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die"},{"term":"rebecca"},{"term":"recap"},{"term":"reconciliation"},{"term":"reddy"},{"term":"referrals"},{"term":"reframing"},{"term":"rehabilitation"},{"term":"remke"},{"term":"reproduction"},{"term":"request"},{"term":"resolve"},{"term":"resource"},{"term":"respirator"},{"term":"restlessness"},{"term":"rich"},{"term":"riley"},{"term":"ritz"},{"term":"room"},{"term":"rossmassler"},{"term":"rotella"},{"term":"rousseau"},{"term":"rural"},{"term":"sachs"},{"term":"sager"},{"term":"schenker"},{"term":"scrambler"},{"term":"secretions"},{"term":"secrets"},{"term":"senna"},{"term":"sexuality"},{"term":"shin"},{"term":"sincliar"},{"term":"sivendran"},{"term":"sparacio"},{"term":"sports"},{"term":"spouse"},{"term":"state"},{"term":"statin"},{"term":"statte"},{"term":"steinberg"},{"term":"stepfamily"},{"term":"steroids"},{"term":"strang"},{"term":"student"},{"term":"supervision"},{"term":"survivorship"},{"term":"systems theory"},{"term":"tappana"},{"term":"tarbi"},{"term":"taylor"},{"term":"tea"},{"term":"telehealth"},{"term":"theatre"},{"term":"thienprayoon"},{"term":"thurston"},{"term":"time"},{"term":"tinianov"},{"term":"toomey"},{"term":"transdisciplinary"},{"term":"transgender"},{"term":"transition"},{"term":"trapasso"},{"term":"trauma"},{"term":"triangulation"},{"term":"tribute"},{"term":"trust"},{"term":"twiter"},{"term":"uncertainty"},{"term":"unconscious"},{"term":"universe"},{"term":"upstairs"},{"term":"urology"},{"term":"van Meines"},{"term":"van mienes"},{"term":"vandekieft"},{"term":"veteran"},{"term":"video"},{"term":"volunteering"},{"term":"warraich"},{"term":"washington"},{"term":"weakness"},{"term":"webinar"},{"term":"whitburn"},{"term":"wollesen"},{"term":"young"},{"term":"young adult"},{"term":"zitter"}],"title":{"type":"text","$t":"Pallimed"},"subtitle":{"type":"html","$t":"Pallimed covers current palliative medicine, hospice, and end-of-life research and news, with a particular focus on publications not from the major palliative care journals.  It is aimed at health care professionals who work with people nearing the end of life."},"link":[{"rel":"http://schemas.google.com/g/2005#feed","type":"application/atom+xml","href":"https:\/\/www.pallimed.org\/feeds\/posts\/default"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/-\/non-pain+symptoms?alt=json-in-script\u0026max-results=6"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/search\/label\/non-pain%20symptoms"},{"rel":"hub","href":"http://pubsubhubbub.appspot.com/"},{"rel":"next","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/-\/non-pain+symptoms\/-\/non-pain+symptoms?alt=json-in-script\u0026start-index=7\u0026max-results=6"}],"author":[{"name":{"$t":"Drew Rosielle MD"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/04345646798042773615"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"32","height":"32","src":"\/\/3.bp.blogspot.com\/-sdxTTBPb3Kw\/UddApiGn9-I\/AAAAAAAABLE\/mriu5xh44dA\/s113\/ea37b7645cd78e7867d246cd755bc8d4.jpeg"}}],"generator":{"version":"7.00","uri":"http://www.blogger.com","$t":"Blogger"},"openSearch$totalResults":{"$t":"82"},"openSearch$startIndex":{"$t":"1"},"openSearch$itemsPerPage":{"$t":"6"},"entry":[{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-950467589203708657"},"published":{"$t":"2017-09-25T14:59:00.003-05:00"},"updated":{"$t":"2017-09-26T09:01:36.727-05:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"ESAS"},{"scheme":"http://www.blogger.com/atom/ns#","term":"non-pain symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"quality"},{"scheme":"http://www.blogger.com/atom/ns#","term":"research"},{"scheme":"http://www.blogger.com/atom/ns#","term":"research issues"},{"scheme":"http://www.blogger.com/atom/ns#","term":"symptoms"}],"title":{"type":"text","$t":"Moving From Research to Implementation to Research in Palliative Care, Part 1"},"content":{"type":"html","$t":"\u003Cdiv class=\"MsoNormal\"\u003Eby Christian Sinclair\u003Cbr \/\u003E\u003Cbr \/\u003EIn 2003, I began my hospice and palliative medicine (HPM) fellowship in Winston-Salem, NC. I was a solo fellow in a new program, and as luck would have it, I had loads of time to dedicate myself to learning. Since my wife, Kelly, was beginning her pediatric emergency medicine fellowship in Kansas City at the same time, I only had my dog and my fellowship to worry about. I always enjoyed reading articles and imagined how it would apply in my own practice. But when it came down to it, I was never really able to implement much of what I was reading, let alone have the numbers to benchmark against the research.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ca href=\"https:\/\/2.bp.blogspot.com\/-SJFRqR1hHc4\/WcleFe4rG0I\/AAAAAAAB5xw\/9Y1GGIlIiyk9XSHGQ40E1p9S1SyLAKZ_gCLcBGAs\/s1600\/No%2Bresearch%2Bwithout%2Baction.No%2Baction%2Bwithout%2Bresearch..png\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" data-original-height=\"800\" data-original-width=\"800\" height=\"320\" src=\"https:\/\/2.bp.blogspot.com\/-SJFRqR1hHc4\/WcleFe4rG0I\/AAAAAAAB5xw\/9Y1GGIlIiyk9XSHGQ40E1p9S1SyLAKZ_gCLcBGAs\/s320\/No%2Bresearch%2Bwithout%2Baction.No%2Baction%2Bwithout%2Bresearch..png\" width=\"320\" \/\u003E\u003C\/a\u003EFast forward to Spring of 2016. With years of experience across multiple care settings, I finally had an opportunity to implement research tools into everyday clinical practice by\u0026nbsp;using the \u003Ca href=\"https:\/\/www.google.com\/url?sa=t\u0026amp;rct=j\u0026amp;q=\u0026amp;esrc=s\u0026amp;source=web\u0026amp;cd=1\u0026amp;cad=rja\u0026amp;uact=8\u0026amp;ved=0ahUKEwjRyM3ZjsHWAhVG2mMKHfqhB48QFggoMAA\u0026amp;url=http%3A%2F%2Fwww.npcrc.org%2Ffiles%2Fnews%2Fedmonton_symptom_assessment_scale.pdf\u0026amp;usg=AFQjCNEdA0dV2iDkUFhI7QD0g5ykDJK4Mw\" target=\"_blank\"\u003EEdmonton Symptom Assessment Scale (ESAS)\u003C\/a\u003E in each visit and tracking how patients do over time. I had used the ESAS in a few visits over the years, but could never seem to use it reliably at every visit with every patient.\u003Cbr \/\u003E\u003Cbr \/\u003EAt KU, we have been using a modified ESAS (with Mild, Moderate Severe) on the inpatient side for a long time, but never the numbers-based ESAS that would be most applicable to research. In practice, my symptom assessments were always driven more by the narrative of the patient, winding indirectly as the patient told their story. I never pressed hard on getting the mild, moderate, severe directly from the patients mouth, but would interpret their story into the scale and document it. Eventually I would get a comprehensive view of symptoms and make a good clinical plan, but I was never going to be able to use that to demonstrate quality nor publish research.\u003Cbr \/\u003E\u003Cbr \/\u003EEven admitting this publicly, has taken me some time to do. I figured that everybody was already getting patient-reported outcomes. Frankly, it feels kind of embarrassing to admit. But as I talked to more people, I realized that other HPM clinicians were also not able to apply tools like the ESAS universally. Sure they might get few numbers or severity scores, but to do that at EVERY visit and for EVERY patient, that takes more than just clinician will. It takes a system-based approach to change. And that is not easy.\u003Cbr \/\u003E\u003Cbr \/\u003ESo in 2016, I talked with the outpatient nurse navigators, Amy and Wendy, and I asked them to help make sure that EVERY patient at EVERY visit was getting an ESAS form and that we were documenting it in the chart. They were both game, which I look back on and count my blessings. In all my previous attempts, when moving from research to implementation that culture change step always worked for a week or two and then regressed to the baseline. Someone gets too busy, or behind and then the standardized thing you are trying to do feels like 'extra work' for no good reason.\u003Cbr \/\u003E\u003Cbr \/\u003ETo help ensure our success, we made it a focus to talk about the ESAS at the beginning of the clinic day, in between patients and a debrief at the end of clinic. At first, our language was probably inelegant as we introduced the ESAS concept. When people rebelled against 'one more form' or 'hating those damn numbers', we initially backed down, but we persisted and it paid off, because we refined our language and we discovered how to overcome the hesitation of our patients. We helped our patients see the ESAS numbers as a demonstration of their voice and experience. After one interesting conversation with a patient, we began to call these numbers 'our palliative care labs' because 'no blood draw is going to tell me that your nausea was awful last night.'\u003Cbr \/\u003E\u003Cbr \/\u003EIt took a while but we also recognized that just 'getting the numbers' was not enough. Going back\u0026nbsp;\u0026nbsp;to get these numbers after the visit was over and the plan was made was showing the patients that the symptoms were not necessarily driving the plan. So we adjusted and worked to make sure the ESAS was one of the first things we discussed with the patient, which in turn became the spine of the visit and therefore drove the plan.\u003Cbr \/\u003E\u003Cbr \/\u003EOnce we began to get consecutive visits with ESAS scores, we were able to show the patients their numbers over time. The feedback was tremendous in demonstrating that we cared about their symptom experience, and as we have become more facile in applying the ESAS we have noticed the objections fall greatly.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ca href=\"https:\/\/2.bp.blogspot.com\/-spMdF_yKSrA\/WcldKfEuhyI\/AAAAAAAB5xs\/fIp8v4qBF4skRD929tPYfw3D4MIWyJzdACLcBGAs\/s1600\/2017%2B%2523hpm%2Bsqaure.png\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" data-original-height=\"800\" data-original-width=\"800\" height=\"320\" src=\"https:\/\/2.bp.blogspot.com\/-spMdF_yKSrA\/WcldKfEuhyI\/AAAAAAAB5xs\/fIp8v4qBF4skRD929tPYfw3D4MIWyJzdACLcBGAs\/s320\/2017%2B%2523hpm%2Bsqaure.png\" width=\"320\" \/\u003E\u003C\/a\u003EAnd now we have lots of ESAS numbers over lots of visits, but (and this is a BIG BUT) they were all buried in the narrative\/free text part of the chart. So we needed to find a way to get this data exported from the Electronic Health Record. I'll share how we did that in part two tomorrow, because when I tried to figure out how to accomplish that, there was no guidance online I found helpful. My hope is that these stories of my clinical transformation from research wanna-be to providing the founding blocks of research and quality improvement may help someone else see that it is possible.\u003Cbr \/\u003E\u003Cbr \/\u003EIf you want to join in the conversation, this Wednesday we will be hosting the September #hpm Tweet Chat on the topic of \"Moving from Research to Implementation to Research in HPM.\" #hpm Tweet Chats are held on the last Wednesday of the month at 9p ET\/6p PT. \u003Ca href=\"http:\/\/www.hpmchat.org\/\" target=\"_blank\"\u003ESign up on hpmchat.org\u003C\/a\u003E to be updated of the monthly topic.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ci\u003EChristian Sinclair, MD, FAAHPM is immediate past president of AAHPM, editor-in-chief of Pallimed and a palliative care doctor at the University of Kansas Health System. If he isn't reading about HPM research, you can find him reading board game rules.\u003C\/i\u003E\u003C\/div\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/950467589203708657"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/950467589203708657"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2017\/09\/moving-from-research-to-implementation.html","title":"Moving From Research to Implementation to Research in Palliative Care, Part 1"}],"author":[{"name":{"$t":"Christian Sinclair"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/14685043408496367587"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"https:\/\/2.bp.blogspot.com\/-SJFRqR1hHc4\/WcleFe4rG0I\/AAAAAAAB5xw\/9Y1GGIlIiyk9XSHGQ40E1p9S1SyLAKZ_gCLcBGAs\/s72-c\/No%2Bresearch%2Bwithout%2Baction.No%2Baction%2Bwithout%2Bresearch..png","height":"72","width":"72"}},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-8959432897081561020"},"published":{"$t":"2017-02-07T15:39:00.000-06:00"},"updated":{"$t":"2017-02-07T15:39:00.850-06:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"ASCO"},{"scheme":"http://www.blogger.com/atom/ns#","term":"guidelines"},{"scheme":"http://www.blogger.com/atom/ns#","term":"non-pain symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"oncology"},{"scheme":"http://www.blogger.com/atom/ns#","term":"sinclair"},{"scheme":"http://www.blogger.com/atom/ns#","term":"symptoms"}],"title":{"type":"text","$t":"ASCO Supports Concurrent Palliative Care for People with Advanced Cancer"},"content":{"type":"html","$t":"\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"https:\/\/4.bp.blogspot.com\/-KWbzgl8iMuc\/WJoiE75Cl0I\/AAAAAAABqaw\/mRsA_tw_TzMrGIkF3ZVOJzsuK_mTJ5XZACLcB\/s1600\/oncologists%2Blike%2Bus.jpg\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" height=\"256\" src=\"https:\/\/4.bp.blogspot.com\/-KWbzgl8iMuc\/WJoiE75Cl0I\/AAAAAAABqaw\/mRsA_tw_TzMrGIkF3ZVOJzsuK_mTJ5XZACLcB\/s320\/oncologists%2Blike%2Bus.jpg\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003Eby Christian Sinclair\u003Cbr \/\u003E\u003Cbr \/\u003EThe \u003Ca href=\"http:\/\/www.asco.org\/\" target=\"_blank\"\u003EAmerican Society of Clinical Oncology\u003C\/a\u003E recently \u003Ca href=\"http:\/\/ascopubs.org\/doi\/abs\/10.1200\/JCO.2016.70.1474\" target=\"_blank\"\u003Epublished the strongest call for concurrent palliative care in oncology\u003C\/a\u003E. Released online on Halloween 2016, and published in the\u003Ca href=\"http:\/\/ascopubs.org\/journal\/jco\" target=\"_blank\"\u003E Journal of Clinical Oncology\u003C\/a\u003E just last month, this Clinical Practice Guideline (CPG) should be in the pocket of every palliative care team as they meet with their oncology colleagues to collaborate on better care for patients.\u003Cbr \/\u003E\u003Cbr \/\u003EThe guideline holds more weight and expands the scope compared to the\u003Ca href=\"http:\/\/ascopubs.org\/doi\/abs\/10.1200\/JCO.2011.38.5161?url_ver=Z39.88-2003\u0026amp;rfr_id=ori:rid:crossref.org\u0026amp;rfr_dat=cr_pub%3dpubmed\" target=\"_blank\"\u003E 2012 Provisional Clinical Opinion\u003C\/a\u003E which emerged after the Temel article. In 2010, \u003Ca href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1000678%E2\" target=\"_blank\"\u003ENEJM published a randomized control trial (RCT) of palliative care in metastatic non-small cell lung cancer (NSCLC).\u003C\/a\u003E Many people (outside of palliative care and within the field) focused on the secondary outcome that palliative care might prolong life. That mania often overshadowed the primary outcome which demonstrated that palliative care provided concurrently could improve the quality of life (QOL) of patients, dispelling the common barrier because oncologists ‘already do this.’ (\u003Ca href=\"http:\/\/www.pallimed.org\/2010\/08\/game-changer-early-palliative-care-for.html\" target=\"_blank\"\u003ESee Lyle Fettig’s excellent analysis here\u003C\/a\u003E.)\u003Cbr \/\u003E\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"https:\/\/2.bp.blogspot.com\/-ZB66eEA8GeE\/WJoknMidNDI\/AAAAAAABqbE\/er0MIwzZEn8VX4W8kdFF-a9tG__prxQOACLcB\/s1600\/Slide1.PNG\" imageanchor=\"1\" style=\"margin-left: 1em; margin-right: 1em;\"\u003E\u003Cimg border=\"0\" height=\"180\" src=\"https:\/\/2.bp.blogspot.com\/-ZB66eEA8GeE\/WJoknMidNDI\/AAAAAAABqbE\/er0MIwzZEn8VX4W8kdFF-a9tG__prxQOACLcB\/s320\/Slide1.PNG\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003Cbr \/\u003E\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"https:\/\/3.bp.blogspot.com\/-p_OJW1gyzQA\/WJoknf-HebI\/AAAAAAABqbI\/PCFqoH_ep-0yxMnSvR9Kc7RFvAgClPnqQCLcB\/s1600\/Slide2%2B-%2BCopy.PNG\" imageanchor=\"1\" style=\"margin-left: 1em; margin-right: 1em;\"\u003E\u003Cimg border=\"0\" height=\"180\" src=\"https:\/\/3.bp.blogspot.com\/-p_OJW1gyzQA\/WJoknf-HebI\/AAAAAAABqbI\/PCFqoH_ep-0yxMnSvR9Kc7RFvAgClPnqQCLcB\/s320\/Slide2%2B-%2BCopy.PNG\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003Cb\u003ESo what changed between 2012 and 2016?\u003C\/b\u003E\u003Cbr \/\u003EThe 2012 PCO focused more on symptom burden and QOL, Instead of focusing on the survival benefit secondary outcome of Temel, they emphasized lack of harm. They did pull from other key studies including Bakitas (ENABLE), Brumley (in-home PC), Meyers (patient\/caregiver dyads), and Rabow (outpatient clinics). The 2016 Expert Panel looked at 16 total studies to come up with the 6 areas of focused recommendations for the CPG, which are:\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cul\u003E\u003Cli\u003EEffective symptom control\u003C\/li\u003E\u003Cli\u003EPractical models of palliative care\u003C\/li\u003E\u003Cli\u003EDefining palliative care in oncology\u003C\/li\u003E\u003Cli\u003ERelation of palliative care to existing\/emerging services\u003C\/li\u003E\u003Cli\u003EInterventions for caregivers\u003C\/li\u003E\u003Cli\u003EWhich patients benefit and at what time in illness\u003C\/li\u003E\u003C\/ul\u003E\u003Cbr \/\u003E(A quick sidebar on definitions. \u003Ci\u003EAdvanced cancer\u003C\/i\u003E includes those with distant metastases, late-stage disease, or cancer that is life-limiting and\/or with a prognosis of 6-24 months. There was a specific lack of focus on end of life as a criterion. ASCO defined \u003Ci\u003Epalliative care\u003C\/i\u003E in this guideline as: patient and family-centered care that optimizes quality\u0026nbsp;of life by anticipating, preventing and treating suffering. Palliative care throughout the continuum of illness involves addressing physical intellectual emotional, social and spiritual needs, in addition to facilitating patient autonomy, access to information and choice.)\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003EWill this new guideline change practice?\u003C\/b\u003E\u003Cbr \/\u003EHistory may give you a reason to be cynical. Palliative care has been trying to get upstream with oncology for a LONG time. Surprisingly, the 2012 Provision Clinical Opinion and Temel study had \u003Ca href=\"http:\/\/www.pallimed.org\/2013\/05\/lung-cancer-guidelines-with-no-mention.html\" target=\"_blank\"\u003Eno impact on the 2013 NCCN Guidelines for lung cancer (0 mentions of palliative care in 100 pages)\u003C\/a\u003E. But with studies like \u003Ca href=\"http:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2585978\" target=\"_blank\"\u003EAl-Jawhari's\u0026nbsp;Palliative Care in Stem Cell Transplantation\u003C\/a\u003E and the growth of the \u003Ca href=\"http:\/\/pallonc.org\/\" target=\"_blank\"\u003EPalliative Oncology conference\u003C\/a\u003E, things may be changing. In addition, value-based payment models like the \u003Ca href=\"https:\/\/innovation.cms.gov\/initiatives\/oncology-care\/\" target=\"_blank\"\u003EOncology Care Model emphasize QOL\u003C\/a\u003E.\u003Cbr \/\u003E\u003Cblockquote class=\"tr_bq\" style=\"text-align: center;\"\u003E\u003Ca href=\"http:\/\/www.pallimed.org\/search\/label\/oncology\" target=\"_blank\"\u003ECheck out more Pallimed posts about oncology.\u003C\/a\u003E\u003C\/blockquote\u003EThis week, I was able to present these guidelines at the Cancer Center Business Summit in a session dedicated to palliative care. The audience was primarily administrators and executives of community cancer centers wanting to talk about how to make palliative care more integrated into their care delivery, so I am hopeful there is a plowed field ready to plant some seeds of concurrent palliative care.\u003Cbr \/\u003E\u003Cbr \/\u003ESo go \u003Ca href=\"http:\/\/ascopubs.org\/doi\/abs\/10.1200\/JCO.2016.70.1474\" target=\"_blank\"\u003Edownload this open access PDF\u003C\/a\u003E, read it, make sure you are doing the best evidence palliative care you can do, discuss it with your palliative care colleagues and only THEN when you have your ducks in a row, go talk with your oncology peers and see what beautiful things you can create together.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ci\u003EChristian Sinclair, MD, FAAHPM is a palliative care doctor at the University of Kansas, editor of Pallimed, and really loves doing outpatient care in the oncology clinic.\u003C\/i\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/8959432897081561020"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/8959432897081561020"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2017\/02\/asco-supports-concurrent-palliative.html","title":"ASCO Supports Concurrent Palliative Care for People with Advanced Cancer"}],"author":[{"name":{"$t":"Christian Sinclair"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/14685043408496367587"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"https:\/\/4.bp.blogspot.com\/-KWbzgl8iMuc\/WJoiE75Cl0I\/AAAAAAABqaw\/mRsA_tw_TzMrGIkF3ZVOJzsuK_mTJ5XZACLcB\/s72-c\/oncologists%2Blike%2Bus.jpg","height":"72","width":"72"}},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-2796167360912001020"},"published":{"$t":"2015-04-20T09:56:00.000-05:00"},"updated":{"$t":"2017-04-20T09:43:58.233-05:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"ethics\/law"},{"scheme":"http://www.blogger.com/atom/ns#","term":"marijuana"},{"scheme":"http://www.blogger.com/atom/ns#","term":"non-pain symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pain"}],"title":{"type":"text","$t":"Medical marijuana in hospice and palliative care"},"content":{"type":"html","$t":"\u003Cdiv class=\"separator\" style=\"clear: both; text-align: center;\"\u003E\u003Ca href=\"http:\/\/4.bp.blogspot.com\/-IUn_J7ok-0k\/VTURtmYAXZI\/AAAAAAAAr2k\/RzAtn1C_GBU\/s1600\/Untitled%2Bdesign%2B(3).png\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" height=\"320\" src=\"https:\/\/4.bp.blogspot.com\/-IUn_J7ok-0k\/VTURtmYAXZI\/AAAAAAAAr2k\/RzAtn1C_GBU\/s1600\/Untitled%2Bdesign%2B(3).png\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/div\u003EJust in time for the \u003Ca href=\"https:\/\/news.vice.com\/article\/the-story-behind-every-potheads-favorite-number-420\" target=\"_blank\"\u003Eunofficial holiday celebrating marijuana (4\/20\u003C\/a\u003E), there is a lot more cannabis chatter. \u003Ca href=\"http:\/\/www.slate.com\/blogs\/the_slatest\/2015\/04\/19\/obama_voices_support_for_medical_marijuana_in_cable_news_interview.html\" target=\"_blank\"\u003EPresident Obama is expressing more support for decriminalization of medical marijuana\u003C\/a\u003E. The new Surgeon General, Dr. Vivek Murthy, notes that in \u003Ca href=\"http:\/\/takingnote.blogs.nytimes.com\/2015\/02\/05\/marijuana-can-be-helpful-admits-surgeon-general\/\" target=\"_blank\"\u003Esome medical situations 'marijuana can be helpful.'\u003C\/a\u003E\u0026nbsp;It made me curious to see what are hospice and palliative care advocates saying about the topic.\u003Cbr \/\u003E\u003Cbr \/\u003EPalliative care clinicians are often concerned about access to symptom controlling medications and therapies when it comes to relieving suffering. For example with opioids, you can hear clinicians advocate for access to these important medications, but also recognize the public health risk which comes from diversion and inappropriate\/non-prescribed use. Similarly with integrative medicine, you may also hear people in hospice and palliative care advocating for access and use of massage, acupuncture, hypnosis, biofeedback, aromatherapy among others, even though the research may not be strong for any one particular complementary\/alternative therapy.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ctable align=\"center\" cellpadding=\"0\" cellspacing=\"0\" class=\"tr-caption-container\" style=\"margin-left: auto; margin-right: auto; text-align: right;\"\u003E\u003Ctbody\u003E\u003Ctr\u003E\u003Ctd style=\"text-align: center;\"\u003E\u003Ca href=\"http:\/\/4.bp.blogspot.com\/-UpnIddoO6CA\/VTUI8VnVakI\/AAAAAAAAr2U\/oeROfWg84Cs\/s1600\/marijuana%2Bstate.PNG\" imageanchor=\"1\" style=\"clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;\"\u003E\u003Cimg border=\"0\" height=\"239\" src=\"https:\/\/4.bp.blogspot.com\/-UpnIddoO6CA\/VTUI8VnVakI\/AAAAAAAAr2U\/oeROfWg84Cs\/s1600\/marijuana%2Bstate.PNG\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/td\u003E\u003C\/tr\u003E\u003Ctr\u003E\u003Ctd class=\"tr-caption\" style=\"text-align: center;\"\u003EData accurate as of April 1, 2015\u003C\/td\u003E\u003C\/tr\u003E\u003C\/tbody\u003E\u003C\/table\u003EYet when it comes to marijuana for symptom control, hospice and palliative care as a field is relatively quiet in comparison to these other areas mentioned above, in addition to being much quieter than the 'medical marijuana' and 'recreational marijuana' movements happening across the United States. In Kansas and Missouri, where I currently practice there are no current laws which allow for medical marijuana or recreational marijuana. In a quick search I found hospice organizations in \u003Ca href=\"http:\/\/blogs.phoenixnewtimes.com\/valleyfever\/2014\/06\/hospice_service_offers_medical-marijuana_help_for_patients.php\" target=\"_blank\"\u003EArizona\u003C\/a\u003E, \u003Ca href=\"http:\/\/www.hightimes.com\/read\/hospice-marijuana-weed-dying\" target=\"_blank\"\u003EColorado\u003C\/a\u003E\u0026nbsp;and \u003Ca href=\"http:\/\/www.daily-journal.com\/news\/local\/hospice-groups-see-benefits-of-medical-marijuana\/article_1295c8bb-2ff8-5bc5-8add-d6164c6488fb.html\" target=\"_blank\"\u003EIllinois\u003C\/a\u003E advocating medical marijuana use for their patients. So, I'm wondering from those of you who work in states where there is either form of allowed cannabis use, do you see a different level of engagement (e.g., advocacy or prescribing) from local hospices or physicians that care for people with serious illness? Please share in the comments.\u003Cbr \/\u003E\u003Cbr \/\u003EIf you would like to know more about what hospice and palliative care clinicians are saying about marijuana as an option for symptom control here are links I discovered while researching this post. If you have quality links, please share in the comments below and I will check them out and potentially add them in the original post. All links are open access unless otherwise noted.\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cul\u003E\u003Cli\u003E\u003Ca href=\"http:\/\/hpna.advancingexpertcare.org\/wp-content\/uploads\/2014\/09\/The_Use_of_Medical_Marijuana_2014.pdf\" target=\"_blank\"\u003EThe Use of Medical Marijuana\u003C\/a\u003E\u0026nbsp;-\u0026nbsp;HPNA position statement (2014)\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\"http:\/\/learnaboutmarijuanawa.org\/Reports\/Marijuana_review_ReppRaich_Oct2014.pdf\" target=\"_blank\"\u003EMarijuana and health: A comprehensive review of 20 years of research\u003C\/a\u003E\u0026nbsp;-\u0026nbsp;Oregon Department of Health and Human Services -\u0026nbsp;(2014)\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\"http:\/\/en.wikipedia.org\/wiki\/Legality_of_cannabis\" target=\"_blank\"\u003ELegality of cannabis (global)\u003C\/a\u003E\u0026nbsp;- Wikipedia\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\"http:\/\/www.nhpco.org\/sites\/default\/files\/public\/meetings\/ctc14\/handouts\/CTC14_4B.pdf\" target=\"_blank\"\u003EEvidence-Based Approach to Medical Marijuana (PPT)\u003C\/a\u003E (from NHPCO conference 2014)\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\"http:\/\/www.pallimed.org\/2007\/03\/randomized-trial-of-smoked-marijuana.html\" target=\"_blank\"\u003EPallimed review on marijuana in HIV neuropathy\u003C\/a\u003E\u0026nbsp;(2007)\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\"http:\/\/aahpm.org\/uploads\/education\/publications\/Summer_12_Quarterly_Feature.pdf\" target=\"_blank\"\u003EMedical marijuana: What should palliative care providers know?\u003C\/a\u003E\u0026nbsp;- AAHPM Quarterly (2012)\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\"http:\/\/www.aahpm.org\/apps\/ws_resource\/index.php?task=view_category\u0026amp;category_id=243\u0026amp;section_id=16\" target=\"_blank\"\u003ECannabis-focused issue of PC-FACS - 8\/14\/14\u003C\/a\u003E (AAHPM Members only)\u0026nbsp;\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\"http:\/\/www.jpsmjournal.com\/article\/S0885-3924(13)00267-4\/pdf\" target=\"_blank\"\u003ETherapeutic review of cannabinoids\u003C\/a\u003E - JPSM and \u003Ca href=\"http:\/\/www.palliativedrugs.com\/\"\u003Ewww.palliativedrugs.com\u003C\/a\u003E (2013)\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv\u003EReader provided links (added after the initial article ran)\u003C\/div\u003E\u003Cdiv\u003E\u003Cul\u003E\u003Cli\u003E\u003Ca href=\"https:\/\/www.mypcnow.org\/blank-vg8y7\" target=\"_blank\"\u003EFast Facts #280 Cannabis for Symptom Control\u003C\/a\u003E\u003C\/li\u003E\u003Cli\u003E\u003Ca href=\"http:\/\/www.cannabinologist.org\/Documents\/Cannabis-in-Palliative-Care-1.pdf\" target=\"_blank\"\u003ECannabis in Palliative Medicine Am Journal of HPM 2011\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv\u003EThe research literature on marijuana use exclusively in hospice and\/or palliative care patient populations is quite thin. \u003Ca href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=(palliative+OR+hospice)+AND+(cannabis+OR+marijuana)\" target=\"_blank\"\u003EOnly 110 articles on PubMed with the search criteria of (palliative OR hospice) AND (cannabis OR marijuana)\u003C\/a\u003E\u0026nbsp;(only 82 in 2015).\u003C\/div\u003E\u003Cbr \/\u003EMedical marijuana is not without potential medical risk, especially in a population that may be seriously ill. \u0026nbsp;There have been \u003Ca href=\"http:\/\/journal.publications.chestnet.org\/data\/Journals\/CHEST\/21581\/432.pdf\" target=\"_blank\"\u003Ecase reports\u003C\/a\u003E of significant \u003Ca href=\"http:\/\/jco.ascopubs.org\/content\/26\/13\/2214.full\" target=\"_blank\"\u003EAspergillosis infections of the lung\u003C\/a\u003E in neutropenic patients, and it is not uncommon to see transplant patients (who are necessarily immunocompromised by their treatment) to be counseled against smoking marijuana expressly because of this reason.\u003Cbr \/\u003E\u003Cbr \/\u003EThis post is not about taking a side, but instead a reflection on what are our (meta-)responsibilities as symptom control advocates. As we gain a larger foothold in the halls of our hospitals and our statehouses, like\u0026nbsp;\u003Ca href=\"http:\/\/www.edmondsun.com\/news\/state_news\/palliative-care-bill-signed-intolaw\/article_4820af18-e2e8-11e4-9305-bf2de9b1e919.html\" target=\"_blank\"\u003EOklahoma who recently passed (ACS-supported) laws that encourage more input from palliative care experts\u003C\/a\u003E, we need to ask ourselves, \"With limited time and resources, how do we help out patients best?\"\u003Cbr \/\u003E\u003Cbr \/\u003EIt seems like the medical\/recreational marijuana movement has considerable inertia behind it when it comes to changing state laws. How do you think will this change our clinical practice, our fellow education, and our research opportunities?\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003E\u003Ci\u003EChristian Sinclair, MD, FAAHPM, is a palliative care physician at the University of Kansas Medical Center, editor of Pallimed, and president-elect of the American Academy of Hospice and Palliative Medicine. He has a significant interest in questions that don't always have clear answers and likes to be able to hear other people's opinions on challenging topics.\u003C\/i\u003E\u003C\/span\u003E\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003EAbbreviations:\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003EHPNA = Hospice and palliative Nurses Association\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003EPPT = Powerpoint\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003ENHPCO = National Hospice and Palliative Care Organization\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003EAAHPM = American Academy of Hospice and Palliative Medicine\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003EJPSM = Journal of Pain and Symptom Management\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003EACS = American Cancer Society\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003E\u003Cbr \/\u003E\u003C\/span\u003E\u003Cspan style=\"font-size: x-small;\"\u003E\u003Ci\u003EImage credit: Medical marijuana neon sign by Laurie Avocado\u0026nbsp;\u003Ca href=\"http:\/\/en.wikipedia.org\/wiki\/Medical_cannabis_in_the_United_States#\/media\/File:Medical-marijuana-sign.jpg\" target=\"_blank\"\u003EWikimedia Commons via CC\u003C\/a\u003E\u003C\/i\u003E\u003C\/span\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/2796167360912001020"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/2796167360912001020"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2015\/04\/medical-marijuana-in-hospice-and.html","title":"Medical marijuana in hospice and palliative care"}],"author":[{"name":{"$t":"Christian Sinclair"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/14685043408496367587"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"https:\/\/4.bp.blogspot.com\/-IUn_J7ok-0k\/VTURtmYAXZI\/AAAAAAAAr2k\/RzAtn1C_GBU\/s72-c\/Untitled%2Bdesign%2B(3).png","height":"72","width":"72"}},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-247054164591022756"},"published":{"$t":"2015-03-10T09:34:00.001-05:00"},"updated":{"$t":"2019-03-30T13:36:49.852-05:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"non-pain symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"psychosocial"},{"scheme":"http://www.blogger.com/atom/ns#","term":"shukraft"},{"scheme":"http://www.blogger.com/atom/ns#","term":"social work"},{"scheme":"http://www.blogger.com/atom/ns#","term":"social worker"},{"scheme":"http://www.blogger.com/atom/ns#","term":"SWHPN"},{"scheme":"http://www.blogger.com/atom/ns#","term":"tweetchat"},{"scheme":"http://www.blogger.com/atom/ns#","term":"twitter"}],"title":{"type":"text","$t":"Celebrate Social Workers!"},"content":{"type":"html","$t":"by Allie Shukraft\u003Cbr \/\u003E\u003Cbr \/\u003EMarch 2015 marks two events in the world of American hospice and palliative medicine (HPM) social worker: National Social Worker’s Month and the 60\u003Csup\u003Eth\u003C\/sup\u003E anniversary of the \u003Ca href=\"https:\/\/www.socialworkers.org\/\" target=\"_blank\"\u003ENational Association of Social Workers\u003C\/a\u003E, our largest member organization.\u0026nbsp; \u0026nbsp;This year’s theme is “social work paves the way for change”.\u0026nbsp; I love this theme because it brings me back to a conversation with a hospice social worker who told me why he loved his job and that I should become a social worker (I laughed at that point in time . . . little did I know).\u0026nbsp; He said that patients and families in hospice are making their way through this dark, twisted path in the forest that is illness.\u0026nbsp; They are lost and confused, and though they want to find a way out, sometimes there is none.\u0026nbsp; He said his job then was not to shine a light on the path and make it easier, nor was it to show them the way out of the forest.\u0026nbsp; Rather, it was to walk with them on their journey and be present. \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ca href=\"https:\/\/1.bp.blogspot.com\/-h5iGiMO7UU8\/VPnOmTlwY2I\/AAAAAAAAAD8\/lpco0os84EU\/s1600\/SWM-2015LogoFinal60th.jpg\" imageanchor=\"1\" style=\"clear: right; float: right; margin-bottom: 1em; margin-left: 1em;\"\u003E\u003Cimg border=\"0\" src=\"https:\/\/1.bp.blogspot.com\/-h5iGiMO7UU8\/VPnOmTlwY2I\/AAAAAAAAAD8\/lpco0os84EU\/s1600\/SWM-2015LogoFinal60th.jpg\" height=\"320\" width=\"256\" \/\u003E\u003C\/a\u003ESo what paths are we trying to accompany our patients and families on as they navigate? Although our patients and families are each unique, there are some common paths that they may tread upon within palliative and hospice care. Social workers are there to meet the bio-psychosocial-spiritual needs of the patient and family, emphasis on the psychosocial. Yes, what we do overlaps with some of the roles of our other team members (I envision interdisciplinary team roles like a Venn diagram), but a social worker's training is specialized to meet the patients and families where they are and help them determine where they want to go. As part of our Master’s preparation, our ongoing training, and our licensure requirements, we learn about human development, psychological theory, the intricate interactions of the systems in which we operate, and many more specific skills. \u003Cbr \/\u003E\u003Cbr \/\u003EOn Wednesday night 3\/11\/15, join me for this week’s #HPM Tweetchat as we take a look at the psychosocial elements of the work we all do through discussion of the following topics: \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003ETopic 1:\u003C\/b\u003E what are the psychosocial needs of #HPM patients and families\/caregivers? \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003ETopic 2:\u003C\/b\u003E what is the most difficult part of psychosocial care of the #HPM patients and family members? \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003ETopic 3:\u003C\/b\u003E how can we measure the effectiveness of our teams at meeting these needs of #HPM patients and family members? \u003Cbr \/\u003E\u003Cbr \/\u003EJoin me \u003Ca href=\"https:\/\/twitter.com\/Alifrumcally\" target=\"_blank\"\u003E@alifrumcally\u003C\/a\u003E this Wednesday night at 8pm CST to explore the concept of social work and psychosocial needs in HPM. \u003Cbr \/\u003E\u003Cbr \/\u003ESpecial thanks to Lizzy Miles, MA, MSW, LSW and the social workers and chaplain from Carolinas Palliative Care and Hospice Network for their input on these thoughts . . . they are invaluable! \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ci\u003E\u003Cspan style=\"font-size: x-small;\"\u003EAllie Shukraft, MAT, MSW, LCSWA is a reformed high school English teacher turned pediatric palliative care social worker with Carolinas Healthcare System in Charlotte, NC. \u0026nbsp;She enjoys spending time with her family and exploring the country whenever she can. \u0026nbsp;You can find her on Twitter at\u0026nbsp;\u003Ca href=\"https:\/\/twitter.com\/Alifrumcally\" target=\"_blank\"\u003E@alifrumcally\u003C\/a\u003E\u003C\/span\u003E\u003C\/i\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003E\u003Cbr \/\u003E\u003C\/span\u003E\u003Cspan style=\"font-size: x-small;\"\u003EPhoto courtesy \u003Ca href=\"https:\/\/www.socialworkers.org\/\" target=\"_blank\"\u003ENASW\u003C\/a\u003E\u003C\/span\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/247054164591022756"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/247054164591022756"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2015\/03\/celebrate-social-workers.html","title":"Celebrate Social Workers!"}],"author":[{"name":{"$t":"Anonymous"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/04949961851164613136"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"https:\/\/1.bp.blogspot.com\/-h5iGiMO7UU8\/VPnOmTlwY2I\/AAAAAAAAAD8\/lpco0os84EU\/s72-c\/SWM-2015LogoFinal60th.jpg","height":"72","width":"72"}},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-1748383983610982529"},"published":{"$t":"2015-02-28T08:56:00.001-06:00"},"updated":{"$t":"2015-02-28T08:56:18.898-06:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"AAHPM"},{"scheme":"http://www.blogger.com/atom/ns#","term":"cards\/chf"},{"scheme":"http://www.blogger.com/atom/ns#","term":"non-pain symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pain"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pulmonary\/copd"},{"scheme":"http://www.blogger.com/atom/ns#","term":"randomized control trial"},{"scheme":"http://www.blogger.com/atom/ns#","term":"research"},{"scheme":"http://www.blogger.com/atom/ns#","term":"symptoms"}],"title":{"type":"text","$t":"AAHPM Assembly State of the Science 2015"},"content":{"type":"html","$t":"As David Currow said when he received his Excellence in Research award, hospice and palliative medicine researchers need to meticulously measure toxicity in addition to benefits of palliative interventions.  How do you think the State of the Science studies did with this goal?   What do you think about the conclusions of each of the studies?  Any changes in your practice? Thanks to the presenters Jay Horton, Kimberly Johnson,Nick Dionne-Odom, and Cardinale Smith for reviewing and presenting.  Always a fun presentation.  \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003ENeurolytic sympathectomy in management of cancer pain-time effect: a prospective, randomized multicenter study \u003Ca href=\"http:\/\/t.co\/fdqI1A2meB\"\u003Ehttp:\/\/t.co\/fdqI1A2meB\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571670862375596032\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EComparative effectiveness-senna to prevent problematic constipation in peds onc patients receiving opioids:\u003Ca href=\"http:\/\/t.co\/rYyx3xY7jI\"\u003Ehttp:\/\/t.co\/rYyx3xY7jI\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571672408442077185\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003ERandomized Controlled Trial of Expressive Writing for Patients With Renal Cell Carcinoma \u003Ca href=\"http:\/\/t.co\/2reY7q5CM0\"\u003Ehttp:\/\/t.co\/2reY7q5CM0\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571673788460359680\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003ESafety of benzodiazepines and opioids in very severe respiratory disease: national prospective study \u003Ca href=\"http:\/\/t.co\/CsbkLEa0jF\"\u003Ehttp:\/\/t.co\/CsbkLEa0jF\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571675418668875776\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EAn integrated palliative and respiratory care service for patients with advanced disease: An RCT \u003Ca href=\"http:\/\/t.co\/awhOMOKRAy\"\u003Ehttp:\/\/t.co\/awhOMOKRAy\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571676886910160896\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EInpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. \u003Ca href=\"http:\/\/t.co\/HCRVaXRIw4\"\u003Ehttp:\/\/t.co\/HCRVaXRIw4\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571678668436713472\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EIntervention to improve care at life\u0026#39;s end in inpatient settings: the BEACON trial. \u003Ca href=\"http:\/\/t.co\/Ht7MwhzIYF\"\u003Ehttp:\/\/t.co\/Ht7MwhzIYF\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571680700027568129\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E \u003Cblockquote class=\"twitter-tweet\" lang=\"en\"\u003E\u003Cp\u003EAssociation of experience with illness and end-of-life care with advance care planning in older adults \u003Ca href=\"http:\/\/t.co\/S04ifi57iM\"\u003Ehttp:\/\/t.co\/S04ifi57iM\u003C\/a\u003E \u003Ca href=\"https:\/\/twitter.com\/hashtag\/hpm15?src=hash\"\u003E#hpm15\u003C\/a\u003E\u003C\/p\u003E\u0026mdash; Lyle Fettig (@lfettig) \u003Ca href=\"https:\/\/twitter.com\/lfettig\/status\/571682819963006976\"\u003EFebruary 28, 2015\u003C\/a\u003E\u003C\/blockquote\u003E\u003Cscript async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"\u003E\u003C\/script\u003E         "},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/1748383983610982529"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/1748383983610982529"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2015\/02\/aahpm-assembly-state-of-science-2015.html","title":"AAHPM Assembly State of the Science 2015"}],"author":[{"name":{"$t":"Lyle Fettig"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/00710388898582754749"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}]},{"id":{"$t":"tag:blogger.com,1999:blog-13495125.post-8061211824486913057"},"published":{"$t":"2014-11-01T12:44:00.001-05:00"},"updated":{"$t":"2021-04-06T23:28:56.157-05:00"},"category":[{"scheme":"http://www.blogger.com/atom/ns#","term":"AAHPM"},{"scheme":"http://www.blogger.com/atom/ns#","term":"advance care planning"},{"scheme":"http://www.blogger.com/atom/ns#","term":"ASCO"},{"scheme":"http://www.blogger.com/atom/ns#","term":"cancer"},{"scheme":"http://www.blogger.com/atom/ns#","term":"communication"},{"scheme":"http://www.blogger.com/atom/ns#","term":"conference reviews"},{"scheme":"http://www.blogger.com/atom/ns#","term":"learner"},{"scheme":"http://www.blogger.com/atom/ns#","term":"medical student"},{"scheme":"http://www.blogger.com/atom/ns#","term":"newport"},{"scheme":"http://www.blogger.com/atom/ns#","term":"non-pain symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"pain"},{"scheme":"http://www.blogger.com/atom/ns#","term":"research"},{"scheme":"http://www.blogger.com/atom/ns#","term":"sivendran"},{"scheme":"http://www.blogger.com/atom/ns#","term":"symptoms"},{"scheme":"http://www.blogger.com/atom/ns#","term":"The profession"}],"title":{"type":"text","$t":"2014 Palliative Care In Oncology Symposium Review"},"content":{"type":"html","$t":"\u003Ctable cellpadding=\"0\" cellspacing=\"0\" class=\"tr-caption-container\" style=\"float: right; margin-left: 1em; text-align: right;\"\u003E\u003Ctbody\u003E\u003Ctr\u003E\u003Ctd style=\"text-align: center;\"\u003E\u003Ca href=\"http:\/\/4.bp.blogspot.com\/-0jMk2yOIhTo\/VFUR3frzO1I\/AAAAAAAAixQ\/mxibtBy_0lg\/s1600\/onc%2Band%2Bpall.PNG\" imageanchor=\"1\" style=\"clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/4.bp.blogspot.com\/-0jMk2yOIhTo\/VFUR3frzO1I\/AAAAAAAAixQ\/mxibtBy_0lg\/s1600\/onc%2Band%2Bpall.PNG\" \/\u003E\u003C\/a\u003E\u003C\/td\u003E\u003C\/tr\u003E\u003Ctr\u003E\u003Ctd class=\"tr-caption\" style=\"text-align: center;\"\u003EThe surprsingly inclusive sign from OhioHealth\u003C\/td\u003E\u003C\/tr\u003E\u003C\/tbody\u003E\u003C\/table\u003Eby Kristina B. Newport MD and Shanthi Sivendran MD, MSCR\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Ci\u003E\u003Cspan style=\"font-size: x-small;\"\u003E(This is the second of two reviews of the apparently fantastic inaugural\u0026nbsp;2014 Palliative Oncology conference. \u003Ca href=\"http:\/\/www.pallimed.org\/2014\/10\/2014-inaugural-palliative-oncology.html\" target=\"_blank\"\u003EPlease see Sydney Dy's review for additional perspectives\u003C\/a\u003E. If you use these conference reviews with your teams\/orgs, please let us know in the comments below. - Ed.)\u003C\/span\u003E\u003C\/i\u003E\u003Cbr \/\u003E\u003Cb\u003E\u003Cbr \/\u003E\u003C\/b\u003E\u003Cb\u003EPalliative + Oncology = Love\u003C\/b\u003E\u003Cbr \/\u003E\u003Cbr \/\u003EBut it hasn’t always been that way.   Palliative and hospice specialists have been caring for cancer patients for decades. Oncology specialists have been implementing palliative principles before we used that term.  However the \u003Ca href=\"http:\/\/pallonc.org\/\" target=\"_blank\"\u003EPalliative Care in Oncology Symposium\u003C\/a\u003E deliberately and publicly cemented this relationship in a way that has not been done before.  Sponsored jointly by \u003Ca href=\"http:\/\/www.asco.org\/\" target=\"_blank\"\u003EASCO\u003C\/a\u003E, \u003Ca href=\"http:\/\/www.astro.org\/\" target=\"_blank\"\u003EASTRO\u003C\/a\u003E, \u003Ca href=\"http:\/\/www.mascc.org\/\" target=\"_blank\"\u003EMASCC\u003C\/a\u003E and \u003Ca href=\"http:\/\/www.aahpm.org\/\" target=\"_blank\"\u003EAAHPM\u003C\/a\u003E, the symposium aimed to merge the key elements that each field uses in their approach to improved patient care.\u003Cbr \/\u003E\u003Cbr \/\u003EWe (an Oncologist and a Palliative medicine physician- AKA Palliatrician) attended this symposium with the goal of improving our own collaboration.   As colleagues, running partners and research partners, we often laugh about our different approaches to patient care, and sometimes life, that are rooted in our respective specialties.  When comparing our annual meetings, with the ASCO meeting presenting multitudes of p-values and the AAHPM meeting highlighted each year by a tear-jerking memorial service, it must have been a daunting task for the steering committee (made up of Michael Fisch, MD, MPH (Chair), Dorothy Keefe, MD, Traci Balboni, MD and J. Cameron Muir, MD) to marry the two approaches. \u003Cbr \/\u003E\u003Cbr \/\u003EWhen 700+ practitioners, including physicians, nurses, social workers, psychologists, dieticians, nurse practitioners, administrators and patient advocates  packed into the designated conference hall (it was full to capacity because the organizers adjusted to accommodate a higher than expected attendance) we were greeted to an opening introduction that was akin to a long awaited wedding ceremony.  Michael Fisch reflected on the history of both Palliative and Oncologic medicine that paved the way to the point we have reached, emphasizing the barriers that have been overcome by many of the people who were in attendance.  And, like a marriage of two families, the remainder of the meeting celebrated the union but also pointed out the differences and room for growth.  Jamie Von Roenn MD, who was recognized as the driving force behind the symposium, described the ASCO perspective why palliative care is a necessary component of oncology care, stating “Palliative care always, anticancer therapy sometimes”. She firmly believes that every oncologist needs to know how to do primary palliative care and advises that oncologists need to be clear about reasons for treatment- with patients and with themselves.  She clarifies that palliative chemotherapy is only palliative if it is helping a symptom.    \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003EEvidence based symptom management was emphasized\u003C\/b\u003E, with the words of Dorothy Keefe MD, MBBS, “we cannot practice good cancer care without good symptom science”.  Illustrating the science were: \u003Cbr \/\u003E\u003Cul\u003E\u003Cli\u003EStephen Sonis DMD, DMSc on Predicting risk in treating cancer pain- Determining genetic pre-diposition to side effects and symptoms that will soon help us to tailor symptom management.\u003C\/li\u003E\u003Cli\u003EJeannine Brant PhD, APRN, AOCN on Electronic integration of patient reported outcomes- The need to better elicit patient reported outcomes through electronic patient input, emphasizing that when oncologists elicit symptoms in person, they miss a lot, particularly psychosocial distress.\u003C\/li\u003E\u003Cli\u003EPatrick Mantyh PhD, JD on Mechanisms of cancer pain- Presenting the evidence that Early cancer pain management is imperative to preventing sensory nerve sprouting, and worsening pain down the road.\u003C\/li\u003E\u003C\/ul\u003E\u003Cb\u003EAbstract session highlights include:\u003C\/b\u003E\u003Cbr \/\u003E\u003Ctable cellpadding=\"0\" cellspacing=\"0\" class=\"tr-caption-container\" style=\"float: right; margin-left: 1em; text-align: right;\"\u003E\u003Ctbody\u003E\u003Ctr\u003E\u003Ctd style=\"text-align: center;\"\u003E\u003Ca href=\"http:\/\/2.bp.blogspot.com\/-UW2_QbOYQUQ\/VFUUrkY__RI\/AAAAAAAAixY\/qP1N0WhBClI\/s1600\/burnoutcrisis.jpg\" imageanchor=\"1\" style=\"clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/2.bp.blogspot.com\/-UW2_QbOYQUQ\/VFUUrkY__RI\/AAAAAAAAixY\/qP1N0WhBClI\/s1600\/burnoutcrisis.jpg\" height=\"240\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/td\u003E\u003C\/tr\u003E\u003Ctr\u003E\u003Ctd class=\"tr-caption\" style=\"text-align: center;\"\u003E\u003Cspan style=\"font-size: xx-small; text-align: start;\"\u003EArif Kamal’s starting visual\u003Cbr \/\u003Ecomparing burnout rates by speciality\u003C\/span\u003E\u003C\/td\u003E\u003C\/tr\u003E\u003C\/tbody\u003E\u003C\/table\u003E\u003Cul\u003E\u003Cli\u003EA survey of \u003Ca href=\"http:\/\/abstract.asco.org\/153\/AbstView_153_137848.html\" target=\"_blank\"\u003Eburnout in palliative care providers\u003C\/a\u003E by Arif Kamal, MD showing that more than 60% palliative care providers report high burnout, a number that is significantly higher than other specialties, despite our intentional emphasis on humanizing medicine and employing self-care techniques. Burnout was correlated with isolation from colleagues and long hours.\u003C\/li\u003E\u003Cli\u003EA \u003Ca href=\"http:\/\/abstract.asco.org\/153\/AbstView_153_137374.html\" target=\"_blank\"\u003EPalliative\/Oncology Co-rounding\u003C\/a\u003E system described by Richard Riedel, MD resulted in decreased length of stay and re-admission to the Duke inpatient cancer unit. His team emphasized the personal tailoring of this model, since the team decided whether patients needed the Palliatrician, the Oncologist or both, on a daily basis.\u003C\/li\u003E\u003Cli\u003EA study of \u003Ca href=\"http:\/\/abstract.asco.org\/153\/AbstView_153_137740.html\" target=\"_blank\"\u003Eadvanced care planning\u003C\/a\u003E by Joanna Paladino MD showing that Oncologists are responsive when prompted to have advanced care planning discussions with their advanced cancer patients\u003C\/li\u003E\u003Cli\u003EA survey on \u003Ca href=\"http:\/\/abstract.asco.org\/153\/AbstView_153_136544.html\" target=\"_blank\"\u003Eresident code status discussions by medical student David Johnson Einstein showing   resident physicians are unlikely to s\u003C\/a\u003Ehare the poor prognosis or offer specific recommendations on CPR in treatment-refractory cancer because of a perceived conflict with patient autonomy.\u003C\/li\u003E\u003Cli\u003EA \u003Ca href=\"http:\/\/abstract.asco.org\/153\/AbstView_153_137957.html\" target=\"_blank\"\u003Edescription of an automated symptom reporting system for hospice patients\u003C\/a\u003E  was described by Kathi Mooney PhD, RN, FAAN, showing evidence that daily automated reporting of symptoms by caregivers  resulted in improved symptom management and caregiver vitality.\u003C\/li\u003E\u003Cli\u003EAn \u003Ca href=\"http:\/\/abstracts.asco.org\/153\/AbstView_153_137917.html\" target=\"_blank\"\u003Eevaluation of a modified CAPC trigger tool for palliative care consults\u003C\/a\u003E did not capture all patients who could have benefitted from consult, presented by Michelle Farnan RN MSN\u003C\/li\u003E\u003Cli\u003EA \u003Ca href=\"http:\/\/abstract.asco.org\/153\/AbstView_153_137871.html\" target=\"_blank\"\u003Ecost analysis \u003C\/a\u003Eby Joseph Greer\u0026nbsp;of \u003Ca href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=20818875\" target=\"_blank\"\u003ETemel’s early palliative care in lung cancer trial\u003C\/a\u003E\u0026nbsp;showed a $117\/day inpatient savings and no increased use of healthcare dollars overall despite additional supports provided to patients\u003C\/li\u003E\u003C\/ul\u003E\u003Cb\u003EWith the emphasis on increased research\u003C\/b\u003E\u0026nbsp;in palliative\/oncology care, the session on funding and research for palliative in oncology was well attended despite the allure of lunch.  Highlights included the emphasis from both \u003Ca href=\"http:\/\/staffprofiles.cancer.gov\/brp\/prgmStaffProfile.do?contactId=2510298\" target=\"_blank\"\u003ELynne Padgett, PhD  (NCI Health\/Behavior research program\u003C\/a\u003E) and \u003Ca href=\"http:\/\/prevention.cancer.gov\/about\/staff\/omara-ann\" target=\"_blank\"\u003EAnn O’Mara PhD, RN\u003C\/a\u003E to contact them directly when developing proposals.  NCI received more than 8,000 proposals last year and funded 14% of them, so the application, the study and the applicants must all be stellar.\u003Cbr \/\u003E\u003Cbr \/\u003EAnthony Back, MD whose mission is to \u003Cb\u003Eimprove communication skills\u003C\/b\u003E, gave an entrancing presentation, as expected, emphasizing that good communication takes practice and a \u003Ca href=\"http:\/\/vitaltalk.blogspot.com\/\" target=\"_blank\"\u003Eframework\u003C\/a\u003E.  He used the metaphor of a jazz musician who has trained so well that even their improvisations are beautiful- the good communicator can handle the difficult situations only because of practice.    BJ Miller MD offered a complimentary session emphasizing incorporation of the arts and philosophy to “make life more wonderful” not just for our patients, but for ourselves as well. \u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cb\u003EAttention to the need for earlier palliative care\u003C\/b\u003E involvement was one of the major themes because, as Ira Byock MD simply stated, “It’s always too early, until it’s too late”.  Impactful talks given on this topic included:\u003Cbr \/\u003E\u003Cul\u003E\u003Cli\u003EJennifer Temel, MD’s plenary session highlighting data from the three studies:  The first was \u003Ca href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=20818875\" target=\"_blank\"\u003Eher own study\u003C\/a\u003E (referred to as “The Big Bang” of Palliative Oncology) showing that automatic, regular palliative care in advanced lung cancer patients resulted in decreased depression, increased QOL, less aggressive care at end of life and improved survival. The intervention was loosely defined but occurred monthly. This data had come out in the midst of the series of 3 ENABLE trials, by Marie Bakitas DNSc that have shown improvements in depression and survival via a phone intervention with caregivers. \u003Ca href=\"http:\/\/meetinglibrary.asco.org\/content\/130067-144\" target=\"_blank\"\u003EENABLE III\u003C\/a\u003E showed that early vs late (12 weeks later) enrollment had a significant effect.  Their \u003Ca href=\"http:\/\/abstract.asco.org\/153\/AbstView_153_137946.html\" target=\"_blank\"\u003Elatest analysis\u003C\/a\u003E reveals the important finding that receiving the intervention significantly reduced mortality among clinically depressed patients. Zimmermann’s 2014 cluster-RCT of \u003Ca href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24559581\" target=\"_blank\"\u003Eearly palliative care in advanced cancer\u003C\/a\u003E was also highlighted for it’s promising findings of a tendency toward increased quality of life. \u0026nbsp;Temel went onto analyze the key elements of these studies, emphasizing how they can be improved upon for future research including attention to Reproducibility, Cost effectiveness and Generalizability\u003C\/li\u003E\u003Cli\u003ECharles Von Gunten MD PhD presented the perspective he has gained while working to incorporate palliative care into oncology care in Ohio and made us all laugh with a satirical video like \u003Ca href=\"https:\/\/www.youtube.com\/watch?v=bCj4G9hwxmA\" target=\"_blank\"\u003Ethis one.\u003C\/a\u003E He noted that local institutions often need to see their own data before accepting and acting on national data.\u003C\/li\u003E\u003Cli\u003ETraci Balboni MD MPH discussed \u003Ca href=\"http:\/\/www.ascopost.com\/issues\/september-1,-2014\/the-role-of-integrated-palliative-care-in-radiation-oncology.aspx\" target=\"_blank\"\u003Epalliative care in radiation oncology\u003C\/a\u003E, where she finds that symptom burden is high, with more than 40% of patients receiving non-curative treatments.  She highlighted that although 1 (to up to 10) fractions of radiation are adequate to treat bony pain from metastases as per \u003Ca href=\"http:\/\/www.choosingwisely.org\/astro-releases-list-of-five-radiation-oncology-treatments-to-question-as-part-of-national-choosing-wisely-campaign\/\" target=\"_blank\"\u003EChoosing Wisely\u003C\/a\u003E, nationwide over 50% of patients receive greater than 10 fractions potentially leading to greater side effects, precious time away from family at end of life, and decreased quality of life.  She also comments, repeatedly, that palliative education is limited in Radiation Oncology training programs, something that she wants to see change.\u003C\/li\u003E\u003Cli\u003EDeborah Jane Dudgeon MD- Reflected on \u003Ca href=\"http:\/\/meetinglibrary.asco.org\/content\/98819\" target=\"_blank\"\u003EThe Cancer Care Ontario Integration Experience\u003C\/a\u003E, recommending standard use of the Queens’ ESAS and sharing that over 61% of regional cancer patients in Ontario are now being screened. Also recommends that the term “active” care be abolished due to its unintended message.\u003C\/li\u003E\u003C\/ul\u003E\u003Ctable align=\"center\" cellpadding=\"0\" cellspacing=\"0\" class=\"tr-caption-container\" style=\"margin-left: auto; margin-right: auto; text-align: center;\"\u003E\u003Ctbody\u003E\u003Ctr\u003E\u003Ctd style=\"text-align: center;\"\u003E\u003Ca href=\"http:\/\/4.bp.blogspot.com\/-pPfwiqGjZb4\/VFUXHa_FxoI\/AAAAAAAAixg\/Ia00psU6Bx8\/s1600\/Palliative%2BPersonalization%2Bpic.jpg\" imageanchor=\"1\" style=\"margin-left: auto; margin-right: auto;\"\u003E\u003Cimg border=\"0\" src=\"http:\/\/4.bp.blogspot.com\/-pPfwiqGjZb4\/VFUXHa_FxoI\/AAAAAAAAixg\/Ia00psU6Bx8\/s1600\/Palliative%2BPersonalization%2Bpic.jpg\" height=\"240\" width=\"320\" \/\u003E\u003C\/a\u003E\u003C\/td\u003E\u003C\/tr\u003E\u003Ctr\u003E\u003Ctd class=\"tr-caption\" style=\"text-align: center;\"\u003E\u003Cspan style=\"font-size: xx-small; text-align: start;\"\u003EA visual interpretation of the need to personalize the palliative care package\u003Cbr \/\u003E\u0026nbsp;for patients as their needs dictate, much like targeted therapies for lung cancer.\u003C\/span\u003E\u003C\/td\u003E\u003C\/tr\u003E\u003C\/tbody\u003E\u003C\/table\u003EIra Byock, MD gave the AAHPM perspective that the science is not enough.  First, he addressed timing; “We are doing brink-of-death care, not end-of-life care, let alone concurrent care,” he said. “It is time to call out bad care when physicians are not being honest with their patients about their prognosis and letting them benefit from palliation”. Then he addressed the ‘person’ component; “High quality palliative care should be consistent with standards and guidelines, BUT science only becomes \"care\" when it's applied to help patients. It's not just symptoms and suffering; it's more personal. It's life completion, grief, relationships, greater meaning.” Of course, we know that these areas are difficult to study.  Evidence that was presented along these lines included:\u003Cbr \/\u003E\u003Cul\u003E\u003Cli\u003ETracy Balboni MD MPH was tasked with speaking for our spiritual care colleagues, during which time she shared evidence that attention to spirituality is desired by patients and results in \u003Ca href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20008625\" target=\"_blank\"\u003Eincreased quality of life, increased hospice use\u003C\/a\u003E and \u003Ca href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21563177\" target=\"_blank\"\u003Edecreased costs\u003C\/a\u003E.\u003C\/li\u003E\u003Cli\u003EHarvey Chochinov MD PhD delivered an elegant discussion of his work on dignity therapy, where he has found that patients’ perception of their appearance significantly affects their dignity and dignity correlates positively with good symptom control and patient satisfaction.\u003C\/li\u003E\u003Cli\u003EJames Zabora ScD Reflected on the difficulty of measuring psychosocial distress, showing that the NCCN Distress tool is an adequate screening tool but misses 50% of distress that BSI-18 identifies.\u003C\/li\u003E\u003C\/ul\u003EWhile most presenters implied or stated that palliative care has potential benefit for patients across the continuum of care, Dorothy Keefe MD provided the controversial view from MASCC that palliative care has a specific role only in advanced cancer patients, preferring the unique terms\/models of ‘supportive care’ and ‘survivorship care’ for the remainder of patients. \u003Cbr \/\u003E\u003Cbr \/\u003EPatricia Ganz, MD presented strong evidence to the contrary, stating that “survivorship and palliative care are joined at the hip” due to their similar goals and approaches.  Discussing difficult symptom management issues in cancer survivors were:\u003Cbr \/\u003E\u003Cul\u003E\u003Cli\u003EJulienne Bower PhD discussed the debilitating fatigue survivors can experience how it is under-reported, under-treated and may persist for months or years after treatment. She has some evidence that inflammatory cytokines are involved. See also \u003Ca href=\"http:\/\/www.asco.org\/screening-assessment-and-management-fatigue-adult-survivors-cancer-american-society-clinical\" target=\"_blank\"\u003EASCO Guidance Recommendations for Fatigue\u003C\/a\u003E.\u003C\/li\u003E\u003Cli\u003ETim Ahles PhD commented on the predictors cognitive impairment after chemotherapy, including children under 5, high dose chemotherapy, and treatment for brain treatment.  Interestingly, 20-25% of breast cancer survivors had cognitive impairment even before adjuvant treatment and 15-30% have it afterward.\u003C\/li\u003E\u003Cli\u003EN Lynn Henry MD PhD commented on the difficult problem of aromatase inhibitor-associated Musculoskeletal symptoms (\u003Ca href=\"http:\/\/www.cancernetwork.com\/articles\/aromatase-inhibitor%E2%80%93associated-musculoskeletal-symptoms-etiology-and-strategies-management\" target=\"_blank\"\u003EAIMSS\u003C\/a\u003E), suggesting AI switching, duloxetine, vitamin D, acupuncture and exercise as possible interventions although none are standard of care.\u003C\/li\u003E\u003C\/ul\u003EAt Symposium closing, we leave with the feeling that we, like a newly married couple, have solidified a relationship that will continue for many years.  But also one that will have bumps in the road and will need continued work (that may include a few arguments along the way).  Our mission is to maximize this, our honeymoon period, by bringing more science to the palliative world so that evidence supports our recommendations for increased teamwork, improved communication and symptom management. As Anthony Galanos MD commented, “It’s not just about Oncologists learning from the Palliatricians, it’s also about us learning from them.” \u003Cbr \/\u003E\u003Cbr \/\u003EAbstracts available at: \u003Ca href=\"http:\/\/www.pallonc.org\/\" target=\"_blank\"\u003Ewww.pallonc.org\u003C\/a\u003E\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cdiv style=\"text-align: center;\"\u003E\u003Cb\u003E\u003Cspan style=\"font-size: large;\"\u003EOur palliative leaders have knocked on the door for years.\u003C\/span\u003E\u003C\/b\u003E\u003C\/div\u003E\u003Cdiv style=\"text-align: center;\"\u003E\u003Cb\u003E\u003Cspan style=\"font-size: large;\"\u003E\u003Cbr \/\u003E\u003C\/span\u003E\u003C\/b\u003E\u003C\/div\u003E\u003Cdiv style=\"text-align: center;\"\u003E\u003Cb\u003E\u003Cspan style=\"font-size: large;\"\u003EThe door is open.\u003C\/span\u003E\u003C\/b\u003E\u003C\/div\u003E\u003Cdiv style=\"text-align: center;\"\u003E\u003Cb\u003E\u003Cspan style=\"font-size: large;\"\u003E\u003Cbr \/\u003E\u003C\/span\u003E\u003C\/b\u003E\u003C\/div\u003E\u003Cdiv style=\"text-align: center;\"\u003E\u003Cb\u003E\u003Cspan style=\"font-size: large;\"\u003ETo be invited in, we have to bring data.\u003C\/span\u003E\u003C\/b\u003E\u003C\/div\u003E\u003Cbr \/\u003EKristina B. Newport MD, \u0026nbsp;Palliative Medicine Consultants, \u003Ca href=\"http:\/\/www.hospiceandcommunitycare.org\/\" target=\"_blank\"\u003EHospice and Community Care, Lancaster PA\u003C\/a\u003E \u003Ca class=\"twitter-follow-button\" data-show-count=\"false\" href=\"https:\/\/twitter.com\/kbnewport\"\u003EFollow @kbnewport\u003C\/a\u003E\u003Cscript\u003E!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=\/^http:\/.test(d.location)?'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+':\/\/platform.twitter.com\/widgets.js';fjs.parentNode.insertBefore(js,fjs);}}(document, 'script', 'twitter-wjs');\u003C\/script\u003E\u003Cbr \/\u003E\u003Cbr \/\u003EShanthi Sivendran MD, MSCR – Hematology\/Oncology Medical Specialists, Ann B Barshinger Cancer Institute, Lancaster General Health, PA\u003Cbr \/\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003E\u003Ci\u003EPhoto Credit: Oncology and Palliative Medicine - Courtesy of Charles Von Gunten\u003C\/i\u003E\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003E\u003Ci\u003EPhoto Credit: Burnout in Palliative Care slide - Courtesy of Arif Kamal\u003C\/i\u003E\u003C\/span\u003E\u003Cbr \/\u003E\u003Cspan style=\"font-size: x-small;\"\u003E\u003Ci\u003EPhoto Credit: Personalized Palliative Care slide - Courtesy of Jenifer Temel\u003C\/i\u003E\u003C\/span\u003E"},"link":[{"rel":"edit","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/8061211824486913057"},{"rel":"self","type":"application/atom+xml","href":"https:\/\/www.blogger.com\/feeds\/13495125\/posts\/default\/8061211824486913057"},{"rel":"alternate","type":"text/html","href":"https:\/\/www.pallimed.org\/2014\/11\/2014-palliative-care-in-oncology.html","title":"2014 Palliative Care In Oncology Symposium Review"}],"author":[{"name":{"$t":"K Newport"},"uri":{"$t":"http:\/\/www.blogger.com\/profile\/03589697433225081093"},"email":{"$t":"noreply@blogger.com"},"gd$image":{"rel":"http://schemas.google.com/g/2005#thumbnail","width":"16","height":"16","src":"https:\/\/img1.blogblog.com\/img\/b16-rounded.gif"}}],"media$thumbnail":{"xmlns$media":"http://search.yahoo.com/mrss/","url":"http:\/\/4.bp.blogspot.com\/-0jMk2yOIhTo\/VFUR3frzO1I\/AAAAAAAAixQ\/mxibtBy_0lg\/s72-c\/onc%2Band%2Bpall.PNG","height":"72","width":"72"}}]}});