Podcasts about supportive care

In his weekly clinical update, Dr. Griffin with Vincent Racaniello in horror examine dismantling of public infrastructure for establishing vaccine guidelines, the creation of a autism taskforce by someone disciplined for practicing medicine without a license, the ongoing pertussis, bird flu and measles outbreaks, before Dr. Griffin reviews recent statistics on RSV, influenza and SARS-CoV-2 infections the Wasterwater Scan dashboard, the effective of oseltamivir vs supportive care when one is hospitalized with influenza infection, whether or not the NB.1.8.1 should be included in the fall 2025 vaccines, approval of another anti-RSV monoclonal antibody for treatment in infants, immunization recommendations for COVID-19 vaccines, where to find PEMGARDA, results from the phase 3 randomized clinical trial of pemivibart, provides information for Columbia University Irving Medical Center's long COVID treatment center, where to go for answers to your long COVID questions, how artery disease impacts SARS-CoV-2 infection outcomes, contacting your federal government representative to stop the assault on science and biomedical research and the recent public health programs that have been unfunded. Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode Vaccine Opponent Hired by RFK Jr. Scours Official Records for Link to Autism (Wall Street Journal) Correcting our record (Salon) You are FIRED! Kennedy removes all ACIP members, eyes replacement (CIDRAP) UPI Investigates: The vaccine conflict…..investigative reporting? (UPI) RFK Jr.: HHS Moves to Restore Public Trust in Vaccines…to avoid conflicts UGHHHH! (Wall Street Journal) GREAT Vaccine advisory panel (Great Barrington Declaration) National Vaccine Information Center (Wikipedia: National Vaccine Information Center) Nonprofit organization 501(c)  (Wikipedia) Kennedy Announces Eight New Members of C.D.C. Vaccine Advisory Panel (NY Times) Whooping cough deaths! (Kentucky. Gov) Kentucky announces two pertussis deaths in infants this year (CIDRAP) H5 bird flu: current situation (CDC: Avian Influenza) Stability of influenza viruses in the milk of cows and sheep (medRxiv) Wastewater for measles (WasterWater Scan) Measles cases and outbreaks (CDC Rubeola) Weekly measles and rubella monitoring (Government of Canada) Canada's Ontario province reports death of child from measles (Reuters) Measles outbreaks continue with risk of holidays causing surge (gov.UK) Measles (WHO) Measles vaccine recommendations from NYP (jpg) Get the FACTS about measles (NY State Department of Health) Measles (CDC Measles (Rubeola)) Measles vaccine (CDC Measles (Rubeola)) Presumptive evidence of measles immunity (CDC) Contraindications and precautions to measles vaccination (CDC) Measles (CDC Measles (Rubeola) Adverse events associated with childhood vaccines: evidence bearing on causality (NLM) Measles Vaccination: Know the Facts (ISDA: Infectious Diseases Society of America) Deaths following vaccination: what does the evidence show (Vaccine) Influenza: Waste water scan for 11 pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) Weekly surveillance report: clift notes (CDC FluView) Respiratory virus activity levels (CDC Respiratory Illnesses) Weekly surveillance report: clift notes (CDC FluView) Oseltamivir Treatment vs Supportive Care for Seasonal Influenza Requiring Hospitalization (JAMA) FDA-CDC-DOD: 2025-2046 influenza vaccine composition (FDA) RSV: Waste water scan for 11 pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) RSV-Network (CDC Respiratory Syncytial virus Infection) Approval for Merck's ENFLONSIA™ (clesrovimab-cfor) for Prevention of Respiratory Syncytial Virus (RSV) Lower Respiratory Tract Disease in Infants Born During or Entering Their First RSV Season (Merck) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 deaths (CDC) COVID-19 national and regional trends (CDC) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Antigenic and Virological Characteristics of SARS-CoV-2 Variant BA.3.2, XFG, and NB.1.8.1 (biRxiV) COVID-19 vaccine for 6 months, 12 years (CDC: childhood vaccination) COVID-19 vaccine for65 years and older (CDC: Adult vaccination) Where to get pemgarda (Pemgarda) EUA for the pre-exposure prophylaxis of COVID-19 (INVIYD) Infusion center (Prime Fusions) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) Drug interaction checker (University of Liverpool) Infectious Disease Society guidelines for treatment and management (ID Society) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (ID Society) What to do when sick with a respiratory virus (CDC) Managing healthcare staffing shortages (CDC) Steroids,dexamethasone at the right time (OFID) Anticoagulation guidelines (hematology.org) Daniel Griffin's evidence based medical practices for long COVID (OFID) Long COVID hotline (Columbia : Columbia University Irving Medical Center) The answers: Long COVID Long-term outcomes of patients with pre-existing coronary artery disease after SARS-CoV-2 infection (eBioMedicine) Reaching out to US house representative Trump Budget Eliminates Funding for Crucial Global Vaccination Programs(NY Times) Letters read on TWiV 1226 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene Ramsey. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv Content in this podcast should not be construed as medical advice.

Jeff Bennett, Chief Strategy and Innovation Officer at Modivcare, is addressing and expanding supportive care services to provide transportation, personal care services, and remote patient monitoring. A lack of transportation leads to missed appointments and therapies, necessitating a coordinated approach to support vulnerable populations. Modivcare utilizes remote sensors and AI to enhance human engagement and coordination, and is designed to be both preventative and predictive, keeping patients healthy and out of the hospital.  Jeff explains, "Modivcare works on behalf of health plans, states, and risk-based entities. We provide supportive care services that meet the needs and address the needs of patients. One of those services is transportation, so non-emergency medical transportation. We also provide personal care services, which support members with activities of daily living, like bathing, meal preparation, and such. And then finally, I lead the monitoring organization, which provides services to monitor members or patients at home so they can live and age at home on their own." "The biggest need, at the top, is that our members have health-related social needs or SDOH needs. They also are living with chronic conditions, so they need supportive care services that not only provides that core service -- so there's the obvious "I need a ride" or "if I press the button because I've fallen and I need 911 to be called if I need an ambulance or my caregiver or family member to come help me." But most importantly, the services that they need are providing an engagement service. Really, what we provide is a supportive care service that drives human connection through cutting-edge technology that drives continuous engagement. They always know that we're here, and we listen to them. We understand their needs and try to address those needs, which could be healthcare-related, social-related, or simply loneliness. So it spans that broad spectrum. And any one of our services, we're delivering that core service, but we're also driving engagement and listening for what else the member needs." #Modivcare #SDOH #SupportiveCareServices #MedAI #DigitalHealth #CareCoordination modivcare.com Download the transcript here

Jeff Bennett, Chief Strategy and Innovation Officer at Modivcare, is addressing and expanding supportive care services to provide transportation, personal care services, and remote patient monitoring. A lack of transportation leads to missed appointments and therapies, necessitating a coordinated approach to support vulnerable populations. Modivcare utilizes remote sensors and AI to enhance human engagement and coordination, and is designed to be both preventative and predictive, keeping patients healthy and out of the hospital.  Jeff explains, "Modivcare works on behalf of health plans, states, and risk-based entities. We provide supportive care services that meet the needs and address the needs of patients. One of those services is transportation, so non-emergency medical transportation. We also provide personal care services, which support members with activities of daily living, like bathing, meal preparation, and such. And then finally, I lead the monitoring organization, which provides services to monitor members or patients at home so they can live and age at home on their own." "The biggest need, at the top, is that our members have health-related social needs or SDOH needs. They also are living with chronic conditions, so they need supportive care services that not only provides that core service -- so there's the obvious "I need a ride" or "if I press the button because I've fallen and I need 911 to be called if I need an ambulance or my caregiver or family member to come help me." But most importantly, the services that they need are providing an engagement service. Really, what we provide is a supportive care service that drives human connection through cutting-edge technology that drives continuous engagement. They always know that we're here, and we listen to them. We understand their needs and try to address those needs, which could be healthcare-related, social-related, or simply loneliness. So it spans that broad spectrum. And any one of our services, we're delivering that core service, but we're also driving engagement and listening for what else the member needs." #Modivcare #SDOH #SupportiveCareServices #MedAI #DigitalHealth #CareCoordination modivcare.com Listen to the podcast here

Welcome to the fourth episode of ASTCT Talks' exclusive 8-part series, supported by an educational grant from Sanofi US. In this episode, former ASTCT President Dr. Corey Cutler sits down with Dr. Connie R. Shi from the Cutaneous Oncology Program at Dana-Farber Cancer Institute. They discuss Dr. Shi's recent article, Cutaneous Chronic Graft-Versus-Host Disease: Clinical Manifestations, Diagnosis, Management, and Supportive Care.Tune in as they explore the complexities of cutaneous GVHD, including acute and chronic presentations, diagnostic challenges and skin-directed treatment strategies such as topical steroids and phototherapy. They also cover key considerations for recognizing and diagnosing cutaneous GVHD in patients of all skin tones and managing long-term complications like skin cancer risk.

Oncology Here & NowIn this interview, OncoAlert faculty members Dr. Joseph McCollom from Parkview Health (USA) and Dr. Cristiane Bergerot from OncoClinicas (Brazil) explore supportive care and the future of telemedicine. Their discussion spans the evolution of telehealth—from its pivotal role during the pandemic to its current applications—and what lies ahead.Join us for this insightful conversation!

Dermatologic toxicities associated with oncology treatment can significantly impact quality of life and treatment adherence for patients with breast cancer. The Association of Cancer Care Centers (ACCC) is committed to providing up-to-date guidance on managing these dermatologic side effects to enhance clinical outcomes. In this episode of CANCER BUZZ, Allison Gordon, MD, a supportive oncodermatologist at Memorial Sloan Kettering Cancer Center, discusses the dermatologic toxicities associated with breast cancer treatment. Dr Gordon explores preventive measures that oncologists can implement early in the treatment course and offers alternative resources for oncology clinicians when an oncodermatologist referral is not feasible. Additionally, she highlights capivasertib, a recently approved antineoplastic drug, and reviews its associated cutaneous adverse events, along with supportive care and management strategies. Thank you to AstraZeneca for their support of this program.   Allison Gordon, MD Dermatologist Memorial Sloan Kettering Cancer Center New York, NY   “Because many of these medications can cause dry skin, which can be debilitating for patients... [we recommend] using a thick ointment or cream moisturizer on their damp skin after they shower... it doesn't have to be anything expensive... I always recommend that to all patients regardless of what treatment they're on.”– Allison Gordon, MD    Additional Reading/Sources  ACCC Supportive Care Strategies for Dermatologic Toxicities Related to Cancer Therapies education program (https://www.accc-cancer.org/home/learn/comprehensive-cancer-care-services/dermatologic-toxicities?)   Targeted Therapy Side Effects – American Cancer Society  (https://www.cancer.org/cancer/managing-cancer/treatment-types/targeted-therapy/side-effects.html)   Oncodermatology: Advancing the Science and Care of Cancer Patients and Survivors (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569770/)   Dermatologic Adverse Events of Systemic Anticancer Therapies: Cytotoxic Chemotherapy, Targeted Therapy, and Immunotherapy (https://ascopubs.org/doi/10.1200/EDBK_289911)   Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatolgy Study Group (https://mascc.org/resources/mascc-guidelines/)   Guidelines for the Prevention and Treatment of Radiation-Induced Skin Reactions (https://mascc.org/resources/mascc-guidelines/)   Guidelines for Prevention and Management of Dermatological Toxicities Related to Anticancer Agents (https://pubmed.ncbi.nlm.nih.gov/33248228/)

Dr. Mellar Davis discusses the joint guideline from MASCC, ASCO, AAHPM, HPNA, and NICSO on opioid conversion in adults with cancer. He reviews the limited evidence, and the formal consensus process used to develop the guideline. He shares the key recommendations on pre-conversion assessment, how opioid conversion should be conducted, including opioid conversion ratios, and post-conversion assessment. We touch on gaps and questions in the field and the impact of these new recommendations.  Read the full guideline, “Opioid Conversion in Adults with Cancer: MASCC-ASCO-AAHPM-HPNA-NICSO Guideline” at www.asco.org/supportive-care-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/supportive-care-guidelines. Read the full text of the guideline in the Supportive Care in Cancer, https://link.springer.com/article/10.1007/s00520-025-09286-z   Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Mellar Davis from Geisinger Medical Center, lead author on “Opioid Conversion in Adults with Cancer: Multinational Association of Supportive Care and Cancer, American Society of Clinical Oncology, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, Network Italiano Cure di Supporto and Oncologia Guideline.” Thank you for being here today, Dr. Davis. Dr. Mellar Davis: Thank you. I'm glad to be here. Brittany Harvey Before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Davis, who has joined us here today, are available online with the publication of the guideline, which is linked in our show notes. So then, to dive into the content here, Dr. Davis, can you provide an overview of both the scope and purpose of this guideline on opioid conversion in people with cancer? Dr. Mellar Davis: This is an important topic in management of cancer pain and this topic came up as a result of a survey that MASCC had done, which involved 370 physicians in 53 countries. They were queried about how they change or convert one opioid to another, which is a common practice, and we found that there was quite a divergence in opioid conversion ratios. To step back a little bit, about two thirds of patients with advanced cancer have moderate to severe pain and most of the time they're managed by opioids. But about 20% or 40% require a switch either because they have an adverse reaction to it or they don't respond to it, or the combination of both. Rarely, it may be that they need a route change, perhaps because they have nausea or vomiting. So, the opioid conversion works basically because of the complexity of the new opioid receptor which has at least four exons to it as a result of that non-cross tolerance between opioids. As a result of the survey, we convened a group of specialists, 14 international specialists, to look to see if we could develop an international guideline. And we did a systematic review which involved viewing 21,000 abstracts and we came up with 140 randomized trials and 68 non-randomized trials. And after reviewing the data, we found that the data was really not strong enough to provide a guideline. As a result, ASCO, MASCC, the AAHPM, the HPNA and the Italian Group formed a supportive network that allowed us then to do a Delphi guideline based upon ASCO modified criteria for doing Delphi guidelines. And so we then involved 27 additional international experts informing the guideline to it. And this guideline is then the result of the Delphi process. It consists basically of a pre-conversion ratio recommendations, conversion ratios, which is actually a major contribution of this guideline, and then what to do after converting someone to another opioid. Our target audience was not only oncologists, but also we wanted to target nurses, pharmacists, hospitalists, primary care physicians, patients and caregivers. Brittany Harvey: I appreciate that background information, particularly on the evidence that is underpinning this and the lack of quality of evidence there, which really transformed this into a formal consensus guideline. We're glad to have all of these organizations coming together to collaborate on this guideline. So then next I'd like to review the key recommendations. So starting with, what is recommended for pre-conversion assessment? Dr. Mellar Davis: In regards to pre-conversion, physicians and clinicians need to be aware of pain phenotypes. That is, there are pains that are more opioid refractory than others, such as neuropathic pain, hence, they may be more resistant to the opioid that you're converting to. One needs to be aware of the fact that patients may not be compliant, they're either afraid of opioids not taking what was prescribed, so it's important to query patients about whether they are taking their opioid as prescribed. Occasionally, there are patients who will divert their medication for various reasons. Pain may be poorly controlled also because of dosing strategies that are poorly conceived, in other words, giving only ‘as needed' opioids for continuous cancer pain. And there are rare circumstances where an opioid actually induces pain and simply reducing the opioid actually may improve the pain. The other issue may be cancer progression. So that poorly controlled pain or rapidly increasing pain may actually be a result of progressive cancer and changing treatment obviously will be important. And you need to assess the pain severity, the quality of the pain, the radiating localizing effects, which does require not only a physical exam but also radiographic examinations. But the other thing that's very important in opioid conversions are pain scales with function. A significant number of patients don't quite understand a numerical scale which we commonly use: 0 to 10, with 10 being severe pain and 0 being no pain. They may in fact focus more on function rather than on pain severity or pain interference with daily activities or roles. Sometimes patients will say, “Oh, my pain is manageable,” or “It's tolerable,” rather than using a numerical scale. Choices of opioids may be based on cost, drug-drug interactions, organ function, personal history or substance use disorder so that one will want to choose an opioid that's safe when converting from one to another. And obviously social support and having caregivers present and understanding the strategy in managing pain will be important. Brittany Harvey: Thank you, Dr. Davis, for reviewing those pre-conversion assessment considerations and particularly the challenges around some of those. So, following this pre-conversion assessment, what are the recommendations on how opioid conversion should be conducted? Dr. Mellar Davis: Opioid conversions are basically the safe dose. People have used the term ‘equianalgesia', but the panel and the consensus group felt that that would be inappropriate. So a conversion ratio is the dose at which the majority of patients will not experience withdrawal or adverse effect. It would be the safe dose. Thereafter, the dose will need to be adjusted. So, in converting, that's only the first step in managing pain, the doses need to be adjusted to the individual thereafter. There are a significant number of conversions that are done indirectly, that is that there has not been a study that has looked at a direct conversion from one opioid to another in which one needs to convert through another opioid. We call that a ‘morphine equivalent daily dose'. So, most of the time a third opioid is used in the conversion. It allows you then to convert when there hasn't been a direct study that has looked at conversion between those two opioids, but it is less accurate and so one has to be a little bit more careful when using morphine daily equivalents. We found, and I think this is the major advantage to the guideline, is that commonly used opioids - oxycodone, morphine, hydromorphone - we did establish conversion ratios to which we found in the MASCC guideline they were widely divergent and hope that actually, internationally, they will be adopted. We also found some conversion ratios for second-line opioids. However, we felt also that an opioid like methadone, which has a unique pharmacology, should be left to experts and that experts should know at least several ways of converting from morphine usually to methadone. There is what appears to be a dose-related increased potency of methadone relative to morphine, which makes it more difficult, particularly at higher doses, to have an accurate conversion ratio. Most patients will have transient flares of pain. We came up with two suggestions. One is using a 10 or 15% of the around-the-clock dose for the breakthrough dose, but we also realized that there was a poor correlation between the around-the-clock dose and the dose used for transient flares of pain. And so the breakthrough dose really needs to be adjusted to the individual responses. There was also a mention of buprenorphine. One of the unique things about buprenorphine is that if you go from high doses of a drug like morphine to buprenorphine in a stop-start dosing strategy, you can precipitate withdrawal. And so one has to be careful and have some experience in using buprenorphine, which can be an effective analgesic. Brittany Harvey: Yes, I think that the conversion ratios that you mentioned that are in Table 3 in the full guideline are a really useful tool for clinicians in practice. And I appreciate the time that the panel and the additional consensus panel went through to develop these. I think it's also really key what you mentioned about these not being equianalgesic doses and the difficulties in some of these conversions and when people need to really look to specialists in the field. So then, following opioid conversion, what assessments are recommended post-conversion? Dr. Mellar Davis: Post-conversion, probably the cardinal recommendation is close observation for response and for toxicity. And I think that probably summarizes the important parts of post-conversion follow up. So assessment should be done 24-48 hours after conversion and patients followed closely. Assessment scales should include patient personalized goals. Now, it used to be in the past that we had this hard stop about a response being below 4 on a 0 to 10 scale, but each patient has their own personal goals. So they gauge the pain severity and their function based upon response. So a patient may function very well at “a severity of 5” and feel that that is their personal goal. So I think the other thing is to make sure that your assessment is just not rote, but it's based upon what patients really want to achieve with the opioid conversion. The average number of doses per day should be assessed in the around-the-clock dose so those should be followed closely. Adverse effects can occur and sometimes can be subtle. In other words, a mild withdrawal may produce fatigue, irritability, insomnia and depression. And clinicians may not pick up on the fact that they may be actually a bit under what patients have or they're experiencing withdrawal syndrome. It's important to look for other symptoms which may be subtle but indicating, for instance, neurotoxicity from an opioid. For instance, visual hallucinations may not be volunteered by patients. They may transiently see things but either don't associate with the opioid or are afraid to mention them. So I think it's important to directly query them, for instance, about visual hallucinations or about nightmares at night. Nausea can occur. It may be temporary, mild, and doesn't necessarily mean that one needs to stop the second opioid. It may actually resolve in several days and can be treated symptomatically. Pruritus can occur and can be significant. So close observation for the purposes of close adjustments are also necessary. As we mentioned, you want to start them on an around-the-clock of breakthrough dose, but then assess to see what their response is and if it's suboptimal then you'll need to adjust the doses based both upon the around-the-clock and the breakthrough dose or the dose that's used for breakthrough pain. Also looking at how patients are functioning, because remember that patients frequently look at pain in terms of function or interference with their roles during the day. So, if patients are able to do more things, that may, in fact, be the goal. Brittany Harvey: Thank you for reviewing all of these recommendations across pre-conversion assessment, how opioid conversion should be conducted, including conversion ratios, and what assessments are recommended after opioid conversion. I think it's really important to be watching for these adverse events and assessing for response and keeping in mind patient goals. So, along those lines, how will these guideline recommendations impact both clinicians and people with cancer? And what are the outstanding questions we're thinking about regarding opioid conversion? Dr. Mellar Davis: I think it's important to have a basic knowledge of opioid pharmacology. There's, for instance, drugs that are safer in liver disease, such as morphine, hydromorphone, which are glucuronidated. And there are opioids that are safer in renal failure, such as methadone and buprenorphine, which aren't dependent upon renal clearance. I think knowing drug-drug interactions are important to know. And sometimes, for instance, there may be multiple prescribers for a patient. The family physician's prescribing a certain medication and the oncologist is another, so being aware of what patients are on, and particularly over-the-counter medications which may influence opioid pharmacokinetics. So complementary medications, for instance, being aware of cannabis, if patients are using cannabis or other things, I think, are important in this. There are large gaps and questions and that's the last part of the guideline that we approach or that we mentioned that I think are important to know. And one is there may be ethnic differences in population in regards to clearance or cytochrome frequencies within communities or countries, which may actually alter the conversion ratios. This has not been explored to a great extent. There's opioid stigmata. So we are in the middle of an opioid crisis and so people have a great fear of addiction and they may not take an opioid for that reason, or they may have a relative who's been addicted or had a poor experience. And this may be particularly true for methadone and buprenorphine, which are excellent analgesics and are increasingly being used but may in fact have the stigmata. There are health inequalities that occur related to minority groups that may in fact not get the full benefit of opioid conversions due to access to opioids or to medical care. Age, for instance, will cause perhaps differences in responses to opioids and may in fact affect conversion ratios. And this may be particularly true for methadone, which we have not really explored to a great extent. And finally, the disease itself may influence the clearance or absorption of an opioid. So for a sick patient, the opioid conversion ratio may be distinctly different than in a healthy individual. This is particularly seen with transdermal fentanyl, which is less well absorbed in a cachectic patient, but once given IV or intravenously has a much longer half life due to alterations in the cytochrome that clears it. And so conversion ratios have frequently been reported in relatively healthy individuals with good organ function and not that frequently in older patient populations. So just remember that the conversion ratios may be different in those particular populations. Brittany Harvey: Yes. So I think a lot of these are very important things to consider and that managing cancer pain is key to quality of life for a lot of patients and it's important to consider these patient factors while offering opioid conversion. I want to thank you so much for your work to review the existing literature here, develop these consensus-based recommendations and thank you for your time today, Dr. Davis. Dr. Mellar Davis: Thank you. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

Join us for an insightful episode featuring seasoned Pediatric Nurse Practitioner Meggan Mikal-DeMont DNP, APRN-FPA, PCNS-BC, CPNP-PC, CHPPN ®, FPCN® with more than10 years of experience in palliative care and pain management. In this whole-hearted interview, she reflects on her husband's nine-month experience with Stage IV colorectal cancer and offers an insider's perspective as both a palliative care clinician and caregiver- how as a couple they navigated the miracle they were hoping for within the system, how these experiences have transformed Meggan's clinical practice, and how life has unfolded since then. Listen for what the health care teams did well, areas where they could improve, and how administrators can champion hospice and palliative care services to make end of life easier for patients and their families.     Meggan Mikal DNP, APRN-FPA, PCNS-BC, CPNP-PC, CHPPN®, FPCN®Meggan Mikal-DeMont is the nurse practitioner of Pediatric Advance Care Team - Palliative & Pain at Advocate Children's Hospitals in Oak Lawn, IL.  Pursuing her interest in working with families that have children living with complex and series illnesses, Meggan has completed a fellowship in pediatric neurodevelopmental disabilities through the Illinois Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program. She also has completed a fellowship in pediatric palliative and hospice nursing through University of Illinois in Chicago and through the Coleman Foundation. This led her to also become a board-certified pediatric hospice and palliative nurse in 2009.  Meggan, along with an interdisciplinary committee, started the Pediatric Palliative and Supportive Care program at Advocate Children's Hospital - Oak Lawn in October of 2012.  Her background as a pediatric intensive care nurse is where her love and passion for working with children with critical and chronic illness grew.  She is an End-of-Life Nursing Education Consortium (ELNEC) trainer and received that training at St. Jude's Hospital in Memphis, TN.  Meggan is an active member of the Hospice and Palliative Nurses Association (HPNA) where she serves on the Advocacy and Legislative Committee. She participated as both an item writer and chair for the pediatric hospice and palliative nurse exam from 2010-2016. Meggan was also recently inducted as a Fellow of Palliative and Hospice Nursing (FPCN®) and is so thrilled to be recognized for her true passion and purpose to this field.   Becoming a widow and a solo parent in 2017 after her husband Andrew died from advanced colorectal cancer has only grown her passion for delivering and advocating for nothing short of the best delivery of palliative and hospice care. Meggan is blessed to be given a new chapter and now lives with her husband Nate, eight year old son Andy, bonus seven year old daughter Elizabeth, and two and a half year old rescue dog Zoey, in Plainfield.   Within palliative care, Meggan has a strong interest in the areas of patient-provider boundaries, patient and family advocacy, and the delivery of diverse, equitable, and inclusive care.   Meggan believes that caring for children with serious illnesses truly starts at the grassroots of relationships. She believes that the family is the center of the care being provided and it is a relationship built on partnership. Helping children live life to their fullest ability without burdensome symptoms is something that she strives to achieve each day.  Brett Snodgrass, DNP, FNP-C, ACHPN®, FAANP Dr. Brett Snodgrass has been a registered nurse for 28 years and a Family Nurse Practitioner for 18 years, practicing in multiple settings, including family practice, urgent care, emergency departments, administration, chronic pain and palliative medicine. She is currently the Operations Director for Palliative Medicine at Baptist Health Systems in Memphis, TN. She is board certified with the American Academy of Nurse Practitioners. She is also a Fellow of the American Association of Nurse Practitioners and an Advanced Certified Hospice and Palliative Nurse. She completed a Doctorate of Nursing Practice at the University of Alabama – Huntsville. She is a nationally recognized nurse practitioner speaker and teacher. Brett is a chronic pain expert, working for more than 20 years with chronic pain and palliative patients in a variety of settings. She is honored to be the HPNA 2025 podcast host. She is married with two daughters, two son in laws, one grandson, and now an empty nest cat. She and her family are actively involved in their church and she is an avid reader.  

La neutropénie fébrile est une urgence oncologique qui nécessite des interventions rapides, sans quoi elle peut mener à des complications importantes. Pour ce premier épisode d'une série de deux, Trait pharmacien reçoit Benoît Crevier et Barbara Vadnais, pharmaciens au CISSS de la Montérégie-Centre et détenteurs de la certification américaine du Board of Pharmacy Specialties en soins critiques et en oncologie, respectivement. Référence : Klastersky J, Paesmans M, Rubenstein EB et coll. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 2000;18:3038-51.

This episode features Dr Madhurangi Perera (Cancer and Palliative Care Outcomes Centre, School of Nursing and  Australia Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia)   What is already known about the topic? Providing palliative and supportive care in the home setting for people with heart failure is advantageous because care can be provided in accordance with an individual's way of life. Home-based palliative and supportive care for people with heart failure has the potential to improve person and caregiver outcomes and reduce healthcare costs.   What this paper adds? The components of home-based palliative and supportive care are symptom management; expert communication; multidisciplinary team involvement; continuity of care; education; end-of-life discussions; and caregiver support. While initiation of care, the services provided in the home-setting and health care approaches provided differed across the reported studies, in all included studies, nursing staff were strategically placed to provide a wide range of services in the home-setting. Continuous and early liaison between cardiology, palliative care and primary care providers is needed to provide continuous, non-fragmented care.   Implications for practice, theory, or policy The detailed findings of this review which highlight the components of home-based palliative and supportive care can provide guidance to enable health care providers to tailor care for this population. Future research into the perspectives of people with heart failure on each of the identified components and their implementation will assist service providers to gain a better understanding of how to enable home-based palliative and supportive care for persons with heart failure.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241290350   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk  

In the face of terminal illness and loss, hope can feel elusive, yet it remains one of the most powerful forces guiding us through life's darkest moments. In this episode, your host, Cindy Watson sitsdown with Debra Parker Oliver, the Ira Kodner Professor of Research in Supportive Care at Washington University, to discuss the powerful topic of Negotiating Hope. With over 20 years as a hospice social worker and administrator, Debra has dedicated her life to improving hospice care, contributing more than 200 peer-reviewed articles on palliative and hospice care. Together with her late husband, David, she created a blog to share their cancer journey, offering guidance and advocacy for those facing terminal illness. Even after David's passing, Debra continues to share her story of grief and healing, inspiring hope for others navigating similar challenges.   Key takeaways:   Negotiating with the doctors What is the love-grief equation? What is hope and how to define your hope? Dealing with a loved one with a terminal illness How can we prepare for tragic events or obstacles in our life while still holding on to hope? What are some of the benefits of of hope, of seeking hope, of living a hopeful life? And many more!   Learn more about Debra:   Website: www.legaciesfromthelivingroom.com Facebook: https://www.facebook.com/legaciesfromthelivingroom/?ref=embed_page YouTube: https://www.youtube.com/@Legaciesfromthelivingroom Email: oliverd@wustl.edu   Get her book: Legacies from the Living Room: A Love-Grief Equation If you're looking to up-level your negotiation skills, I have everything from online to group to my signature one-on-one mastermind & VIP experiences available to help you better leverage your innate power to get more of what you want and deserve in life. Check out our website at www.artofFeminineNegotiation.com if that sounds interesting to you. Get Cindy's book here: Amazon   https://www.amazon.com/Art-Feminine-Negotiation-Boardroom-Bedroom-ebook/dp/B0B8KPCYZP?inf_contact_key=94d07c699eea186d2adfbddfef6fb9e2&inf_contact_key=013613337189d4d12be8d2bca3c26821680f8914173f9191b1c0223e68310bb1 EBook   https://www.amazon.com/Art-Feminine-Negotiation-Boardroom-Bedroom-ebook/dp/B0B8KPCYZP?inf_contact_key=94d07c699eea186d2adfbddfef6fb9e2&inf_contact_key=013613337189d4d12be8d2bca3c26821680f8914173f9191b1c0223e68310bb1 Barnes and Noble   https://www.barnesandnoble.com/w/the-art-of-feminine-negotiation-cindy-watson/1141499614?ean=9781631959776 CONNECT WITH CINDY: Website: www.womenonpurpose.ca Facebook:  https://www.facebook.com/womenonpurposecommunity/ Instagram: https://www.instagram.com/womenonpurposecoaching/ LinkedIn: linkedin.com/in/thecindywatson Show: https://www.womenonpurpose.ca/media/podcast-2/ X(Twitter):  https://twitter.com/womenonpurpose1 YouTube:https://www.youtube.com/@hersuasion Email:  cindy@womenonpurpose.ca

In this episode, Dennis and Doug discuss acute liver injury, its causes, recognition, and management. They explore the liver's vital functions, the implications of liver injury in shock situations, and the importance of early recognition and treatment. The conversation also touches on the role of supplements and heat injury in exacerbating liver issues, emphasizing the liver's resilience and the need for vigilant care in critical situations.TakeawaysThe liver plays a crucial role in toxin clearance and blood metabolism.Acute liver injury can result from hypoxia, heat stroke, and toxins like acetaminophen.Recognizing signs of liver injury early can significantly impact patient outcomes.Supportive care for liver injury includes maintaining glucose levels and managing coagulopathy.The timeline for liver injury can vary, often showing signs later than other organ failures.Preventing acute liver injury involves early recognition and treatment of shock.Supplements can increase the risk of liver injury, especially in heat-related cases.The liver's resilience allows it to withstand significant damage before showing dysfunction.Monitoring lactate and glucose levels can help in diagnosing liver injury.Effective resuscitation is key to preventing progression to severe liver injury.Chapters00:00 Introduction to Acute Liver Injury02:58 Understanding Liver Functions and Injury06:04 Recognizing Acute Liver Injury08:57 Supportive Care for Liver Injury11:47 Challenges in Managing Acute Liver Injury15:04 The Timeline of Liver Injury17:47 Preventing Acute Liver Injury21:13 The Role of Supplements and Heat Injury24:07 Conclusion and Key TakeawaysThank you to Delta Development Team for in part, sponsoring this podcast.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In today's episode, we're finishing up our series on kidney failure treatment options with a discussion on conservative care. What exactly is conservative care and who can benefit from it? Christine Corbett, Associate Chief Nursing Officer and nurse practitioner specializing in palliative care is here to answer that question and more. Sara Hicklin and Bobbie Reed who have firsthand experience with conservative care in their families are also here to share their perspectives on this treatment option. Christine Corbett, DNP, APRN, FNP-BC, CNN-NP, FNKF is the newly appointed Assistant Research Professor at George Washington University and Executive Director for the Coalition for Supportive Care of Kidney Patients. She is a practicing Nurse Practitioner specializing in kidney palliative care, and a Trauma-Sensitive HeartMath Certified Practitioner. Dr. Corbett has over 25 years of nephrology experience and four years of experience in Palliative Care. Her doctoral focus was shared decision-making, advance care planning and appropriate palliative care referral for select patients with chronic kidney disease. In the past four years she developed, implemented, and managed the Comprehensive Conservative Kidney Care Clinic for patients who choose to forego dialysis at an academic safety net hospital in Kansas City. Bobbie Reed is on a mission for her son and for the millions of others living with chronic kidney disease. A graduate of Indiana University of Pennsylvania with a Bachelor of Family Consumer Science degree, Bobbie is the office manager at her family's insurance business. She wants to pay it forward by helping others with their struggles in dealing with kidney disease. As part of the NKF's Kidney Advocacy Committee, Bobbie is not only the Pennsylvania Liaison, but is the immediate past Region 2 leader for the group.  She continues to help her son navigate his kidney disease journey and, in addition, use her experience to benefit and advocate for many others afflicted with kidney disease. Sara Hicklin and her family has a genetic kidney disease called Polycystic Kidney Disease or PKD. With this family and personal history, Sara is passionate about educating others about kidney disease, along with recruiting and educating potential organ donors. She is also fascinated by the advances in treatment options in three generations and wants to contribute in a small way to what may become available for treatment of kidney disease in generations to come.   Additional Resources Coalition for Supportive Care Palliative Care Resources Palliative Care Resources Advanced Directives The Patient Will See You Now by Eric Topol Palliative Care in Nephrology Definitions from the episode: Durable Power of Attorney (DPOA) Portable Medical Orders (POLST): https://polst.org/   Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts.

  This episode features  Dr Masanori Mori (Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan)   What is already known about the topic? As in Western countries' health-care systems, advance care planning is being increasingly implemented in Asian ones, but consensus on its definition and recommendations based on Asian culture are lacking. In high-context, Confucian-influenced Asian societies, explicit conversations about end-of-life care with patients are not always the norm. Family involvement is crucial in decision-making. Health-care providers in Asia uncommonly involve patients in advance care planning, partly due to their lack of knowledge and skills in advance care planning, personal uneasiness, fear of conflicts with families and their legal consequences, and the lack of a standard system for advance care planning.   What this paper adds? A key domain not previously highlighted in Western Delphi studies is “a person-centered and family-based approach” that facilitates families' involvement to support an individual's engagement in advance care planning and the attainment of the individual's best interest through shared decision-making. Treatment preferences in Asian contexts are often shaped by relationships and responsibilities toward others, with families and health-care providers supporting individuals to meaningfully participate, even in the presence of physical or cognitive impairments.   Implications for practice, theory, or policy Our definition and recommendations can guide clinical practice, education, research, and policy-making in advance care planning, not only in the Asian sectors included in our study, but also in regions with Asian residents and other areas where implicit communication and family-centered decision-making are valued. Our findings, combined with the existing evidence, will help future investigations to develop culturally sensitive advance care planning interventions, identify appropriate outcomes, and build an infrastructure where Asian individuals receive care consistent with their values, goals, and preferences.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241284088   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk  

Synopsis: Adverse reactions involving the skin, nails, and hair are common among patients undergoing treatment for cancer and are often underreported and overlooked. These reactions directly impact patient quality of life and may be the reason for interruptions in lifesaving antineoplastic treatment. To address these toxicities, the Association of Cancer Care Centers (ACCC) is leading an initiative that aims to educate providers and other cancer care team members about the optimal management of dermatologic side effects.     In this episode, CANCER BUZZ speaks with Julie Ryan Wolf, PhD, MPH and C.J.G. (Corina) van den Hurk, PhD, the chair and vice chair of the Oncodermatology Study Group at the Multinational Association of Supportive Care in Cancer (MASCC) about common oncodermatological toxicities including radiation dermatitis, hair loss, and nail changes unique to EGFR-inhibitors. Also discussed are strategies to increase provider collaboration to intervene at an early stage to improve quality of life for patients receiving cancer treatment.   “If we have symptom monitoring on a regular basis throughout the course of treatment, we'll be able to intervene sooner… helping improve [patient] quality of life” – Julie Ryan Wolf, PhD, MPH   “In effect, almost each patient has a dermatologic side effect at the end of the treatment, or has experienced that during the treatment, and they are all very interfering.” – CJG (Corina) van den Hurk, PhD                     Julie Ryan Wolf, PhD, MPH   Chair, Oncodermatology Study Group  Multinational Association of Supportive Care in Cancer (MASCC)  Associate Professor, Department of Dermatology, Department of Radiation Oncology   University of Rochester Medical Center   Rochester, NY      CJG (Corina) van den Hurk, PhD   Vice Chair, Oncodermatology Study Group  Multinational Association of Supportive Care in Cancer (MASCC)  Senior Researcher, Santeon Hospitals   Netherlands         Thank you to Johnson & Johnson for their support of this program.     Additional Reading/Sources     Multinational Association of Supportive Care in Cancer (MASCC) Home  Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology Study Group   MASCC Study Group Evidence-Based Clinical Practice Guidelines   ACCC Supportive Care Strategies for Dermatologic Toxicities Related to Cancer Therapies  Oncology Issues – Supportive Oncodermatology: Addressing dermatologic adverse events associated with oncologic therapies  Dermatologic Adverse Events of Systemic Anticancer Therapies: Cytotoxic Chemotherapy, Targeted Therapy, and Immunotherapy  Oncodermatology: Advancing the Science and Care of Cancer Patients and Survivors  Supportive oncodermatology-a narrative review of its utility and the way forward =

Discover how pharmacists can play a pivotal role in improving the quality of life for patients with cancer through supportive care interventions. This episode explores practical strategies for managing side effects, enhancing adherence, and addressing the unique needs of oncology patients. Don't miss this chance to expand your impact—listen now and learn how to provide compassionate, evidence-based care to your patients. HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTOlivia Fahey, PharmD, BCOPCancer Care Education PharmacistThe University of Kansas Cancer CenterPharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/CPE INFORMATION Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1.  Describe common supportive care needs for patients with cancer, including management of side effects and comorbidities.2. Identify evidence-based strategies pharmacists can use to enhance medication adherence and improve the overall quality of life for patients with cancer.0.05 CEU/0.5 HrUAN: 0107-0000-25-021-H01-PInitial release date: 1/20/2025Expiration date: 1/20/2026Additional CPE details can be found here.

Discover how pharmacists can play a pivotal role in improving the quality of life for patients with cancer through supportive care interventions. This episode explores practical strategies for managing side effects, enhancing adherence, and addressing the unique needs of oncology patients. Don't miss this chance to expand your impact—listen now and learn how to provide compassionate, evidence-based care to your patients.HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTOlivia Fahey, PharmD, BCOPCancer Care Education PharmacistThe University of Kansas Cancer CenterReferencea Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE INFORMATIONLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1.  Describe common supportive care needs for patients with cancer, including management of side effects and comorbidities.2. Identify evidence-based strategies pharmacists can use to enhance medication adherence and improve the overall quality of life for patients with cancer.0.05 CEU/0.5 HrUAN: 0107-0000-25-021-H01-PInitial release date: X/X/2024Expiration date: X/X/2025Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

In this episode, Alexa Basilio, PharmD, BCOP and Jessica Davis, PharmD, BCOP, CPP discuss immune-related adverse events and toxicities among patients using immune checkpoint inhibitors. This overview will include discussion about: How and when to monitor and treat mild vs severe immune-related toxicitiesThe art of balancing and tapering low-dose and high-dose corticosteroidsDifferentiating between immune-related and chemotherapy- or targeted therapy–associated adverse events for optimal management approachesInvolvement of multidisciplinary teams early during treatment to prevent immune-related adverse eventsImportance of educating patients, caregivers, and providers on immune-related toxicitiesPresenters: Alexa Basilio, PharmD, BCOPUniversity of Florida College of Pharmacy Oncology Pharmacy Specialist McKesson, The US Oncology NetworkTampa, Florida Jessica Davis, PharmD, BCOP, CPP Levine Cancer InstituteClinical Pharmacist Coordinator, Adult Hematology/OncologyAtrium Health Levine CenterCharlotte, North Carolina Link to full program: https://bit.ly/3We4HJy

In this episode, host Lynn Reinke, PhD, ANP-BC, FAAN, FPCN®, ATSF discusses approaches to philanthropy with Amy Jacobs, MSN, RN and Catherine Pyke, M.A. Ed., board members of the Hospice and Palliative Nurses Foundation. Related Resources: Learn more about the Hospice and Palliative Nurses Foundation (HPNF) Contribute to HPNF's 2024 Annual Appeal About the Speakers: Amy Jacobs, MSN, RN Amy Jacobs received her BSN from Lock Haven University of Pennsylvania and her MSN from the University of South Alabama. Amy is currently a Hospice Compliance RN for Compassus. Prior to her current position, she held leadership positions in hospice, palliative care, and quality with BJC Homecare in St. Louis. She was an integral part in the development and opening of Evelyn's House, a 16-bed hospice inpatient house, in St. Louis. She also assisted in the implementation of a system-wide palliative care program. She has volunteered with HPNA and HPNF for several years as an award reviewer, member of the planning committee for the annual assembly, and a member of the HPNA Professional Development Advisory Council. She is especially proud to have facilitated support for the Emerging Leaders Award with HPNF and the BJC Institute for Palliative and Supportive Care.   Catherine Pyke, M.A. Ed.  Catherine Pyke worked for thirty years in non-profits in the San Francisco Bay Area, primarily as a program officer for the Hearst Foundations and more recently as a Philanthropic Advisor for the Gladstone Institutes in Mission Bay. She is the founder of Centerpiece Philanthropy, a consultancy that provides philanthropic advising and coaching, grant writing, strategic planning and group facilitation. She is the author of Jane Lathrop Stanford, Mother of a University. In addition to serving on the HPNF board, she serves as the Communications Chair for the San Francisco Region of the Order of St John, an international volunteer organization whose mission is to support St John of Jerusalem Eye Hospital and social and health care needs in the U.S. She recently completed two terms on the board of the Episcopal Impact Fund in San Francisco. An alumna of Scripps College in Claremont California, with a Masters in Education from Stanford University, she came to appreciate the contributions of innovative philanthropists, while visiting colleges, universities, medical centers arts organizations and social service agencies throughout the West. A native of Salt Lake City, she currently lives in Santa Rosa, California.

Love the episode? Send us a text!Dr. Abram reshapes the common perception of palliative care, emphasizing that it should not be viewed solely as end-of-life support, but rather as an essential form of supportive care that can significantly improve patient outcomes and quality of life when integrated early. With over 20 years of experience at the Dana-Farber Cancer Institute, Dr. Abram is a leading expert in the palliative care needs of cancer patients and the author of the Comprehensive Guide to Supportive and Palliative Care for Patients with Cancer. She has been recognized with the prestigious Walther Cancer Foundation Supportive Oncology Award from the American Society of Clinical Oncology. Tune in to hear valuable insights from Dr. Abram about the importance of palliative care in the journey of cancer patients and their families.Support the show

In this episode, we talk with Dr. William Breitbart, Chairman of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center, and a pioneer in psycho-oncology. Dr. Breitbart sheds light on the critical yet often overlooked issue of meaning and purpose in cancer care. He delves into how patients may encounter a profound loss of meaning, which can lead to anxiety and depression, even if they are not clinically diagnosed with depression. Drawing from his extensive experience, Dr. Breitbart shares insights from his pioneering work in the psychiatric and neuropsychiatric dimensions of cancer and palliative care. He discusses strategies to assist patients in rediscovering meaning and enhancing their quality of life during challenging times. Join us for a conversation that underscores the vital intersection of mental health and cancer treatment, featuring Dr. Breitbart's significant contributions to the field, including his groundbreaking work on Meaning-Centered Psychotherapy. William Breitbart, M.D. Chairman, Jimmie C Holland Chair in Psychiatric Oncology; Chairman, Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center Dr. Breitbart is a pioneer and leader in the field of psycho-oncology. At Memorial Sloan-Kettering Cancer Center, he led the way for innovative, award-winning initiatives that provided high-quality research focusing on psychiatric and neuropsychiatric aspects of cancer and palliative care. He is the Chairman, Jimmie C Holland Chair in Psychiatric Oncology, Chairman, Psychiatry Service, Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York. Dr. Breitbart is also a Professor of Clinical Psychiatry at Weill Medical College of Cornell University. Dr. Breitbart is known for numerous influential leadership roles, and has been recognized in the field of psycho-oncology for his contributions, receiving top research awards and lifetime achievements since 2003. He has edited/written twelve textbooks, including Psychiatric Aspects of Symptom Management in the Cancer Patient, published by the American Psychiatric Press, Psycho-oncology - 1st, 2nd and 3rd Editions, and Handbook of Psychiatry in Palliative Medicine- 1st and 2nd Editions. Dr. Breitbart recently authored treatment manuals on Meaning-Centered Group and Individual Psychotherapy in Advanced Cancer Patients by Oxford University Press. He is currently editor-in-chief of the Cambridge University Press' international palliative care journal, Palliative & Supportive Care. Dr. Breitbart also helped found IPOS Press and authored the IPOS Press/Oxford University Press Text Psychosocial Palliative Care. --- Support this podcast: https://podcasters.spotify.com/pod/show/aimatmelanoma/support

In the face of terminal illness and loss, hope can feel elusive, yet it remains one of the most powerful forces guiding us through life's darkest moments. In this episode, your host, Cindy Watson sitsdown with Debra Parker Oliver, the Ira Kodner Professor of Research in Supportive Care at Washington University, to discuss the powerful topic of Negotiating Hope. With over 20 years as a hospice social worker and administrator, Debra has dedicated her life to improving hospice care, contributing more than 200 peer-reviewed articles on palliative and hospice care. Together with her late husband, David, she created a blog to share their cancer journey, offering guidance and advocacy for those facing terminal illness. Even after David's passing, Debra continues to share her story of grief and healing, inspiring hope for others navigating similar challenges.   Key takeaways:   Negotiating with the doctors What is the love-grief equation? What is hope and how to define your hope? Dealing with a loved one with a terminal illness How can we prepare for tragic events or obstacles in our life while still holding on to hope? What are some of the benefits of of hope, of seeking hope, of living a hopeful life? And many more!   Learn more about Debra:   Website: www.legaciesfromthelivingroom.com Facebook: https://www.facebook.com/legaciesfromthelivingroom/?ref=embed_page YouTube: https://www.youtube.com/@Legaciesfromthelivingroom Email: oliverd@wustl.edu   Get her book: Legacies from the Living Room: A Love-Grief Equation   If you're looking to up-level your negotiation skills, I have everything from online to group to my signature one-on-one mastermind & VIP experiences available to help you better leverage your innate power to get more of what you want and deserve in life. Check out our website at www.practicingwithpurpose.org if that sounds interesting to you. Get Cindy's book here: Amazon   https://www.amazon.com/Art-Feminine-Negotiation-Boardroom-Bedroom-ebook/dp/B0B8KPCYZP?inf_contact_key=94d07c699eea186d2adfbddfef6fb9e2&inf_contact_key=013613337189d4d12be8d2bca3c26821680f8914173f9191b1c0223e68310bb1 EBook   https://www.amazon.com/Art-Feminine-Negotiation-Boardroom-Bedroom-ebook/dp/B0B8KPCYZP?inf_contact_key=94d07c699eea186d2adfbddfef6fb9e2&inf_contact_key=013613337189d4d12be8d2bca3c26821680f8914173f9191b1c0223e68310bb1 Barnes and Noble   https://www.barnesandnoble.com/w/the-art-of-feminine-negotiation-cindy-watson/1141499614?ean=9781631959776 CONNECT WITH CINDY: Website: www.womenonpurpose.ca Facebook:  https://www.facebook.com/womenonpurposecommunity/ Instagram: https://www.instagram.com/womenonpurposecoaching/ LinkedIn: linkedin.com/in/thecindywatson Show: https://www.womenonpurpose.ca/media/podcast-2/ X(Twitter):  https://twitter.com/womenonpurpose1 YouTube:https://www.youtube.com/@hersuasion Email:  cindy@womenonpurpose.ca  

Interview with author of: “Legacies from the Living Room: A Love-Grief Equation”Debra Parker Oliver is the Ira Kodner Professor of Research in Supportive Care at Washington University. She has a Masters of Social Work and PhD in Rural Sociology from the University of Missouri. She was a hospice social worker and administrator in three hospice programs for a total of more than 20 years. After getting her doctorate she continued her commitment to the improvement of hospice care through research with more than 200 peer -reviewed articles related to palliative and hospice care.https://legaciesfromthelivingroom.com/about-the-author/

What is supportive care or supportive oncology? What is cancer-related distress? How might NET patients benefit from supportive care? Yale oncologist Dr. Maryam Lustberg suggests strategies to manage cancer-related fatigue, diarrhea, nausea, mouth sores, peripheral neuropathy, distress, anxiety, and anxiety. She also addresses considerations for fertility and sexual health.MEET DR. MARYAM LUSTBERGDr. Maryam Lustberg is an American breast oncologist. She is the Director of The Breast Center at Smilow Cancer Hospital and Chief ofBreast Medical Oncology at Yale Cancer Center. Dr. Lustberg previously served as the Medical Director of Cancer Supportive Care Services atOhio State's Comprehensive Cancer Center. She is the Immediate Past President of the Multinational Association of Supportive Care in Cancer. She is also an Associate Editor for the Journal of Cancer Survivorship.TOP TEN QUESTIONS ABOUT SUPPORTIVE CARE: What is supportive care in cancer (or supportive oncology)? What is survivorship? How do these concepts apply to the NET community?What is the 1st step for patients to get supportive care?What are the most common treated-related adverse events or side effects? What are risk factors for them? (Will all patients experience all potential side effects?)What causes cancer-related fatigue (CRF)? What are some strategies to manage cancer-related fatigue?What are some strategies to manage diarrhea?What are some strategies to manage nausea?What are some strategies to manage mouth sores?What is peripheral neuropathy? When do patients experience it and what can be done to prevent it?What should patients understand about sexual health and fertility?How can psychosocial needs such as distress, anxiety, and depression be addressed and supported?For more information, please visit https://www.lacnets.org/podcast/37. For more information, visit LACNETS.org.

Host:  Mindy McCulley, MS Extension Specialist for Instructional Support, Family and Consumer Sciences Extension, UK Cooperative Extension Service, Martin-Gatton College of Agriculture, Food and Environment Guest: Katrina Nickles, MD, Assistant Professor, Department of Internal Medicine, Division of Palliative Care and Support, UK Markey Cancer Center Welcome to another enlightening episode of Cancer Conversations on Talking FACS where Dr. Nichols breaks down the multifaceted nature of palliative care, explaining its role as both an approach and a medical sub-specialty aimed at enhancing the quality of life for individuals with serious illnesses, particularly cancer. She outlines the comprehensive, team-based approach required for effective palliative care, emphasizing the collaboration among various healthcare professionals including pharmacists, nurses, social workers, and chaplains. The conversation also delves into the differences between palliative care and hospice care, the types of support patients and their caregivers can expect, and the importance of mental and spiritual health in the treatment process. For more palliative care resources, visit the links below: For clinicians: Center to Advance Palliative Care For patients and caregivers: Get Palliative Care Connect with the UK Markey Center Online Markey Cancer Center On Facebook @UKMarkey On Twitter @UKMarkey Connect with FCS Extension through any of the links below: Kentucky Extension Offices UK FCS Extension           Website           Facebook           Instagram           FCS Learning Channel  

Jacqueline S. Garcia, MD - Small Words, Big Differences: Best Practices in Supportive Care for Patients With AML

Jacqueline S. Garcia, MD - Small Words, Big Differences: Best Practices in Supportive Care for Patients With AML

Jacqueline S. Garcia, MD - Small Words, Big Differences: Best Practices in Supportive Care for Patients With AML

Jacqueline S. Garcia, MD - Small Words, Big Differences: Best Practices in Supportive Care for Patients With AML

Listen to ASCO's Journal of Clinical Oncology poem, "Mandatum” by Dr. David Harris, who is an Associate Staff in the Department of Palliative and Supportive Care and Program Director for the Hospice and Palliative Medicine Fellowship at Cleveland Clinic. The poem is followed by an interview with Harris and host Dr. Lidia Schapira. Dr Harris share how his team honors a patient's spirit TRANSCRIPT Narrator: Mandatum, by David Harris, MD   Where does the soul reside in the darkness of the body?   Does it flicker along the highways of nerves up the spine up the neck to the globe of the skull   or does it pulse, a lightening bug in the vast caverns of our bellies?   The foot was his answer his left, to be precise.   The cancer mushrooming from his heel a small price for a soul.   We told him he had a choice: We would take the foot or this sarcoma would take all of him.   But when he chose, we did not understand.   We told him a hundred times in a hundred ways.   We told him he did not understand could not understand so could not choose.   He told us he once walked all night through the cold to reach us. “When I die I want to be whole.”   The foot where our flesh greets the earth's flesh. Where our weight collects builds presses down.   Where else would a soul want to be when we slip bare feet into sand letting the cool stream run over?   We washed and wrapped the foot in white, clean cloth then unwrapped it, to wash again. Washing as the cancer grew.   Washing as the soul flickered. Each day washing. Choosing what we could not understand. Dr. Lidia Schapira: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I am your host, Dr. Lidia Schapira, Professor of Medicine at Stanford University. Today we're joined by Dr. David Harris, Associate Staff in the Department of Palliative and Supportive Care and Program Director for the Hospice and Palliative Medicine Fellowship at Cleveland Clinic. In this episode, we will be discussing his Art of Oncology poem, “Mandatum.” At the time of this recording, our guest has no disclosures.  David, welcome to our podcast and thank you for joining us.  Dr. David Harris Thank you, Lidia. It's wonderful to be here.  Dr. Lidia Schapira: Let's start by talking a little bit about your process for writing. You're a published author. We've published one of your beautiful poems in the past. This is, I believe, the second time. So tell us a little bit about when you write, why you write, and when you decide to share your writing with others through publications. Dr. David Harris: I think my writing starts when I have an experience that feels profound and sticks with me, and there's a certain way that feels in my body. I'll leave a room and I'll say, something happened in there. It didn't just happen to the patient, but something happened to me. It'll be one of those moments, and I think we all have these that we keep coming back to, a patient that we keep coming back to, sometimes even a single sentence that somebody said that we keep coming back to. And over time, I've realized that when I have that feeling, there's some poetry there, if I can sit with it. And I spend a lot of time just sitting and thinking about the story and trying to find what pieces of it are meaningful to me, what images are meaningful. And from there, after a long time just sitting and experiencing and listening to myself, then I begin to write, and the writing piece ends up not taking that long. It's much more of the first piece.  Dr. Lidia Schapira: And tell me, why did you choose poetry? Or do you write prose and poetry, and we just happen to be talking about poetry? Dr. David Harris: I find poetry to be so much easier than prose. One of the things I love about poetry is that so much is left unsaid. And the idea of writing something with a plot and with dialogue and character development, that seems like a real task and a real feat. There are so many different types of poetry, and the poetry that I'm interested in writing just describes a moment. That's all it is, just shares a moment that I think other people might also enjoy. And so that seems simple.  Dr. Lidia Schapira: So, David, help me translate what you just said for our readers. In a way, many people feel that somehow they don't understand poetry, or they're not capable of fully grasping everything the poet maybe intends. Why do you think people have this feeling about poetry, almost, I will compare it here to abstract art? This feeling that somehow you need something else to understand it? Is that real or is that just a perception? Dr. David Harris: I think that's the real experience for so many people. And maybe a better comparison than art would be music, in that there's pieces of music that I will listen to, and I'll say, I can't understand this, and they might be masterworks of famous composers, but for me, I don't have the ability to access that. And then there are pieces of music that I love, Taylor Swift, that's kind of my speed. And I think that poetry can be like that, too. I think there's poetry that you need training to be able to appreciate and to understand, and then there's poetry where just your human experience is what you need, and you can read it, and whatever it means to you, that's what it means, just like when you listen to a song. The first time I experienced poetry, and I bet this is the case for a lot of the listeners, was in English class, where I got graded on my ability to understand poetry and talk about a way to take the joy out of it is to be evaluated. I guess they probably didn't pick poems that were super easy to understand, because that's not really the point of it. I wonder if a lot of it comes from these experiences we all had in junior high and high school English, reading poetry. I don't think it has to be like that.  Dr. Lidia Schapira: Good. No, I don't think it has to be like that. So let's talk about your beautiful poem here. What inspired the poem? It sounds like this was an encounter with a patient that really moved you and made you question many of our practices. Tell us a little bit about this person.  Dr. David Harris: Yes. This was a person who came to our hospital with a mass on his left heel, a fungating, bleeding mass. And the sarcoma team we have here, the surgeons and the medical oncologists, felt quite confident that it was a sarcoma without even biopsying it. Confident enough that they recommended a resection even before biopsy as a curative approach. And when they shared this with the patient, the patient refused the curative surgery. And the reason that he refused is he said that if we amputated part of his body, his soul would be lost through the amputation. And in medicine, we're not used to talking about souls, or at least my team is not, and we didn't really know what to do with this. This person had a longstanding history of severe schizophrenia, and when our psychiatrist came to evaluate him, they did not think that he had capacity to make decisions. And there were no people in his life that could be a surrogate for him. So he was a patient without a surrogate. And there were so many complex issues that this brought up for us. We were in the uncomfortable position of having to make a choice for a patient, and that's not something that we're used to doing in medicine, and I think that's a very good thing. There was this discomfort of making this life or death choice for this patient. How could we do that? How could we take that responsibility? Dr. Lidia Schapira: So let's think about this a little bit from at least your perspective as a palliative care doctor who was brought in, I assume that was your role here, right? Dr. David Harris: Yes. Dr. Lidia Schapira: Perhaps as an ethicist or palliative care consultant to bring it all together. So maybe the way to think about it, or perhaps if I imagine how you thought about it, was the suffering that this imposed for this person who was right in front of you. You couldn't change him. You couldn't change his mental health. You couldn't change his decision. But somehow you approached him as somebody, perhaps, who is a sufferer, who has a big problem. Tell us a little bit about how you and your team aligned yourself with what the patient wanted or the patient expressed, even though you understood that, from medical legal perspectives, he lacked capacity to decide. Dr. David Harris: We spent a lot of time with him. We spent a lot of time talking as a group. Our bioethics team, in addition to me and many of our palliative docs were all really involved. One of the things that really played into our thought process was that he did not have a temporary lack of capacity. And this desire not to have the amputation was not temporary. This was permanent. And there wouldn't be a day that he woke up and said, “Thank goodness, you didn't listen to me and you did that amputation.” And the other thing we thought a lot about is how much suffering do we give somebody if they feel they've lost their soul, and how do we quantify that?  Dr. Lidia Schapira: And if we're talking about souls, I can't help but ask you about all of the religious implications here. In your poem, you talk about washing feet. You give the poem a title that evokes a part of a religious liturgy. Can you tell us a little bit about how that theme came into the construction of your poem?  Dr. David Harris: I think that this will sound a little silly, but as I was sitting here with this story and thinking about it, which is a part of my process in writing, I spent a lot of time thinking about feet because that's where his cancer was. And after we chose to not do the surgery and before he passed away, we spent a lot of time wrapping and unwrapping and washing his feet. And what we chose instead of doing the surgery was- that was what we moved towards. What we chose to do was do wound care and wash his feet. One of the things I think a lot about is the mundane actions that we do as physicians, as medical teams, and how significant and profound they can sometimes be. I think one example that many people have talked about and discussed is the physical exam and how it's not just a way for us to listen to the heart, but it's also this ritual. And for him, when I talked to the nurses who were caring for him, the wound care and the washing of his feet became a ritual. And I saw this parallel with what I learned about the washing of the feet that is done in Catholicism. I am not Catholic myself, and it's not something that I have personal familiarity with, but I feel like there are parallels to what we do as physicians in medical care, caring for the body and what other groups do, caring for other parts of humans. And so I saw that parallel there. Dr. Lidia Schapira: That's beautiful. Now, can you tell us a little bit about the title? I'm sure it's not something that the readers of the Journal of Clinical Oncology often encounter as a heading for an article. Dr. David Harris: I know, I was so excited. Poets are famous for having a title that doesn't make any sense. So I think one of the things I hope readers associate when they hear that word that they may not know is the word mandate. And when we think about what we do in healthcare, how does the word mandate come into what we do? And for this case, where we determined he had a lack of capacity, where we chose whether he would have surgery or not, how does that word play into the story? And then, in addition, “Mandatum” as sort of a ceremony of washing the feet, and the significance of that as a spiritual ritual and what we did for him as a medical ritual, and the parallels there. Dr. Lidia Schapira: David, I wonder if, wearing your educator hat as an educator of fellows, you can talk a little bit about how you bring all of this beautiful and complex philosophy of care, of seeing the whole person, of responding to suffering and reflection, or your reflection through poetry and through the arts, how you bring that to your fellows and how you help them to develop some of these greater techniques for their own enjoyment and for their own development. Dr. David Harris: That's such a wonderful and thought provoking question and something that I've been thinking about so much this year as our new fellows are joining us. The way I bring it into the room when I'm seeing patients is one of the easiest ways to show them, because we will go see patients together, and they can begin to see how learning about the non-medical pieces of a person can change the whole medical interview and the whole interaction between a physician and a patient. And I think that's something that our fellows leave the year with, and also our oncology fellows, when they rotate with us, they've said that one of the things they leave the rotation with is this appreciation for how all parts of a patient are important in their receiving excellent care.  The second thing you were asking is, how do I help fellows in their personal journey inward. And for me, that's been a journey through poetry, and I feel like that's something I'm still trying to understand how to do, because each person has their own way in, and I don't know if writing poetry- I will say, I'm sure that not everyone's way in is going to be writing poetry, and it shouldn't have to be. And so how can I invite my fellows inward on this journey? Show them how I do it, show them how other people in my department have done it, and then also not force them because I don't think that's helpful at all. Dr. Lidia Schapira: Yeah, and it doesn't work. This has been such an important conversation for me, and I'm sure it'll be very impactful for our listeners. So let me end by asking what you and your team learned from caring for this person. Dr. David Harris: One of the things that I'm really proud of my team for is how much time and how carefully we approached the situation. And it was not comfortable to make choices for somebody else. And I remember we all got together on a call, and every single person, med student, resident, bioethicist, nurse, physician, they all sort of shared their own thought process about what should happen. And every single person on that call had the same opinion about what to do. And I was proud of my team for that process. This thing that none of us really wanted to do, that at least we did it very carefully. Dr. Lidia Schapira: That's a beautiful reflection and really speaks to good leadership in the team and also the value of teamwork of feeling that you can- that you're safe and that you can express your views. And I imagine it must have been incredibly difficult. But thank you, David, for writing about it, and thank you for sending us your work. Dr. David Harris: It was a pleasure talking to you, Lidia. Dr. Lidia Schapira: And until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all of the ASCO shows at asco.org/podcasts.    The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Like, share and subscribe so you never miss an episode and leave a rating or review.     Guest Bio: Dr. David Harris is an Associate Staff in the Department of Palliative and Supportive Care and Program Director for the Hospice and Palliative Medicine Fellowship at Cleveland Clinic.

Finding hope with terminal illness is possible! Dr. Debra Parker Oliver is the Ira Kodner Professor of Research in Supportive Care at Washington University. She has a Masters of Social Work and PhD in Rural Sociology from the University of Missouri. She was a hospice social worker and administrator in three hospice programs for a total of more than 20 years. After getting her doctorate she continued her commitment to the improvement of hospice care through research with more than 200 peer -reviewed articles related to palliative and hospice care. In an effort to teach and advocate for those facing cancer and terminal illness Debbie and her husband David created a blog to share their journey with others. In episode 475 of the Fraternity Foodie Podcast, we find out why Dr. Oliver chose Missouri Western State University for her undergraduate experience, why she wanted to dedicate her life to hospice social work, how her husband David was able to tell all the people he loved that he had a terminal cancer illness, what is the right way to love someone through that grief experience, what are some strategies to find hope, how you can get doctors to listen to you, advice to college students who prefer to not think about death and dying, and what it was like to receive the Project Death in America Community Education Award from American Academy of Hospice and Palliative Medicine care two weeks before David passed away.

Oncologic Emergencies: Part 2 In this two-part series, we dive into the world of oncological emergencies with guest expert, Dr. Monica Wattana. In part 1, we covered everything from making new cancer diagnoses in the ED, to hypercalcemia, febrile neutropenia, and tumor lysis syndrome. We also discussed some of the tricky complications that often accompany cancer treatments, like mucositis, vomiting and diarrhea, anemia, and neuropathic pain. In part 2, we tackle pain management, palliative care, and some tough ethical dilemmas. The goal is to make sure we're all equipped to provide the best care possible for our patients with cancer.  Did you learn something new that changed your practice? We'd love to hear about it. Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Monica Wattana, Associate Professor and Education Director for the Department of Emergency Medicine at The University of Texas MD Anderson Cancer Center in Houston, Texas Resources: Pocket Guide to Oncologic Emergencies, by Dr. Monica Kathleen Wattana  Gould Rothberg BE, Quest TE, Yeung SJ, et al. Oncologic emergencies and urgencies: A comprehensive review. CA Cancer J Clin. 2022 Nov;72(6):570-593. doi: 10.3322/caac.21727. Epub 2022 Jun 2. PMID: 35653456. Multinational Association of Supportive Care in Cancer (MASCC) Guidelines SPIKES: A Strategy for Delivering Bad News, by Dr. Claire Ciarkowski **** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Send us a Text Message.Welcome to the latest episode of Supportive Care Matters. Join Medical Oncologist Professor Bogda Koczwara AM and Dr. David Mizrahi,  Exercise Physiologist and Research Fellow at the Daffodil Center, University of Sydney. Learn how precisely prescribed exercise can transform not just the physical health but also the clinical outcomes for cancer patients. We break down the distinctions between exercise and physical activity, showing how each contributes uniquely to improved mood, heart health, muscle strength and metabolic health. Dr. Mizrahi shares ground-breaking insights on how integrating exercise into cancer treatment regimes can not only enhance survival rates and reduce chronic disease risks but also alleviate the financial burdens on healthcare systems.Discover innovative methods to incorporate physical activity into cancer treatments, such as the use of mini bikes during chemotherapy at Chris O'Brien Lifehouse. We discuss exciting, play-based exercise initiatives for children undergoing cancer treatment and the importance of healthcare providers setting a proactive example. By the end of this episode, you'll come away inspired by practical strategies and real-world examples, reaffirming that every bit of movement counts on the journey to better health for cancer patients. Visit www.oncologynews.com.au for show notes and more information about Supportive Care Matters!This conversation is proudly produced by The Oncology Network.

In this two-part series, we dive into the world of oncological emergencies. Our guest expert, Dr. Monica Watana, an emergency physician specializing in this area. In part 1, we cover everything from making new cancer diagnoses in the ED, to hypercalcemia, febrile neutropenia, and tumor lysis syndrome. We also talk about some of the tricky complications that often accompany cancer treatments, like mucositis, vomiting and diarrhea, anemia, and neuropathic pain. The goal is to make sure we're all equipped to provide the best care possible for our patients with cancer. Stay tuned for part two, when we'll tackle pain management, palliative care, and some tough ethical dilemmas.  Did you learn something new that changed your practice? We'd love to hear about it. Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Monica Wattana, Associate Professor and Education Director for the Department of Emergency Medicine at The University of Texas MD Anderson Cancer Center in Houston, Texas Resources: Pocket Guide to Oncologic Emergencies, by Dr. Monica Kathleen Wattana  Gould Rothberg BE, Quest TE, Yeung SJ, et al. Oncologic emergencies and urgencies: A comprehensive review. CA Cancer J Clin. 2022 Nov;72(6):570-593. doi: 10.3322/caac.21727. Epub 2022 Jun 2. PMID: 35653456. Multinational Association of Supportive Care in Cancer (MASCC) Guidelines SPIKES: A Strategy for Delivering Bad News, by Dr. Claire Ciarkowski ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Scott Maurer, MD, division chief, Pediatric Palliative Medicine and Supportive Care, and Justin Yu, MD, MS, physician researcher, Pediatric Palliative Medicine and Supportive Care, both at UPMC Children's Hospital of Pittsburgh, discuss the “full-service” palliative and supportive care program at Children's and their work to support children and caregivers where they are both emotionally and physically.

What You Will Learn: An Introduction and overview of kidney functions (1 min) Dr. Jenna Henderson's Bio (2 min) Dr. Henderson's journey relating to her own diagnose of chronic kidney disease (5 min) What is dialysis? (11.30 min) The kidneys' capacities to heal (16.30 min) The number one reason that people go into kidney failure that is not a “kidney disease” (17 min) The second leading cause of kidney failure that is not a “kidney disease” (18 min) Why we have to consider heart health when we think about the kidneys (21.30 min) Some common kidney disorders Dr. Henderson works with (21.45 min) The staging of kidney disease (23.30 min) The reason chronic kidney disease is a “silent killer” (26 min) Where to start if your numbers on labs indicate a kidney issue (29.30 min) At what age our kidney cells begin to break down (31 min) Some common symptoms that could indicate kidney compromise (33 min) The difference between iron-deficiency anemia and renal anemia (35 min) How to support the kidneys for someone who has diabetes using diet, herbs, supplements, and essential oils (37 min) Why you should be mindful of diuretics for kidney disease (40 min) The use of diet modifications, herbs, supplements, and essential oils to support the kidneys of someone with high blood pressure (41.30 min)  The healing power of laughter, a sense of humor, and music for the kidneys (44.30 min) The different types of kidney stones and natural support for them, including essential oils (47 min) Why dairy should not be demonized for kidney disease (50 min) How urinary tract infections impact the kidney, how often you should urinate, and what essential oils may be supportive (55 min) Can myrrh oil be helpful for kidneys? (1 hr. 1 min)  Can you use essential oils in late-stage kidney disease? (1 hr. 2 min) Closing questions and Dr. Henderson's favorite essential oils (1 hr. 4 min) Links to Learn More About Dr. Jenna Henderson, ND and Her Offerings: Website: Holistic Kidney FB: Holistic Kidney LinkedIn: Jenna Henderson References on Essential Oils for Kidney Health: Top 5 Essential Oils to Reduce Kidney Stones (NAHA Certified Aromatherapists Blog, Lemon, Lavender, Helichrysum, Peppermint, and Orange) Essential Oils for Kidney Failure: Do They Really Work? (Animal and Mechanistic Studies: Fennel, Cypress, and Juniper are Diuretics, Some May Enhance Urine Output) 16 Best Essential Oils for Kidney Health (Overview on General Health) Harness the Power of Nature: Essential Oils for Optimal Kidney Function (Rose for Renal Colic Study, Supportive Care of Essential Oils for Mood, Fatigue, and Other Symptoms) Myrrh Essential Oil Mitigates Renal Ischemia/Reperfusion-Induced Injury Deep Insights Into Urinary Tract Infections and Effective Natural Remedies  Antimicrobial Activity of Five Essential Oils against Bacteria and Fungi Responsible for Urinary Tract Infections (In Vitro) Prophylactic and Curative Potential of Peppermint Oil Against Calcium Oxalate Kidney Stones (In Vivo) The Effect of Topical Application of Lavender Essential Oil on Intensity of Pain Caused By the Insertion of Dialysis Needles in Hemodialysis Patients: A Randomized Clinical Trial  Effect of Aromatherapy on Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Meta-Analysis  Additional Resources from the Show: The Epigenetics of Mind-Body Medicine: Smile and Relax…You Can Change Your Gene Expression and Alter Your Health by Being Mindful! Discover More in Part III Ep. 394: Essential Oils and the Microbiome, Do They Harm or Hurt our Gut Bugs? Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Douglas Peterson presents the latest evidence-based guideline from ISOO, MASCC, and ASCO on the prevention and management of osteoradionecrosis (ORN) in patients with head and neck cancer treated with radiation therapy. He covers topics such as recommended initial workup, best practices for prevention of ORN of the head and neck before and after radiation therapy, nonsurgical and surgical management of ORN, and management of adverse events associated with ORN. Dr. Peterson also comments on the importance of this guideline and what researchers should address moving forward. Read the full guideline, “Prevention and Management of Osteoradionecrosis in Patients with Head and Neck Cancer Treated with Radiation Therapy: ISOO-MASCC-ASCO Guideline” at www.asco.org/head-neck-cancer-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/head-neck-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO.23.02750.   Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts, bringing you timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all our shows, including this one, at asco.org/podcasts.   My name is Brittany Harvey and today, I'm interviewing Dr. Douglas Peterson from UConn Health, lead author on “Prevention and Management of Osteoradionecrosis in Patients with Head and Neck Cancer Treated with Radiation Therapy: International Society of Oral Oncology, Multinational Association for Supportive Care in Cancer, American Society of Clinical Oncology Guideline.” Thank you for being here, Dr. Peterson. Dr. Douglas Peterson: Thank you, Brittany. My pleasure to be here. Brittany Harvey: Before we discuss the guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensures that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Peterson, who has joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes.  So then, to dive into the topic we're here to discuss, Dr. Peterson, could you first provide an overview of the scope and purpose of this joint ISOO-MASCC-ASCO guideline? Dr. Douglas Peterson: I'll be pleased to do so, Brittany. Again, thank you for the opportunity to represent the panel in this guideline. The panel has strived to present a guideline that brings consistency in clinical practice regarding prevention and management of osteoradionecrosis of the jaw (ORN) based on the highest quality contemporary science. Given the mechanistic and clinical complexity of ORN, we also stress the importance of interprofessional oncology care of these patients. The team includes, but is not limited to, clinicians representing radiation oncology, head and neck surgery, medical oncology, otolaryngology, dental medicine, oral medicine, oral oncology, oral and maxillofacial surgery, and patient advocacy organizations. So it really is a collective enterprise that we bring to bear in the guideline.  In some cases, the panel has been fortunate to be able to utilize a high quality evidence base in the literature upon which we could build strong recommendations. In selected other cases, however, we utilized informal consensus given the low evidence quality in the field. The recommendations presented have been carefully framed in this context, with the goal of providing state-of-the-science guidelines in clinical decision making and management of ORN. I'd also like to point out that the guideline brings linkage to other guidelines published by ASCO and other major oncology organizations, regarding management of symptoms and other supportive care needs associated with ORN. These companion guidelines include addressing pain, dysphagia, oral care, trismus, and psychosocial impact and survivorship, to name a few. I'd also like to say that combining the expertise of ISOO, MASCC, and ASCO has provided an important opportunity to produce this guideline. This has been a comprehensive effort by many experts. In addition to the outstanding input from the panel, I am also personally so very grateful for the expert input from ASCO's Evidence-Based Medicine Committee, as well as endorsements from other key organizations, including the American Head and Neck Society, the American Society for Radiation Oncology, and the American Academy of Oral Medicine as endorsees of the guideline. Finally in addition, Dr. Nofisat Ismaila's leadership as ASCO staff has been absolutely invaluable as well.  Brittany Harvey: Excellent. I appreciate you providing that background on the development of this evidence-based guideline, which was developed by a multi-organizational and multidisciplinary panel.   So to dive into the key recommendations of this guideline, this guideline addresses six clinical questions. So, starting with question one, what key points would you like to highlight regarding how ORN is characterized, graded, and reported, and what is the recommended initial workup for patients?  Dr. Douglas Peterson: Osteoradionecrosis of the jaw of the mandible and maxilla should be characterized in the view of the panel as a radiographic, lytic, or mixed sclerotic lesion of bone, and/or visibly exposed bone, and/or, importantly, bone probed through a periodontal pocket or fistula. In the latter case, the clinical appearance of exposed bone may be extremely subtle. ORN is occurring within an anatomical site previously exposed to a therapeutic dose of head and neck radiation therapy. So we have a combined radiographic/clinical approach characterizing the lesion in the context of the patient having received previously a therapeutic dose of head/neck radiation therapy. We do recommend that clinicians evaluate ORN based on the most contemporary staging system, the ClinRad system, which is cited in the publication itself. We also advocate for the use of the ClinRad staging system not only in clinical assessment of patients, but also in clinical trials moving forward. We'll touch a little bit later on future research opportunities as well.  Finally, the initial evaluation of ORN should include a clinical intraoral examination, and again, the appearance of exposed bone may be extremely subtle, and/or a formal radiographic examination. The guideline delineates the various types of radiographic examinations that we recommend.  Brittany Harvey: Understood. Thank you for reviewing those recommendations regarding reporting and characterization of ORN, as well as the workup.   The next section of the guideline, it focuses on best practices to prevent ORN of the head and neck prior to radiation therapy. What are the key recommendations of that section?  Dr. Douglas Peterson: As with other adverse events in oncology patients, prevention is key. Prevention of ORN does require interprofessional management. The guideline lists several key recommendations along these lines. Now, an important caveat in what the guideline presents is that the target coverage of the tumor should not be compromised in order to avoid radiation dose to bone. So that's a very important caveat. Now having said that, focused effort should be made to reduce the mean dose to the jaw and the volume of bone receiving above 50 Gy whenever possible. So it's really a balance between maximizing target coverage of the tumor while limiting exposure to normal bone. In addition, a dental assessment by a dentist and dental specialist, if possible, is strongly advised prior to therapeutic-intent radiation therapy. The purpose of this assessment by the dental team is to identify and remove teeth which will place the patient at risk of developing ORN during the patient's lifetime, and to comprehensively educate the patient about the lifelong risk of ORN. Dental extraction in advance of radiation is often a consideration to these patients, and if clinically indicated, should occur at least two weeks prior to the commencement of radiation therapy. Now having said that, in the setting of a rapidly progressive tumor, extraction should be deferred and not cause delay in the initiation of radiation therapy. Brittany Harvey: So you just touched on key points of prevention prior to radiation therapy. Following those recommendations, what does the expert panel recommend regarding best practices to prevent ORN after radiation therapy? Dr. Douglas Peterson: This can be a challenging clinical issue. So the panel recommends that before finalizing dental treatment plans that may include extractions in patients with a history of head and neck radiation therapy, a review of the radiation therapy plan should be performed with particular attention focused on dose to the mandible and maxilla. For teeth in areas of high-risk for ORN, alternatives to dental extraction may be possible, for example, root canal or endodontic procedures, crowns, or dental restorations, or dental filling should be offered unless the patient has recurrent infections, intractable pain, or other symptoms that cannot be alleviated without extraction. So it really becomes a combined clinical decision making effort between the dental team and oncology team.  One controversial area has been hyperbaric oxygen being administered prior to dental extractions in patients who have received head and neck radiation therapy previously. The panel does not recommend routine use of prophylactic HBO prior to dental extractions in these patients who have received prior head and neck radiation therapy. However, the evidence base here is limited with low quality and we offer a weak strength of recommendation. It is a controversial area, so we did also include a qualifying statement that prophylactic HBO may be offered to patients undergoing invasive dental procedures at oral sites where a substantial volume of the mandible and/or maxilla receive at least 50 Gy. This is an area of controversy. We can talk about this in the future research directions, but clearly, new high quality research related to the role of HBO in the management of these patients is needed.  Brittany Harvey: Definitely. Thank you for touching on those points and that area of controversy. We can definitely touch on that a bit later as we talk about future research in this field.  As you mentioned, Dr. Peterson, this guideline addresses both prevention and management. So, in moving into the management of ORN, how should ORN be managed nonsurgically?  Dr. Douglas Peterson: The guideline relative to nonsurgical management of ORN is focused on the use of pentoxifylline. Now this maybe used in, and this is important, in cancer-free patients with mild, moderate, and severe cases of ORN. But pentoxifylline, the guideline also notes, is most likely to have a beneficial effect if the treatment is combined with tocopherol, antibiotics, and prednisolone as well. So there's clinical judgment involved in the nonsurgical management of ORN, centered with pentoxifylline in combination with tocopherol, antibiotics, and prednisolone. Brittany Harvey: Understood. And then expanding on the management of ORN, what are the key points for surgical management of ORN? Dr. Douglas Peterson: The panel offered several recommendations for which the strength of the recommendations was strong. Just to cite a few, in partial thickness ORN as defined by the ClinRad stage one and two that we talked about earlier, surgical management can start with transoral minor interventions which can lead to resolution over time. It may take time. It may take weeks or even a few months. Now this minimally invasive surgery may include debridement, sequestrectomy, alveolectomy, and/or soft tissue flap closure. Furthermore, small defects, clinically, for example, less than 2.5 cm in length, may heal spontaneously with local topical measures such as we described. It is recommended that larger defects, larger than 2.5 cm, in general be covered with vascularized tissue.  Brittany Harvey: Appreciate you reviewing those recommendations regarding surgical management of ORN. So to wrap up our discussion of the recommendations with the final clinical question, what is recommended for assessment and management of adverse events associated with ORN?  Dr. Douglas Peterson: This is a really important area as well in addition to prevention and management of ORN per se. The panel recommends that patients should be assessed by their healthcare providers for the presence of adverse events at the time of ORN diagnosis and periodically thereafter until the adverse event resolves based on patient status including any interventions or the adverse events that are clinically indicated. The panel and its literature evaluation learned that there is a relative lack of data specifically directed to the management of adverse events associated with ORN. However, this is such an important area that we wanted to address it head on. And so the management we recommend should be informed by pertinent available other guidelines that had been developed for analogous symptoms and/or disease states. The guideline provides links to these companion guidelines developed by ASCO as well as by MASCC and ISOO, the European Society of Medical Oncology, and NCCN. And so in the guideline we provide links on management of adverse events as produced by these other organizations. Table 3 presents a summary of the guidelines that address symptoms and supportive care needs associated with ORN.  Brittany Harvey: Thank you for reviewing all of these recommendations. It's clear that the panel put a lot of work and thought into these recommendations and provided needed guidance in areas with limited evidence. We'll have links available in the show notes for listeners to be able to go and read these recommendations for themselves and refer to the tables that you mentioned.  So in your view, Dr. Peterson, what is the importance of this guideline and how will it impact clinicians and patients with head and neck cancer? Dr. Douglas Peterson: As we talked about throughout this podcast, the guideline is designed to synthesize the contemporary science regarding ORN and translate that into recommendations for clinical practice in both prevention and management. As noted in the guideline, oncologists plus other interprofessional healthcare providers have been directly involved in the creation of the guideline, that interprofessional theme, which we believe is so essential given the mechanistic and clinical complexity of ORN.  Now, in addition to the expertise of the panel, the pending widespread distribution of the guideline represents an additional important opportunity for extending the impact across clinical oncology. So in addition to the publication in the Journal of Clinical Oncology, dissemination by MASCC and ISOO as well as our endorsees, the American Head and Neck Society, the American Society for Radiation Oncology, and the American Academy of Oral Medicine will also be key in broadening the impact and hopefully the utilization of the guideline. And members of these organizations may very well be involved in the management of these patients as well.  And then finally, the guideline is also designed to stimulate future research based on current gaps of the knowledge and we touched on some of those gaps, for example, with HBO for which new high quality research is needed.   Brittany Harvey: Absolutely. It's great to have so many partners in this guideline and we hope that this guideline will have a large impact for patients with head and neck cancer to improve their quality of life.   So then your final comment leads nicely into my last question and that we've already talked a little bit about some of the future research opportunities that this guideline highlights. So, to wrap us up, Dr. Peterson, what are the outstanding questions regarding osteoradionecrosis of the jaw secondary to head and neck radiation therapy in patients with cancer?  Dr. Douglas Peterson: There are several key areas that the panel identified as we went through a rigorous review of the highest quality literature. Some of the key areas to address moving forward include: prospective studies are needed to evaluate the clinical presentation, trajectory, and response to treatment of ORN-related symptoms and function impairment, in other words, the adverse event side of the story. In addition, social determinants of health, quality of life, and psychosocial impact of ORN warrant further investigation in head and neck cancer survivors as well. In addition, new research including randomized controlled trials and prospective multicenter trials regarding the systemic and surgical treatment of ORN is also warranted, and we touched on, for example, hyperbaric oxygen. Hyperbaric oxygen has been a long standing management strategy of ORN. However, the trials to date are of limited quality in relation to supporting its use. So high quality new research related to the role of HBO in these patients is needed.   And the expert panel also encourages creation of predictive tools, a priori tools, directed to development, grading, and staging of ORN. These could include, for example, bone turnover markers and genetic markers to name two. And finally, the research opportunities that are presented in the guidelines such as what I briefly summarized today should ideally be addressed in large prospective multicenter observational studies of risk, outcomes, and financial cost of ORN or the various treatment strategies that are highlighted in the guideline.    Brittany Harvey: Excellent. Well, we'll look forward to research that addresses those outstanding questions and I want to thank you so much for your all your work on this guideline and for taking the time to share the highlights of this guideline with me today, Dr. Peterson.  Dr. Douglas Peterson: Thank you. My privilege to do so, Brittany. Brittany Harvey: And thank you to all our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/head-neck-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app in the Apple App Store or the Google Play Store. If you have enjoyed what you heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

Kidney supportive care (KSC) is palliative care for people with advanced kidney disease. It provides relief of suffering and improves quality of life through early identification, assessment, and management of the symptom burden associated with kidney disease. KSC encompasses advance care planning (ACP)—a key element—in which patients' goals, values, and preferences for present and future […]

Dr. Raymond Chan and Dr. Larissa Nekhlyudov share the newest standards and practice recommendations from MASCC and ASCO on survivorship care for people with advanced or metastatic cancer. They discuss highlights of the standards across seven domains: person-centered care, coordinated and integrated care, evidence-based and comprehensive care, evaluated and communicated care, accessible and equitable care, sustainable and resourced care, and research and data-driven care. Drs. Nekhlyudov and Chan also comment on the impact of these standards for clinicians and for patients with advanced and metastatic cancer and the goal of providing high-quality evidence-base survivorship care for all patients. Read the standards, “Survivorship Care for People Affected by Advanced or Metastatic Cancer: MASCC-ASCO Standards and Practice Recommendations” at www.asco.org/standards. TRANSCRIPT These standards, recommendations, and resources are available at https://asco.org/standards. Read the full text of the standards and review authors' disclosures of potential conflicts of interest in the JCO Oncology Practice, https://ascopubs.org/doi/10.1200/OP.23.00716.  Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts.   My name is Brittany Harvey, and today I'm interviewing Dr. Larissa Nekhlyudov from Brigham and Women's Hospital and Harvard Medical School, and Dr. Raymond Chan from Flinders University, authors on, “Survivorship Care for People Affected by Advanced or Metastatic Cancer: Multinational Association for Supportive Care in Cancer (MASCC) and American Society of Clinical Oncology (ASCO) Standards and Practice Recommendations”. Thank you for being here, Dr. Nekhlyudov and Dr. Chan. Dr. Raymond Chan: Thank you for having us. Dr. Larissa Nekhlyudov: Great to be here. Brittany Harvey: Then, before we discuss these standards, I'd like to note that ASCO takes great care in the development of its guidance products and ensuring that the ASCO conflict of interest policy is followed through each panel. The disclosures of potential conflicts of interest for the expert panel, including the guests on this episode today, are available online with the publication of the standards in the JCO Oncology Practice, which is linked in the show notes.  So then, to dive into the content of the standards and recommendations. First, Dr. Chan, could you provide both an overview of the scope and purpose of these joint MASCC-ASCO standards and practice recommendations? Dr. Raymond Chan: Thank you, Brittany. First of all, as outlined and introduced by yourself, I would like to acknowledge that this is a great collaboration between the Multinational Association for Supportive Care in Cancer and ASCO. And if you may indulge me for a minute, I would like to give you a little bit of background of how this all started. It was in 2019 when I came across an article written by Ms. Terry Langbaum and Dr. Thomas Smith, who wrote a piece in the New England Journal of Medicine outlining the insufficient work and research done to advance care for people with incurable, long-term, metastatic cancer survivorship. And both Terry and Tom were living with metastatic cancer, and with their lived experience, they provided a new level of meaning to our work. And subsequently, in honor of Terry Langbaum, who is a renowned and esteemed hospital administrator who worked in cancer care, Dr. Thomas Smith and myself created the Terry Langbaum Cancer Survivorship Fellowship and appointed Dr. Nicholas Hart to complete this work.   Within this work, we aim to develop international standards and practice recommendations to guide care for people living with treatable but incurable, metastatic, and advanced cancer. In this work, we conducted an extensive systematic review involving 81 studies, 17 guidelines, and framework documents, gathering the wisdom and consensus from 77 experts from 33 countries around the globe. Together, we reached consensus on 45 recommendations that we hope will be helpful for the clinical care community in improving care, experiences, and outcomes for people living with metastatic cancer. Brittany Harvey: Excellent. Thank you for providing this essential background information and describing the impetus for this project.  Then, as you discussed, Dr. Chan, these standards and recommendations have over 45 recommendations within them. So I'd like to review each of those key points from each section. This document provides these standards and practice recommendations across seven domains. So to start with that first domain, Dr. Chan, what are the key points you'd like to highlight regarding person-centered care?  Dr. Raymond Chan: Sure, Brittany. Now, without repeating what is in the document because I hope that this podcast can lead you to that document and for you to read it in detail, it is really around a comprehensive set of principles that experts felt were important to ensure that patients themselves participate in the care as much as possible. It is around respecting their agency and making sure that their clinical and psychosocial care needs associated with their metastatic cancer diagnosis are considered and addressed.  Brittany Harvey: Absolutely. Thank you for providing those key points regarding person-centered care. So, moving into that next section, coordinated and integrative care, what points would you like to highlight there? Dr. Raymond Chan: Thank you, Brittany, for the question. The standards and recommendations within this section are really around articulating the coordination, navigation, and the multidisciplinary care team approach requirements for this population. In particular for people living with metastatic or advanced cancer, it is not a given that they will be able to access survivorship care services or palliative care services. And a lot of the time, we know that care access is around the resource setting. And a lot of the time, palliative care services may not necessarily be able to cover people living with relatively longer prognosis, such as this population, the longer term metastatic and advanced cancer population. Another point is around transition and the shared care arrangement between the oncology team, survivorship care clinicians where available, and the palliative care team. Once again, these recommendations really articulate the importance of a well-coordinated, integrated approach for these patients. Brittany Harvey: Absolutely. Those points that you just highlighted are important for care for the whole patient.  So then, next, Dr. Nekhlyudov, I'd like to turn to you for the next couple of sections. Could you review what the highlights are for the next section: evidence-based and comprehensive care? Dr. Larissa Nekhlyudov: Yes. Thank you, Brittany. This standard emphasizes that people affected by advanced or metastatic cancer receive the most up-to-date, evidence-based, comprehensive, multidisciplinary, and interprofessional survivorship care and receive it in programs that continuously evolve their approach as guided by evidence. So as such, it is important that these survivorship programs are informed by ongoing professional development, including educational programs for healthcare professionals, that also includes active contributions by those affected by advanced or metastatic cancer. The other piece is that people affected by advanced and metastatic cancer should receive comprehensive care that encourages and supports informed decision-making in order to promote health, manage disease, and reduce stress. Brittany Harvey: Definitely, those are very important points regarding care of the patient.  So then, moving into the fourth domain, Dr. Nekhlyudov, what are the key points for evaluated and communicated care? Dr. Larissa Nekhlyudov: So the famous line is, "What can't be measured can't be improved." And so it is important that clinicians routinely and systematically evaluate and monitor supportive care needs and provide appropriate referrals to relevant survivorship care services and healthcare professionals. In order to do that, we need to establish multidirectional communication systems that take into account communication with patients and communication across healthcare professionals involved in their care. Effective communication, of course, needs to be timely, it needs to be clear, effective, respectful, and appropriate. We all know that communication is challenging across cancer care, but it may be particularly so in this specific patient population. For example, in communicating with patients, cancer care clinicians may be comfortable communicating with those with early-stage cancers or patients with early- stage cancers. And may also have had training to communicate with those patients nearing the end of life. But as we already mentioned, those affected by advanced or metastatic cancer may have different needs and as such, it is important that there is additional training for clinicians to address survivorship care needs among these individuals and their caregivers.  And then, in addition to patient-clinician communication, to enable timely communication and collaboration between multiple healthcare providers who may be involved in caring for these patients, enhanced and secure communication strategies are needed. And as with everything else, it's important that healthcare settings engage in service evaluations and quality improvement activities to continue to examine what works, what does not, and make changes that are needed. Brittany Harvey: It is important that these patients with metastatic or advanced cancer have their unique needs met by providing care and appropriate communication to them.  So then, into the next section. Dr. Nekhlyudov, I believe Dr. Chan mentioned this briefly already in talking about being able to access care as part of integrative care. But what is recommended regarding accessible and equitable care? Dr. Larissa Nekhlyudov: Right. Absolutely. I mean, as with any healthcare or cancer care, the standard emphasizes that cancer survivorship care for all people affected by advanced or metastatic cancer is not only comprehensive but also accessible. So affordable, acceptable, available, appropriate, and equitable. And the key is that it does not vary based on someone's personal, cultural, or religious factors. It is important that health workforce diversity and cultural awareness training with the development and provision of culturally and linguistically appropriate resources, that these can help healthcare professionals better understand and cater to the unique needs of the cancer survivor and the caregiver populations. We also need to develop metrics to assess the evaluation  and improvement and make sure that supportive care options are innovative, inclusive, and targeted towards eliminating disparities.  Some of the work that Dr. Chan has otherwise led is looking at provision of telehealth and virtual care for cancer survivors. So particularly for this patient population, it is important to examine the potential benefits of virtual healthcare so that these patients who may have a lot of different needs, physical challenges, mental health challenges, caregivers, that we don't necessarily bring them to the healthcare setting and can potentially provide them the care that they need. And the last thing that I would like to point out with respect to this is that people affected by advanced or metastatic cancer may face additional challenges particularly returning to work in some capacity and should be supported by advocacy groups, or consumer groups as they are often called internationally, that advocate for accessible and equitable care and then work with specific personnel to access employment, financial and legal assistance that they may need.  Brittany Harvey: Those are important for providing both inclusive and individualized care to every patient who a clinician may see.  So then following those points, what is recommended and what are the key points you'd like to highlight regarding sustainable and resourced care? Dr. Larissa Nekhlyudov: Thanks, Brittany. This is a really important point, and not to take away from any of the other standards, but in order for us to provide ongoing high quality cancer survivorship care for people affected by advanced and metastatic cancer, we need to have a sustainable and adequately resourced approach to do so. So, these standards acknowledge that not all countries or healthcare systems have access to sufficient resources. As such, supportive care may need to utilize a step-care or resource stratified approach that offers the least resource-intensive care that aligns with the needs of the patient, but then also takes into account resources that are available, but really the care should not stop there.  Survivorship care interventions and models of care should be cost-effective yet clinically relevant and meaningful and need to have the adequate financial investment by the healthcare systems. So healthcare settings providing survivorship care for those affected by advanced and metastatic cancer have to be properly resourced in order to provide high quality ongoing care. And this includes intentional planning for support services, and  where healthcare settings provide these programs with adequate level of human resources, equipment, facilities, and leadership who value support, facilitate, and appropriately invest in such care. And as we mentioned before, it's always important to continue to evaluate what is being provided, what is being offered, sort of what are the return on investment metrics in order to continue to evolve the programs to serve the needs of the population.  Brittany Harvey: Understood. I appreciate you providing highlights across these past couple of domains. So then to turn to the last domain, Dr. Chan, what is recommended regarding research and data-driven care? Dr. Raymond Chan: So the panel actively advocated for cancer registries to enable population-wide surveillance of the incidence and prevalence of people with advanced or metastatic cancer. Knowing the number of people with advanced or metastatic cancer is extremely important for care planning. We also advocated for the active involvement of people affected by advanced or metastatic cancer to participate in the co-design of research so that we can make sure that our research better meets the needs or end-users and enhance the rigor, relevance, reach, and impact of survivorship research.  The last point I would like to highlight is that a number of survivorship trials out there only limit the population or the focus of the trial being on early stage disease, people treated with curative intent. And within this standards and principles, we advocated for research trials to explicitly include people affected by advanced or metastatic cancer in the clinical trials and trying to address also the barriers that impede people from enrolling or participating at all levels.  Brittany Harvey: Thank you both for reviewing these key points, standards, and practice recommendations across these seven domains.   These standards and recommendations cut really across all aspects of care for people impacted by advanced and metastatic cancer. Dr. Nekhlyudov, in your view, what is the importance of these standards and how they will impact clinicians? Dr. Larissa Nekhlyudov: Thank you for that question, Brittany. The MASCC-ASCO standards were developed, as we already mentioned, to promote the provision of high-quality, evidence-based survivorship care for people with advanced or metastatic cancer emphasizing the need for care that is person-centered, coordinated and integrated, evidence-based and comprehensive, evaluated, and communicated, accessible and equitable, sustainable and resourced, as well as research and data-driven. For clinicians, these standards and practice recommendations provide a critical resource in order to facilitate tailored and effective care for people living with advanced or metastatic cancer across disciplines and settings.  As we know, and much of it is due to the efforts of ASCO, cancer care is always changing resulting in changing prognoses. As such, people diagnosed with cancer in the past that had poor prognosis are now living and are living longer. And so diagnoses that fall into this specific category of patients that we're discussing here today will continue to evolve. And likewise, advanced cancer is less clearly defined for other cancer such as hematologic or CNS malignancies, but these survivors may face similar issues and challenges.   So overall, applying these standards will help provide survivorship care to these patients. And the important piece is that what we hoped to achieve with these standards is that when we consider survivorship care, we are not only applying it to those who have early stage disease. We're not applying it only to those whose disease has been “cured.” We're not applying it to those who have been deemed disease-free or those who have completed treatments. We really need to make sure that clinicians understand the challenges experienced by often disregarded or forgotten population of cancer survivors and yet acknowledge the ever changing landscape of cancer survivors and appropriately apply these survivorship standards for people affected by advanced or metastatic cancer. And I think as Ray would probably say as well, we should focus on including rather than excluding people with cancer, all cancers, from survivorship services and programs.  Brittany Harvey: Definitely. This is an important population with often unrecognized or unmet needs, and the goal of these standards, as you've mentioned, is to provide a better quality survivorship care for patients with advanced and metastatic cancer.   So that leads nicely into my final question for you, Dr. Chan. In your view, how do these standards and recommendations impact people affected by advanced or metastatic cancer? Dr. Raymond Chan: As we continue to promulgate these standards of recommendations, I believe that patients will benefit from these standards in three ways.  First, as clinicians, researchers, and service planners continue to improve care as per outlining the standards, patients are going to indirectly benefit from it. It is meant to lead to better care, better experiences, and better outcomes.  Secondly, it is around the expectations of care. Many of us here would know that if we don't expect that care, it is unlikely that we would go and try to access it. And so it is extremely important that patients know what to expect. So now that I have been diagnosed with advanced or metastatic cancer, what does good care look like? So in the past, there are a number of pallaiative care standards whereby people are thinking, “Do I need palliative care? What does good palliative care look like?” Their set of standards. And now, these standards would enable patients to develop that expectation around what good care looks like.  Thirdly is around the patients, the family units, and their navigators or their care networks to advocate for themselves, to advocate for the patient, to be able to access that care from the care team. So we hope that as we continue to promulgate these standards, that benefit would be translated into the real world for people affected by advanced or metastatic cancer. Brittany Harvey: Excellent. We definitely hope that this improves care for all patients impacted by advanced and metastatic cancer.   So, I want to thank you both so much for this important work to develop these recommendations and standards. And thank you for taking the time to speak with me today, Dr. Nekhlyudov and Dr. Chan.   Dr. Larissa Nekhlyudov: Thank you. Great to be here.   Dr. Raymond Chan: Thank you.   Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full standards and practice recommendations, go to www.asco.org/standards. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.  The purpose of this podcast is to educate and 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, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

Michael McGilvary and Ali Fenno sit down with Brooke and Tim in the studio to dish out all the details about Trellis Supportive Care's 12th Annual Kentucky Derby Party on May 4th. Listen to find out more about what Trellis has to offer the Triad community, information about the upcoming event's silent auction, bowtie contest, and live music, and how to buy tickets and get involved. Find Trellis Supportive Care online and on social media: Website: www.trellissupport.org Buy tickets online: https://trellisderbyparty.org/ Instagram: @trellissupport

Wellness House of Annapolis welcomes triage nurse Liz Hutchison, Quality Manager and Project Coordinator at Maryland Oncology Hematology, who talks about ‘National Healthcare Decisions Day‘, promoting establishing an individual's ‘advance directives', or guidelines for treatment, in the case of an injury or illness leaving that person unable to make care decisions.

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this Meaningful Conversations podcast, Dr. Karan Jatwani talks to Dr. Amy Case about what people with cancer should know about hospice care, including the difference between palliative and supportive care and hospice care, who is eligible to enroll in hospice care, and the types of support available for people receiving hospice care and their family and caregivers. Meaningful Conversations is a Cancer.Net blog and podcast series that describes the important discussions people may need to have with their providers, caregivers, and loved ones during cancer and offers ways to help navigate these conversations. Dr. Jatwani is a Medical Oncology Fellow at Roswell Park Comprehensive Cancer Center. Dr. Case is the Lee Foundation Endowed Chair of the Department of Palliative and Supportive Care at Roswell Park Comprehensive Cancer Center, and Professor of Medicine at the Jacobs School of Medicine and Biomedical Sciences of the University at Buffalo. View disclosures for Dr. Jatwani and Dr. Case at Cancer.Net. Dr. Jatwani: Hi, everyone. My name is Karan Jatwani. I'm one of the 3-year fellows at Roswell Park Comprehensive Cancer Center. I have finished my palliative care fellowship from Memorial Sloan Kettering Cancer Center. And I am interested in the integration of oncology as well as palliative care, and that is where I envision my future career to be. And it's my pleasure to be involved in a podcast with Cancer.Net and looking forward to it. Dr. Case: Hello. My name is Amy Case, and I'm the chair of the Department of Supportive and Palliative Care here at Roswell Park Comprehensive Cancer Center, and we're in Buffalo, New York. So I appreciate being invited to speak today. And we also have a fellowship that we run here and a pretty comprehensive department with 8 divisions that include palliative, social work, psychiatry, psychology, spiritual care, bioethics, and geriatrics, and also employee resilience. So we have a lot of kind of passion projects we work on in our supportive care department. Dr. Jatwani: Thank you so much, Dr. Case, for joining us today. I think I've always admired your work. And just to start off, just for our listeners and our audience, if you can just give us a brief idea of what palliative care is, I think that would be the best segue to enhance the discussion. Dr. Jatwani: So “to palliate” means to make feel better. And when I talk to patients about what it is that we do, I talk about how we take care of the whole person, which includes the physical symptom management, the emotional support, which could include psychiatry, psychology, or social work support of the emotional piece. And then also the spiritual support, which often we work as a team. In order to be palliative care, you actually need to be a team. It can't just be one physician, for example, doing palliative. You need to work as a team. So generally, a core team consists of a physician, a nurse, a chaplain, a spiritual care professional, and a social worker at its core. But sometimes it can be a nurse practitioner providing that or other specialists helping on that team. Dr. Jatwani: I think one of the key questions that always arise with the patients is, as soon as you talk about palliative care, patients start equating it to death. How do you make sure that the patients you're interacting with, how do you differentiate it with them, and how do you relieve that anxiety whenever the patient hears “palliative care”? Dr. Case: So no matter what you call the work that we do, there will always be a stigma. So if we change the name to yellow banana, people would be afraid of yellow bananas, right? So I think that the word hospice has-- I joke that it's kind of like a 4-letter word type of situation. We call it “the H word.” Sometimes patients are really fearful to hear that word. And even now, palliative has adopted this stigma. So generally, what I do is I kind of say that it's focused on quality of life. The main goal is to help people feel better, live a better quality of life, to get through their cancer treatments. And I also educate them that people who receive palliative care tend to have better outcomes. Patient-reported outcome metrics are better. So patients often have a prolonged survival. They may be able to tolerate their cancer treatment better and get through those treatments. And that generally, I would say, is something that they're happy to hear. That's something that they're usually, "Yeah, sign me up for that." When we start with somebody-- we spend an hour with every patient for a new visit. When I start with them, they're really skeptical. Oftentimes, they're looking at me mistrustfully, like, "What is this?" And by the end of the visit, they say, "Where has this been from the beginning of my cancer journey? And why am I only getting this now? This was the best interaction I've had at this organization." And it's because we give them kind of what we call a “wrap-around care,” which is almost like a big hug. We use a lot of skills that include empathy. And with our communication, we often spend a lot of time listening. And I think people really walk out feeling heard. Even if you can't solve it or cure it, you can discuss things that can just make them feel that you were there for them and you listened. And that is very powerful. Dr. Jatwani: I 100% agree. I mean, that has been my sort of experience as well during my fellowship. I took a lot of those learnings with me when I see my patients. But also, I think coming from an oncology standpoint, I can definitely now understand that I have been at fault when I have not given that palliative blanket that you were talking about at different times. And so my question is, when can patients ask for palliative care? And we'll discuss “the H word,” as you mentioned at the beginning. So we'll discuss with that as well. But when should patients undergoing cancer treatment, when should they ask for involvement of palliative care, or they should advocate for themselves or even the caregivers should advocate? Dr. Case: Yeah. So I think that generally, palliative care, the beauty of palliative care is that it doesn't really have a time limit. Someone can ask for it anytime. And often, we encourage people right from the beginning. So there's people who may be looking for that extra added support right from the beginning. And so we usually encourage oncologists and the oncology teams to start those discussions themselves. Dr. Jatwani: And I think at this point of time, I would like to definitely ask you. I think you mentioned “the H word” in the beginning. So can we discuss a little bit more about what is hospice care? Dr. Case: So palliative care is provided on a trajectory. So it can be provided anytime, even for survivors, for people who are earlier in their diagnosis. But hospice has a timeline on it because it's actually a Medicare benefit that it's like almost like an insurance benefit that kicks in, but the government pays for the patient's care. And so in order to enroll or sign up for hospice, a patient has to have certain criteria in order to meet that. In order to get those things paid for. And so hospices have to—generally, it's when a patient has a life expectancy of 6 months or less, and they have decided that the cancer treatment, meaning chemotherapy, radiation in most cases, immunotherapy, the burden of that is higher than the benefit. Most of the patients who see us in palliative are still getting their cancer treatment, and we're helping them walk the journey with them through their treatment, helping them feel better, starting those conversations. And then we do something called a transition to hospice. So many of the patients we see in palliative end up transitioning to hospice. How is palliative care different than hospice? How is hospice different than palliative care? They're very similar. The philosophy of care and the way it's provided is almost exact, meaning that it's a team-based approach made up of physical, emotional, and spiritual support for the patient provided by a team. Although in palliative care, many times that's done in a clinic or an inpatient setting. There are home palliative programs that exist. We have one here at Roswell as well. But hospice, 80% of the time, is done at home. Because generally, when people prefer to pass away and we talk to them, where do they want to be at the end of their life? I'd say 95% of people do want to be at home if that's feasible. The biggest barrier that they are worried about dying at home is that they worry about being a burden on their loved ones. And so that's the way I frame those discussions, is that I ask them about what are the things that they're hoping for. What are the things that they're worried about? And when I find out, inevitably, like I said, it's probably the number 1 fear of people to be a burden on their loved ones. It's this wonderful thing that can reduce burden on family to help care for you and have you be at peace in the place that you wish to be. Dr. Jatwani: I 100% agree. I think you framed it perfectly that if the discussions-- I think, as you said, they should happen at the right time point. And the other thing is I think they should happen often. They should not happen only once. They should happen at every juncture of time when the cancer care has sort of transitioned into going into the more risk and less benefit window. And that's a spectrum, as you mentioned. It does not have to happen only once, and the provider feels, “OK, I've done that discussion. Now I don't have to do it again.” Dr. Case: It's a journey. Dr. Jatwani: It's a journey, yes. Dr. Case: I think we always talk about a journey and that advanced care planning does not happen, excuse me, just once in the trajectory. It happens over multiple time points. And I call it “loosening the lid,” where the lid is often on really tight. There's maybe often mistrust of the health care system. People are really scared. And you really need to give them that emotional support. And that's why palliative is so beautiful because we provide them that wrap-around hug when they're feeling at their most vulnerable. And then when they have comfort with us, then it's much easier to discuss these really tough topics. And I think establishing rapport, getting to know them as a human being and who they are is extremely important. So, for example, my style is to start any medical visit with a social interaction and asking them about themselves socially. I say, “Let's put the cancer aside. I want you to tell me about you. Tell me about your family. Tell me about the things that you enjoy doing for fun.” And they often laugh because they want to talk just about the cancer, right? They say, “I don't have fun anymore.” And then I try to ask them about the things they did before they had cancer. And you see them light up, and you see the rapport being built, and you see the trust. And once you have those types of relationships, these discussions become much easier. Dr. Jatwani: I agree. So just to transition a little bit more about hospice care, I think you talked about that this hospice care is a Medicare benefit. Can you tell our audience, is it only at home or is it available inpatient as well? And can you speak a little bit about that? Dr. Case:  Sure. So I mentioned before that generally, the majority of hospice care is preferred to be in the home, and really taking care of someone at the end of life actually can be less scary when you have the support of hospice. And so anyone who's in the hospital where a discussion is had and then advanced care planning is done, and they say, “You know what? I don't want to end up being on a ventilator. I'm going to elect to be a, “do not resuscitate or allow natural death.'" If that happens, I actually think it's almost imperative for hospice to also be consulted and offered. Because if you send someone home that is a “do not resuscitate” without those family support in place, the family will struggle. And so I think that it goes hand in hand. So dying at home goes hand in hand with having hospice in place. End of story. You need to have those supports in place. I do not think it will work out well for the family if you do not. And so there are rare circumstances where some physicians provide that support or home palliative can provide that support. But hospice really is the gold standard. So I'd say most of it is in the home. But once someone enrolls in hospice, there is caveats where if a patient is having uncontrolled symptoms that are not managed by the nurses in the home and the physicians by phone or by home visit, that the patient may be able to be brought in to an inpatient hospice unit or a hospital. They can unelect—to come off of, or unenroll—in hospice. For example, they change their mind. They decide, oh, they fall they break a hip, OK? And hospice is not going to fund a non-cancer-related hip fracture repair. So they would have to unenroll from that Medicare benefit, hospice Medicare benefit, and enroll in a different part of their insurance. And it's very easy to enroll and unenroll. And so there are different parts of that Medicare benefit that pay for different things. And so if somebody gets a hip fracture, it doesn't mean they have to not have it repaired. I mean, so you adjust and unenroll them from hospice, get the hip repaired, and then enroll them back in the hospice. And so those types of things can totally be done. It doesn't mean the patient can never come back to the hospital. It doesn't mean they can't change their mind. It doesn't mean that if, say, they get pneumonia, that they can't have their pneumonia treated. So simple infections, like Clostridium difficile (C. diff), pneumonia, the hospice actually gives antibiotics. They manage a lot of medical treatments like anticoagulation and things like that. So there are, depending on the hospice, leeway with some of those medical treatments. For example, total parenteral nutrition (TPN), percutaneous endoscopic gastrostomy (PEG) tubes, some of those things can be managed in hospice. However, if a PEG tube or a TPN is causing more burden, they will continue to have those discussions about, is this treatment in the best interest of comfort and quality of life? And so that's generally the philosophy of care. And so, yes, they can be inpatient. There can be coming back to the hospital. And there are hospice inpatient units kind of all over the country. Some cities may not have hospice inpatient units, and they have other things like something called a “comfort home,” where comfort homes are depending on the area, the region that you live. Comfort homes exist in some cities where they're run by volunteers, and a patient may not be able to be at home, but they can go to a comfort home. Sometimes hospice can be provided in an assisted living where a patient's home is actually not home, it's in a facility or it can be provided in a nursing home. However, I think there's a misperception that hospice pays for the room and board of those places, and that is actually not true. So if someone needs a facility to live, then the family or the patient is on the hook, unfortunately, for the room and board. And so a lot of times, that delays discharge. So, for example, family does not want to take that patient home. They are not able to do that. The patient then needs a facility with hospice. The assumption is the hospice will pick up the bill of the facility. So that does not happen. But hospice covers all of the costs related to the care of the patient that's related to their hospice diagnosis. Dr. Jatwani: For patients who are living alone, who are in the elderly population, who are undergoing cancer-directed treatments, for those patients, is hospice an option? If it is, because that is always a challenging area that we face, how do you deal with those patients? Dr. Case: That's very challenging. Generally, we would call on social work and some of those specialties to help us figure out a support care network for that patient. And so often, you can actually recruit folks to take shifts coming in and checking on that patient. And so, yes, you can have hospice care for a patient who has a care-- generally, you need to have a caregiver who is around for that patient. Ideally, in an ideal world, there's somebody with that patient 24/7 when the patient is really ill. If the patient is pretty functional and they're on hospice, walking around, there may be some hours out of the day where they may not need someone with them. And really, we kind of determine that on a case-by-case basis. I would say it's not a door-shut situation that if someone lives alone, they could never have hospice. I would not say that. But in an ideal world, we do need to recruit someone to be there with the patient. If someone has absolutely no one to be there with them during hours during the day, which I think is pretty rare, then generally, if the person is too ill to stay home alone, it'll be a conversation that you have with that patient that they may be moved to a higher level of care, meaning that they may need a skilled nursing facility with hospice on board coming in and checking on them. That's their new home, or they may need an assisted living. And there are some facilities that provide their own hospice, meaning that if you go to that facility, they have a team that's built into that facility that provides them the end-of-life care at the facility, and they don't allow in external hospices. So it kind of depends on your area where you're practicing and asking those questions as, "Do you have an external hospice or do you provide hospice services internally?" And those are questions I often steer patients to ask. Dr. Jatwani: Just some parting thoughts on in terms of, as you said, hospice has a very selective criteria. And some patients might say, "How can you prognosticate me for living less than 6 months?" That's a challenging question that we often get. And I think you have answered it partly, that it's enroll “on and off switch” kind of situation. But what if a patient starts feeling much, much better on hospice and they feel that they want to come back and get cancer-directed treatment, how does palliative care and hospice care come into that domain? Dr. Case: Prognostication, when a physician is asked to prognosticate a patient, we call it “the art of prognostication” because you can't always look it up in a textbook and get the right answer. And what one physician may determine is a prognosis for a patient, another one may give a different one. Because we look at the same things, but a lot of times, there's a clinician estimate that comes into it that is really one of those, you put a bunch of facts together and you come up with what we call an estimate. And so sometimes, we may be correct. Sometimes, we may underestimate or we may overestimate. If a patient enrolls in hospice and they, for example, are doing a lot better, they're outliving the 6 months, the hospice programs often reevaluate those patients, and they do allow folks to stay enrolled with hospice care sometimes quite longer than the 6 months. Sometimes, people are on hospice a year or even longer. What they need to document is that the patient has an ongoing need where they need the multi-disciplinary team supportive care. And so as long as you meet certain criteria, and generally, the criteria are often that they have the continuing progression of the cancer or whatever the other medical illness is, the disease itself, and advancing illness, whether that be chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF). It doesn't have to just be cancer. And you need to also have often a documentation of potentially continued functional decline or functional impairment. So prognosis is tied hand in hand with functional status. And so we don't just look at the computed tomography (CT) scan when we're determining prognosis. We look at nutritional. We look at weight loss. We look at appetite. We look at functional status and comorbidities. And there's a lot of other things that go into that, not just, “Is the tumor growing on the scan, yes or no?” So it's really important to look at a wide array of things when we're determining prognosis. Dr. Jatwani: Yes. And I think that sort of I just wanted to give our patients some idea of how we determine. I know there are a lot, many things that we have not covered, and we haven't even touched the expertise of Dr. Case, which we hope to do that in the future. And from my end, these are the questions that I had. And we hope to reconnect soon Dr. Case, and get some more insights into other aspects of palliative care, which you have done a lot of wonderful work in. Dr. Case: Thanks, Dr. Jatwani. ASCO: Thank you, Dr. Jatwani and Dr. Case. Find more podcasts and blog posts in the Meaningful Conversations series at www.cancer.net/meaningfulconversations. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative and Supportive Care, Affordable Housing - Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service and the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

Your care team is crucial to being in the driver's seat of your pregnancy and postpartum journey and having the experience that you want. As a first time mom, I definitely felt like I was "swept in" to the healthcare mix and didn't think to get additional support with things like labor prep, breastfeeding, baby sleep, and more. In this episode, I'm speaking with Dr. Carly Buxton — a Lactation Counselor, Postpartum Doula and the CEO/Co-Founder of Nessle, your parenting co-pilot. She shares important questions to ask your provider, what to consider as you build your care team, and how to identify what support you might benefit from most. I truly wish I had listened to this episode prior to my first baby and cannot wait for you to listen in! Learn More Nessle Website: www.nessle.com Nessle Instagram: www.instagram.com/nessletogether Let's Connect! Work with me! ⁠Learn more about fitness coaching Get FREE monthly pre/postnatal resources > ⁠Become a Strong Mama Insider!⁠ Connect with me on Instagram! ⁠@strongmamawellness⁠ Learn more about my work on the ⁠website⁠

Your care team is crucial to being in the driver's seat of your pregnancy and postpartum journey and having the experience that you want. As a first time mom, I definitely felt like I was "swept in" to the healthcare mix and didn't think to get additional support with things like labor prep, breastfeeding, baby sleep, and more. In this episode, I'm speaking with Dr. Carly Buxton — a Lactation Counselor, Postpartum Doula and the CEO/Co-Founder of Nessle, your parenting co-pilot. She shares important questions to ask your provider, what to consider as you build your care team, and how to identify what support you might benefit from most. I truly wish I had listened to this episode prior to my first baby and cannot wait for you to listen in! Learn More Nessle Website: www.nessle.com Nessle Instagram: www.instagram.com/nessletogether Let's Connect! Work with me! ⁠Learn more about fitness coaching Get FREE monthly pre/postnatal resources > ⁠Become a Strong Mama Insider!⁠ Connect with me on Instagram! ⁠@strongmamawellness⁠ Learn more about my work on the ⁠website⁠

“I think educating patients of what can happen and those are the symptoms you're really looking for to decrease this from getting to the severe level is like the sensory stuff. It's kind of your starting point and it progresses from there,” Colleen Erb, MSN, CRNP, ACNP-BC, AOCNP®, hematology and oncology nurse practitioner at Jefferson Health Asplundh Cancer Pavilion in Willow Grove, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about what nurses need to know about cancer- and treatment-related peripheral neuropathy. This episode is part of a series on cancer symptom management basics; the rest are linked below.  You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.   Music Credit: “Fireflies and Stardust” by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD), which may be applied to the symptom management, palliative care, and supportive care ILNA categories, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by December 15, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning outcome: The learner will report an increase in knowledge related to peripheral neuropathy.  Episode Notes  Complete this evaluation for free NCPD.   Oncology Nursing Podcast Cancer Symptom Management Basics series  Clinical Journal of Oncology Nursing articles: Balance and Gait Impairment: Sensor-Based Assessment for Patients With Peripheral Neuropathy  Chemotherapy-Induced Peripheral Neuropathy: Use of an Electronic Care Planning System to Improve Adherence to Recommended Assessment and Management Practices Instruments for Assessing Chemotherapy-Induced Peripheral Neuropathy: A Review of the Literature Extremity Cooling: A Synthesis of Cryotherapy Interventions to Reduce Peripheral Neuropathy and Nail Changes From Taxane-Based Chemotherapy  Oncology Nursing Forum article: Chemotherapy-Induced Peripheral Neuropathy Assessment Tools: A Systematic Review  ONS Symptom Interventions and Guidelines™: Peripheral Neuropathy  American Cancer Society's patient information for peripheral neuropathy  American Society of Clinical Oncology (ASCO) Guideline: Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers  Multinational Association of Supportive Care in Cancer (MASCC): Neurological Complications  Overview of nursing skills for routine neurologic assessments   To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.  Highlights From Today's Episode  “Our nervous system is sort of divided into three parts. The autonomic nervous system, which is kind of controlled homeostasis, blood pressure, your intestinal motility, things like that. The motor system, which is the efferent system, which is reflexes, muscle strength, sort of your big muscle movements, if you want to think of it that way. And then the sensory system, which is the afferent system, which is really what defines motion.” TS 1:51  “I think patients tend to blow off the mild numbness and tingling because they're just like, ‘Oh, it's just the side effect of my chemo' and they don't realize that that can get progressively worse. So, they tend to not tell you, you know, ‘Oh do you have numbness and tingling? Yeah, I get it every visit.' But they're like, ‘No, no, it's fine. It's just once in a while,' and all of a sudden, two months down the line, they come in and they can't walk as well.” TS 6:53  “Some other disease-related comorbidities, things like diabetes, thyroid disease, there's nutritional deficiencies—like vitamin B is a big one. We tend to check B12, but B1, which is thiamin, can also cause this. Other things like inherited neurologic disease, toxin exposures like alcohol and people with alcohol dependance, infections like HIV and herpes or shingles as we all know it. Cardiac disease, which, you know, peripheral vascular particularly, but other cardiac diseases can do it too. And then medications that people have been on forever, you know, there's a list of like the highly likely ones, things like amiodarone, aminoglycosides, colchicine, hydralazine, metronidazole, linezolid, and statins can actually cause a preexisting peripheral neuropathy or make you more likely to develop it in the duration of your cancer treatment.” TS 9:38  “I think the most important thing for any patient, but specifically when you're looking for peripheral neuropathy is a really good history and review of systems like other medications, any supplements, any comorbidities, any underlying diseases that they may not be treated for yet, or things like that. But a good history can really go a long way in finding out sort of your risk factors.” TS 11:55  “I think nurses knowing how to do a basic neuro exam, you know, we all learn this. But do we actually do it all the time? Probably not. But I think really knowing how to like, you know, can they feel a light touch or a pinprick, test their muscle strength, watch them walk down the hallway and see if it changes over time? Like are they starting to sway a little bit when they walk? Can they get out of the chair without pushing on the handle and using their arms to get up? Things like that really can tell you a lot.” TS 13:36  “Sadly, there's really nothing proven to prevent the development of neuropathy. You know, we know that you can't really catch it before people start having symptoms. Unfortunately, it's really when you start to detect symptoms that you can prevent it from getting to the severe point where it's really impacting their quality of life. And I think the biggest thing is proactive assessment and diagnosing it when it's early and being able to kind of intervene before it gets to the point of debilitating.” TS 16:52  “It can really happen to anyone at any time. And generally, with any drug, not just those ones that it's the tough side effect; it really can affect any drugs. So, assessment is kind of key for everyone.” TS 27:06 

Kimberson Tanco gives us his insights on medical cannabis and cannabinoids in supportive care and symptom management.

During this episode of The Parkinson's Podcast, panelists from our Living with Parkinson's meetup discussed fear and Parkinson's. They talked about the difference between shame, guilt, and embarrassment, and they shared the various ways shame shows up for them. Again, this panel doesn't hold back, and we're so fortunate to have them tell the hard truth and share their journeys with all of us. In this episode, topics discussed include: Feeling a loss of relevance Shame when I was diagnosed Shame around impulse control Side-effects of medications and shame Importance of community to overcome shame and more! We hope you enjoy! Want to read the article associated with this podcast? Check it out on our website! Want to watch the video version of this podcast? You can watch it on our YouTube! Loving the Parkinson's Podcast? You can listen to more episodes on our website! Want to come to the next Living with Parkinson's Meetup? Join us on the third Thursday of every month at 1 pm MDT by registering here.

Forsyth Magazines Podcast veteran Ann Gauthreaux visits Brooke and Tim for a second time to tell all about why Trellis Supportive Care changed its name and how Trellis staff members go above and beyond for their patients. Ann explains how this holiday season is a perfect time to have difficult conversations about hospice care, along with how to learn more about volunteer opportunities available at Trellis. Find Trellis Supportive Care online and on social media: Website: www.trellissupport.org Instagram: @trellissupport Phone: (336) 768-3972