The oncologist
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Although calls for improvements in cancer survivorship planning and programming exist, implementation has lagged. As with most guidelines, moving from recommendations to implementation requires active planning and systems changes to insure sustained use. Here, we draw on the latest in implementation science to outline a process that cancer organizations can use in designing, implementing, prioritizing, and evaluating cancer survivor programs to improve patient outcomes, using smoking cessation as a primary example. We consider the scientific evidence for benefit from interventions and the strategy for implementation and evaluation to sustain programs.
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Palliative care consultation services are now available in the majority of cancer centers, yet most referrals to palliative care occur late. We previously found that the term "palliative care" was perceived by oncology professionals as a barrier to early patient referral. We aimed to determine whether a service name change to supportive care was associated with earlier referrals. ⋯ The name change to supportive care was associated with more inpatient referrals and earlier referrals in the outpatient setting. The outpatient setting facilitates earlier access to supportive/palliative care and should be established in more centers.
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Recommendations for communicating bad or serious news are based on limited evidence. This study was designed to understand patient perspectives on what patients value when oncologists communicate news of cancer recurrence. ⋯ This study suggests that oncologists giving news of cancer recurrence could think of the communication as going back and forth between recognition and guidance and could ask themselves: "Have I demonstrated that I recognize the patient's experience hearing the news?" and "Have I provided guidance to the next steps?"
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Anemia in cancer patients can be treated with transfusions, and 15% of patients with solid tumors are being treated by transfusions. Different cutoff values are used for transfusions, depending on clinical symptoms and patient characteristics, with a hemoglobin (Hb) level of <9 g/dL most commonly used. After the administration of one unit of red blood cells (RBC), the Hb rises with 1 g/dL, and the life span of transfused RBC is 100-110 days. ⋯ RBC transfusions have been related to increased risk of the development of non-Hodgkin lymphoma and chronic lymphocytic leukemia, and are related to a worse treatment outcome in selected cancers. In addition, the cost of a transfusion for the patient and society is around 300-500 euros per unit transfused. RBC transfusions should be used carefully to correct anemia in patients with cancer.
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To describe the clinical studies that led to the FDA approval of rituximab in combination with fludarabine and cyclophosphamide (FC) for the treatment of patients with chronic lymphocytic leukemia (CLL). ⋯ On the basis of the demonstration of clinically meaningful prolongation of PFS, the FDA granted regular approval to rituximab in combination with FC for the treatment of patients with CLL. The magnitude of the treatment effect in patients 70 years and older is uncertain.