is through that synthetic opioid fentanyl. And it's often laced with heroin. And the recent volumes that have confiscated at the US border are enough to kill ever single US citizen. And the escalation of opioid abuse is really complex societal issue. And it includes contribution from all of those social determinants of health and mental illness. And when policymakers sometimes they like to look at a one size fits all kind of solution, which means they oftentimes want to largely focus on physician prescribing habits and just regulating patient access to opioids. Is there evidence that this kind of solution of targeting opioid prescriptions is impacting opioid prescribing in cancer patients? There is a negative impact there. But let me just say that cancer pain is very real and it's very frightening. And we know that cancer pain is historically undertreated. 8 out of 10 advanced cancer patients experience moderate to severe pain. And about 55% of cancer patients and 40% of cancer survivors experience chronic cancer related pain. So upwards of 43% of cancer patients and 10% of survivors use opioids to manage chronic cancer pain. Because of the heightened media awareness about the opioid epidemic, cancer patients are really experiences a lot of fear firsthand. Many of my patients have expressed to me that they actually have a fear of dying from taking opioids. And there's also of addition. And then on the other hand, they also have a fear that they may not even be able to get their hands on pain medicines at all. That actually is a really interesting topic that I hadn't thought of because I have the same problem with my patients worrying about taking opioids. You think that this being so much in the public eye is really influencing cancer patients' ideas about whether they should be taking opioids or not. They feel like they're at risk for addiction and contributing to the problem. Our cancer patients I think do have those real concerns and they have fear over it. And we're actually seeing that about a 1/3 of cancer patients and survivors are actually having difficulty to getting access to their prescribed opioid medications. And that has continued to increase markedly since just a few years ago in 2016. And the vast US oncology practices are concerned that restrictions on opioid prescribing is going to ultimately result in undertreatment of cancer pain. So it's these kind of dynamics what makes it difficult for physicians to treat pain, particularly cancer and cancer survivors. And while judicious prescribing is important, patients with cancer and cancer related pain, they need to have consistent access to pain control. Well, I think we can all agree on that. Before we talk about how we can protect cancer patients' access to these drugs, can you talk a little bit about what is being done sort of at the state and national level to address the opioid crisis and sort of how that's impacting our cancer patients? Yeah, absolutely. The opioid epidemic will continue to be a bipartisan priority for both state and federal governments with currently over 100 state bills that are out there that are identified. In a lot of upcoming state legislative sessions, there will be consideration of bills that are related to such things prescription fill limits and prescription drug monitoring programs and opioid prescribing guidelines. And we're all expecting to see bills that are going to be related to the identification of outlier prescribers and bills that are promoting the utilization of opioid alternative therapies in the cases of both acute and chronic pain. Just on the federal level, you know in 2016, President Obama, he signed the first major federal addiction law in 40 years. And that was the Comprehensive Addiction Recovery Act. And that bipartisan legislation authorized evidence-based prevention and treatment programs and recovery programs and law enforcement initiatives to help prevent overdose death and proper prescriptions. And as you had asked, in 2017 when President Trump came into office, he announced that his administration was declaring an opioid crisis and made a national public health emergency under federal law. And as a result, the White House office of the national drug control policy directed numerous federal agencies to address the opioid problem. But that was largely within their current budgetary confinements. But I think actions by both administrations had positive impacts on the opioid problem primarily just by initiating activity in our government agencies. So when the various laws and policies are passed, do they have built in protections for vulnerable populations that need access to opioids, like cancer patients? Yeah, that's one thing that we've pushed a lot for. And in general, most of them do. And so President Trump signed a sweeping legislation in 2018 that was touted as the single largest bill to combat the drug crisis in our countries history. And there was a lot of efforts to do things like expanding access to treatment for substance abuse disorders and those kind of things. But, for example, January 1st of this year, as part of that law, it included new opioid prescribing policies that will impact Part D beneficiaries and the prescribers. And this includes such things as real-time safety alerts on pharmacy dispensing of opioids and drug management and utilization tools and the improvement of communications between the pharmacists and the physicians. But as you asked, one important note about this legislation that was passed is that residents of long-term care facilities and those that are in hospice care and patients receiving palliative care or end of life care, and patients being treated for active cancer related pain, they are exempt from a lot of these interventions. Well, it's good that at least someone is considering our patients in this. But I know that certainly-- I believe ASCO has quite a bit of concern about maintaining access to patients. So what role is ASCO playing in this issue? You know, Nate, ASCO is very sensitive to the needs, to address the opioid crisis and to support thoughtful and evidence-based interventions aimed at decreasing substance misuse and abuse and overdose death. However, ASCO really continues to advocate for appropriate access to pain medications for cancer patients, recognizing that that typical one size fits all solution risks oftentimes marginalizing our cancer patients and their needs. And so in 2016, ASCO released an ASCO policy statement on opioid therapy which emphasizes the unique pain management needs of patients with cancer and especially those with advanced disease. And in this policy statement, ASCO points out a lot of core principles to balance public health concerns and cancer patients' needs. Well, I really like the fact that ASCO is focusing not so much on specific individual needs, but rather making sure everyone recognizes that there is no one size fits all solution here and also you know acknowledging that there is a real problem with opioid misuse in the United States, but that our patients need to be considered carefully in this. One of the things I liked about your editorial was focusing on how physicians might actually be able to learn about managing pain in cancer patients and not necessarily just focusing on the use of opioids. Can you talk a little bit about that? Yes, sure. You know, just in general, as we all know, as oncologists, we rely heavily on the use of opioids. But we should never rely solely on the use of opioids. And we need to determine if opioids are indeed the right drug for particular type of cancer-related pain. And so ASCO published recent clinical practice guidelines for chronic pain management in cancer survivors that gives advice on careful assessment of pain and its effects on function and of the possible risk associated with an opioid. And so I generally recommend that clinicians review some of these practice guidelines because many of these recommendations can help reduce opioid prescribing and actually consider other good, viable non-opioid alternatives, such as using pain specialists and other interventional procedures. Yeah, I think everyone would benefit from being aware of the problem and making sure that they are using opioids appropriately. I guess I'm just a little concerned about how all this attention is impacting our patients and their access to drugs. We did a JOP podcast, oh, I think a year or so ago with Dr. Bruera, who is a palliative care specialist at MD Anderson, who published a study showing that palliative care physicians were actually prescribing significantly less morphine equivalents for cancer patients. And there was a lot of alternative treatments, such as tramadol, that were being used. And we had a nice discussion about how perhaps some of that was a good idea. But they're also putting sometimes patients at risk of being under treated. Yeah, that dynamic is very complex, because I think we all realize that are certain types of pain that do get effectiveness with opioids to get appropriate pain relief. But the palliative doctors are usually very good and many oncologists also about entertaining those alternatives. And so oftentimes there are many kinds of cancer pain syndromes, both acute and chronic that can be managed with non-opioid alternatives. We as oncologists, we realize that this is a really vulnerable patient population. And we'll continue to develop and utilize all the latest advances in the comprehensive management of cancer in accordance with published evidence-based physician developed guidelines. However, we also want to design the statutory and regulatory requirements do not unduly restrict access to opioids and acknowledge the need to exempt cancer-related pain in our opioid policies. And I think that's absolutely critically important. And you know this is exactly the kind of function that societies like ASCO and the AMA really exist for, to protect our patients and the physicians who are prescribing these necessary medications to our patients. Well, it's been my pleasure to share this publication with you. And I hope it will be an important educational tool for the oncologists to work on to deal the opioid access problem for our patients. Thank you so much for joining me. I also want to thank all of our listeners out there who joined us for this podcast. The full text of the paper will be available online at ascopubs.org/Journal/JOP in April 2019. This is Dr. Nate Pennell for the Journal of Oncology Practice signing off.

Dr. Eduardo Bruera is chair of the Department of Palliative, Rehabilitation and Integrative Medicine at the University of Texas M.D. Anderson Cancer Center. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. E. Bruera. Parenteral Opioid Shortage - Treating Pain during the Opioid-Overdose Epidemic. N Engl J Med 2018;379:601-3.

In which Shree talks to Dr. Eduardo Bruera, a palliative care doctor who has ironically made it his life’s mission to talk about death, dying, and dignity. We talked about how to approach my own career with the patient first, and how to combat distress and dying with helping people be comfortable with their own mortality.

The purpose of this podcast is to provide education to clinicians on the frequency, clinical presentation, contributors, assessment, and management of delirium in the palliative care setting. 

Nos ponemos en el pasado Gran Premio de los Estados Unidos en Austin, una carrera que prometía muy poco y desde la salida no dejó de darnos emociones en casi todas las posiciones. Y no dejamos de lado el incidente del Gran Premio: El adelantamiento de Max Verstappen a Kimi Raikkonen en la última vuelta que resultó en sanción. Con Alejandro Fernández, Stefanía Bruera, Mar de Fulgencio y Chemi Calavia.

FELICITAMOS Y AGRADECEMOS LA EXCELENCIA Y COMPROMISO CON LA VIDA, Y LA SALUD,de DRA.GUADALUPE BRUERA,experta en NEUROLOGIA.,con sello familiar de docente de UNR, COORDINADORA NACIONAL DE PREVENCIÓN ATAQUE CEREBRAL SNA. ..recordemos que PREVENIR ES CURAR... ,y la PREVENCIÓN TIENE QUE VER CON LA EDUCAICÓN para la SALUD, y DIVULGACION CIENTIFICA.. ASI QUE INFINITAS GRACIAS.. ABRAZOTES DE PAZ Y LUZ.. MARISAPATIÑO.EmbajadoradePaz./CEO.www.esperanzargentina.com.ar

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FELIICTAMOS Y AGRADECEMOS A LA DRA.BRUERA,por su genetica de excelencia en la docencia enNEUROLOGIA.. y su incansable, investigación sobre temas que hacen al BIENESTAR DE LA HUMANIDAD.. LA EDUCACIÓN PARA LA SALUD, ES PRIMORDIAL, PARA TRAER PAZ, Y SALUD.. INTEGRAL.. Retransmitimos, estos temas, dando respuestas a las multiplies consultas que recibimos... GRACIAS.. ABRAZOTES DE PAZ Y LUZ.. MARISAPATIÑO.Embajadora de paz./CEO.www.esperanzaargentina.com.ar

Brasil vive una crisis política que se ha agudizado en las últimas semanas, cuyas causas hay que buscar tanto en algunas acciones del gobierno de Dilma Rouseff como en los engranajes de un sistema que descansa en la corrupción y los acomodos pragmáticos entre partidos. El politólogo Hernán Gómez Bruera explica el asunto.

Joan Stephenson, PhD, discusses Palliative Management of Fatigue at the Close of Life with Dr Eduardo Bruera.

JAMAevidence Podcast