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Online Resources

Journey Forward
A free online resource for creating cancer treatment summaries and survivorship care plans.
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pain-topics.org
Opioid Rotation: Benefits, Challenges, Hazards.
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Pallimed.org
I have previously highlighted the excellent palliative care blog, Pallimed.org [Disclosure:  Tom Quinn, Editor of YaleCares, is a former regular contributor to Pallimed].  I would like to point out some recent excellent blogs on the Arts & Humanities section of Pallimed.  One of these is The Death of Mr. Hooper on Sesame Street.  It includes an audio interview with the creator of Big Bird.  Another is Eco-Friendly Burial.  Who knew?
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palliativecaregr.blogspot.com
Palliative Care Grand Rounds is a monthly review of palliative care blogs.  A different blogger hosts it each month.
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Integrative Oncology
A collection of short reviews from a monthly column by Barrie Cassileth, PhD in Oncology.  The most recent review is on Oxygen Therapies.  (free registration required to access articles)
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Natural Medicines Comprehensive Database
Includes CE opportunities for Physicians, Nurses, and Pharmacists.
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cancer.gov
Adapting the Science of Supplements and Cancer Prevention.  From the NCI Cancer Bulletin.
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Continuing Education


Yale

Feb 2, 5:30-7:00pm
Yale Bioethics Center End of Life Issues group. Prognostication: Meaning and Interpretation of an Imprecise Science.

April 21, 2010

4th Annual Yale Cancer Survivorship Symposium: Sexuality and Survivorship.  New Haven Lawn Club.  Stay tuned for registration details.


Elsewhere

April 27 - May 4, 2010 and
November 9-15, 2010

Program in Palliative Care Education and Practice. Harvard Medical School, Boston. Perhaps the premier course for physicians and nurses in palliative care.
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Online
Pain and Addiction 101
A series of courses at Emerging Solutions in Pain. (CME, CPE, CNE)
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January 2010          Volume 3 No 11

Does Morphine Encourage Cancer Growth?

Thomas Quinn, APRN, MSN


Some recent scary headlines in the lay press hyped a very preliminary study in lung cancer cell lines, suggesting that use of morphine (or other opioids) in advanced cancer patients may hasten death, and that methylnaltrexone, a peripherally acting opioid antagonist, may retard cancer growth.  The news reports cite "growing clinical evidence" of this phenomenon.  Unfortunately, the "clinical evidence" cited is barely tenuous and the laboratory studies are very preliminary.  

  • The news reports were based on a press release by the University of Chicago press office.  It should be noted that methylnaltrexone, which is currently indicated only for opioid-induced constipation in advanced cancer patients, was developed at the University of Chicago and licensed to a pharmaceutical company.

  • The press release is based on a presentation at a scientific meeting.  Even early research findings by well-regarded scientists must be subjected to peer review through publication in reputable scientific journals; this report is yet to be published.

  • The research was initiated after a small number of patients in a methylnaltrexone study lived longer than expected.  Similarly, a very small number of patients with advanced cancer in an intrathecal analgesic study lived a little longer than expected (but did not reach statistical significance, and it was not a study end-point).

  • Three small, single-institution clinical studies are mentioned (two of them at the same institution in Ireland).  Longevity related to opioid use was not a study question in any of these studies.  There are multiple other factors that could have contributed to any perceived survival advantage.

  • There are several small studies which show that well-managed pain (using aggressive opioid treatment) in end-stage disease does not shorten life and may have a slight survival advantage in some cases (these studies did not address the direct affect of opioids on tumor growth, which is the presumed reason for the observed survival effect). 

  • Opioid analgesics have a long and well-documented track record of relieving pain and dyspnea associated with advanced cancer, reducing suffering, and improving quality of life.

Clinical practice in any arena should not be changed based on the findings of a single study, even one that is well-designed and conducted.  The findings from these studies are speculative. From a research perspective they raise interesting questions that suggest hypotheses and form the basis for future laboratory research.  Based on results of those future studies, clinical trials can then be designed.  


There is some fascinating science at work in this, and it will be prudent to follow its progress in the coming years.  However, it would be imprudent, at best, to change current pain management practices with opioid analgesics based on this report.  Patients and clinicians need to have the news reports put in perspective.


In the News

Connecticut Cancer Partnership
New issue of the Connecticut Cancer Partnership newsletter, CA CONNection is available online.
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New York Times Articles
In Hospice, Care and Comfort as Life Wanes.
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New NIH-funded Pain Center Led By School Of Nursing At The University of MD, Baltimore
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Journal Watch

Recent articles on sexuality and cancer (see discussion in November 2009 issue)

Apperley J.  Issues of imatinib and pregnancy outcome. 
J Natl Compr Canc Netw. 2009 Nov;7(10):1050-8.
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Bober SL.  Out in the open:  Addressing Sexual Needs after Cancer. 
Cancer Journal
2009; 15(1):13-14.
This is an editorial by the Guest Editor of a special issue of Cancer Journal (2009 Jan-Feb;15(1)] that has several articles on sexuality.  Dr. Bober will be the keynote speaker for the 4th Annual Yale Survivorship Symposium, April 21, 2010
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Dizon DS.  Quality of Life After Breast Cancer:  Survivorship and Sexuality. 
Breast J.  2009;15(5):500-504. 
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Hughes MK.  Sexuality and Cancer:  The Final Frontier for Nurses. 
Oncol Nurs Forum
.  2009;36(5):E241-E246.
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Irani J, et al.  Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial. 
Lancet Oncol
. 2009 Dec 4.
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Jukkala AM, Meneses KM.  Preserving Fertility in Young Women Diagnosed with Breast cancer. 
Oncology Nurse Edition
.  2009;23(11):36-38.
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Kiserud CE, et al.  Do male lymphoma survivors have impaired sexual function? 
J Clin Oncol. 2009 Dec 10;27(35):6019-26.
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Lester JL, Bernhard LA.  Urogenital atrophy in breast cancer survivors. 
Oncol Nurs Forum. 2009.  36(6):693-8.
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Loprinzi CL, Wolf SL.  Hot flushes: mostly sex neutral? 
Lancet Oncol. 2009 Dec 4.
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Matzo M, Hijjazi K.  If You Don't Ask Me . . . Don't Expect Me to Tell:  A Pilot study of Sexual Health in Hospice Patients. 
J Hosp Palliat Nurs
.  2009;11(5):  271-281.
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Rowland JH, et al.  Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention. 
Breast Cancer Res Treat. 2009;118(1):99-111.
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Wittmann D, et al. The psychosocial aspects of sexual recovery after prostate cancer treatment.
Int J Impot Res. 2009 Mar-Apr;21(2):99-106.
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