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Online Resources

Life Before Death is a new web site developed by the Lien Foundation and the Singapore Hospice Council.  "This is clearly not a website for anyone who thinks they are immortal. But the mere mortals amongst you will find lifebeforedeath.com fun, offbeat, wonderfully weird, insightfully inspiring and even delightfully practical. And why not? It's all about everyone's least favorite "D" word - Death. It's no big secret that Death has a bad rep. It is after all the End-of-Life. Boo-hoo. But now, Death is being re-branded with a new image and attitude. All this to try and change your mind about this whole Death & Dying thing."  See discussion on Life Before Death and its companion website, Quality of Death Index, in the Pallimed blog.
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United Breast Cancer Foundation is an educational and advocacy group for people affected by breast cancer.  Among other programs, UBCF financially assists women with breast reconstruction surgery.
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Healthy Steps is an exercise/dance program that has been used to improve fitness in cancer patients and survivors, including those with lymphedema.  Classes are available in several sites in Connecticut.
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Continuing Education


Schwartz Rounds
Schwartz Rounds will resume September 16th at noon (thereafter it will be on the 2nd Thursday of the month) in a new location:  Smilow Cancer Hospital at Yale-New Haven in the Park Street Auditorium. (CME)
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Yale Bioethics Center End of Life Issues Group will resume September 14th at the Yale Child Study Center, 230 South Frontage Road.  Theme for 2010-2011:  "Ethical Aspects of the Advances in Modern Medicine." See web site after mid-August for complete schedule. (CME)
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September 25
9th Annual Oncology Nursing Symposium
Challenges in Oncology Nursing Practice.  Smilow Cancer Hospital.  Contact Lisa Barbarotta, MSN. (CNE)

November 15
Yale Symposium on Palliative and End-of-Life Care.  (CME)
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September 3  - October 1
(5 consecutive Fridays)
Basic Oncology Core Course
Hospital of St. Raphael, New Haven.  Contact Susan Fisher (203) 789-3391.  Deadline:  August 20. (CNE)

September 30
Connecticut Challenge Survivorship Summit
Jewish Community Center, Woodbridge (CME, SWCE)
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October 8 & 15
ONS Chemotherapy & Biotherapy Course
Hospital of St. Raphael, New Haven.  Contact Susan Fisher (203) 789-3391.  Deadline:  September 16. (CNE)

September 17-19
First Annual Navigation & Survivorship Conference
Academy of Oncology Nurse Navigators.  Baltimore. (CNE)
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October 8 - 10
Practical Aspects of Palliative Care:  Integrating Palliative Care
into Clinical Practice
HMS Center for Palliative Care.  Cambridge, MA. (CME)
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November 5 - 6
Quality of life for the Children
4th Annual Pediatric Palliative Care Conference. Washington, DC.
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Suncoast Institute is a program of Suncoast Hospice (Florida). The Institute offers a variety of courses in several formats, including online.
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August  2010          Volume 4 · No 7
Survivorship Themes: Fear of Recurrence

Last month we introduced common themes that occur as we discuss survivorship issues with participants in the Connecticut Challenge Survivorship Clinic.  In this issue we'll explore perhaps the most common concern of people who have recently completed cancer treatment, fear of recurrence.  Fear of recurrence is expressed in various ways:
  • I'm scared to death that the cancer will come back.
  • They got it all.  Right?
  • Can I do something to keep the cancer from coming back?
  • I just can't face going back to that clinic.
  • I think I've become a hypochondriac-I worry that every twinge or change is the cancer coming back.
We asked our specialists to address this concern in a hypothetical participant.

Social Worker: Fear of recurrence is very common.  A helpful way to think of this is that fear of the cancer returning is a projection into the future...we are imagining the future in a negative way.  I suggest that, if we are going to use our imagination, then it is helpful to use it in a positive way and imagine ourselves healthy.  There are visualizations and affirmations that can be helpful in projecting into the future.  Best of all, there are techniques to assist in keeping us in the present.  Meditation or mindfulness and conscious breathing bring us into the present moment. There are numerous books, CDs, and DVDs that are presently available, as well as classes in most communities to learn these skills.  We have a survivor support group following individual sessions in our clinic, which includes a short conscious breathing/meditation practice.  Concern about health can be a motivator to adopt other healthy practices, such as nutritious eating and exercise.
Physical Therapist: Regular exercise has been shown to reduce the risk of several illnesses, including cancer.  Exercising 5 times a week for 30 minutes may reduce one's risk of recurrence or developing a secondary cancer.  Moderate to vigorous levels of exercise are the most effective.  If we think of exercise on a scale of 1-10-1 is sitting on the couch, at 10 you feel like you'll pass out-aim for 5-7.  Additional benefits of exercising after cancer treatment include weight reduction, improved cardiovascular endurance, increased muscular strength, and improved mood.  Exercising not only reduces one's risk of a recurrence of cancer but it also decreases one's risk for other chronic diseases such as diabetes and high blood pressure and reduces the risk of stroke and heart attack.

Nutritionist: There is no one food that will trigger a cancer recurrence or protect a person from recurrence. However, following a healthy diet plan may help prevent recurrence of some cancers.  In addition, a nutritious diet will contribute to weight management, improved cardiovascular health, and help manage blood pressure, cholesterol levels, blood glucose levels, and even mood.

The ideal diet plan is outlined below:
  • Eat a predominately plant-based diet rich in vegetables, fruits, and whole grains.  Eat a rainbow of colors of fruits and vegetables.  Each color represents a different constellation of vitamins, minerals, and phytonutrients packaged by nature to act in synergy.  Eat at least 5 servings of fruits and vegetables a day, as whole foods have a potency not found in use of supplements.
  • Limit consumption of processed and red meats. Think of meat as a condiment.
  • Emphasize omega-3 fatty acids.  Omega-3 sources (salmon, eggs fortified with omega-3, flaxseed, fish oil supplement) may have specific benefits for cancer survivors. 
  • Limit consumption of alcohol.  Moderate drinking is one drink per day for women and 2 per day for men.
  • Observe food safety practices.  It is important to protect your immune system from food-borne illnesses.
APRN: Participants in our clinic have had state-of-the-art cancer treatment and have no detectable cancer.  The chances of recurrence are low, but it is difficult to assign a percentage.  We know that in some people the cancer will come back, but we can't predict with any certainty the risk of recurrence for a specific person.  It is helpful, and prudent, to look on this as an opportunity to begin a personal wellness program.  Taking preventive or maintenance medications (if applicable) significantly reduces risk.  In addition, keeping to the schedule of physical exams, lab tests, and scans (as applicable) increases the chances of early detection just in case there is a recurrence.  Taking advantage of the fitness, nutrition, and emotional health resources available in the community or a survivorship clinic will provide tools for health promotion that survivors can continue to develop with a primary care provider.

In the News

The Connecticut Challenge
The Connecticut Challenge bicycle ride to raise money for survivorship programs throughout Connecticut was held July 24th in Fairfield.  Over 740 riders, the largest field ever, and hundreds of volunteers turned out on one of the hottest days of the year. The ride is over, but fundraising is not! Please contribute in the name of your favorite rider or team or to the general cause of supporting cancer survivors across Connecticut.
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Journal Watch

Virtual Mentor is the American Medical Association's online ethics journal. The July issue is devoted to the topic of Pediatric Palliative Care.

Bonebrake D, et al.  Clinically Differentiating Palliative Care and Hospice.  Clinical Journal of Oncology Nursing. 2010;14(3):273-275.

Burstein HJ, et al.  American Society of Clinical Oncology Clinical Practice Guideline: Update on Adjuvant Endocrine Therapy for Women With Hormone Receptor-Positive Breast Cancer.  Journal of Clinical Oncology.  2010 Jul 12.

Craig L.  Prolonged Grief Disorder. Oncology Nursing Forum. 2010 Jul;37(4):401-6.

DuHamel KN, et al.  Randomized Clinical Trial of Telephone-Administered Cognitive-Behavioral Therapy to Reduce Post-Traumatic Stress Disorder and Distress Symptoms After Hematopoietic Stem-Cell Transplantation.  Journal of Clinical Oncology.  2010 Jul 10.

Krelstein M.  Exploring the Interface Between Cancer and Psychiatry.  Oncology. 2010;24(7):657-658. (Free full text)

Liénard A, et al.  Is it Possible to Improve Residents Breaking Bad News Skills? A Randomised Study Assessing the Efficacy of a Communication Skills Training Program.  British Journal of Cancer. 2010;103(2):171-177.

Pollock AB, et al. Morphine to Methadone Conversion: An Interpretation of Published Data.  American Journal of Hospice and Palliative Medicine.  2010 Jun 16.

Schlairet M, et al.  Piloting a Needs Assessment to Guide Development of a Survivorship Program for a Community Cancer Center.  Oncology Nursing Forum. 2010 Jul;37(4):501-8.

Schmidt BL, et al.   Mechanism of Cancer Pain.  Molecular Interventions. 2010;10(3):164-178.

Schmitz KH, et al.  American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors.  Medicine and Science in Sports and Exercise. 2010; 42(7):1409-26.

Walz DA.  Cancer-Related Anorexia-Cachexia Syndrome.   Clinical Journal of Oncology Nursing.  2010;14(3):283-287.

Winters L, et al.  "I feel like I am 100 years old!"  Managing Arthralgias from Aromatase Inhibitors.  Clinical Journal of Oncology Nursing.  2010;14(3):379-382.

Wolin KY, et al.  Obesity and Cancer.  The Oncologist. 2010;15(6):556-565.