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Online Resources

ASCO Guidelines on follow up care  Breast Cancer
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Colorectal Cancer
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Continuing Education


Yale Bioethics Center
End of Life Issues group
All meetings 5:00 - 7:30pm (CME)

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March 2
John Arras, PhD
Justice and Health Care
77 Prospect Street

March 25
Timothy Quill, MD
Justice at End-of-Life
Cohen Auditorium, Child Study Center, 230 Frontage Road

April 6
John D. Lantos, MD

Extreme Prematurity
Cohen Auditorium, Child Study Center, 230 Frontage Road

March 4 

Yale Research Symposium on Complementary and Integrative Medicine
Harkness Auditorium, Yale School of Medicine.  CME, CNE
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April 21
4th Annual Yale Cancer Survivorship Symposium: Sexuality and Survivorship
New Haven Lawn Club.  CME, CNE
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February 26, March 5, 12, 19, April 1

Basic Oncology Core Course
Hospital of St. Raphael (CNE)
Pre-registration required: (203) 789-3391

April 9 & 16; 7:30am-4:30pm
ONS Chemotherapy & Biotherapy Course
Hospital of St. Raphael (CNE) Pre-registration required: (203) 789-3391

April 17
Oncology Nurses Connecting in Connecticut
3rd Annual Oncology Symposium. The Oakdale Theatre. 95 South Turnpike Road, Wallingford, CT.  Registration details to follow.

April 23
Continuing the Conversation . . . Addressing Barriers to End-of-Life Care
Annual Spring Conference of Connecticut Coalition to Improve End-of-Life Care.  Albertus Magnus College, New Haven.  Registration details to follow.
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April 27 - May 4, 2010
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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February 2010          Volume 4 ยท No 1

Unwarranted Fears about Use of Opioids and Sedatives at the End-of-Life

It is common to use opioid analgesics and, less commonly, sedatives to manage symptoms of advanced and progressive disease at the end-of-life.  The prevalent symptoms of pain, dyspnea, and severe agitation are treated with one or more medications in these classes.  A common fear, even assumption, about end-of-life care is that these medications may lead to early death.   This concern exists even when these agents are used appropriately and judiciously for specific indications.  

An ethical justification for use of these agents at the end-of-life, the "Double Effect Principle," has been cited numerous times in this context.  In simplest terms, 'double effect' recognizes that an appropriate medical treatment may have an unwanted serious effect (possibly including death).  The use of this ethical argument assumes that other, less dangerous treatments have been ineffective or are unavailable, that the intent is to relieve the symptom, not to cause death, and that a risk vs. benefit discussion has been held with the patient and/or surrogate decision-makers so that informed consent may be given.

A series of retrospective and prospective studies over more than a decade in multiple countries and settings have largely dispelled the concerns about the use of these agents near the end-of-life, and obviated the need to resort to double effect as an ethical justification for their appropriate use.  Studies have been done in home-care hospice, inpatient hospice, and palliative care settings.  The conclusion of these researchers is that even 'high,' 'very high,' and 'increasing' doses of opioids at the end-of-life (usually last week of life) do not contribute to shortened survival.  Nigel Sykes, who participated in two studies, states in an editorial on a more recent and the largest study, that the question of whether appropriate opioid use leads to early death in patients with advanced disease has been answered.  He concludes "Let's move on, everyone," to looking at other variables in disease and patient characteristics that affect time of death.

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In the News

Healing Physically, Yet Still Not Whole.
Dana Jennings' column from the New York Times on the difference between recuperation and recovery from cancer treatment.

Illness, Crisis, and Loss
A Special Issue of the journal Illness, Crisis, and Loss was devoted to the legacy of Florence Wald, former Dean of the Yale University School of Nursing (YSN) and founder of the Connecticut Hospice and the hospice movement in the United States.  Three faculty and former colleagues at YSN contributed.

Obese Breast Cancer Patients Carry Greater Recurrence Risk.

The Connecticut Challenge 2010
Registration is open for the 2010 Connecticut Challenge, to be held Saturday July 24th in Fairfield, CT. The Challenge is an annual bicycle ride that raises money to support cancer survivorship programs in Connecticut. The first two programs to receive support were the Connecticut Challenge Survivorship Clinic at Yale Cancer Center and the HEROS Pediatric Survivorship Clinic at Yale University.
Learn More >>
Journal Watch

Berger AM, et al.  One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. 
J Clin Oncol. 2009 Dec 10;27(35):6033-40.

Bokhari F, Sawatzky JA. Chronic neuropathic pain in women after breast cancer treatment. 
Pain Manag Nurs. 2009 Dec;10(4):197-205. Epub 2008 Dec 13.

Boykoff N, et al. Confronting chemobrain: an in-depth look at survivors' reports of impact on work, social networks, and health care response. 
J Cancer Surviv. 2009 Sep 16.

Evens K, Eschiti VS. Cognitive effects of cancer treatment:  "chemo brain" explained.
Clin J Oncol Nurs. 2009 Dec;13(6):661-666.

Fu MR, Rosedale M. Breast cancer survivors' experiences of lymphedema-related symptoms. 
J Pain Symptom Manage. 2009 Dec;38(6):849-59.

Khan QJ, et al. Effect of vitamin D supplementation on serum 25-hydroxy vitamin D levels, joint pain, and fatigue in women starting adjuvant letrozole treatment for breast cancer. 
Breast Cancer Res Treat. 2010 Jan;119(1):111-8.

Lasheen W, Walsh D. The cancer anorexia-cachexia syndrome: myth or reality? 
Support Care Cancer. 2009 Nov 24.

Palaska PK, et al. Bisphosphonates and time to osteonecrosis development. 
Oncologist. 2009. 14(11):1154-66. (CME)

Parsons HA, et al. Methadone initiation and rotation in the outpatient setting for patients with cancer pain. 
Cancer. 2009 Nov 18.

Scott SA. Life-support interventions at the end of life:  Unintended consequences. 
Am J Nurs. 2010;110(1):32-39. (CNE)

Snapp J. Partnering with palliative care.
Nursing Management. 2010;41(1):18-23. (CNE)

Spence RR, et al. Exercise and cancer rehabilitation: A systematic review. 
Cancer Treat Rev. 2009 Dec 3.

Surbone A, Baider L. The spiritual dimension of cancer care.
Critical Reviews in Oncology/Hematology 2010;73 (3) 228-235.

Woodcock J. A Difficult Balance - Pain Management, Drug Safety, and the FDA. 
NEJM.  2009;361(22):2105-2107.

[See a different opinion at Pain-Topics.org:  REMS: When Elephants Prance, Ants Take a Pounding]