Podcasts about psychosocial oncology

Cancer changes more than just the body, it reshapes how we see ourselves. In this episode of the Cancer Assist Podcast,  Dr. Karen Zhang, Psychologist and Interim Head of Service, Psychosocial Oncology, joins Dr. Bill Evans to explore the emotional, cognitive, and social impacts of cancer on identity. From changes in physical appearance and brain fog to shifts in relationships and career roles, they unpack what it really means to rebuild your sense of self after treatment. With compassion and practical advice, Dr. Zhang offers insight into coping strategies, supportive resources, and the importance of curiosity and self-compassion on the road to healing. 

Mary Cortes and Dr. Pozo-Kaderman join Gresh and Fauria to discuss Dana Farber's Young Adult Program (YAP). The aim of YAP is to o   Ease the emotional burden of living and coping with cancer o   Empower young adults to become active participants in their cancer treatment o   Provide emotional and social support in the form of educational workshops, conferences, opportunities to network with other young adults with cancer, and clinical mental health services  Mary was diagnosed with lymphoma in May 2023. Mary sought consultation at two other hospitals before deciding to proceed with her care at Dana-Farber. Mary's treatment included a port placement for a six-month course of chemotherapy.  Mary is a nursing student and surgical assistant at a Cranio-Maxillofacial surgeon's office in Medford. Dr. Pozo-Kaderman is a senior psychologist and the Director of the Young Adult Program (YAP) and Director of Interprofessional Education in the Department of Psychosocial Oncology and Palliative Care at the Dana Farber Cancer Institute with a faculty appointment at Harvard Medical School.

Artful Oncology - A Psychosocial Oncology Curriculum for Heme/Onc Fellows: Jafar Al-Mondhiry, MD by i3 Health

In previous episodes, Talking About Kids has addressed the need for trauma-informed care and the importance of involving youth in the design and oversight of programs for them. This episode combines the two. Recently, Yehudis Stokes, Marjorie Robb, and their colleagues published a paper on the perspectives of youth, caregivers, and other stakeholders on implementing trauma-informed care in an inpatient mental health program. Yehudis Stokes is a Registered Nurse at the Children's Hospital of Eastern Ontario and a Clinical Nurse Specialist with the Psychosocial Oncology team at Princess Margaret Cancer Centre, and Marjorie Robb is the Acting Chief of Psychiatry at Children's Hospital of Eastern Ontario and the Division Chief of Community-Based Psychiatry. The episode was recorded live using a webinar platform to encourage questions from Alliance members and other listeners. If you would like to participate in the webinars, you can join the Arizona Alliance for Adolescent Health's mailing list at healthyazyouth.org. More information about Yehudis, Marjorie, their research, and the Arizona Alliance for Adolescent Health is at talkingaboutkids.com.

ASCO: You're listening to a podcast from Cancer.Net (Cancer dot 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 podcast, Dr. Fay Hlubocky  and Shelly Rosenfeld discuss what people should know about returning to work after cancer treatment. This podcast is intended for informational purposes only and does not constitute legal or medical advice.  Dr. Hlubocky is a licensed clinical health psychologist with an expertise in psychosocial oncology and a health care ethicist at the University of Chicago. She's also the Cancer.Net Associate Editor for Psychosocial Oncology. Ms. Rosenfeld is the director of the Disability Rights Legal Center's Cancer Legal Resource Center, which provides free information and resources about cancer-related issues.  View disclosures for Dr. Hlubocky and Ms. Rosenfeld at Cancer.Net. Claire Smith: Hi, everyone. I'm Claire Smith, a member of the Cancer.Net team, and I'll be your host for today's Cancer.Net podcast. Cancer.Net is the patient education website of ASCO, the American Society of Clinical Oncology. Today, we'll be talking about what people with cancer should know about returning to work after treatment, including information about the legal protections available to people with cancer in the United States. Our guests today are Dr. Fay Hlubocky and Ms. Shelly Rosenfeld. Dr. Hlubocky is a licensed clinical health psychologist with an expertise in psychosocial oncology and a health care ethicist at the University of Chicago. She's also the Cancer.Net Associate Editor for Psychosocial Oncology. Thanks for joining us today, Dr. Hlubocky. Dr. Fay Hlubocky: Thank you, Claire. It's such an honor and a privilege to be with you and Shelly today. Claire Smith: Wonderful. Our next guest, Ms. Rosenfeld, is the director of Disability Rights Legal Center's Cancer Legal Resource Center, which provides free information and resources about cancer-related legal issues to members of the cancer community across the U.S. Thanks so much for being here, Ms. Rosenfeld. Shelly Rosenfeld: Thank you. I'm honored and grateful to be here today. Claire Smith: Before we begin, I should mention that Dr. Hlubocky and Ms. Rosenfeld do not have any relationships to disclose related to this podcast, and you can find their full disclosures on Cancer.Net. So, to start, Dr. Hlubocky, can you talk a little bit about some of the ways that people might think about work differently after an experience like cancer? Dr. Fay Hlubocky: Thank you, Claire. That's such an important question to start today's talk with. For many, the thoughts and decision-making surrounding returning to work can be very complex. Perspectives on if, how, and when to return to work will differ from person to person. Although one may feel quite motivated and even inspired to return to work after the cancer experience, the idea to return to work immediately after this post-cancer journey phase may simply seem overwhelming and bring about anxious and worrying thoughts. Thoughts and questions such as, "Am I ready to return to work after all I've been through?" or "Can I do the job like I did before?" are common and expected. For some who may experience financial burdens, these individuals feel compelled to return to work with thoughts of, "I have to get back to work," and feel like that's the only option is to return to work immediately even if not ready. Yet others may ask themselves, "Should I work full- or part-time? How can I return to work?" Or, "Can I return to that same busy schedule as I had engaged in before?" Finally, some may wonder if that same job is right for them after all one has been through. Again, these are very normal, common, and expected thoughts and questions regarding return to work that the individuals certainly may hold after the cancer experience. Claire Smith: Wonderful. Thank you for that overview. And next, you touched on some concerns, but I'd love to hear about what concerns someone might have about returning to work after cancer. Let's go to you, Ms. Rosenfeld. Shelly Rosenfeld: Well, one concern for someone returning to work, it could be either, of course, returning to their job, but it can also be returning to work and starting a new job. And that might be when one might need to perhaps take additional days off, and whether it's for treatment or follow-up care or perhaps just monitoring as well. But to use up those sick days and then to need additional sick days, there is protections out there such as Family and Medical Leave Act, or FMLA. But a concern for someone starting a new job is, in order to be covered by FMLA or the Family and Medical Leave Act, someone has to have worked for the employer for a total of 12 months and have worked at least 1,250 hours in the last 12 months, which comes out to a little more than part-time. But that is certainly a concern because taking time off whether to care-- actually, it could also be a caregiver taking care of someone with cancer, that they need to have worked for that employer for at least 12 months. Later, I think we might be talking about one way to work with the employer in terms of - just to kind of hint with the Americans with Disabilities Act - kind of a creative way to ask for additional time off and to see if that can work out with the employer. So I want to wait until we talk about that a little more in depth, but I just want to say there is hope and there is something that perhaps can be worked out with your employer if there is that concern. But I just want to say that while FMLA, and just to kind of briefly touch upon it, it allows certain employees to take up to 12 work weeks per year to take care of oneself or certain family members with a serious health condition. For example, that could include a spouse, parent, or child. So it is unpaid, but one's job has to stay open for that person until the end of that 12-week period, and the employer has to keep providing health benefits. So it's something to keep in mind if somebody is returning to work and is at their job now for some time and needs to take those days off. Beyond those sick days, there are protections out there. But if they're just returning to work and they haven't been at a job for that long, then they should consider, "OK. Maybe the state has additional protections that the federal law does not have," or to think about-- and we'll talk about reasonable accommodations in Americans with Disabilities Act in a bit, I think, as a solution. So with every challenge, I think there is some kind of option, but that is certainly a concern. Claire Smith: Yeah. Absolutely. I think it's so important to sort of think about these concerns as people are going to worry about them, but there are ways to sort of address and hopefully cope with them. Dr. Hlubocky, do you have anything else to add? Dr. Fay Hlubocky: I agree, many survivors we know with cancer do desire to return to work. Just recognizing the fact that holding a job provides a routine, a schedule, freedom, income, meaning, it makes us feel fulfilled, it gives us a sense of purpose, and work specifically for survivors can bring a sense of normality, especially after that cancer experience. Yet for others, we know that the thought of returning to work can be very concerning. Folks might be worried over their energy and their endurance and ability to really perform at their job due to continuing or existing cancer-related or treatment-related symptoms, such as fatigue or insomnia or pain. Others may worry about colleagues' attitudes and relationships, concerns and fears over if colleagues will judge them for their appearance or their performance may arise. As well, many survivors question, “How will I be treated?” or “Will they work with me as they did before?” These are also frequent and commonly held concerns by many patients and survivors. For all survivors, it's important to recognize that this is a new normal, a new phase in this journey post-cancer and cancer treatment that can really bring a new perspective with greater meaning and purpose. This new perspective - really, this growth - can be a motivator and inspire not only you in the work environment but your colleagues as well. Claire Smith: So talking about maybe some of the things that we can share with our listeners to help assuage some of these concerns that they may have. I want to start, if someone is applying for a new job after cancer treatment, maybe they've been out of the workforce for a little while while going through cancer and its treatment, are there any legal protections available to them during that process, Ms. Rosenfeld? Shelly Rosenfeld: There are. So I briefly mentioned the Americans with Disabilities Act, or ADA, which is a federal law that makes it illegal for employers with 15 or more employees to discriminate against, and it includes qualified job applicants or qualified employees with disabilities in any stage of the employment process. So that includes the interview process. A lot of people don't know that before someone even starts working, that they do have those protections. So that is really important for someone to keep in mind as they go through the interview process. So an employer is not allowed to ask about a job applicant's medical history, whether they've taken any leave in the past, or whether they expect to take leave. The only 2 questions related to disability or cancer that employees are allowed to ask are, "Are you able to perform the essential job functions?" and "How will you perform the essential job functions?" So, in order for someone to receive protection under the ADA, they have to be able to do the essential job functions. For example, without anyone knowing me, I don't have experience playing football. So, I do not have the ability currently to do the essential functions of being an NFL football player, not at this time and not in the past, so far. So, for example, the ADA, no matter what, wouldn't protect me because I can't do those job tasks. But if someone can do the essential functions of a job, right, they're applying for it, hopefully they're able to do those essential functions, if they have cancer or are affected by the effects of cancer treatment, they could be protected. So it is really important to keep in mind during that job application process, the employer can't ask if you're disabled. I know that sometimes they'll have things on the end of an application, but those are optional, right? So someone does not have to answer that, but they can ask, of course, if you can do the essential functions of the job. And so, yeah, I think that's just something to really keep in mind as someone's going out through that process. Claire Smith: You talked a little bit about the ADA and how we can use those protections. And a lot of people with cancer, they may have mental changes like brain fog or even physical changes, fatigue, or other side effects, long-term side effects of their cancer and treatment, where they might need some accommodations to be able to accomplish those essential job functions that they can do. Can you talk a little bit about what that process looks like to ask for those accommodations? Shelly Rosenfeld: Just to recap, cancer, the effects of cancer can be a disability under the Americans with Disabilities Act. I know for some people affected by cancer, thinking of the word “disabled” as it relates to cancer might be just a new way to think about it. So I'm only talking legally. So somebody might have been in the best health of their life and been in the best shape and then they're affected by cancer, and then the law may consider them as disabled. So we're talking about disability in terms of the legal definition for the Americans with Disabilities Act.  So let's talk about reasonable accommodations. So as you mentioned, of course, the effects of cancer can be a disability because they might substantially impair major life activities such as eating, sleeping, concentrating. And so reasonable accommodations can range anywhere from making changes to a physical environment, such as moving file drawers to a more accessible location, or changes to the way that someone works. For example, teleconferences into meetings rather than in person. Whether an employer has to give someone the type of accommodation they're trying to get depends on whether giving it would be an undue hardship to the employer. Being an undue hardship usually means practically that it will cost the employer too much to give someone the accommodations, so what costs too much really depends on the specific job and the specific employer at issue. So, for example, what might be easy to do for one employer may actually be really difficult for another, but we usually ask for folks to ask for accommodations before their work performance starts to suffer. So if your performance suffers at work, an employer may take negative action against you if they don't know you have a disability or a need for accommodation. So if an employer sees someone sleeping at their desk, they can be fired. So if the employee decides to ask for a reasonable accommodation under the ADA and tells the employer that they have fatigue from cancer treatment and need more frequent breaks due to fatigue before the employer has a chance to see them sleeping on the job, the employee has more protection at work. It is a personal decision, and I just want to touch upon this because this question sometimes comes up where people say, "Should I talk to my employer or not?" I know, the CLRC, we don't take a position, yes or no. It is completely that person's decision, and I would respect someone either way. So that might on the one side be a little nerve-racking, but it could also on the flip side be reassuring. But there's no wrong choice. It's best to do what is best for that person. I do recommend, however, if you do want to have that discussion with your employer, if you can find someone trusted, whether it's a parent or a friend or just even a doctor or patient navigator, and try to have that conversation, because it can be difficult talking to an employer about that. Even if you feel like you really have a good relationship with that employer, it is still a different type of discussion. And I just want to also mention that it is an interactive process. So suppose someone asks for accommodation, a reasonable accommodation under the ADA, and the employer says, "This is not something that we can do. It's going to cost too much. It's not practical." Then hopefully they come back with something and say, "How about this option?" And then the employee could say, "It still doesn't really help what is the ultimate challenge here. How about this?" And hopefully it's both sides working together in the interactive process. Now, of course, if someone asks for a reasonable accommodation, it may very well be granted in its original request. But just to keep in mind that if an employer pushes back, it is designed to be reasonable for both sides. And just to give an example, because I think it could be hard when someone says, "It depends on the employer. It depends on the employee." Right? So many people have such different jobs and employers are also so different, but here's an example. Suppose, for example, someone is a cashier, and they have to interact with people. They have to ring them up and take money and work at the cash register, but they're going through cancer treatment. And they're still able to work, but they do need a reasonable accommodation. So, for example, they might ask for a stool to sit between helping people. So if there's not someone else next in line, they can at least sit down. Giving them a separate office with a gold chair might not be reasonable, because they actually have to be there to help folks, but a stool doesn't take too much space, gives someone the opportunity to sit down, could very well be reasonable. So that's just kind of a way to think about it as an example. And I think the doctor or also patient navigator team can be partners in this. You can ask, "When someone has this treatment, what side effects can I expect? I do this as my job. Have you had patients like this in the past? What are some things that might have helped them?" And you just start that conversation going and also think about your job and how you go about your job and what might help, or how you're feeling and what could really make a big difference. It might be that snacks are not allowed at the desk, but having a snack and being able to eat it can really combat nausea. It can also be more than one accommodation. There might be more than one side effect that needs to be addressed. So it is something to keep in mind. Be aware of yourself and what helps you ultimately succeed so you can keep having that income, keep having that job, and hopefully keep having that health insurance. Of course, there's the FMLA protections if someone needs to take that time off, but that is something to keep in mind. And because I promised this, I just want to raise it now, is that if someone is not eligible for FMLA based on they haven't worked at their job long enough to qualify and there's no additional state protections that apply, they may be able to ask for some additional time off under the Americans with Disabilities Act beyond their sick days. Saying, "I don't know when I'll get back," and kind of an indefinite time of leave, that might be harder to get approval for as a reasonable accommodation. But saying, "I need X number of days, and then I'll check in with you about that." Or, "I need X number of days," might be something that the employer might be more willing to work with that person. So like I said, there is something to be worked out potentially. Claire Smith: Oh, wonderful. Thank you for outlining all of that. I think that's really helpful to sort of understand what that process looks like, what maybe some reasonable accommodations are, and the fact that it is sort of an interactive process. So another thing that Dr. Hlubocky mentioned earlier as maybe being a concern is how to talk to coworkers. Are there questions that coworkers might have after you've been out for cancer treatment, how to manage perhaps uncomfortable conversations. Can you talk about some of the ways that someone with cancer can kind of help prepare mentally for those kinds of conversations, Dr. Hlubocky? Dr. Fay Hlubocky: Reactions will be different, and they'll vary from person to person, colleague to colleague. Some colleagues will be supportive, know when to ask or not to ask questions, and these colleagues will also try to be helpful with tasks as you return to work. Yet others might be very avoidant because they simply don't know what to say, and that can be hurtful because we all want to feel supported by our colleagues, especially after an experience like cancer. Therefore, it's important for you to prepare and plan on what you want to say before you're returning to work. Honestly, there's really no right or wrong way to address this, as everybody deals with the cancer experience differently. You may desire to talk openly about the cancer experience, or you might wish to simply move on in order not to be treated differently by colleagues. Empowering yourself by setting boundaries on how to address these questions is key. For example, you can thank your colleagues for their concerns. However, express that, for you, now is not the time or the place to discuss your experience. Remember, you have to feel comfortable and safe in discussing your experience. Accept help if offered, especially in the initial stages of returning to work. Also, it's important to be prepared that some relationships may change. For example, those who were supportive and close to you before the cancer may distance themselves afterwards. You will learn who you can count on, and that is what's important. If you do feel comfortable, talk to your supervisor regarding any concerns that you may have about returning to work and addressing colleagues' questions so the supervisor can also help prepare the staff as well. But, again, only if you are comfortable. Be sure to check in with your supervisor, especially if you feel that the work environment is not supportive. Claire Smith: Wonderful. Great advice. And working can sometimes be stressful under the best of circumstances, and especially if you've gone through cancer treatment, you're maybe starting a new job or returning to a workplace. What are some tips for coping with some of those emotions and stresses that might arise? Dr. Fay Hlubocky: First and foremost, it's talking with your oncology team about when is the best time to return to work given your specific phase in the cancer survivorship journey, as well as inquiring about symptoms that you may have, like fatigue or cancer-related cognitive dysfunction and any other worries or symptoms that may interfere with returning to work. We want to be sure that you're physically healthy to return to work, and be sure to talk to them about any fears associated with working. Remember, we, your cancer team, are here to help you. Also, knowledge is power, and thus education on what is needed or how to return to work after cancer, taking into consideration life changes and symptoms can help to alleviate some of this distress. Also, again, if comfortable, talk to your supervisor about your options and to determine a plan. With the change in work environment, you may have the option to return slowly, gradually to the work environment first, maybe virtually, then part-time with fewer hours and gradually full-time. Again, if comfortable, talk to your supervisor about any time and work accommodations you may feel. Planning this return to work in partnership with your supervisor can really help you prepare as well as address any worries and anxieties you may hold. If the stress and the anxiety associated with returning to work is just really simply too overwhelming, talk to your therapist to help you plan to return to work. If you're not already connected to psychosocial support, engaging in the service can be a really valuable tool to help you determine your readiness to return to work. A psychologist, a social worker can really help you with preparing and problem-solving and planning when or if returning to work is an option now or in the future. Cognitive behavioral therapy, or CBT, is a research-based psychotherapy that we use that can help to address anxious and worried thoughts that you may have. And the goal of CBT is really to learn to control, challenge, and overcome distressing thoughts and beliefs about returning to work and helps you learn skills to really change your behaviors. It's also OK to realize that your job is now not right for you. Remember, a comprehensive plan in collaboration with your doctor, potentially your supervisor and psychosocial support, can really help prepare you, empower you as you begin the process of returning to work. Claire Smith: One other thing I wanted to touch on a little bit is issues around workplace discrimination. If someone is worried that they might face workplace discrimination after cancer, are there any resources available to them, Ms. Rosenfeld? Shelly Rosenfeld: Yes. If someone believes they've been discriminated against in the workplace or have questions about anti-discrimination protections, first of all, the Cancer Legal Resource Center, or CLRC, we have handouts on our website about someone's right to be free from discrimination in the workplace. Our website is thedrlc.org/cancer, and we recommend that someone speak with an employment attorney to discuss their legal options if someone thinks that they've been faced with discrimination. Someone also might want to file a complaint with the Equal Employment Opportunity Commission, or EEOC. The person can bring a claim for a violation of the Americans with Disabilities Act, or ADA, file a complaint with their state fair employment agency - of course, that depends on the person's state, where they live and work - or file a lawsuit against their employer. So, there's also an organization called the Job Accommodation Network, or JAN, which is a service of the U.S. Department of Labor's Office of Disability Employment Policy, where someone can learn more about resources available to them. So certainly, there are different options. We hope that no one experiences discrimination because of cancer, their history of cancer, an association with someone with cancer. Hopefully, no one ever experiences that. But if they do, hopefully they feel empowered already that there are options out there for them to assert their rights and hopefully ensure that others in the future will be free from discrimination as a result of cancer in the workplace. Claire Smith: Thank you for sharing those resources. Absolutely. Do either of you have any final thoughts before I let you go today or anything else you wanted to touch on for our listeners? Shelly Rosenfeld: I just want to say that, at times, it can be overwhelming, in addition to having a cancer diagnosis, to encounter so many different legal issues that are kind of these non-medical side effects of cancer. And I just want to say that at the Cancer Legal Resource Center, and I know that patient care teams really do care about keeping someone informed of their rights, and so it is important to know that there are rights out there and not to be hopeless about their rights because there might be things that you just never knew were possible. But just by making that effort to learn more about what's out there and what you might be entitled to, whether it's a health insurance appeal, whether if someone has to take a longer time off their job more than a year because of cancer, that there are income replacement options potentially through Social Security, that there are just health insurance options potentially out there for them, that there is hope and it is worth trying. It is worth appealing. And to work with your doctor and medical team saying, "Can you give me a letter? Can you write this for me? Do you have something that you've submitted for someone else for appeal for this medication or for this type of treatment?" And try to seek support in a practical way to stand up for yourself because the results and the upside of doing so are so important. So I just hope that someone comes away with this knowing-- you don't have to memorize or take notes or be an expert to know this after this podcast, just know that it's out there and that there are resources, and you can learn. And what the CLRC does, we do free. So just to know that there is something out there for them. Claire Smith: Wonderful. Great message. Dr. Fay Hlubocky: That's great, Shelly. Thank you. I've learned so much from this podcast. And to all the Cancer.Net audience out there, whether you're a patient or a caregiver or even part of the team, please know that we're here to help you in any capacity. Don't fight this alone, have self-compassion, be patient with oneself. This process does take time, and there's lots of resources here to help you to decide if returning to work is right for you now or in the future. Again, we're here to help you. Claire Smith: I love that. Thank you. And thank you both so much for sharing your expertise today. It was really wonderful having you, Dr. Hlubocky and Ms. Rosenfeld. Thanks for joining us. Shelly Rosenfeld: Thank you. Dr. Fay Hlubocky: Thank you so much. It was an honor and a pleasure to be with you all. Thank you. ASCO: Thank you, Dr. Hlubocky and Ms. Rosenfeld. You can find more resources and information about life during and after cancer treatment at www.cancer.net/survivorship. 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.

Integrative therapies have been proven to help reduce the adverse effects (AEs) of anxiety and depression in patients with cancer, according to Linda E. Carlson, PhD, RPsych.  Carlson, Enbridge Research Chair in Psychosocial Oncology and a professor in the Department of Oncology, Cumming School of Medicine at the University of Calgary, explained how different therapies such as mindfulness-based interventions, yoga, and relaxation could work to manage anxiety and depression in patients with cancer. Specifically, she talked about the new recommendations published by The Society for Integrative Oncology (SIO) in collaboration with the American Society of Clinical Oncology (ASCO), which highlighted integrative approaches to managing AEs related to anxiety and depression.1 During the interview, Carlson spoke about the current guidelines, which recommendations clinicians can begin to use in their everyday practices, and what aspects future research should focus on. Specifically, she highlighted the benefits of yoga, tai chi, and relaxation as possible therapies that can help mitigate the AEs of anxiety and depression. “For the clinician, [it's important to understand] that these options are available and that they're evidence-based,” Carlson said.  “Then, [it's important to figure] out where in your local area these kinds of treatments are available. Many comprehensive cancer centers have integrative therapies; they have yoga, tai chi, mindfulness-based interventions, relaxation, and imagery. Many counselors can offer those kinds of services and cognitive behavioral therapy. Being aware that [these options are] effective and that they are first-line treatments, finding out where they're available, knowing how patients can access them, facilitating the treatments in whatever way [clinicians] can, and advocating for more of these programs within cancer treatment centers will be important.”  Carlson is also the past president of SIO and a current editorial advisory board member of ONCOLOGY®. Reference Carlson LE, Ismaila N, Addington EL, et al. Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology–ASCO guideline. J Clin Oncol. 2023;41(28):4562-4591. doi:10.1200/jco.23.00857

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. The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today's episode, our guests will discuss new research in symptom tracking and improving health equity in childhood cancer. First, Dr. Fay Hlubocky discusses research on new ways of tracking symptoms in order to improve outcomes in people with cancer. Dr. Hlubocky is a licensed clinical health psychologist with an expertise in psychosocial oncology and a health care ethicist at the University of Chicago. She is also the 2023 Cancer.Net Associate Editor for Psychosocial Oncology. You can view Dr. Hlubocky's disclosures at Cancer.Net. Dr. Hlubocky: Welcome. I'm very glad that you are able to join us today. My name is Dr. Fay Hlubocky. I am honored to serve as the Cancer.Net Associate Editor for Psychosocial Oncology. I'm a clinical health psychologist specializing in psychosocial oncology at the University of Chicago Medicine. Psychosocial oncology centers on addressing the emotional needs of patients, caregivers, and clinicians from clinical research and educational perspectives. I have no conflicts of interest to report today. Today, we will discuss research on quality cancer care that was presented at the 2023 ASCO Annual Meeting. The theme for this year's meeting selected by the 2022-2023 ASCO President, Dr. Eric Winer, required all attendees to critically examine how interactions between clinicians and patients have changed over the years. “Partnering with Patients: The Cornerstone of Cancer Care and Research” centered on the need to observe what has been improved, what has worsened, and what can be achieved to make interactions between clinicians and patients better. The extraordinary quality and psychosocial care research presented at this meeting honored and fulfilled Dr. Winer's theme. For example, one session centered on the use of novel informatics technology to carry out research and care in the cancer clinical setting. This session, entitled, “Implementing Innovation Informatics-based Technologies to Improve Care Delivery and Clinical Research,” illuminated the current research progress of implementation for emerging information technology innovations in cancer care delivery. This session was designed to help oncologists and cancer care team to evaluate whether and how to integrate these innovations into their own clinical context. One outstanding research presentation was by Dr. Monika Krzyzanowska from Toronto's Princess Margaret Hospital called, “Implementing ePROs in the Real World Oncology Practice,” where she emphasized the importance of not only identifying and monitoring patient-reported outcomes or specific symptom burdens such as pain, fatigue, depression, or anxiety in the clinic, but yet they need to be monitored across the patient's treatment course well into survivorship at different time points, including at home. Therefore, there is a need for a standardized approach of identifying symptoms from patients because as Dr. Krzyzanowska said, patients forget to report even distressing symptoms, and clinicians at times are not always prepared to obtain these symptoms from patients. Historically, in the clinic setting and as patients receive treatment in the chemo suite, we have moved from paper and pencil clinical assessments to the use of robust assessments via electronic medical records systems in both the clinic and subsequently while patients are at home. She reported that more than 10 randomized clinical trials examined the benefits of remote monitoring for patients who undergo mostly systematic therapy with consistent improvements in both symptom control and other outcomes, including survival. She provided very robust real-world and life examples of successful implementation of patient symptom monitoring systems. For example, these have shown consistently that there's a need of improvements in symptom control, but improvement with the other outcomes. To date, she reported on several ongoing initiatives, including a large oncology community practice in Arkansas, who reported on their preliminary initial experiences with an assessment platform of 1,000 patients on systemic therapy who reported symptoms on a weekly basis. This team identified a very high recruitment rate of 79% with amazing retention rate at 88% at 6 months, dropping to about 67% at 12 months. Another real-world implementation example she noted is the work by the National Cancer Institute-funded SIMPRO consortium project, where 6 cancer centers evaluate symptom burdens in 2 different clinical scenarios: patients receiving systematic therapy and patients recovering from surgery. Here, patient data and symptoms are collected via an EMR-based E-system to readily respond to patient needs. The preliminary data and a whole host of research presentation centered on SIMPRO at the Annual Meeting showed that it was feasible, but yet a dynamic design is needed to address any operational and technical barriers for optimal implementation. Ideal partnerships between oncologists, cancer teams, patients, administrators, as well as the IT team is needed for optimal implementation as Dr. Krzyzanowska emphasized. Once these interventions are implemented, a study of sustainability of consistent patient reporting with adequate follow-up by team members, such as nursing, is important for long-term practice success. Finally, she reports that the future research of ePROs evaluation will involve novel approaches, such as clinical teams that will need to gather more complex data, including the use of dynamic approaches, such as wearable technologies, machine learning to address barriers and to improve the overall patient experience. In fact, a specific example of this type of research which reported on both the benefits and barriers centering on ePROs trials at the ASCO Annual Meeting included a very large randomized controlled trial by a Danish team led by Dr. Blechingberg Friis to evaluate the effects of remote symptom monitoring of patients with advanced lung cancer completing induction treatment in a Danish setting. Patients were randomized 1-to-1 to a remote symptom monitoring or an intervention arm added to standard care or just a standard care arm alone. Patients in the intervention arm completed an electronic questionnaire from home covering 13 common symptoms related to lung cancer. A severity alarm or threshold was applied to each question where elevated scores were sent to a clinical nurse for intervention. Weekly compliance to symptom monitoring during that first year was 82% with an intention to monitor population. Although remote monitoring did not significantly improve clinical outcomes for all patients with advanced lung cancer in the Danish population, the benefits were identified for a subgroup of patients not receiving maintenance therapy and for those with a prior organizational experience with ePROs monitoring, which may be essential for improving outcomes of symptom monitoring. In summary, as indicated by the researchers and Dr. Krzyzanowska, more research is needed using these novel approaches to determine the best ePROs platforms for the practice setting. Yet these approaches are critical to improve the overall quality of life of patients, especially during treatment, after surgery, and well into long-term survivorship. In summary, patients should be encouraged to discuss symptom burdens from physical to emotional with their oncology team and to use this technology. It was an honor and pleasure to present this research to you today. Thank you for listening to this brief summary of new research and quality care from the 2023 ASCO Annual Meeting. Best wishes. ASCO: Thank you, Dr. Hlubocky. Next, Dr. Daniel Mulrooney discusses new research on improving health equity in children, adolescents, and young adults with cancer. Dr. Mulrooney is an Associate Member in the Division of Cancer Survivorship at St. Jude Children's Research Hospital. He is also the 2023 Cancer.Net Associate Editor for Pediatric Cancers. You can view Dr. Mulrooney's disclosures at Cancer.Net. Dr. Mulrooney: Hello, my name is Dr. Dan Mulrooney from St. Jude Children's Research Hospital. I am the Deputy Director of the After Completion of Therapy Clinic at St. Jude and primarily care for survivors of pediatric cancers. Like previous meetings, the 2023 ASCO Annual Meeting was quite busy and full of research presentations sharing knowledge and advances in cancer treatment and care. Nearly 100 abstracts were presented concerning children with cancer, and these ranged from early studies of new agents to treat relapsed or refractory cancers, some of the most difficult to cure, to molecular profiling of tumors, to late outcome studies characterizing late effects, improved surveillance methods, and potential preventive treatments for adverse effects after cancer therapy. Now, while all of these were particularly exciting to hear and learn about, this year's meeting also had an important focus on addressing equitable cancer care for all children diagnosed with cancer. When a child is ill, it affects the entire family and can be very stressful for all concerned and may especially place a burden on families economically, particularly for those who may live in underserved areas or lack resources when their child is first diagnosed with cancer. Importantly, financial stresses can increase over the course of treatment. And unfortunately, studies have shown that outcomes are inferior for children from low socioeconomic backgrounds compared to those from other, more resource-filled backgrounds, despite the same protocol-driven therapies. Today, I'd like to highlight some of these presentations. Please note, I do not have any relationships to disclose related to any of these studies. A study with the goal of determining the ability to assess social determinants of health in upfront treatment protocols was conducted by the Children's Oncology Group, or COG, a large consortium of pediatric oncology centers that runs national and international trials to advance the treatment of children with cancer. Historically, the COG was only collecting information on race, ethnicity, insurance, and ZIP code. Collecting information on household material hardship may provide information that might be addressed and modified and help improve the treatment of children with cancer. However, before this study, it was not clear if parents would be willing to share this information with their child's treatment team. Investigators asked parents of children newly diagnosed with neuroblastoma and enrolling on the COG study ANBL1531 to complete a survey about where they live, their household income, and their access to stable food, housing, utilities, and transportation, which were called “measures of household material hardship.” Investigators also asked about access to social supports. The surveys were administered with paper and pencil and in the primary language of the participant. 360 of 413 eligible participants, or 87%, opted to complete the survey across 101 different treating sites. 89% of the surveys were completed within 11 days of enrollment. Most participants answered all of the questions. In fact, less than 1% left some questions unanswered. Importantly, nearly one-third of participants reported having household material hardship, of which 55% reported a single insecurity around food, housing, utilities, or transportation. And 45% reported multiple hardships in these domains. These investigators are planning to extend this work and evaluate associations with cancer outcomes in the hopes of better understanding the mechanisms of these disparities and developing interventions to address these issues in future COG studies. This study raised important issues about what can be done to improve or minimize household material hardship for families of children with cancer. In a pilot study conducted by the same study group at the Dana-Farber Cancer Institute and in collaboration with the University of Alabama, investigators studied the feasibility of a randomized intervention providing transportation and groceries to low-income pediatric oncology families. To be eligible, participants had to be less than 18 years of age at diagnosis of cancer and living in a household that screened positive for food, housing, utility, and/or transportation insecurity, the measures of household material hardship, and those who would be receiving at least 4 courses of chemotherapy. Participants were treated at the Dana-Farber Cancer Institute or the University of Alabama between May 2019 and August 2021, and were randomized to receive the intervention called PediCARE, which provided transportation and groceries versus usual care, and this was conducted over a 6-month period. The main outcome was to test the feasibility of the intervention. Would families participate? And the secondary outcome was to assess what proportion of recipients successfully received the intervention and if they found it acceptable. The total of 40 families agreed to participate and be randomized, and none dropped out of the study. All completed surveys at baseline and at the 6-month follow-up period, suggesting that the intervention was feasible, could be successfully delivered, and was acceptable to families. Now another study from the large Childhood Cancer Survivors Study, or CCSS, assessed the association between the expansion of Medicaid under the Affordable Care Act, or ACA, and Medicaid enrollment among childhood cancer survivors. These investigators linked data from over 13,000 5-year childhood cancer survivors to Medicaid insurance data across the years of 2010 to 2016. Survivors were adults, ages 18 to 64 years old, and all had been diagnosed with cancer prior to age 21 years, between the years of 1970 and 1999. The analyses were adjusted for age, sex, race, ethnicity, income, education, and chronic health conditions. The primary aim for these researchers was to determine any Medicaid enrollment for greater than 1 month in the year. They found that Medicaid enrollment rates increased in states that expanded Medicaid coverage from 17.6% pre-expansion to 24% post-expansion, compared to those states that did not expand pre-expansion and 16.9% post-expansion. Adjusting for other factors, the net enrollment increase was 6.6 percentage points. In the expansion states, the increase was greatest among survivors of leukemia and non-Hodgkin's lymphoma. It was also greater among non-Hispanic Black and Hispanic survivors compared to non-Hispanic White survivors and among those with lower household incomes or a high school degree or less. These investigators now plan to look at associations between Medicaid access and health care utilization and long-term cancer outcomes, such as chronic health conditions and mortality. And additionally, a small study from Stanford University reported a partnership with a community-based nonprofit organization [Jacob's Heart] to improve cancer center-based follow-up for Latinx adolescent and young adult cancer survivors, or AYA survivors. These investigators conducted interviews in the participants' preferred language, with cancer survivors, their parents, and staff from the community organization. They were able to identify important themes around unmet needs for this population, such as challenges with obtaining health care and understanding which providers to see for which health issues, an oncologist or primary care provider, uncertainty about what questions to ask these providers, difficulty adjusting to life after treatment, and understanding the late effects of cancer on the whole family, economically and mentally. For example, issues with parental job loss, financial strain, or impacts on other siblings in the home. However, these investigators also found supportive themes such as gratitude, strength, and support. Addressing these barriers is important for families and communities to promote follow-up after cancer treatment. This study was particularly unique because of its ability to successfully partner with a community organization to reach out and provide opportunities to improve care for Latinx AYA cancer survivors. The studies highlighted here and presented at this year's ASCO Annual Meeting focused on identifying barriers to equitable care for all children diagnosed with cancer and has laid the groundwork for future investigations to address these issues for children and families during treatment as well as after treatment and during survivorship. Thank you for listening to this brief summary of some of the exciting and novel research in pediatric oncology presented at the 2023 ASCO Annual Meeting. ASCO: Thank you, Dr. Mulrooney. You can find more research from recent scientific meetings at www.cancer.net. 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.

Mariusz is a person who knows how to support people with cancer, and how to change our mindset to feel better and this is our main topic for today. He is the medical director for the PsychoSocial Oncology program in the Todd Cancer Institute at Long Beach Medical Center. #Team CBT

Rev. David Maginley is a spiritual counselor for the cancer program, palliative care, and ICU at the QEII Health Sciences Centre in Halifax, Nova Scotia, Canada, and an award-winning author of Beyond Surviving: Cancer and Your Spiritual Journey.While David has degrees in philosophy and religious studies, his real education came from surviving cancer four times. This resulted in a profound near-death experience and explorations into the nature of consciousness and the connection of body, mind, and spirit.He knows what it's like to have cancer from both sides of the hospital bed and has a sense of this life from both sides of the veil.David is ordained with the Evangelical Lutheran Church in Canada, a specialist with the Canadian Association for Spiritual Care, a member of the Canadian Association for Psychosocial Oncology, and the International Association for Near-Death Studies, and is featured in the documentaries Here Right Now, and When You Die.David is also an avid photographer, using the camera as a tool for self-psychology and conducting workshops on creativity and spirituality. An advisor for provincial and federal cancer initiatives, David lectures throughout Canada on meaning in suffering, the wisdom of grief, mindfulness, death and dying, compassion fatigue, and integrative spirituality.Please enjoy my conversation with David Maginley.

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. Brielle Gregory Collins: Hi, everyone. I'm Brielle Gregory Collins, 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 what health equity and quality care mean in the context of cancer care and discuss highlights from the 2022 Quality Care Symposium in these areas. Our guests today are Dr. Fay Hlubocky and Dr. Manali Patel. Dr. Hlubocky is a licensed clinical health psychologist with an expertise in psychosocial oncology and a health care ethicist at the University of Chicago. She's also the Cancer.Net Associate Editor for Psychosocial Oncology. Thanks for joining us today, Dr. Hlubocky. Dr. Fay Hlubocky: Thank you, Brielle. Hello, everyone. So wonderful to be with you all today. Brielle Gregory Collins: Thank you so much. And Dr. Patel is an assistant professor at Stanford University in the division of oncology and a staff thoracic oncologist at the Veterans Affairs Palo Alto Health Care System. She's also the Cancer.Net Associate Editor for Health Equity. Thanks for joining us today, Dr. Patel. Dr. Manali Patel: Of course. And thanks for hosting both me and Fay to discuss this really fun topic. Brielle Gregory Collins: Of course, we're looking forward to it. Before we begin, we should mention that Dr. Hlubocky and Dr. Patel do not have any relationships to disclose related to this podcast, but you can find their full disclosure statements on Cancer.Net. So to start, Dr. Patel, can you first describe what the term health equity means and how it relates to cancer care? Dr. Patel: Great question. Nice one to start off this podcast. So I think we've always been really focused on health disparities. So I love that you've asked, what is health equity? Health equity is really reframing disparities or differences in cancer outcomes with more of a justice lens. And the full definition, which I love from the Robert Wood Johnson Foundation, describes health equity as meaning that everyone has a fair and just opportunity to be as healthy as possible. This means that you remove obstacles that may impede people's ability to attain their highest health, such as poverty, discrimination, and the consequences of such powerlessness, lack of access to good jobs, having fair pay, quality education and housing, safe environments, and health care. And as it relates to cancer care, it means that everyone has a fair and just opportunity to be as healthy as possible, even with a cancer diagnosis. This means having a fair and just opportunity to receive all of the evidence-based care that we know makes a difference, as well as high quality care that matters from screening to the end of life. Brielle Gregory Collins: Thank you so much for explaining that. And Dr. Hlubocky, talking about quality care, what does quality care mean in the context of cancer care? Dr. Hlubocky: Thank you, Brielle. So according to the Institute of Medicine, now known as the National Academy of Medicine, quality care requires the safety, the efficacy, and the efficiency of care delivery. It's also timeliness and a patient-centered approach that's coordinated by an inter-professional oncology team with the integration of evidence-based or research-based practices to continually improve cancer care. It's a very comprehensive, a very value-based form of care that adheres to evidence-based guidelines. It assures the treatment of symptoms, and the side effects of cancer, and the cancer treatment. And it's also coordinated care with strong communication amongst all clinicians and patients, which might involve a written care plan that details all of cancer care, the care in a clinical trial, if that's a potential option for patients. And it also involves shared decision-making, including honest and frank discussion about prognosis, the intensive therapy, patient's values, and also preferences regarding care. As well, it's a research-based support for psychosocial needs. It provides palliative care throughout the course of treatment from diagnosis through the end of life, and end of life care involving hospice. So quality cancer care was first coined by Dr. Joseph Simone, who was a pediatric oncologist and was the first, really, to advocate for quality-based cancer programs in pediatric oncology for both leukemia and lymphoma. And he was the one who truly started this movement that involves centering on every patient with cancer and every care program. So this year in Chicago at the Quality Care meeting, these interdisciplinary experts really highlighted the latest quality improvement research, as well as guidelines that helps us to improve the quality of cancer care from diagnosis through treatment to survivorship, and again, through end of life care. Brielle Gregory Collins: Great. Thank you so much for walking through that. And yeah, we're excited to discuss more research from the Quality Care Symposium, too, a little later in this podcast. Dr. Patel, we know that health equity and quality care are linked. So how do health equity and quality care relate to better overall cancer care? Dr. Patel: Great question. I love the fact that you brought up the Institute of Medicine's definition of quality because in my mind, doing work in health equity for over a decade now, really looking at health equity and quality, I've always thought of them as being intricately linked. But what I loved about the ASCO symposium and now some of the word choices that we're using, really does think that equity is not just a single component of quality, which previously it was. And now, the Institute of Medicine moved equity into being more of a cross-cutting dimension where it is an underpinning of all aspects of what Fay just outlined, in terms of effectiveness, safety, timeliness of care, etc. I think equity, in order to actually achieve high quality care, especially in the cancer realm, health equity has to be a fundamental component of such care. And so now, I'm going to take a step back because I think for years, we've been looking at equity as more of an issue of just access. But you heard in Fay's definition, and the definitions that are out there, that exist for quality, that equity and quality are not really just about access. In other words, differences in cancer care and inequity in cancer care is due to the fact that some populations, such as racial and ethnic minorities, for example, have poorer access to care than others. That is true, but this is just one factor, and it's not the only factor. Even when access is equal, we know that some populations tend to receive lower quality cancer care than others, be it by race and ethnicity, be it by socioeconomic status, gender identity and sexual orientation, or even age. So really, equal access does not equate to equitable care. What's nice about linking quality and equity and this intricate linkage of the 2 means that you're addressing the effectiveness of the care. You're ensuring that, when you think of quality in terms of equity, the outcomes you're thinking about in terms of race and ethnicity and actually moving towards considering, for example, what different things mean to different patients in terms of effectiveness, safety, timeliness of care, and ensuring that not only are people receiving the care, but that they're all receiving high quality care. I hope that makes sense. Brielle Gregory Collins: It absolutely does, and I appreciate you, again, walking through that and just explaining how those 2 are connected. And I want to go into some of the research that was presented at this year's Quality Care Symposium. So Dr. Hlubocky, can you introduce some of the key studies or themes that came out of this year's symposium that addressed quality care? Dr. Hlubocky: Thank you. Absolutely. There were several key quality cancer care themes that had to illuminate the cutting-edge research that is being conducted today and the advances by noted experts in the field, specifically at the symposium. The first being financial toxicity, or financial hardship, and problems that patients may encounter that's caused by the cost of treatment. This was identified as a major thematic session, where multidimensional approaches to addressing financial toxicity were presented, things like screening interventions, survivorship advocacy, and policy. Additional interventions to address financial toxicity were presented. And Dr. Ezekiel Emanuel, from the University of Penn, he's Vice Chair of Global Affairs, but a well-known ethicist in the country. He actually launched the meeting with a phenomenal keynote that was entitled, “New Directions for Cancer Care in the U.S.: Building a Transformational Research and Development Ecosystem and Healthy Payment Landscape That Better Supports Our Patients.” We then heard about how screening tools add value to identify patients with financial hardship and how to best implement them. We learned what other cancer centers have implemented regarding financial toxicity programs, and how any cancer center or any practice can implement these tools and interventions aimed at helping our patients with financial toxicity or hardship. Additionally, smart solutions like leveraging digital health tools to improve cancer care delivery, this also included a study on how health technology can be utilized to improve the delivery of cancer care today and the future, which evaluated the use of web versus mobile devices for ePRO reporting [electronic patient-reported outcomes reporting] and severe symptom responses. I believe it was 6 cancer centers. Symptom monitoring and what we refer to as patient-reported outcomes was also a key topic. And we heard about severe symptom reporting in medical oncology patients at a community center that was assessed through a platform, as well as severe symptom reporting and surgical patients assessed through an EHR-integrated ePRO questionnaire, again, at 6 centers by Dr. Wong at Dartmouth. Physical impairment, pain, and fatigue were top concerns that were identified, and Dr. Wong and her team also identified predictors of severe symptoms so that population surveillance should be considered a priority. And she also encouraged that interventions are really needed to address common severe symptoms and that these future studies should define what is the most effective migration strategies for these symptoms. Successful integration of health care and health services research interventions in oncology was also another thematic session, and it offered a framework for leveraging health care services research to improve cancer care delivery across the diverse populations. And we know that leaders in the field discussed a variety of these interventions, including hospital at home and geriatric assessment. For example, guidance and geriatric assessment and clinical practice was also presented by the former Cancer.Net geriatrics editor, Dr. William Dale, which included a need to use to inform treatment decisions which would systematically change cancer care delivery. And finally, an interactive roundtable on rethinking advanced care planning was also held here. These panel experts examined the current model of advanced care planning. What is the merits? How can it be reimagined? And how do we measure outcomes and tools, and what is the impact on caregivers? And finally, regarding the smart solutions, leveraging the digital health tools, we looked at big-tech solutions to common care delivery obstacles, leveraging electronic health records to support treatment and achieving equitable screening. Especially, for example, lung cancer was discussed. I think that hit most of the studies that were presented. What do you think, Manali? Did I miss anything? Dr. Patel: You did a really nice job of highlighting all of them. There were so many exciting studies that were presented, and it was really a fun meeting not only to spend time with you, Fay, but then also to meet up with colleagues and to see the cross-cutting research across both equity and quality, and the linkage between the 2. On that note, I think I can talk about the different ones that were kind of more focused on equity. And the opening theme was a really nice theme about the structural barriers to equitable care delivery. And again, when you think about quality and equity as being intricately linked, if people are unable to get the highest evidence-based care, providing care-- we can provide care, but if it's not evidence-based care, then are you really moving the quality needle forward? And so the opening theme really looked at, I think, reframing and shifting our views of the focus on the patient as the reason for disparities and inequities to really thinking about structural barriers and barriers that may exist not only at the policy level, but also barriers that exist just in the way that our system is set up with structural racism, ways to overcome structural racism through system-level changes. Another theme that I thought was really nice that was highlighted was the impact of social determinants and complications from social determinants of health on being able to achieve the highest quality of cancer care for patient populations. And a lot of studies looked at associations of the impact of housing and other health-related social needs such as transportation aspects, which we all know are a clear indicator and a clear barrier for some in terms of being able to achieve the highest quality care. We also saw a lot of abstracts both in the poster discussion, as well as in the main plenary session, including Dr. Otis Brawley's presentation that talked about this very question really here that you're asking us, which is about the linkage between quality and equity. And that entire plenary session that I would love for others to go back and to listen to had some very key poignant takeaways about the linkage, and how that has changed and morphed over time, and also, how our view of equity and this intricate linkage-- again, I know I keep saying intricate linkage, but that's because that's what it is. But this component being more of an underpinning, looking at quality from a whole, from the lens of equity, he did a really nice job of shedding light on this topic. Brielle Gregory Collins: And Dr. Patel, I do want to ask one follow-up question. So you mentioned this term, social determinants of health. Can you just briefly describe for our audience what that term means? Dr. Patel: Yeah, very good question. And I think there's a lot being done at ASCO, but also at the national level. And the social determinants of health are these structures that are set up within the way that our social system is set up. So things like housing, transportation, food. Interpersonal violence, for example, is one kind of health-related social need that can come out of not having access. But these are the social structures that are set up that determine how healthy you can be. So if you take a step back and you think about cancer care, for example, and you look at individuals that may not have a home and may have homelessness, and you think about how our treatments may impact. So many of our treatments may cause people's white blood counts to lower during periods of their treatment where we hope they aren't living in congregated areas such as homeless shelters, for example, where they can then become really infected with what we call opportunistic or other infections during treatment. How the homelessness situation impacts someone's health. We know that it not only impacts their ability to receive and our ability, as clinicians, to provide the highest evidence care for individuals living in those situations, but it also impacts other health. And we know that homelessness really does impact an ability for one to be able to be as healthy as possible. The same with food. We know that the pandemic and some of the work that we've done, Fay and I together, as well as others, have looked at the impact of the pandemic on food insecurity. Now, food insecurity has been a large issue for people, and a determinant of health is what I call it, a social determinant of health. But we know that food is medicine, and for people during the pandemic, we saw food insecurity significantly rise due to wage loss, due to other issues regarding income loss. And that then led to being unable to be able to eat as healthily as possible. If you don't have access to the right food, we know that that makes a difference in terms of your ability to make it through particular cancer treatments. For example, if you're unable to get enough magnesium, calcium, potassium, that can influence what we call your electrolytes and your labs, and make it very difficult for us to give treatment. But even prior to a cancer diagnosis, we know that food determines how healthy you are. And if you're unable to attain food sustenance even from an early age, that can really lower your ability - if you go back to the definition of health equity - your ability to be as healthy as possible. And these social structures then, which I loved about the ASCO Meeting this year, is-- I've been going to the ASCO Quality Meeting for many years and have kind of been-- Fay knows, right? We've kind of been like these lone people out in our little group of people that come to the ASCO Meeting and the Quality Meeting. We all speak the same language, but there was a real emphasis on interventions this time around, and how can you overcome what, traditionally in the medical realm, we don't think of as being linked with health or at least in oncology? I think primary care physicians and pediatricians have been focused on this for many years. But for us, in oncology, it hasn't really been first and foremost as part of our problem that as oncologists, if we know that people cannot get to our clinic, we need to intervene on transportation. But these other issues like homelessness and food insecurity and poverty really are also in our realm as well in terms of impacting one's ability to achieve health equity. Brielle Gregory Collins: Thank you so much. That's a really helpful explanation. And too, I want to get into-- there was all this great research to come out of quality, but I want to talk a little bit about what changes are happening in cancer care to improve health equity and quality care. So Dr. Hlubocky, we can start with you. Can you talk a little bit about some of the changes you're seeing happening in cancer care to improve health equity and quality care? Dr. Hlubocky: Well, I love what Manali has said about coming together first as a community at the meeting, where we're not just friends and colleagues, but we're collaborators and mentors to one another, and we are stimulated by one another's presentations to truly design research that optimizes care for every patient everywhere. And I think that's now the priority in that. And it's important to learn about some of the best practices that can help clinicians really reshape strategies and make key decisions to improve, as we said, that quality, that safety, and the efficiency of cancer care delivery. Certainly at ASCO, we're doing quite a bit with the QOPI Initiatives, the Quality Practice Initiatives, where every cancer center or practice has access to measures that are evidence-based, so we can identify what are the key symptom issues that patients are experiencing so we can use these measures. And ASCO has really been a wonderful partner for many practices along the way. So it's really, really seeing this research is such a motivator. And I wonder, Manali, what additional highlights stick in your mind as to what is the future when it comes to cancer care? Dr. Patel: Yeah. I mean, that's a fantastic question. I love this question, Brielle, that you're asking us to reflect on. As I mentioned, I really do think that there's been a real shift. And sadly, I think it took George Floyd's murder to link us to the huge discourse. Now that's happening not only in our own small circles locally, but also at the national and policy level, that equity, more so than I've ever seen at a meeting, even at our annual meetings in ASCO, has really become the forefront. And I've started to see meaningful change of not just talking about equity, but also thinking about interventions. I certainly, we think that we're seeing more discussion about equity, more awareness of the importance of equity. The question that you just asked about social determinants of health now is now part of our vernacular and our lingo now, which is wonderful, that we don't always have to describe the impact that social structures and our systems set up for us to be either healthy or not. But what we're also seeing are more dollars being put into incorporating equity, not just research dollars. I think what we saw at the ASCO Quality Meeting was there's a lot of research in this area and there are a lot of like-minded folks that are collaborating together to try to overcome this. But there are also programmatic dollars. And I think even within ASCO and within other organizations that are traditionally medically focused, there's a highlight of equity as part of the mission statement now, which is hugely different than where we were just a couple of years ago when both Fay and I were on the Health Equity Committee, that was not part of the mission statement. So the fact that that's being applied in a visual statement is really different. We're also seeing policies being made both at the local level. For example, in California, lots of policies being made for MediCal organization.  We're starting to see more of a reflection of inequities in care and really, interventions to try to move that on the ground, both within clinics reporting on data, like Fay mentioned, I think is extremely important. A basic step, yes, but one that just has not-- it's been lacking. We conducted a project that was led by Lori Pierce and others through ASCO that looked at just who are the people that are coming into your center? And how many are being enrolled on clinical trials? And what are the race and ethnicity and income and social status of these individuals? And many centers just are unable to report that because we don't collect data on it. So Fay mentioned that something that does seem very basic now is becoming part of the fabric and there's now more understanding as to why these things are important, and why we need to measure them. And what are we going to do about it? So I really like that there's research happening in parallel where, again, as I mentioned, there were a lot of abstracts that were focused on the association of housing. But at the same time, then you've got interventions that address housing. People that are working with housing authority, or even at the VA, for example, creating safe housing for people during treatment. It doesn't address the whole issue of homelessness, but it does try to band-aid the situation until we have national policy that can provide better housing for individuals overall, or to address some of these issues. And I think that it's been really refreshing-- I don't know about you, Fay, but just for me, refreshing to see interventions that are solution-focused. And what can we take away from these abstracts and really try to implement at home? Or what are some novel ideas that we can do to overcome some of these issues? I hate being stuck in the description paradox of disparities, disparities, inequity, but no real solution as to what we can try to do at home. Dr. Hlubocky: I fully 100% agree with Manali's statement right there. Brielle Gregory Collins: Absolutely. And it's so exciting to hear about improvements being made and the needle being moved forward in these areas. I'm sure it's very reassuring for patients to hear that. And speaking of that, there's so much information in this area. For both of you, where do you recommend patients can go online to learn a little bit more about health equity and quality care? Dr. Hlubocky: Yeah. First and foremost, Cancer.Net. Of course, we have such wonderful content associated with many of the topics that we discussed today, such as financial toxicity, and various symptoms, and psychosocial issues, depression, anxiety, palliative care, end-of-life care. So that's definitely the first stop. As well as the American Cancer Society would be the next one. And the National Coalition for Cancer Survivorship. And of course, the National Cancer Institute, which centers-- they all center on quality care issues, such as those we just discussed today. And of course, I don't know about you, Manali, but really talking also to your cancer team. So that's the first step. But really, I think so many patients are fearful to address some of these issues with the team, [and think that] that we don't have time, and we make time. We make time. Our patients are very important to us, and we really want to optimize care the best that you can. So if any of these issues are a burden and barriers to getting the best care, please reach out to us. There are financial navigators, there's palliative care clinicians, psychosocial clinicians, and many cancer centers, as well as some practices in that. So talking to your oncologist, talking to your nurse practitioner, and they are great resources as the first step to attaining care after you've read some of these resources. Are there others that come to your mind, Manali? Dr. Patel: Yeah. I mean, great question. I love how you brought it back to the local teams. In terms of thinking about resources, I agree, there are a lot of resources that are local. And so ask your clinical teams, but then also other patient advocacy groups may have more information about resources to overcome some of the barriers that some patients are having, particular barriers, just to get general information about health equity. As Fay mentioned, we love Cancer.Net. I mean, I think it's one of the best resources that I've seen. In fact, my mother and my father go to the website pretty often. They are both cancer survivors as well. But there's a nice piece, again, about health equity and how it integrates into all facets of care and all facets of one's journey through cancer. I think, as I mentioned before, the Robert Wood Johnson Foundation really has nice resources on health equity and also other web-based portals that you can delve into. So there's as much information as you want to learn about health equity, and also solutions focused more on the general picture that's maybe not related to cancer, but again, is linked to cancer. The American Public Health Association is also another really nice website that has a broad swath of how health equity and the issues that we talked about today, the social and economic structures, impact one's health overall. Again, not cancer-related, but everything is cancer-related. And so you can bring back some of those take-home messages to how it may impact one's cancer care. And then I really love-- for me, personally, the University of California Berkeley is a nice, free resource that has publications, depending on how deeply you want to delve into the questions and some of the brief topics that we've talked here, that are all focused on health equity. And it's a really nice website that hopefully, we can put into the link of the podcast description. Brielle Gregory Collins: Absolutely. Those are great resources. Thank you both for sharing those. And thank you again for your time and for sharing your expertise today. This was such a great discussion. It was really great having you both. Dr. Patel: Well, thank you for even highlighting this important topic of health equity and quality. Again, for me, it seems just completely, almost a no-brainer, that these 2 go together. But it's not always as easy as you think to link the 2. And so it's really nice that you all have come up with this podcast idea and also brought wonderful Fay and me together to do this. [laughter] There's so much admiration for what Fay is doing, and it was really humbling to be on a podcast with you, Fay. Dr. Hlubocky: Oh, it's an honor and a pleasure to be with you, Manali. You truly are an advocate and a guru, a wisdom when it comes to equity and equity issues and illuminating the issues nationally. So such an honor and pleasure to be with you. And of course, with Claire and Brielle, and to all the patients and caregivers and our colleagues, we're here for you. So don't forget to reach out to your oncology team and here with us at Cancer.Net. Brielle Gregory Collins: Thank you both so much. ASCO: 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.

Rozmowy o śmierci nie są łatwe - większość z nas boi się ostatecznego pożegnania z bliską osobą. Z perspektywy psychologicznej bardzo ważne jest, aby oswajać się z tematem śmierci i w jej obliczu zadbać o potrzeby emocjonalne osoby umierającej. W zależności od kraju czy kultury ludzie radzą sobie z tym tematem w bardzo różny sposób. Doskonałym przykładem jest Meksyk, w którym radośnie celebruje się połączenie z osobami z zaświatów, z kolei w Afryce często na pogrzeb wynajmuje się płaczki. W jaki sposób oswajamy się ze śmiercią w Polsce? Twórcy serialu Minuta Ciszy dostępnego na platformie CANAL+ online, postanowili przybliżyć realia branży funeralnej w naszym kraju, oswajając jednocześnie widza z procesem umierania. A co na ten temat mówi nauka? W jaki sposób przebiega proces umierania? Jakie emocje najczęściej towarzyszą osobie umierającej? Czego oczekują chorzy i ich najbliżsi w ostatnich dniach życia? Jak towarzyszyć bliskiej osobie w procesie umierania? W jaki sposób pożegnać się z osobą umierającą? Jak przez lata zmieniało się podejście do śmierci, procesu umierania i żałoby w Polsce? Na te i wiele innych pytań odpowie dr Mariusz Wirga, dyrektor medyczny programu PsychoSocial Oncology w Instytucie Onkologii im. Malcoma Todda w Long Beach w Kaliforni. Spotkanie poprowadzi Joanna Flis, psycholożka kliniczna i zdrowia. Podcast powstał we współpracy z CANAL+ online z okazji premiery serialu “Minuta Ciszy”, pierwszego polskiego serialu pokazującego zaplecze branży funeralnej. (https://can.al/YT-swps-minutaciszy) Strefa Psyche Uniwersytetu SWPS to projekt popularyzujący wiedzę psychologiczną na najwyższym merytorycznym poziomie oraz odkrywający możliwości działania, jakie daje psychologia w różnych sferach życia zarówno prywatnego, jak i zawodowego. Projekt obejmuje działania online, których celem jest umożliwienie rozwoju każdemu, kto ma taką potrzebę lub ochotę, niezależnie od miejsca, w którym się znajduje. Więcej o projekcie: https://web.swps.pl/strefa-psyche

Lęk, obniżona jakość życia, brak stabilizacji — to tylko kilka z rzeczy, z którymi na co dzień borykają się osoby przewlekle chore. Takie sytuacje zawsze wiążą się dla pacjenta z silnym stresem i koniecznością wprowadzenia zmian w życiu. Choroby te przerażają nie tylko możliwą utratą zdrowia, ale także ewentualnymi konsekwencjami poza chorobowymi. W wielu przypadkach z powodu choroby konieczne jest zrezygnowanie z hobby, zainteresowań i wykonywanych jak dotąd czynności. Czym zatem charakteryzuje się choroba przewlekła? Jak opisać psychosomatykę? Z jakimi emocjami i stanami psychicznymi zmagają się osoby przewlekle chore? Jak pracować i wspierać takich pacjentów? Jaką rolę pełni nadzieja w sytuacji choroby i jak ją wzbudzać? Na te i wiele innych pytań odpowie dr Mariusz Wirga, dyrektor medyczny programu PsychoSocial Oncology w Instytucie Onkologii im. Malcoma Todda w Long Beach w Kaliforni. Spotkanie poprowadzi Zofia Szynal. W cyklu „ABC Psychoterapii” realizowanym w ramach Strefy Psyche Uniwersytetu SWPS wraz z zaproszonymi gośćmi poruszamy tematy dotyczące zdrowia psychicznego. Strefa Psyche Uniwersytetu SWPS to projekt popularyzujący wiedzę psychologiczną na najwyższym merytorycznym poziomie oraz odkrywający możliwości działania, jakie daje psychologia w różnych sferach życia zarówno prywatnego, jak i zawodowego. Projekt obejmuje działania online, których celem jest umożliwienie rozwoju każdemu, kto ma taką potrzebę lub ochotę, niezależnie od miejsca, w którym się znajduje. Więcej o projekcie: https://web.swps.pl/strefa-psyche Interesujesz się psychologią? Dołącz do nas w grupie Strefy Psyche Uniwersytetu SWPS (https://www.facebook.com/groups/StrefaPsyche).

Tristan Bilash (he/him/human) is a clinical oncology social worker, writer, speaker, Stage 3C ovarian cancer survivor, ADHD thriver, transgender man, and inclusive health advocate. Tristan has presented at numerous provincial and national conferences in Canada, including being a keynote speaker for the Canadian Association of Psychosocial Oncology (CAPO) 2020 National Conference. As a transgender health advocate, Tristan is a national 2SLGBTQIA+ representative for the Canadian Association of Psychosocial Oncology Advocacy Committee. He is currently collaborating with the World Ovarian Cancer Coalition on their upcoming No Person Left Behind campaign to improve awareness and care for 2SLGBTQIA+ folks diagnosed with ovarian cancer. Tristan's story is featured in the journal article, “Spare Parts: Navigating Ovarian Cancer As A Transgender Man” which Tristan co-authored with his friend and colleague, Dr. Lauren Walker (University of Calgary, Tom Baker Cancer Centre). “Spare Parts” was recently published in the Journal of Clinical Oncology (Volume 40, Issue 9) and remains free-to-access. Tristan was recently invited to write a column for the Society of Gynecologic Oncology. “When The Software Says You Don't Exist: Creating Change As a Trans Man Navigating Ovarian Cancer” was published on SGO's blog on June 8, 2022. Tristan currently resides in Regina (Saskatchewan), Canada. Links: Psychosocial Needs and Experiences of Transgender and Gender Diverse People with Cancer: A Scoping Review and Recommendations for Improved Research and Care Authors: Lauren R. Squires, Tristan Bilash, Charles S. Kamen, Sheila N. Garland LGBT Health, Volume 9, Number 1, 2022 Spare Parts: Navigating Ovarian Cancer as a Transgender Man | Journal of Clinical Oncology (ascopubs.org) Authors: Tristan Bilash BSW, RSW and Lauren M. Walker, PhD, RPsych, DOI: 10.1200/JCO.21.01249 Journal of Clinical Oncology, Art of Oncology - published online before print January 12, 2022 PMID: 35020447 1Supportive Care Department, Allan Blair Cancer Centre, Regina, SK, Canada 2Division of Psychosocial Oncology, Department of Oncology, University of Calgary, Calgary, AB, Canada 3Department of Psychology, University of Calgary, Calgary, AB, Canada When The Software Says You Don't Exist: Creating Change as a Trans Man Navigating Ovarian Cancer | Tristan Bilash, RSW | Society of Gynecologic Oncology (sgo.org) Author: Tristan Bilash, Society of Gynecologic Oncology - published online June 8, 2022 Social Media / Contact Personal Blog – A Cup of Strong T https://acupofstrongt.blog/ Twitter - @strongtlb1

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. Brielle Gregory Collins: Hi, everyone. I'm Brielle Gregory Collins, 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 psychosocial challenges unique to survivors of gynecologic cancers and how survivorship care plans can be helpful to survivors of these cancers. Our guests today are Dr. Fay Hlubocky and Dr. Merry Jennifer Markham. Dr. Hlubocky is a licensed clinical health psychologist with an expertise in psychosocial oncology and a health care ethicist at the University of Chicago in Chicago, Illinois. She is also the Cancer.Net Associate Editor for Psychosocial Oncology. Thanks for joining us today, Dr. Hlubocky. Dr. Hlubocky: It's an honor and a pleasure to be here with all of you today. Thank you so much. Brielle Gregory Collins: Dr. Markham is Chief of the Division of Hematology and Oncology and a clinical professor in the Department of Medicine at the University of Florida in Gainesville, Florida. She is also the Cancer.Net Associate Editor for Gynecologic Cancers. Thanks for joining us today, Dr. Markham. Dr. Markham: Thanks so much for having me. This is going to be fun. Brielle Gregory Collins: Absolutely. Before we begin, we should mention that Dr. Hlubocky and Dr. Markham do not have any relationships to disclose related to this podcast, but you can find their full disclosure statements on Cancer.Net. Now to start, Dr. Hlubocky, what can survivors of gynecologic cancers expect during the transition from treatment to survivorship? Dr. Hlubocky: It's such a very important question. So this stage of survivorship, and if we think about the cancer survivor as anyone with the time of diagnosis, but especially when your treatment ends and that kind of later stage of survivorship begins, both anecdotal reports by survivors as well as research tells us this is very much a time of ambiguity. So complicated feelings such as depression and anxiety can still arise. But there's also this change in one's life and daily activities. So from the constant monitoring and treatment that the survivor actually had to go through and be engaged in constant contact with the team, now it's a time of sometimes emptiness. Patients have told us about not really knowing what to do, missing that contact, that monitoring. And so that can certainly leave us with a lot of complicated emotional distress. But also paradoxically, there are these feelings of greater purpose and feeling and meaning leading to post-traumatic growth. Might not be immediate. As soon as, of course, the treatment ends, there can be some difficulties, even with relationships and social relationships, and we can talk about some of the psychosocial challenges, but that's what at least has been reported both anecdotally also from a research perspective. Dr. Markham: I think that that's exactly right. I think what I see in the clinical side of the patient care is exactly that. I think a lot of people who just finished their cancer treatment don't quite know what to do with themselves. They've just been sort of released back to their lives, hopefully returning back to somewhat of a normal or a new normal life. And it's definitely an anxiety-provoking period of time. And I tend to see in the clinic room a lot of fear of what's going to happen next and what should I be doing and what should I be looking for? And also on the flip side, I think you mentioned relationships. A lot of people who I see in the exam room are telling me when they're done with treatment, I'm still having these feelings. I'm still recovering from some of my treatment experience, but my family or these friends are expecting me to just get on with life. And I'm not quite sure I know how to do that yet. Brielle Gregory Collins: Thank you both for your perspective on this. And Dr. Markham, one of the tools someone might use during this transition is a Survivorship Care Plan. So can you please explain what a Survivorship Care Plan is? Dr. Markham: A Survivorship Care Plan is traditionally a document, some type of a physical document or an electronic document that describes the treatment that the person has been through, describes who the physicians were involved in their care, can be very in depth, can include things like the specifics of the pathology, diagnosis, and the stage. It can also include and should include some things to look out for and what the follow up will be moving forward in the future. I think of it as really a guide and a document to refer back to so that person who receives it knows exactly what they were treated with, they know the dates of their treatment, they know who their doctors were, they know what their diagnosis and stage was. And they have a plan moving forward that they can use for their own empowerment and engagement with the health system, but also their other doctors that can utilize this as well to help know best how to monitor that patient. Brielle Gregory Collins: Absolutely. And why do you think Survivorship Care Plans are especially important for survivors of gynecologic cancers? Dr. Markham: I think they're important really for lots of patients, lots of people who have various cancer diagnoses. Cancer treatment for gynecologic cancers tends to be multidisciplinary, meaning that they may see a gynecologist, they may see a gynecologic oncologist, which is a surgeon who specializes in gynecologic cancers. They may also see a radiation oncologist and a medical oncologist and a genetic counselor and a psycho-oncologist. So there's so many parts to that treatment course that it can be very overwhelming. And I think for any patient who goes through such a complicated experience, not just treatment, but the whole diagnosis piece through treatment, really can benefit from having just a quick and easy reference. A summary. We also found these to be very important in times of natural disasters, for example. So someone who has lived in a hurricane zone or even in the beginning of the pandemic, it's nice to have all of your information in one easy-to-access PDF or Word document or even electronically in your email. This is really helpful for transitions and care. Brielle Gregory Collins: Thank you so much. Yes, it definitely seems like it's a critical part of that survivorship aspect. And Dr. Hlubocky, I know you touched a little bit on the psychosocial challenges that survivors might face, but can you tell us a little bit more about some of these challenges that are unique to survivors of gynecologic cancers? Dr. Hlubocky: Yeah. So certainly one's emotional well-being and physical well-being can be impacted. So we talked a little bit about depression and anxiety, and also sometimes folks have reported post-traumatic stress symptoms. But again, everyone's individual, everyone can vary when it comes to the mental health state. We know a recent study was conducted in Utah just last year that said, specifically, ovarian cancer patients are at a little bit more heightened risk of anxiety and depressive disorders in that longer kind of ovarian cancer survivorship phase. So that's really important for us to know. Certainly also uterine survivors as well. We have to be very conscious when it comes to mental health constraints, but there's also some physical well-being or quality of life, well-being constraints, sleep can be impacted, sleep and insomnia, pain and fatigue. We know that patients record a significant amount of fatigue as well. And that really does take time. And there are certain things, for example, exercise. But additional challenges will be with sexual health, sexual libido. We know that that changes. An altered state of self-image. Certainly, we know that cancer can impact one's self-image of who that woman is. And that as well as financial concerns might be another issue. Dr. Markham talked about the change with family relationships and friends. They may expect you to be that person that you were before the cancer. And we know and a lot of patients have told us that it's a new normal phase for me, right? A new normal. And if we think about the cancer as being a traumatic experience, we certainly know that patients are forever changed, and it isn't necessarily for the negative. Again, there can be a lot of post-traumatic growth, a lot of resilience. And that, again, isn't necessarily going to be immediate. But certainly talking to survivors in that longer phase, we know that a lot of post-traumatic growth, a lot of meaning, a lot of purposes, a lot of impact on spiritual well-being, but it doesn't mean that one is free from stress. Brielle Gregory Collins: And do you mind just discussing how survivors can cope with some of these challenges? Dr. Hlubocky: Absolutely. There are a number of evidence-based treatments. For example, especially psychosocial, and then mental health treatments such as cognitive behavioral therapy, mindfulness-based reduction, using techniques like journaling, using meditation, things like this. And your psychosocial support team, if you don't have it in your cancer center, we certainly have cancer community support programs within each city. These are free community support programs where they can actually help to provide psychosocial support, either in individual or group settings. So there's lots of different modalities that could be used. Adopting breathing techniques, for example, to help address anxiety. These are the folks that can really help you teach you how to adopt some of these practices in that. So certainly there's peer support. We know peer support is a wonderful tool. At my institution, we have a peer support program. And it's really just helped both that longer-term survivor give back to a certain extent. They felt like they've gained so much being a patient and learning from that experience that they very much wanted to mentor active patients. So certainly, we know peer support, social support is very important. Individual therapy, group therapy, and that. So don't hesitate to reach out to your psychosocial support team if it's in the cancer center. If not, talk to your oncologist or your oncology team and try to identify what are the resources within. We understand that sometimes patients don't want to come back to the hospital, and that's completely fine. We want you to get back to your life. But recognizing the fact that being a survivor is also part of this new life. So we're here to support. And empowerment is key and also recognizing that your lifestyle really focusing on exercise and nutrition and sleep is vitally important also in this new phase. But recognizing as well that we have to be cautious, that this will take time for you to adopt certain lifestyle strategies. So start with the little bits. Just even going for a daily walk if you're able to. Just daily walk around the house, so to speak. Those are the little things. And assigning yourself homework to do something just to get out of the house, so to speak. But recognizing that this will take time. Brielle Gregory Collins: Yes. Thank you, Dr. Hlubocky. And you mentioned this term, cognitive behavioral therapy, as one of the methods for coping. Can you just describe for listeners what cognitive behavioral therapy is? Dr. Hlubocky: Oh, sure. It's a specific type of psychotherapy where we actually target what we call automatic thoughts that can be associated, for example, with either depression or anxiety or some other mental health conditions. And we look at their core beliefs. Sometimes some thinking can be black or white. It'll never get better. Well, we know that's not necessarily the case. Maybe for that moment, it doesn't feel like it won't get better. So therapists such as myself that are trained in this modality can actually help you to identify these automatic and core beliefs and help you change them or modify them or what we call reframe them. So that's very therapeutic when it comes to healing. As well as we know, sometimes the cognitive piece can be really tough for folks. So behaviorally, it's just changing one's behavior, so to speak. So as I mentioned, exercise. Sometimes it's really easier to get people moving than it is to change one's thoughts. So prescribing exercise daily or prescriptions for social support, going out and meeting with people, these are the things that can help patients down the line, certainly in the survivorship space. And we know that folks need that. And cognitive behavioral therapy can be both done in an individual level as well as there are certain groups that can be done as well in a group setting. So everyone's different. What is your preference? You can't go wrong no matter what. It's all about empowering yourself. It's all about rewarding yourself for what you've gone through. And right now, your lifestyle is the most important thing. So you have to be a priority. Brielle Gregory Collins: Absolutely. Thank you so much for explaining that. And Dr. Markham, are there any other survivorship challenges or any other methods of coping you want to add? Dr. Markham: Well, it's a very complicated time and there is not one particular issue that faces each of these patients or women with gynecologic cancers. I think that the psychosocial piece is very important. And what is most important I think from my mind for the listeners is that there's a discussion about, what should I expect? And I think that question to the oncology team is really an important one. What should I expect moving forward? What should I be on the lookout for? And are there things that I can do that will help me on that path? Brielle Gregory Collins: Absolutely. And going back to Survivorship Care Plans and using them as a tool during this transition, where can survivors go to find Survivorship Care Plans specifically for gynecologic cancers? Dr. Markham: So amazingly, Cancer.Net has a fantastic resource available with Survivorship Care Plans. And they are very similar for various cancers. But there are some that are directly focused for women with gynecologic cancers through Cancer.Net. And it's very easy to search. You can type in “Survivorship Care Plan” into the search bar and the page will come up with these. A person can print this or can share it with their oncologist. And the cancer care team may actually be presenting this to the patient already. So there's a variety of resources really. But for someone who is interested in just taking a glance at what they may look like, there's a great template available on Cancer.Net. Brielle Gregory Collins: Thank you so much. And thank you both for your time and for sharing your expertise today. It was so great having you both. Dr. Markham: Thank you so much for inviting us. This was great. Dr. Hlubocky: Absolutely. Thank you. And thanks to all the Cancer.Net listeners. We're here to help. 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. [music]

Season 2 Episode 16- Linda Carlson, PhD- Integrative Oncology and MindfulnessOn today's episode of The PQI Podcast we welcome Linda Carlson, PhD. Dr. Carlson holds the Enbridge Research Chair in Psychosocial Oncology, is Full Professor in Psychosocial Oncology in the Department of Oncology, Cumming School of Medicine at the University of Calgary, and Adjunct Professor in the Department of Psychology. She also has worked as a Clinical Psychologist at the Department of Psychosocial Resources at the Tom Baker Cancer Centre (TBCC) since 1997. Dr. Carlson's research in Psychosocial Oncology, Integrative Oncology and Mindfulness-Based Cancer Recovery has been published in many high-impact journals. She is the current president of the Society for Integrative Oncology. Today we discuss the basics of Integrative Oncology and the Society for Integrative Oncology. We also discuss Dr. Carlson's work in mindfulness and cancer patients and how chronic stress affects the body, including tips for our healthcare providers.

This Podcast is an introduction to a program called "The Healing Journey" and some of the people behind it. Please join me as I interview Alastair Cunningham, Sue Davis-Mendelow and Gina Lockwood on the events in their life leading to The Healing Journey (offered through Wellspring, see www.wellsping.ca), and where they are now. The video version of this podcast episode can be found: https://youtu.be/7_aXwA7xgsI

A physician attempts to ease a patient's pain, a painful moment somewhat eased by the joy of music.   TRANSCRIPT SPEAKER 1: 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. [MUSIC PLAYING]   RICHARD LEITER: Ode to Joy. "Is now an OK time?" I asked as I quietly entered the dimly lit room on a Saturday afternoon. "Yes, we've been waiting for you," my patient's wife Julie responded in the same calm, composed voice she had maintained all week. "Before we start, what questions do you have?" "I think you answered all of them this morning. I'm ready. Tom is ready. We just don't want him to suffer anymore." "OK, we'll get started." When I was in training, I had seen my preceptors initiate palliative sedation, but this was my first experience doing so as an attending physician. After being dormant for so long, my impostor syndrome returned. Though I was confident that I was taking the clinically-appropriate next step, I was nervous. I asked Tanya, our charge nurse and the nurse who was primarily caring for him over the last few days, to draw up the syringe. She did so with practiced confidence and handed it to me. I held it between my fingers, wondering how slowly I would need to push it to ensure the 2 milliliters of midazolam went in over a full five minutes. Tanya cleaned off the side port of his IV. I twisted the syringe into place. I looked up at Julie. She squeezed Tom's hand. I had first heard about Tom nearly a week earlier, when my colleague was handing off the service to me. "He's in his 50s, metastatic cancer. He was home on hospice and came in yesterday with uncontrolled pain. We started him on ketamine and he looks much better. The plan is to wean his ketamine, increase his methadone, and get him back home, hopefully in the next day or two." Stoic from years of pain from cancer eating away at his bones, Tom lay in bed with his eyes closed, his furrowed brow the only sign of his ongoing agony. When the nurses tried to move him, he screamed. After we weaned his ketamine, his pain quickly worsened. We increased methadone and hydromorphone. Neither gave him adequate relief. We restarted ketamine, but it proved to be no match for his pain. On rounds one morning, Julie asked if Tom could make it home. I told her I didn't think so and explained how worried I was about his pain. If we sent him home, I was concerned the pain would force him to come right back. Julie told me her kids would be disappointed, but that they'd understand, as she did. Easing Tom's suffering was more important. The hospital bed his family had set up in the living room would remain empty, a physical manifestation of cancer's unending cruelty. The hospital bed his family had set up in the living room would remain empty, a physical manifestation of cancer's unending cruelty. We talked about what would come next. If further titrating his medications proved ineffective, which I worried it would be, we would need to consider palliative sedation. "Whatever you need to do," Julie responded, her voice barely betraying the exhaustion I imagine she was feeling. Palliative sedation is a procedure used to relieve refractory suffering in a terminally-ill patient. Clinicians carefully sedate the patient, often to the point of unconsciousness, to relieve symptoms such as pain, nausea, shortness of breath, or agitated delirium. It is a procedure of last resort, and in our hospital, requires the approval of two attending physicians and the unit's nursing director. Though palliative sedation may shorten a patient's life, ethicists and clinicians have long regarded it as acceptable because its goal is not to hasten death but rather to relieve suffering. This is known as the doctrine of double effect, by which an action with at least one possible good effect and at least one possible bad effect can be morally permissible. Back in his room on that Saturday afternoon, I looked over at Tanya, the nurse, then at Harry, my fellow, who had been caring for Tom all week. I took in a breath under my mask, then slowly began to inject the contents of the syringe into his IV. In the quiet, I could hear the music coming from Julie's phone, which she had placed on the pillow beside his head. A pianist played a slow, mournful rendition of the final movement of Beethoven's Ninth Symphony, the Ode to Joy. In my head, I sang along. (SINGING) Joyful, joyful, we adore thee. I went to a traditionally Anglican school. 600 boys of all faiths and backgrounds, we'd rise each morning in assembly and sing hymns together. We cheered, yelled, and thumped on our pews-- a few minutes of raucous togetherness before we devolved into the usual bullies and cliques for the rest of the day. Tom's room couldn't have been more different. He remained completely still. Though Julie held his hand, he was alone, as we all felt in that room. (SINGING) Hearts unfold like flowers before thee, opening to the sun above. I felt the soft resistance of the syringe's plunger hitting the barrel. I looked back up at Tom. His chest fell, but didn't rise. I waited. He didn't breathe. The music slowed down. I felt Harry's eyes pivoting back and forth between my face and Tom's chest. I fixed my eyes on Julie's hands wrapped around her husband's. Despite the tension of the last week, she was calm, gentle. I matched my breath to hers. If she could exude such peace, so could I, I thought. I noticed Tom's hands. He had a piano player's fingers, long and slender. I pictured him sitting at the piano in their living room. I wondered who would take his place on the bench. I wondered if he could hear the song playing beside him. Had he and Julie chosen it for this moment? Did it bring back joyful memories, as it did for me? (SINGING) Melt the clouds of sin and sadness, drive the dark of doubt away. He didn't breathe. Did my first attempt at palliative sedation become euthanasia? Even if so, was this OK? I rehashed our conversations from the last few days. We talked about the risks. I went over the dose. Double effect, I reassured myself. Even so, as bedside nurses have told me, it's easier to talk about philosophy when you're not holding the syringe. I thought about how I would explain Tom's death to Julie. I wondered if she would be angry, upset, relieved? With the help of my outpatient colleagues, they had spent years preparing for his death. His financial affairs were in order, and he had done legacy work with his kids. More than nearly anyone I had cared for, they were ready. Were we? Was I? (SINGING) Mortals join the happy chorus which the morning stars began. He breathed in. Not a grand gasp, a slow, soft inhalation. Tom's hand flexed ever so slightly around Julie's. In my head, I thumped a pew. [MUSIC PLAYING]   SPEAKER 2: Welcome to "JCO's Cancer Stories-- The Art of Oncology," 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 of the shows, including this one, at podcast.asco.org. SPEAKER 3: The guest on this podcast episode has no disclosures to declare. [MUSIC PLAYING] LIDIA SCHAPIRA: Welcome to "Cancer Stories-- The Art of Oncology" podcast series. I'm your host Lidia Schapira. And with me today is Dr. Richard Leiter, physician and member of the Psychosocial Oncology and Palliative Care team at Dana-Farber Cancer Institute in Boston and the Brigham and Women's Hospital. Welcome to our podcast. RICHARD LEITER: Thank you so much for having me. LIDIA SCHAPIRA: It's a real pleasure. You submitted a beautiful narrative piece called "Ode to Joy." And I'd like to start today, Richard, by just focusing first on the case that you present to us. Let me tell you how I understand Tom's history, and then you can correct me if this is not the way that you'd like him to be understood. And remember, Tom is a man in his 50s who's lived with metastatic cancer to bones for years. In your narrative, you're very careful and document the fact that you've worked with many members of your palliative medicine team for a long time, that there had been many efforts to control his pain, his suffering, and he had to be hospitalized for pain management. He was already receiving home hospice care. There was a bed in the living room in the center of the family home. And he had a very supportive family and a wife that we'll call Julie at bedside. Is that the proper framing for the story? RICHARD LEITER: Exactly. Yep. Yeah. I think what I would add is that the goal was really to control his pain and get him back home. LIDIA SCHAPIRA: So now you're there as the fresh attending in palliative medicine, and you're called in, and it becomes quite clear to you after a few days of changing his medications that the pain is refractory. And that it-- you note here that he screams when he is moved, that the level of pain reaches what you have called agony. So tell us a little bit more about how a palliative medicine consultant or physician approaches this kind of situation in hospital today. RICHARD LEITER: Yeah, no. Great. Thanks so much. So we were, I would say, lucky enough to have him on our intensive palliative care unit, where we're caring for patients with difficult and sometimes refractory symptoms at any stage of the disease. So not only for end of life. But we do see a number of cases like his every year, every few months, where someone is getting closer to the end of life. The goal is to really focus on intensive symptom management. And their symptoms are challenging to control. So I think the first step, always, is a good history, right? Where is this pain coming from? What treatments have they tried already? What's worked? What hasn't? We're going to titrate medications, but select medications based on that and titrate them. I think someone who has been involved with my outpatient colleagues and has been receiving hospice services at home has often gone through many treatment modalities. So it's really taking what they've been on before and starting to add to it. So for Tom, I had inherited him from one of my colleagues, who had admitted him a couple of days earlier. And at that point, he was already on a hydromorphone infusion and ketamine, as I talk about in the piece. Ketamine had been started, hopefully, as a bridge to get him back home. And he had been on methadone, which is one of our most potent agents for, not only nociceptive pain, so our basic kind of bony pain or visceral organ pain, but also if there's pain with a neuropathic component. Methadone is an opioid that can be particularly effective there. So I think it's saying, OK, well, have we hit all of our receptors in managing their pain? Are we managing the anxiety on top of that? Are we doing everything we can? Are there procedures that we could do to help with their pain? Sometimes we're talking about intrathecal pumps for instance. And obviously, that's a more involved discussion. How much time does someone have left? Are the goals really to put them through a procedure in order to get their pain under control? But we frequently work with our interventional pain colleagues to tease out whether a procedure would be helpful for a particular patient. So those are the thoughts that always go through my mind when I'm approaching someone with severe cancer-related pain. LIDIA SCHAPIRA: So this is a very thoughtful approach. And I think one of the messages is that it seems palliative medicine and pain management are integrated into the care of patients with advanced cancer, which is a very important message for our listeners and our readers. And here you are, you have all of this, you have good communication, it seems, with your team members, with the patient's family, and there's nothing more that you can think of doing. And you're now starting to think about interventions that we normally don't think of, except as a last resort. Bring this to the bedside. Tell us a little bit about the recommendation for palliative sedation and when that's indicated in care. RICHARD LEITER: Yeah. So palliative sedation, as I write in the piece, it's a measure of last resort. And certainly, in our hospital's protocol, it explicitly states it's when all other options have been tried. As we start to integrate more options, it's always a conversation we're having among our team-- is when is palliative sedation truly indicated. How many boxes do we need to check before going down the palliative sedation route? And I think-- so we started to think about-- we had him on ketamine. We tried to wean him off, it didn't go well. We restarted ketamine. We started dexmedetomidine, which can be useful. Precedex, the brand name, they oftentimes use it in the ICU for sedation, but we find that it can be helpful in cases of refractory pain as well. And my practice has been-- and though I haven't gotten to palliative sedation until this case-- when I'm thinking about Precedex, I'm also starting conversations with the patient or their family, and certainly our team, about palliative sedation to say if this doesn't work, this is where we're headed. LIDIA SCHAPIRA: And why is this situation so difficult, so personally anxiety-provoking for you? You do use words that convey that you are feeling nervous, or perhaps even anxious. Tell us why. RICHARD LEITER: I think it's-- relieving our patient's suffering, relieving their families suffering is certainly the core of much of medicine and very much the core of what we do in palliative care. And I think to have someone in just such a terrible situation-- putting aside the pain, right? This is a man who's dying of his cancer, has a relatively young family. That alone is an awful situation. And my job is to make that situation a little bit less bad, is to ease the suffering. LIDIA SCHAPIRA: And there's something about this particular procedure, however, that adds a level of intensity and nervousness for you, and that is that perhaps-- you can describe this better than I-- but the fact that in some cases, this could have the unintended effect of actually causing respiratory depression or even hastening death and something that you have explained in your piece, if I understood you correctly, as the double effect. Did I get that right? RICHARD LEITER: Yeah, that's right. So the worry or one of the considerations with palliative sedation is that it could hasten someone's death. Oftentimes, the doses of the medications that we're using, if we're titrating them slowly, there are studies that show that it doesn't necessarily. I do think, though, when we tie it into withholding artificial nutrition and hydration, in that case, had the person been awake enough to eat and drink before, we do know that it would probably hasten their death, right, from that part of it, but not necessarily the sedation aspect. So double effect is basically saying this is ethically OK-- and there are a number of criteria. But if we are intending the good effect and not the bad effect and that it's proportional to the gravity of the situation so that not every patient who comes in with bad pain undergoes palliative sedation. LIDIA SCHAPIRA: My favorite line, Richard, in the piece-- and one that I now have read probably dozens of times-- is this-- "the double effect, I reassured myself. Even so, as bedside nurses have told me, it's easier to talk about philosophy when you're not holding the syringe." And that just gives me goosebumps thinking about it. What did you feel when you were holding the syringe? RICHARD LEITER: Exactly as I wrote about. There's all of the cognitive processes going on. And I ran it by another attending, I ran it by the nursing director, I ran-- everyone was on the same page, that this was medically indicated in this situation. And yet, when I'm standing there in the room-- patient, his wife, my fellow, and the nurse-- and I'm the one holding the syringe, watching the medication go in, it felt completely different to me. And there's a power that comes with it. In one sense, I felt like I was there for my patient. Here I am, standing here doing this to ease his suffering. And then the other, the unintended consequences of the sedation are real, and that feels different when you're the one physically doing it. LIDIA SCHAPIRA: I think one of the incredible gifts you've given us as readers is to share this with us and really adds a different dimension to the discussion of the complexity of what it is to be present, not just as a witness, in this case, but as somebody, as you say, with a power to really control so many things in the situation. And I thank you for sharing that with us. And question to you is, did writing about it in any way help you process this emotional, very powerful experience? RICHARD LEITER: Absolutely. I write to process. I write when I feel like I have something to say. And oftentimes, I write when a particular moment struck me. And I think that that moment, sitting there, pushing the medication, waiting for that breath while the music was playing was so poignant for me that I walked out of the room and I remember thinking to myself that night as I was decompressing on my walk home from work, I think I need to write about this. LIDIA SCHAPIRA: So thank you for writing about it, and then, of course, for submitting for review and to share it with people. Let me bring the music in. Music is such an important part of our sensory experience. So as you were holding the syringe, Julie, Tom's wife, puts the phone on the pillow and she plays the piano version of Ode to Joy from Beethoven's Ninth Symphony, which I want to play for our listeners now. [MUSIC PLAYING]   So Ode to Joy meant something, clearly, to Tom and Julie. And you said that you watched-- perhaps you were watching for his reactions. But tell me a little bit about what it meant to you. You sprinkled your essay with the lines for the choral for Ode to Joy, which has a religious significance as well. So tell us a little bit about that. RICHARD LEITER: Yeah. So I grew up in Toronto. I went to an all-boys school there that had a traditionally Anglican background, though I'm not-- I'm Jewish. We would sing hymns. And over the course of my time there, the hymns became less denominational and more multicultural and inclusive. And it was a moment-- it was a nice moment where everyone got into it. It's 600 boys singing, and so I still remember the words to Ode to Joy vividly. Anytime I hear it, I can replay the words in my head. And I found myself, in those moments in the room, really thinking about it. And the words were still-- as I was processing and watching Tom and Julie and making sure I was pushing the medication at the right speed, there was this soundtrack. It's a strange moment too, because they're good memories for me, and yet I'm in this incredibly solemn, intimate moment in my patient's room. LIDIA SCHAPIRA: And so as we're getting to the end of the piece and there's all of this tension that you've built up in the writing and the narrative-- and here you are, you're waiting and you hear the music and so on-- and then you finally let the tension out and he breathes. It's not a huge breath, but it's a soft, slow inhalation. And you see that the hand is flexed slightly around his wife, so he's still breathing. And you finish with this line that you say, "In my head, I thumped a pew." And I have to ask you about that. What does that mean to you? RICHARD LEITER: Yeah. So in that moment, it was relief, is what it was. Just the sense of, OK, this went-- it's my first time doing this, and this went OK. He appears more comfortable. He is still breathing. This is OK. And it just brought me back when we would thump the pews as we were singing the hymns. Our principal did not like it, but-- [LAUGHTER] But I think it was just that it was relief. I hesitate to say it was joy because I don't think there's joy in a situation like that, in the room. But there was a sense of satisfaction maybe, or professional satisfaction, the, OK, this is what we can do. And as bad as the situation is, there was something that we could do to make him somewhat more comfortable. LIDIA SCHAPIRA: Well, I certainly learned a lot. I wonder if now that some time has passed since this event, if you have any additional reflections on how this story has impacted your professional delivery of care, or perhaps the way you teach others, and if there are any parting comments that you'd like to leave us with. So I haven't had another case where I've needed to do palliative sedation, though we've thought about it in a couple of cases. I do think it's helped me, when I talk about palliative sedation with our trainees, to add the emotional valence. I think I was pretty good at talking about the importance of making sure everyone's on the same page and talking to the patient and the family and nursing staff. But to really talk about the significance of that moment for us as clinicians and how it does feel different-- at least it did for me-- and I think drawing on my personal experience is helpful in teaching it to the fellows that it's OK to feel like that when you're doing this. LIDIA SCHAPIRA: There are moments in medicine-- certainly in what you do-- that are really difficult. And this, probably, I would imagine, ranks as one of the top things. And it should never be easy. It will never be easy. The day that you think it's easy, you need to find something else, right? RICHARD LEITER: I think that's right. I think that's right. LIDIA SCHAPIRA: Well, thank you so much, Richard. You made me laugh, you made me cry reading this, and I thank you very much. My last question is, have you had a chance to talk with Tom's widow Julie about what that moment felt like to her? RICHARD LEITER: I have not, although I hope to in the near future. LIDIA SCHAPIRA: And that will be your next piece for us. [CHUCKLES] All right. Well, thank you very much and until the next time. Hope you all enjoy reading Ode to Joy. RICHARD LEITER: Thank you so much. SPEAKER 1: Until next time, thank you for listening to this "JCO's Cancer Stories-- The Art of Oncology" podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. "JCO's Cancer Stories-- The Art of Oncology" podcast is just one of ASCO's many podcasts. You can find all of the shows at podcast.asco.org. [MUSIC PLAYING]

This episode addresses psychosocial oncology, a growing cancer subspecialty that addresses the variety of psychological, behavioral, emotional and social issues that may arise for cancer patients. The discussion will focus on the Psychosocial Cancer Care Program at Stanford School of Medicine and the various collaborations with other care providers and services. Topics will include the definition of psychosocial oncology and how it differs from palliative care. Listeners will also learn more about the focus of program and how it impacts the psychological responses of patients diagnosed with cancer. CME Information: https://stanford.cloud-cme.com/medcastepisode25 Claim CE: https://stanford.cloud-cme.com/Form.aspx?FormID=972

In this week's episode of We Get It, Dani chats with Dr. Fiona Schulte, Assistant Professor in the Department of Oncology, Division of Psychosocial Oncology in the Cumming School of Medicine, about quality of life and young adult cancer. Thank you to our partners at CIBC for supporting this web series!

Dr. Uma Naidoo is the ultimate triple threat – she's a bestselling author, a renowned Professional Chef, and the Director of Nutritional and Lifestyle Psychiatry at Massachusetts General Hospital.  After pursuing her passion in medicine through a fellowship in Psychosocial Oncology at the Dana-Farber Cancer Institute, Dr. Uma started to conquer her love for cooking by completing both savory and pastry classes at the Le Cordon Bleu in Paris and at the Culinary Institute of America. Uma not only graduated as a Professional Chef from the Cambridge School of Culinary Arts in Cambridge, MA with High Honors, but she was also awarded the coveted M.F.K. Fisher Award for Outstanding Scholarship and Innovation. In 2020, Uma published her book, Your Brain on Food – integrating her professional accomplishments in medicine, psychiatry, nutrition and cooking. Dr. Uma is full of valuable insight into the impact that food can have on your mood, your mind, and other mental health conditions, and I'm confident that this conversation will give you new tools to improve your performance and longevity — let's go!

This Podcast is about a non-dualistic perspective to life and living, cancer and cancer survivorship.  Please join me as I provide a snap-shot of the A Course in Miracle's teachings on the purpose of relationships during our life's journey. Whether you are healthy or having any kind of health challenge, you may find that these reflections about the meaning behind the Course's teachings about relationships and their purpose, inspire you to further reflect on this material.  To learn more about A Course in Miracles please visit www.acim.org or www.facim.org. To view this podcast on YouTube (video recording) please follow the following link: https://youtu.be/MeKpi95v5_Q

This Podcast is about a non-dualistic perspective to life and living, cancer and cancer survivorship.  Please join me as I provide a snap-shot of the A Course in Miracle's teachings for listeners who may be at the start of journey with the Course. Whether you are healthy or having any kind of health challenge, you may find that these reflections about the meaning behind the Course's teachings, inspire you to further reflect on this material.  To learn more about A Course in Miracles please visit www.acim.org or www.facim.org. To view this podcast on YouTube (video recording) please follow the following link: https://youtu.be/mIzfG0EmQw8

Today's Guest is Rev. David Maginley. He had a Near Death Experience during his church service. Luckily he was giving service at a hospital when he had his NDE! Watch this video to find out what happened! Rev. David Maginley is a spiritual counsellor with the cancer, palliative and ICU programs at the QEII Health Sciences Centre in Halifax, Nova Scotia, and author of Beyond Surviving: Cancer and Your Spiritual Journey. While David has degrees in philosophy and religious studies, his real education came from surviving cancer four times. This resulted in a profound near-death experience and explorations in connection of body, mind and spirit. He knows what it's like to have cancer from both sides of the hospital bed, and has a sense of this life from both sides of the veil. David is ordained with the Evangelical Lutheran Church in Canada, a specialist with the Canadian Association for Spiritual Care, member of the Canadian Association for Psychosocial Oncology, the Atlantic Therapeutic Touch Network, and the International Association for Near-Death Studies. He is also featured in the documentaries, "Here Right Now", and "When You Die". #nde #paranormal

The COVID-19 pandemic has affected every corner of American cancer care—including psychosocial services. On this mini-podcast, we explore how patients are dealing with the "new normal,” and how oncology social workers, psychologists, and psychiatrists are working to help them through an unprecedented time.Guest: Jeffrey Kendall, PsyD, LP, Director of Oncology Support Services, University of Minnesota Medical CenterRelated Content:Mini-Podcast: COVID-19 Conversations with PatientsGuided Patient Support: Helping Patients Navigate the Clinical, Psychosocial, and Financial Aspects of Cancer Care, by Jessica Sima, MSN, RN, ACM, et al.Telehealth at its Best: Transitioning a Comprehensive Psychosocial Program to a Virtual Format, by Jennifer Bires, MSW, LCSW, OSW-C, and Drucilla Brethwaite, MSW, LCSWOncology Social Workers’ Role in Patient-Centered Care, by Fran Becker, LCSW, OSW-COncology Social Workers Promote Self-Care in the WorkplaceThe views and opinions expressed herein are those of the author(s)/faculty member(s) and do not reflect the official policy or position of their employer(s) or the Association of Community Cancer Centers.

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. 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 the data described here may change as research progresses. Brielle Gregory: Hi, everyone. I'm Brielle Gregory, 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 chemotherapy-induced peripheral neuropathy. Our guest is Dr. Charles Loprinzi. Dr. Loprinzi is the Regis Professor of Breast Cancer Research at the Mayo Clinic in Rochester, Minnesota, where he is an emeritus chair of the Division of Medical Oncology and an emeritus vice-chair of the Department of Oncology. He is also the Cancer.Net Associate Editor for Psychosocial Oncology. Thanks for joining us, Dr. Loprinzi. Dr. Loprinzi: My pleasure to be here. Brielle Gregory: Today, ASCO is publishing a new guideline on the prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers. Dr. Loprinzi served as the co-chair and lead author for this guideline. Before we begin, we should mention that Dr. Loprinzi has relationships to disclose related to this guideline. You can find his full disclosure statement on Cancer.Net. Now, let's talk a little bit about what this guideline means for people with cancer and those who care for them. So, Dr. Loprinzi, to get started, what is peripheral neuropathy? Dr. Loprinzi: Peripheral neuropathy is pathology of nerves that's in the peripheral part of the body. But my English teacher in high school, a Catholic nun, would not like me to define a term with using the actual words there. So it's disease of the nerves—I'm going to use nerves instead of neuropathy—that's in the part of the body that's at the end of the extremities, the hands and the feet. It's caused by chemotherapy. Not all chemotherapy drugs cause neuropathy or pathology of the nerves, but some do. And that's what we're talking about today. And it is the symptoms that people get, numbness, tingling, and pain. Mostly numbness and tingling start, and then pain can come later on, but they're all three quite obviously. Brielle Gregory: Thank you for explaining that. So why is this guideline on chemotherapy-induced peripheral neuropathy important for patients? Dr. Loprinzi: It's important because it's a very prominent problem. It's very, very common. Again, not all chemotherapy drugs we give caused this particular problem, but some of them that we give-- and a good number of them that we give can cause this problem. And the problem can be bothersome while the patient's getting chemotherapy, and it can also last for a long time after chemotherapy is done. And that when I say a long time, that sometimes is months or years, and it could be a very prominent problem for some patients, a minority of patients there. There are some chemotherapy drugs like oxaliplatin, one of the drugs we give, that actually that neuropathy gets worse, the nerve problems get worse in the three months after stopping chemotherapy, and so you don't know the full extent of it for some time after you're done with the chemotherapy. Brielle Gregory: That's really important to note. So when it comes to preventing chemotherapy-induced peripheral neuropathy, what does this guideline say about preventing chemotherapy-induced peripheral neuropathy? Dr. Loprinzi: There have been a lot of studies that have looked at ways to try to prevent neuropathy. Unfortunately, there's no proven means of doing this, other than not giving the chemotherapy, and the reason for giving the chemotherapy is to try to kill off cancer cells so we don't like that part of it. And the drugs that we used that caused this neuropathy are some of the better drugs against the particular cancers that patients have. There is some suggestions that giving cold therapy, putting ice packs or cold gloves on hands and feet, with cold socks for the feet part of that. That can decrease the amount of blood flow and decrease the amount of nerve trouble that people get. It's not proof of benefit there. You always have to be somewhat careful, there have been occasional episodes of people who have gotten frostbite from that. But that's one of the things that looks like it might be doing some good. Again, more studies is needed. Another way to try to decrease the blood flow is to put tight gloves on the hands, and therefore, the same sort of thing where you decrease the blood flow with cold therapy. There's some data that suggests that might be beneficial. And there are data that suggests that exercise could be beneficial. Patients who exercise more before and during chemotherapy seems to get less neuropathy than those patients who do not. Brielle Gregory: All right. So let's move on to talking about treating chemotherapy-induced peripheral neuropathy. What does ASCO recommend in treating chemotherapy-induced peripheral neuropathy for patients who are currently receiving chemotherapy? Dr. Loprinzi: So for patients who are getting chemotherapy, and for an example, when we're giving adjuvant chemotherapy which means that patients have had a surgical procedure and all known cancer has been removed, but we know based on the size of the cancer and whether it's involved lymph nodes and etc. things, even though we've removed everything we can see, we know that it comes back in a percentage of patients, in the future. And this is again from past experience. And the chance of the cancer coming back might be 10% chance or 20% chance or 50% chance or some other different number from that. So we give 12 weeks of therapy to try to improve the chance that it won't come back. So that's the reason why we give the chemotherapy. But if a patient's getting neuropathy and fairly significant neuropathy, knowing it can get worse if you give more, and it gets worse even after you finish in many patients or in some patients. The doctor's role as per the guidelines is to think about how much additional benefit if I go from stopping at 8 cycles, if I go to the whole 12 cycles, how much additional benefit do we think that would decrease the cancer from coming back? Will that decrease it from coming back by 1 percentage point? Or will that be 5 percentage points? Or will that be 10 percentage points? Those are different numbers. And then with that information, being able to share that with the patients and also share the neuropathy story and how much worse it might get depending on how badly it is getting so that decisions could be made. Should we stop short of what we were planning to do? Given that we do not want to have this neuropathy to be a problem that's around for months or years after finishing chemotherapy. So that's the one suggestion that was made by the guidelines. Having said that, there's no proof of any of this process that's the best way to go, but it's the best recommendation that we get. Brielle Gregory: Now, what about for patients who have completed chemotherapy? What does ASCO recommend in treating chemotherapy-induced peripheral neuropathy for them? Dr. Loprinzi: For those patients who have the problem after finishing chemotherapy, there is one drug that's around. It's a drug called duloxetine. It was developed as an antidepressant, but it also has been shown to be helpful in some pain situations. It's also been shown to be helpful in some pain situations. This drug is the one that in placebo-controlled trials, trials that randomized patients to get the drug or something that looked like it, just a sugar pill, if you will, that it does decrease pain and some tingling that patients get. It significantly decreases it. Having said that, it doesn't decrease it by a lot, and significant is a statistical term that says that this decrease did not happen by just chance alone. So that's the one drug that's recommended in this particular situation. There are some things that look promising that you could argue would be worth trying, but do not have proof of benefit. And in that setting, we're trying to do more experiments to see if we can prove that these things are beneficial. And those three things are, one, acupuncture, two, exercise just like in the prevention mode, exercise seems to be helpful for decrease in the symptoms. And something else called scrambler therapy which is a type of nerve-stimulation therapy that's given on the skin of patients done by a machine in a doctor's office. So those are the three things that looked promising. Again, more work needs to be done to prove the true benefits and risks associated with these approaches. Brielle Gregory: Great. This is definitely an important guideline for patients. So thank you so much for sharing your expertise today, Dr. Loprinzi, and for taking the time. It was such a pleasure having you. Dr. Loprinzi: My pleasure. ASCO: Thank you Dr. Loprinzi. If this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. This Cancer.Net podcast is part of the ASCO Podcast Network. This collection of 9 programs offers insight into the world of cancer care, covering a range of educational, inspirational, and scientific content. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/donate.

[music] 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. 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 the data described here may change as research progresses. Greg Guthrie: Hi, everyone. I'm Greg Guthrie, 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 cachexia. And our guests are Dr. Charles Loprinzi and Hester Hill Schnipper. Dr. Loprinzi is the Regis Professor of Breast Cancer Research at the Mayo Clinic in Rochester Minnesota where he is an emeritus chair of the Division of Medical Oncology and an emeritus vice-chair of the Department of Oncology. He is also the Cancer.Net Associate Editor for Psychosocial Oncology. Thanks for joining us, Dr. Loprinzi. Dr. Charles Loprinzi: It's good to be here, Greg. Greg Guthrie: And Hester is the emeritus manager of oncology social work at Beth Israel Deaconess Medical Center in Boston. And she now works in private practice. A 2-time breast cancer survivor, she's a nationally known speaker, is active in numerous oncology organizations, and has written 2 books about breast cancer. Her daily clinical responsibilities include working with individuals, couples, and families living with cancer, and facilitating support groups. She is also a member of the Cancer.Net Editorial Board. Thanks for joining us today, Hester. Hester Hill Schnipper: Thanks for inviting me. Greg Guthrie: Great. Now, today, ASCO is publishing a new guideline on the management of cancer cachexia. Dr. Loprinzi and Hester both served on the panel for this guideline. Before we begin, we should mention that they do not have any relationships to disclose related to this guideline. But you can find their full disclosure statements on Cancer.Net. Now, let's talk a little bit about what this guideline means for people with cancer and those who care for them. So Dr. Loprinzi, what is cancer cachexia, and how common is it? Dr. Charles Loprinzi: So cancer cachexia, the definition. We oftentimes call it cancer anorexia/cachexia, and so I'll try to define both anorexia and cachexia. A lot of people have heard of anorexia nervosa where people do not eat very well, so it's a loss of appetite is what anorexia is. For the cachexia part, you think of the people in the World War II camps when they came out at the end, where they had not eaten for a long time, and they were very, very, very thin. So cancer anorexia and cachexia is a phenomenon that comes on in patients with cancer, very frequently when they have advanced cancer, but oftentimes when they're just diagnosed, where patients are much thinner, and they're not eating very well. Greg Guthrie:  Hester, did you have something to add on that? Hester Hill Schnipper: I think many patients, when they are newly diagnosed, experience appetite loss even if their weight has been normal up until then. But one of the ways to divide the world, are people who can't stop eating when they're under stress, and people who shut down and don't eat when they're under stress. So plenty of brand-new cancer patients fall into the second category, and, at least for some period of time during the particularly crisis anxiety-filled weeks around diagnosis, are not eating very much or very well. But that, generally, improves then as things settle down and their treatment begins and is not usually a cause for real worry. Greg Guthrie: So is the cause of cancer cachexia often caused by the cancer itself, or is it a reaction to the cancer? Hester Hill Schnipper: I suspect that Dr. Loprinzi can answer that better than I can. But my impression is that it usually is caused by the cancer itself and just the multiple medical problems that may accompany an advanced cancer. Dr. Charles Loprinzi: So I agree with Hester on this point here. And it's not the treatment; it's the cancer itself. People used to think that patients who were receiving chemotherapy for early breast cancer, they were going to lose a lot of weight because patients who were getting chemotherapy for advanced disease lost a lot of weight. But in fact, patients with early breast cancer, when they get chemotherapy to try to help cure them, they gain weight. So it's not the chemotherapy that's causing the problem. It's the cancer itself. It changes the metabolic phenomenon of the body. People don't eat very well. And even if they get calories in, they don't metabolize them well, and so they still lose weight. Greg Guthrie: So, Hester, what are some of the problems that can come from cachexia? Hester Hill Schnipper: Well, certainly there are many medical related problems that Dr. Loprinzi can speak to better than I can. But the psychosocial or psychological issues also can be very troublesome for both the patient and those who love the person who is ill. If you are feeling terrible and not eating, that is obviously worrisome both to the patient and to their family members. And family members, generally, react by trying to encourage or even really pressure somebody to eat: making favorite foods, bringing in much more food than somebody wants, and then feeling very disappointed and perhaps even rejected if the patient just can't eat it. I mean, certainly, much of our advice—and maybe we're going to be talking a little bit more about this later—is to sort of back off and to a large extent let the patient direct what he or she is willing and able to eat. Dr. Charles Loprinzi: And I would add to that, when you've lost a lot of weight and you're not eating well, it can impair your ability to function well. Patients who have lost weight, related to cancer, do worse in terms of prognosis, with shorter survival and more side effects from chemotherapy. And their quality of life is not as good. So it is a big problem with those situations. Greg Guthrie: So who's generally bothered more by a patient's loss of appetite. Is it the patient or the patient's family and loved ones? Hester Hill Schnipper: My experience is that it's generally more the family and loved ones. I mean, if the patient doesn't feel like eating, he or she just doesn't feel like eating. I mean, we've all had viral syndromes where, for a few days, we don't have any appetite. And you just don't have any appetite or are not interested in it. And I think some exaggerated version of that is probably what most patients feel. But family members feel very worried about it. There's all the sort of mythology around food and around nurturing and around love, and most of us take pleasure out of cooking for and feeding people whom we love. And when someone you love is sick, those feelings are even larger than they might otherwise be, and we kind of panic if everything we're trying to do to take care of somebody isn't working. Dr. Charles Loprinzi: So I agree with Hester. In many patients, they just don't have an appetite. It's not a problem. It's not like they have pain, or it's not like they have nausea or vomiting. Now there are some patients whom that bothers them that they don't have an appetite, but many patients it really doesn't bother them. But as Hester said nicely, the family is oftentimes bothered tremendously by this particular situation. Greg Guthrie: Okay. So, Hester, I'm going to follow up a little more. Is it important for family and loved ones to encourage patients to eat more then? Hester Hill Schnipper: I think not. I think it is very important to try in a loving non-pressured way to communicate about it like, "Dad, is there anything you can think of that might taste good? Would you like a little bit of ice cream?" I mean, that kind of comment. And if dad says, "No. I don't want anything," then try again a few hours later. I mean, certainly more frequent offerings of small amounts of food are much more likely to be accepted than bringing in a full dinner plate. But I think it's important to take cues from the patient because too much pressure is going to result in somebody eating even less than she might have otherwise. Dr. Charles Loprinzi:  I agree with that, 100%. There is actually an interesting story, true story, of a patient who mentioned this to somebody who was interviewing the patient afterwards. And the patient had advanced cancer and noted that when some of her relatives came in to visit her—and these are in her dying days and weeks—when her family came in to visit her, she would pretend she was asleep so she wouldn't have to interact with them because she knew they were just going to pressure to eat. And that's just a disaster in my mind. So it's a crazy sort of story to hear and all that. But I've mentioned that sometimes to patients' families so that they know don't over-bother the patients. Hester Hill Schnipper: We can all relate to that. Even though you've always loved my lasagna, you may not want it tonight. Dr. Charles Loprinzi: Yes. Especially if I have a viral syndrome and I just feel bad, I want to kick the food across the room because if I eat it, I'm going to throw up. Hester Hill Schnipper: Right. Greg Guthrie: So for patients who need nutrition, how often should tubes be inserted into the stomach to provide nutritional feedings? Dr. Charles Loprinzi: So that's a great question, Greg. And there are ways you can get nutrition into a person who's not eating well, assuming their bowels are still working, and it's not a bowel obstruction sort of thing. And you can put food into the stomach. How can you do that? You can put a tube down their nose and put food in through that way—liquid nutrition that way. Or you can get a procedure done where you put a tube sticking out from the abdominal wall and the tube right into the stomach that way or to the small intestine. So you can give food in that manner. It's not infrequently done. Some countries more than others. And it's not frequently done. It can be helpful on a patient who might have an obstruction of the esophagus so they can't otherwise swallow food, but, otherwise, the rest of the bowel is working and all that sort of thing. But oftentimes, if the bowel is working, if you put the food in that way, it does not improve quality of life or quantity of life for patients. And it can be a lot of hassle for doing it, and it's uncomfortable. So it's not recommended for most patients in this situation. If they just can't eat, then trying to force the food into them through their bowel does not seem to help things overall in terms of their quality or quantity of life. [crosstalk] Hester Hill Schnipper: Yeah. My experience has been supporting everything you have just said, that this is a particularly difficult part of an ongoing difficult conversation between a doctor and a dying or very ill patient because most people think that if you don't eat, you're going to die more quickly. And families, particularly, often pressure the physician to go ahead in this way. And once you have put in a feeding tube or some other way to artificially feed someone, it's harder to take it out than it would have been to make the decision not to do it in the first place. Greg Guthrie: So this is really an important quality of life decision? Dr. Charles Loprinzi: Yes. You're right. Hester Hill Schnipper: And the quality of life, obviously, being part of the bigger decision about quantity of life, and what are somebody’s values and goals. Greg Guthrie: So that's really interesting. We've talked about introducing nutrition directly to the bowel, but how often should intravenous nutrition be given to people with advanced cancer cachexia? Dr. Charles Loprinzi: That's a great follow up question, Greg. So given intravenous or IV nutrition, that can be done. You can put an intravenous line oftentimes in the neck or sometimes in the thick part of the arm. And you can run nutrition in that way for days or weeks. So it can be done. It is done in patients who do not have functioning bowels, in general. And it could be helpful in that situation and could keep people alive for months and years in that situation. In patients with advanced cancer where they're just not eating and they're losing weight, is it beneficial to do that in those patients where there's this metabolic problem, and even if you give nutrition to them, they don't use it very well, and they may not gain weight otherwise? So that's been the subject of a lot of randomized trials where half the people get the intravenous nutrition and half the people do not. And the data that are available are that those who get the intravenous nutrition do worse than the patients who do not. Part of that is because they can get infections from this process. Or part of it is that you can get the glucose too high. And it's a lot of a hassle that sort of way. There's even some situations where cancers might grow faster by giving them more nutrition there. So it's not recommended to be done in most patients. Sometimes, it is started. And if it is started, there should be clear goals, "Okay. We're going to do this for a month, and our goal is this so that mom gets strong enough to walk to the mailbox," and if at one month, she's doing worse and not doing that then it's oftentimes time to say, "Okay. Let's stop that. It didn't work very well." Greg Guthrie: So Dr. Loprinzi, we've talked about nutrition, but how is cancer cachexia treated? Dr. Charles Loprinzi: That's a good question. We've actually started off with a lot of the things you can't do. But what can you do? And those are somewhat limited, unfortunately. But there are some things. One is nutritional consultation, dietitian, that sort of thing. Part of the benefit they can provide is to recommend patients don't take crazy diets. And there are a lot of crazy diets out there recommended for patients with cancer. And they might be able to help them so that they can get more nutrition in. There's not a lot of randomized data to demonstrate that does a lot of good, but it's a recommendation that makes some sense. On the other hand, what about giving drugs? There are many drugs that have been studied, randomized controlled trials with placebo where half the people get the drug and half the people get a placebo. And there are 10 or 15 things that have been tried. There are a couple of them that do show that you can use the drugs to stimulate appetite and improve weight. And there are 2 different classes of drugs. One is a steroid medication like dexamethasone. And the other is a progesterone hormone-like medication like megestrol acetate. So those can be given. The guidelines that ASCO came out with recently that looked at this, and looked at all the randomized trials, suggested that physicians should not feel pressured to give these medications. And the reason for that is that these medications do not improve quality of life or survival, and they can have some side effects. Steroid medications can increase the chance of infection. They can cause peptic ulcer disease or stomach ulcer disease. The megestrol acetate can cause blood clots. And in some of the randomized trials, the patients who got the megestrol acetate for treating cachexia, on average, died sooner than the patients who did not. So not recommended for everybody. But if a patient really says, "My loss of appetite is really bothering me, not the family, but bothering me," then they might choose to try these medications. It's reasonable to try them for a limited period of time and then see if they work, right? For 2 weeks or 3 weeks, and then stop if it doesn't work. There are studies going on trying to find newer better agents for this situation, but results from those are not available yet. Greg Guthrie: Great. So, Hester, how does this ASCO guideline, management of cancer cachexia, help improve the lives of patients? Hester Hill Schnipper: Well, we're hoping that this ASCO guideline, like all the others, will be useful to physicians, nurses, dieticians, patients, and families themselves, anybody working with cancer patients or thinking about how to improve the quality of life of cancer patients. I am particularly hoping that these guidelines will decrease the use of very difficult treatments that don't generally help or improve somebody's quality of life or the length of time that someone has to live in very difficult and stressful circumstances. We're hoping that it will help families understand why medical recommendations are made and why, often, in this situation, the recommendation is to not do something, because that's not usually what families expect to hear. So understanding better that the focus needs to be on someone's quality of life and how best to make the best of whatever days there are, that's one of our major goals. I also would like to add that I regularly write a blog called Living With Cancer which is published through the BIDMC Cancer Center, and there is a blog available talking more about this issue and primarily from the psychosocial or family side of it. Greg Guthrie: Thanks for sharing that, Hester. We'll definitely put a link to that in our blog post on this podcast and in the transcript. But this has been a really helpful discussion. It's really important to talk about cachexia in terms of quality of life. And, obviously, this is an important facet for this ASCO guideline to cover. So Dr. Loprinzi, Hester, thank you for sharing your expertise and insight today. It was great having you. Hester Hill Schnipper: Thank you so very much for asking me. Dr. Charles Loprinzi: Thank you very much. ASCO: Learn more about cancer cachexia at www.cancer.net/appetiteloss and www.cancer.net/weightloss. And if this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. This Cancer.Net podcast is part of the ASCO Podcast Network. This collection of 9 programs offers insight into the world of cancer care, covering a range of educational, inspirational, and scientific content. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/donate. [music]

Saying you need help is okay according to Dr. Chilcote, Director of Psychosocial Oncology at the West Virginia University Cancer Institute. During this podcast, she discusses the short and long psychosocial effects of cancer including anxiety and depression. She also shares tips on asking for support, how to know when a loved one needs help, and how to find a mental health care provider in your local community. This podcast is for cancer patients, survivors, and their caregivers. Cancer Prevention and Control at the WVU Cancer Institute in collaboration with Mountains of Hope, the state's cancer coalition, and the WV Bureau for Public Health produce the Living Beyond Cancer podcast series. Reach out to us at cpc@hsc.wvu.edu with questions or comments or join our Facebook support group at http://bit.ly/beyondcancer. 

On this episode of the Cancer Dietitian Podcast we're talking about the emotional effects of cancer with Dr. Richard McQuellon, Director of Psychosocial Oncology at Wake Forest Baptist Health Comprehensive Cancer Center's Cancer Patient Support Program. We'll discuss practical coping mechanisms, when to seek professional help for depression, and the power of community. We're also speaking with Julie Pope, a GI Oncology Nurse Navigator at Novant Health Cancer Center about their local cancer support group for cancer survivors, patients and caregivers. Then we'll hear from ten-year colon cancer survivor Rod Hunter about his experience and how he has navigated his emotions from diagnosis to recovery. What we discuss: Coping with disease and management, relationships and how you think and feel The importance of understanding how you work and what gives you hope Finding a support community Practical coping mechanisms When to seek professional help to deal with depression The power of both speaking about how you feel and listening to others Different types of creative therapy options The greatest need for caregivers Links mentioned: ACS Coping Checklist for Patients Wake Forest Baptist Cancer Survivorship Clinic Wake Forest Baptist Comprehensive Cancer Center Cancer Services, Inc. Cancer Dietitian Colon Cancer Coalition Get Your Rear in Gear 2020 Race Race Facebook Event Page

On this episode of the Triad Cancer Connection Podcast we’re talking about the emotional effects of cancer with Dr. Richard McQuellon, Director of Psychosocial Oncology at Wake Forest Baptist Health Comprehensive Cancer Center's Cancer Patient Support Program. We’ll discuss practical coping mechanisms, when to seek professional help for depression, and the power of community. We’re also speaking with Julie Pope, a GI Oncology Nurse Navigator at Novant Health Cancer Center about their local cancer support group for cancer survivors, patients and caregivers. Then we’ll hear from ten-year colon cancer survivor Rod Hunter about his experience and how he has navigated his emotions from diagnosis to recovery. What we discuss: Coping with disease and management, relationships and how you think and feel The importance of understanding how you work and what gives you hope Finding a support community Practical coping mechanisms When to seek professional help to deal with depression The power of both speaking about how you feel and listening to others Different types of creative therapy options The greatest need for caregivers Links mentioned: ACS Coping Checklist for Patients Wake Forest Baptist Cancer Survivorship Clinic Wake Forest Baptist Comprehensive Cancer Center Cancer Services, Inc. Cancer Dietitian Colon Cancer Coalition Get Your Rear in Gear 2020 Race Race Facebook Event Page

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. 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 the data described here may change as research progresses. The 2019 ASCO Annual Meeting, held May 31 to June 4, brought together physicians, researchers, patient advocates, and other health care professionals from around the world to present and discuss the latest research in cancer treatment and patient care. In the annual Research Round Up podcast series, Cancer.Net Associate Editors share their thoughts on the most exciting scientific research to come out of this year’s ASCO Annual Meeting and what it means for patients. First, Dr. Lynn Henry will discuss 3 studies that explored new treatment options for women with breast cancer, including a study on immunotherapy for triple-negative breast cancer and 2 studies on treatment for hormone receptor positive, HER2-negative breast cancer. She also discusses research on the effects of a low-fat diet in women diagnosed with breast cancer, and a study on whether pregnancy after breast cancer increased the risk of recurrence.   Dr. Henry is an Associate Professor and Interim Division Chief of Oncology in the Department of Medicine at the University of Utah and Director of Breast Medical Oncology at the Huntsman Cancer Institute. She is also the Cancer.Net Associate Editor for Breast Cancer. Dr. Henry: Hi. My name is Dr. Lynn Henry. I'm a medical oncologist who specializes in treating breast cancer at the University of Utah. Today, I'm going to discuss research on breast cancer that was presented at the 2019 ASCO Annual Meeting in Chicago. In particular, I'm going to focus on the results of some clinical trials that directly impact how oncologists treat patients with breast cancer. First, I'm going to give just a very brief overview of the types of breast cancer and then talk about some research that was presented on triple-negative and hormone-receptor-positive breast cancer. Then I'm going to briefly review findings related to diet and breast cancer as well as pregnancy after breast cancer in women with BRCA mutations. As a quick reminder, there are multiple kinds of breast cancer. Some breast cancers are called hormone-receptor positive or estrogen-receptor positive, and those are stimulated to grow by estrogen. We treat those cancers with anti-estrogen treatments or anti-hormone treatments to block estrogen or lower the estrogen level in the body. Other breast cancers are called HER2-positive. These are often more aggressive cancers. But because they have extra copies of HER2, they often respond to treatments that block HER2. And finally, there are breast cancers that don't have hormone receptors or HER2, and these are called triple-negative breast cancer. So first, I'm going to focus on this type, triple-negative breast cancer. Until recently, most of the time, we treated triple-negative breast cancer with chemotherapy because we hadn't found other drugs that worked very well. There's a new type of drug, however, called immunotherapy that tries to use a patient's immune system to help fight the breast cancer. Early in 2019, the FDA approved a new treatment for triple-negative breast cancer that is a combination of a chemotherapy called Abraxane and a new immune drug called atezolizumab or Tecentriq. The combination increased the length of time until cancer progressed or grew. Overall, the treatment was fairly well tolerated. But we did learn that in order for the treatment to work, the cells surrounding the cancer have to have at least a small amount of a very specific protein called PD-L1. So at this recent ASCO meeting, we heard an update about this treatment. In the trial, the patients whose cancers had the PD-L1 protein and who got the combination treatment lived 7 months longer than those who got just the chemotherapy, which was an increase from 18 months to just over 2 years. This is an important first step towards finding a better treatment for this difficult type of triple-negative breast cancer. And this treatment is currently available to patients. Additional clinical trials are going on now to try to find even better combinations of chemotherapy and immune therapies to treat this type of cancer. So next, I'm going to talk about hormone-receptor-positive breast cancer. There were two trials of this type of cancer that had important results presented at the ASCO meeting. First, I'll focus on the treatment of early-stage node-negative breast cancer that is hormone-receptor positive and HER2 negative. The Oncotype DX test is a test we commonly run on tumors of this type to help determine whether treatment with chemotherapy is likely to be helpful. For this test, if your tumor has a score over 25, then chemotherapy is generally recommended in addition to anti-hormone therapy. If you have a score under 11, then chemotherapy is not recommended and a patient should receive only anti-hormone therapy. But for those with scores between 11 and 25, it was unclear how beneficial it was to receive chemotherapy. Last year, the results of the TAILORx trial were reported. And that showed that for women over the age of 50, if their tumor had a score between 11 and 25, they were not likely to get benefit from chemotherapy. However, it turned out it was a bit more complicated for women aged 50 and under. For those with scores between 11 and 15, chemotherapy was not likely to be beneficial. However, for those who score 16 to 25, chemotherapy might be beneficial. So we got some answers but not everything. At this recent ASCO meeting, additional information was reported to help guide treatment decision making for this middle group of women aged 50 and under. So for women whose scores were at the higher end, 21 to 25, chemotherapy was found to be likely to be beneficial. However, in that middle group, the 16 to 20 group, chemotherapy might be beneficial but generally only for women with higher risk cancers, meaning larger cancers or higher grade. This information is helpful because it provides more information for oncologists and for patients when they are discussing whether or not chemotherapy should be included as part of their treatment. So switching gears a little, still staying with premenopausal women and hormone-receptor-positive HER2-negative cancer, but now thinking about metastatic breast cancer, so cancer that has spread. We now have additional information about treatment with an anti-hormone therapy plus an additional drug called the CDK4/6 inhibitor. We've routinely been recommending this treatment combination because it leads to a longer time before the cancer progresses. But until now, we didn't know if it actually allows women with this type of cancer to live longer. The results of the MONALEESA-7 trial, which looked at the combination of an anti-hormone therapy plus the drug called ribociclib, showed that women who received the combination instead of anti-hormone therapy alone live almost 30% longer. So looking at women 3 and a half years after they started treatment, just over 70% of the women who were treated with ribociclib plus anti-hormone therapy were alive compared to just under half of women treated with anti-hormone therapy alone. So these results reinforce that this is an excellent first approach to treatment of premenopausal women who have newly diagnosed, hormone-receptor-positive HER2-negative metastatic breast cancer. So in addition to studies looking at these specific types of breast cancer, there were 2 other interesting studies that were applicable to breast cancer more generally. So there was a large study that was reported that looked at whether having a low-fat diet reduced the likelihood of developing triple-negative breast cancer. So in this study, postmenopausal without cancer were randomized to either a low-fat diet or their usual diet and followed for many, many years. Over time, some of these women developed breast cancer with no difference between those who followed the low-fat diet or the regular diet. However, in this new report, they looked specifically at the women who developed breast cancer who were enrolled in this trial. Fewer women died from their breast cancer if they ate the low-fat diet, especially if they had preexisting high cholesterol, diabetes, and obesity. These findings suggest that having a low-fat diet may actually reduce the risk of dying overall and also specifically from breast cancer. Now, these need to be validated, and we don't quite understand why this would be the case. But in general, it seems like having a low-fat diet, avoiding high cholesterol, diabetes, and obesity is a good thing. And then finally, 1 question that comes up often is whether it is safe to have a baby after the diagnosis of breast cancer. This is especially concerning for patients who have a mutation in genes called BRCA1 or BRCA2 since those mutations greatly increase their risk of developing both breast and ovarian cancer and also leads to the diagnosis of breast cancer at an early age. In addition, patients with these mutations are often recommended to have their ovaries removed at a young age. So in this study, patients who became pregnant did so about 4 and a half years after they were diagnosed with breast cancer. There was no apparent increase in miscarriage, preterm birth, or birth defects compared to what would be expected in women without cancer. And in the patients, there was no increase in the risk of breast cancer recurrence compared to those who did not become pregnant. And in fact, those who became pregnant were slightly less likely to have their cancer return, especially those who had mutations in BRCA1. So while there are some limitations to the study, the findings are reassuring that there does not appear to be an increase in risk of breast cancer returning in these patients with BRCA mutations who become pregnant after breast cancer diagnosis. So overall, as you can see, there's a lot of exciting research going on across all the different subsets of breast cancer. The results of many important clinical trials were reported at the recent ASCO meeting, and there are many more trials ongoing that will hopefully result in the approval of multiple new effective treatments for breast cancer. In addition, there's research going on examining the impact of treatment on patients with breast cancer and trying to improve the lives of those living with breast cancer. Clinical trials are critical for the development of these new treatments. Well, that's it for this quick summary of this important research from ASCO 2019. Overall, we continue on a fast track in breast cancer, with many new and exciting therapies being actively studied and research helping support our patients do better than ever before. Stay tuned to Cancer.Net for future updates from upcoming breast cancer conferences. Thank you very much. ASCO: Thank you, Dr. Henry. Next, Dr. Ezra Cohen will discuss several studies that looked at using immunotherapy and targeted therapy to treat different types of head and neck cancer. Dr. Cohen is Associate Director of Translational Science and leads the Solid Tumor Therapeutics research program at Moores Cancer Center at UC San Diego Health. He is the Cancer.Net Associate Editor for Head and Neck Cancer. Dr. Cohen: Hi. I'm Dr. Ezra Cohen from UC San Diego Moores Cancer Center. Today, I'm going to talk about research on head and neck cancer that was presented at the 2019 ASCO Annual Meeting. I think the most impactful presentation at the meeting was a follow-up on the KEYNOTE-048 study, which implemented the drug pembrolizumab, an anti-PD-1 antibody in first-line recurrent metastatic head and neck cancer. These were patients who were treated with curative intent or presented with metastatic disease, and either way, either had recurrence or eventually developed metastases. The first-line standard of care for these patients used to be the so-called extreme regimen, which involved platinum, 5-FU, and cetuximab. This was validated in an earlier phase III study that was conducted about 10 years ago and was the approved first-line regimen for these patients. In KEYNOTE-048, this extreme regimen was tested against either pembrolizumab alone or pembrolizumab, platinum, and 5-FU, in other words, substituting cetuximab for pembrolizumab in one of the experimental arms. We'd initially seen the interim analysis data at last year's ESMO meeting, but this year, we have the final analysis presented at ASCO. And what we saw was that both experimental arms actually achieved an improvement in overall survival compared to the extreme regimen. Interestingly, for pembrolizumab alone, this occurred in patients whose tumors expressed some level of PD-L1. That was evaluated by something called the composite score and takes into account both stromal and tumor cell staining of PD-L1. In fact, even at a very low level—that is CPS greater than or equal to 1—pembrolizumab monotherapy was superior to the extreme regimen with respect to overall survival. For all patients, the regimen of pembrolizumab plus chemotherapy was superior to the extreme regimen irrespective of PD-L1 staining. What we saw at this year's ASCO meeting was that, in fact, first, the higher the expression of PD-L1, the greater the benefit one derived from pembrolizumab either as monotherapy or in combination with chemotherapy. And in patients who had higher levels of PD-L1 and received both pembrolizumab and chemotherapy, the overall survival was quite remarkable with a hazard ratio of just higher than 0.6. In fact, we now have FDA approval in the United States for pembrolizumab monotherapy with tumors that have some expression level of PD-L1—that is CPS greater than or equal to one—or for all comers in patients who either the CPS status is unknown or patients whose tumors don't express PD-L1. Beyond KEYNOTE-048, we saw interesting data in first-line recurrent metastatic using a regimen of taxane, platinum, and 5-FU compared to the same extreme regimen that we just mentioned. That regimen turned out to be much better tolerated with fewer adverse events but with no improvement in overall survival, giving us a regimen that we could substitute for the extreme regimen if one wanted to, realizing that it does not involve immunotherapy, and for some patients, this may still be an appropriate treatment. Beyond the first-line recurrent metastatic studies, we saw a few interesting trials looking at targeted therapy in head and neck cancer but specific subsets. The first was in patients whose tumors expressed HER2 at very high levels—that is HER2 amplified—and had salivary ductal carcinoma. We've known that a proportion of salivary ductal carcinoma patients' tumors amplify this gene, HER2, similar to breast cancer and some other malignancies and that trastuzumab may, in fact, be effective. Well, in this study conducted by the Memorial Sloan Kettering Group, an antibody-drug conjugate trastuzumab emtansine was employed as a single agent in these patients whose, again, tumors amplified HER2. And what they saw was a remarkable 90% response rate. Now, this was only in 10 patients, so the study is small, but I think it's safe to say that this drug appears to be quite effective in patients with HER2-amplified salivary ductal carcinoma. Along those lines, in the subset of thyroid cancer patients whose tumors either mutate or have a RET fusion, the gene RET, there appeared to be very high efficacy for a novel agent that targets the RET oncogene. This was in both patients with medullary thyroid cancers that often have a RET mutation or in papillary thyroid cancers whose tumors often have a fusion of the same RET gene. Again, underscoring the idea that if we can target a driver even in a relatively small subset of patients, the benefit may be quite large. Along those lines, we had seen prior data for track inhibitors in patients who have in track fusions. And again, this applies to subsets of head and neck cancer patients that have either salivary gland cancers or thyroid cancers. Lastly, we continue to see emerging promising data of combinations with immunotherapy, and 2 highlights from ASCO were pembrolizumab with cetuximab showing a response rate of over 40% in a small group of patients and pembrolizumab with a TLR9 agonist called SD-101 showing about a 30% response rate. Of course, these data are very early and uncontrolled, and so we have to follow these stories further along to see if, indeed, these early signs of efficacy turn out to validate. But the idea that further combinations of immunotherapies eventually making their way to larger studies and hopefully approval is now well enforced in head and neck cancer. Thank you very much for your attention and hope you enjoyed the ASCO 2019 Annual Meeting. ASCO: Thank you Dr. Cohen. Next, Dr. Charles Loprinzi will discuss new research on ways to prevent or treat nausea and vomiting caused by cancer treatment. Dr. Loprinzi is a medical oncologist and the Regis Professor of Breast Cancer Research at the Mayo Clinic. He is also the Cancer.Net Associate Editor for Psychosocial Oncology. Dr. Loprinzi: Hello, I'm Charles Loprinzi, Regis Professor of Breast Cancer Research at Mayo Clinic. I'm going to be talking today about chemotherapy-induced nausea and vomiting. Now, chemotherapy can cause a lot of nausea and vomiting. That's well known, for years and years, by many people. It's not all types of chemotherapy, but some chemotherapy drugs cause a lot of nausea and vomiting, and others cause little to none. It's not as big a problem now as it was decades ago when we didn't have good drugs to try to prevent nausea and vomiting. Many drugs over the time have been developed for trying to prevent this nausea and vomiting problem. Examples of the drugs that cause a lot of nausea and vomiting are Cisplatinum, and Adriamycin and cyclophosphamide is a combination that is oftentimes used for patients with breast cancer. So in the past, we have developed many, many drugs for this. Three of the drugs that have commonly been used for the last many, many years for treatment or prevention of nausea and vomiting associated with chemotherapy are corticosteroid medications like Dexamethasone. It's quite cheap. It's got some side effects, but relatively cheap. Then there's a group called 5-HT3 receptor antagonists. I didn't make up that name, but that's the long name for it. They're relatively expensive, some more expensive than other ones. And then there's another group called NK1 receptor antagonists, and they can be quite expensive, sometimes being hundreds of dollars for each dose that's given to try to prevent nausea and vomiting related to chemotherapy. So a couple years ago, 2016, there was a report in the New England Journal of Medicine, which is a prominent journal for us in the business, that looked at a drug called olanzapine. It's a relatively cheap drug. It's a drug that was developed for psychosis-type problems, given for long term in those patients. But it had been noted that if it's given for just a few days, it seems to markedly improve or decrease the instance of nausea and vomiting, or if people were having nausea and vomiting, it appears actually to help and reverse that particular problem. So this trial looked at 10 milligrams of this drug for 4 days, given before chemotherapy, and then for 3 more days after that. Patients who were on this study got the 3 drugs that I talked about before with the olanzapine or with the placebo. And it noted that it improved things by quite a bit. The patients who had what we call a complete response, which means no vomiting and no need to take extra medications because of nausea and vomiting, improved from 41% of the patients who were on the placebo, to 64% who were on the olanzapine, a 23% improvement. And if we looked at a different endpoint there, the number of patients who had no nausea during the five days after chemotherapy, it was 22% in the group that got the placebo and improved to 37% in the group that didn't. So it was a good result in that area. One of the problems with this drug is that it can cause some sedation, cause some drowsiness for some patients. Most patients, not much, but some patients, it's a problem. So most trials that have been done in the past use this 10-milligram dose. And what we learned at ASCO in 2019, our main meeting that we have once a year, was that people looked at a 5-milligram dose and had looked at 5 milligrams instead of the 10 milligrams. And what it showed is that the results seemed to be quite similar to what was seen with 10 milligrams. They did the study quite the same as what had been reported in the previous trial and the results looks similar. They didn't compare 5 milligrams versus 10 milligrams, which would've been nice because then we would have better information along that line. They did note that there was drowsiness that some patients had, and it looks similar to what was seen with the 10-milligram dose. But these data support, but don't prove, that giving 5 milligrams does look like it's good in this particular setting. So data from this year also supported that instead of giving the drug during the day when getting the chemotherapy, sometimes, people take it at bedtime, and there, the drowsiness is not as big a problem because you want to be drowsy at bedtime. So it's not proven that it works as well at bedtime, but it suggests that that actually is the case. Data from this year also supported that if you looked at those 3 drugs I mentioned before and just took out that 1 really, really expensive one, the NK1 receptor antagonist, and put the olanzapine in there instead, that very cheap medication, that that looked like that one with the olanzapine did better than the very expensive one. Not a whole lot better; they looked similar, but a little bit better in that setting, and it was a whole lot cheaper. This was also seen in a publication that came out a couple of years ago which showed the same sort of result. Again, not proof that it's beneficial, that it's okay to do that, but it looked better. So the next obvious question that comes up then is when you have these 4 drugs that you give, the 3 drugs I mentioned before and this fourth one, what about if you take away that more expensive one and see how they do there? So there was a trial at the ASCO meeting that suggested that the addition of that expensive medications didn't provide a whole lot more benefit. Right now, there is a trial going on across the United States, with about 800 patients who are scheduled to go on this trial, and it's approving about 30 patients a month, which is a pretty good accrual rate, which is looking at this particular question where people would get the 4-drug regimen versus 3 drugs where they take away the expensive intravenous medication. So, in summary, 35 to 40 years ago, when I started my cancer career, when I was about 10 years old, most patients had a lot a trouble with nausea and vomiting with drugs like Cisplatinum. Now, this a minority of patients who have a lot of problems, and we're continuing to find new things that will make things better along this line. Thank you for your attention. ASCO: Thank you Dr. Loprinzi. Learn more about these topics and other research presented at the 2019 ASCO Annual Meeting at www.cancer.net. If this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. And stay tuned for additional Research Round Up podcasts coming later this summer. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/support.

This episode features Dr Alex Chan (Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA). Routine assessment of many established quality indicators is nearly impossible because the information is embedded as unstructured free text within electronic clinical notes. A key example of this is timely documentation of patient care preferences in critically ill older adults. The paper demonstrates that deep learning algorithms can be applied to assess a palliative care quality measure endorsed by the National Quality Forum. The deep learning algorithm analyzed clinical notes >18,000 times faster than clinician coders (0.022 s/note vs 402 s/note). The algorithms can analyze electronic clinical notes in a tiny fraction of the time needed for manual review, offering a practical option for rapid audit and feedback regarding care preference documentation at the system and clinician level.   Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216318810421   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: anwosu@liverpool.ac.uk

James A. Tulsky, MD, discusses Teaching Communication Skills at the Bedside. He is the Chair of the Department of Psychosocial Oncology and Palliative Care at the Dana-Farber Cancer Institute, and he is the Chief of the Division of Palliative Medicine at Brigham and Women's Hospital. James is Co-Director of the Harvard Medical School Center for Palliative Care, where he is also Professor of Medicine.

Palliative care is an often misunderstood specialty, focused on providing support and pain management strategies to cancer patients throughout all stages of their illness. This approach, which can be blended into curative cancer therapy, focuses on care for the whole person: mind, body, and spirit. But is it only for patients at end-of-life? And how does it differ from hospice care? In this episode of Cancer Mythbusters, we explore this common misconception and dive into how palliative care really works with James Tulsky, MD, chair of Psychosocial Oncology and Palliative Care at Dana-Farber.

The Holidays are a time of joy and celebration; a time to reunite with family and friends and revel in tradition. However, the news of a cancer diagnosis can halt holiday cheer. In fact, the holiday season can prompt new questions for you, such as: How do I take care of myself and participate in the holiday rush? How can I celebrate when I have so many other things on my mind? What will my life be like next year? Sharing these concerns with friends and family can help you manage the struggles of the season.One of the main stressors that people and patients may experience around the holidays is the pressure of expectations. There is gift giving, visiting with family, party planning and so on. For cancer patients in particular, the added stress of the holidays may be a result of addressing questions of diagnosis and treatment. This creates anxiety in an already stressful time of the year.Here to offer some tips for coping with cancer during the holidays is Megan Pailler, PhD. She is a Psychologist, Department of Psychosocial Oncology with Roswell Park Comprehensive Cancer Center.

The Holidays are a time of joy and celebration; a time to reunite with family and friends and revel in tradition. However, the news of a cancer diagnosis can halt holiday cheer. In fact, the holiday season can prompt new questions for you, such as: How do I take care of myself and participate in the holiday rush? How can I celebrate when I have so many other things on my mind? What will my life be like next year? Sharing these concerns with friends and family can help you manage the struggles of the season.One of the main stressors that people and patients may experience around the holidays is the pressure of expectations. There is gift giving, visiting with family, party planning and so on. For cancer patients in particular, the added stress of the holidays may be a result of addressing questions of diagnosis and treatment. This creates anxiety in an already stressful time of the year.Here to offer some tips for coping with cancer during the holidays is Megan Pailler, PhD. She is a Psychologist, Department of Psychosocial Oncology with Roswell Park Comprehensive Cancer Center.

Dr. Linda Carlson holds the Enbridge Research Chair in Psychosocial Oncology and is Full Professor in Psychosocial Oncology in the Department of Oncology, Cumming School of Medicine at the University of Calgary. She has published over 150 research papers and book chapters in the area of psycho-oncology. In 2010, she published a patient manual with […]

Dr. Linda Carlson holds the Enbridge Research Chair in Psychosocial Oncology and is Full Professor in Psychosocial Oncology in the Department of Oncology, Cumming School of Medicine at the University of Calgary. She has published over 150 research papers and book chapters in the area of psycho-oncology. In 2010, she published a patient manual with […]

Dr. Emily Freeman is a social/behavioral scientist interested in the knowledge translation of medical evidence from clinical trials to evidence-based communication tools for patients and healthcare providers. She is exploring how medical evidence (i.e. risk, benefit, and health outcomes) is constructed and communicated within a patient-healthcare provider clinical encounter. In addition she is interested in the intersection of medical evidence and patient's values (and preferences) and the impact on shared treatment decisions. Emily ‘s research also has focused on the impact of shared treatment decision making on the quality of care received (and experienced) by patients. Finally, she is interested in bringing a more patient-centered approach to drug development through incorporating patient-reported and defined outcomes early in clinical development of new products. In her role at Pfizer, Emily is a Health Behavior and Program Evaluation scientist within the Worldwide Safety and Regulatory- Epidemiology group. She is conducting research to assess the effectiveness of the FDA mandated REMS (Risk Evaluation and Mitigation Strategies) and EMA RMM's (Risk Minimization Measures) on patient and healthcare provider communication and knowledge and the impact of regulatory science on both groups. Emily received her PhD degree in Health Geography from McMaster University with postdoctoral training in Psychosocial Oncology from the University of Toronto. Emily's substantive research interests include patient engagement, health literacy, risk communication, shared treatment-decision making, and patient reported outcomes. In this interview, Dr. Freeman discusses her experiences and how we can improve the system.

Psychosocial Oncology - Prof. Barry Bultz.