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Online Resources


The Connecticut Coalition to Improve End-of-Life Care (CTEOL)

(See also Sudore article in Journal Watch, below).

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Dr. Christian Sinclair, a hospice medical director in St. Louis, is a strong and creative advocate for the use of blogs (Pallimed, GeriPal, etc.) and the social media (Facebook, Twitter, etc.) to advance palliative care.  In an interview on PainEDU he describes the effect of harnessing the power of new media on a specific matter:  the FDA's planned, now aborted, withdrawal of liquid oral morphine from the market.

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Palliative Care on NBC TV

Helping cancer patients live longer, better.

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Doctor: Palliative care is "full approach" to medicine.

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Patient: Palliative care helps me "live my life the fullest".

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Opioids911-Safety is a new patient-focused web site that emphasizes safe medical use of opioids.  There is a section for providers that includes information on how to use materials on the site in clinical practice.  Opioids911-Safety is an education service of Pain Treatment Topics.

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AARP resource

Where Cancer Survivors Can Get Help:  Help with Cancer Bills.

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Continuing Education

Yale Bioethics Center End of Life Issues Group
Theme for 2010-2011:  "Ethical Aspects of the Advances in Modern Medicine." (CME)  Tuesdays 5:30pm - 7:00pm.Audio and video of this year's presentations are available on the Center's web site.
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November 4
Medical Progress: How Much Can We Afford and What Kind Do We Need? Daniel Callahan, PhD, President Emeritus of The Hastings Center.  Cohen Auditorium - 230 South Frontage Rd.
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November 15
Yale Symposium on Palliative and End-of-Life Care  (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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November 5 - 7
Cancer Survivorship for Clinicians:  Helping Survivors Live Well Beyond Cancer

Dana-Farber Cancer Institute.  Boston. CME, CNE, SWCE, Psych CE.
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Advances in Bone Cancer Treatment: Preventing Metastasis and Bone Loss (CME)
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October  2010          Volume 4 No 9

Cancer Survivorship Themes: Concerns about Returning to Work

This is the fourth in a series of descriptions of common themes encountered among cancer survivors who attend the Connecticut Challenge Survivorship Clinic at Yale Cancer Center.

For many adults, the work they do (that is, employment) is an important part of self-identity and socialization and an important source of self-esteem.  Understandably, those who have had to cut back or stop working because of cancer treatment have concerns about returning to work.

  • I'm starting back to work soon.  I'm looking forward to it, but I'm nervous, too. 
  • What if my boss expects too much of me at first? 
  • I've developed some healthy habits after my treatment and I'm afraid I won't have time or will get too busy to continue them.
  •  My co-workers have been supportive, but I don't know if I'm ready to go back full time-will I have the energy, will I be as sharp?
  • I used to have to lift those little kids in my class-I can't do that now.
  • My head is in a very different place now.  I wonder if I'll still fit in.  This job doesn't hold the same meaning it once did.


We have asked the Survivorship Clinic specialists to address these concerns in a hypothetical participant.

Advanced Practice Nurse:  Returning to work (at either the same or a new job) is an important milestone for a survivor.  It does require planning and sometimes soul-searching.  Many survivors "ease into it" by starting back part-time or with a reduced work-load, just as a person might who is recovering from an accident or heart attack.  It is both prudent and acceptable to request certain accommodations, such as office work before resuming field work, for example.

Physical Therapist:  How can you return to work and still find ways to stay active or increase your activity level?  If you work on the upper floors of an office building, take the stairs instead of the elevator (and if you do work on the first floor, you can always walk up and down the stairwell several times anyway!)  You can park farther away from where you work in the parking lot; if there is a shuttle to work from the parking lot, try to walk the distance once a day for two weeks, and then as you get stronger you can walk round-trip.  If you plan on going to a gym or working out after work, bring your gym clothes with you to work, and change into them at the end of your work day.  This way, you don't have to go home first to change and then potentially get distracted from your time to exercise.  Encourage a co-worker (or two or three) to come with you on a lunch-time walk or an after work workout.  Having a partner to exercise with makes the task more fun, it makes the time go by faster, it holds you more accountable, and you are getting somebody else to exercise and be healthy too!  Talk to your co-workers and your supervisor about entering a corporate challenge at a local road race, bike event, or other activities such as a weekend hike.  This will help get more people to be active and help build camaraderie amongst all of your co-workers.

Social Worker:  Communication and flexibility are the keys to transitioning back to work.  Have a head-to-head/heart-to-heart conversation with your boss and communicate your reality.  The contemporary work place seems to have more options for survivors.  Do you need to temporarily (or permanently) reduce your hours/days at work?  Is it possible to work some hours/days from home via computer?  Honesty is usually the best policy and most employers want to support their employees for a myriad of reasons.

Nutritionist:  Returning to work can present many obstacles to eating well. All of them can be addressed with a thoughtful plan and a good food store to arm yourself with on-the-go foods. The first challenge is making sure you schedule the time to eat within your hectic day. This starts with a mandatory breakfast. Either at home or at your desk, eating something quick like a bowl of high fiber cereal with berries and skim milk energizes your day. The work environment itself can present many hazards:  candy bowls on desks, Danish by the coffee maker, or the vending machine down the hall. Stock your work area with healthy snacks such as dried fruits, yogurt, or nuts. Try to enlist your co-workers to establish a healthy-food-only office policy to benefit all. Lunch provides a much needed mental and physical recharging.  Brown bag lunch (a simple sandwich or dinner leftovers and a piece of fruit) then take a brisk walk with co-workers.  The late afternoon snack is essential to eat either at work or on the commute home. This is a natural low energy time. Don't fight it, fuel it. A piece of fruit and some cheese or nuts will take the edge off of your hunger. You don't want to arrive home ravenous, thereby setting yourself up to overeat at dinner, or worse, continually grazing throughout the evening. When you fuel your body throughout your workday, you find that dinner becomes your smallest meal.


For those who work evening and night shifts, adapt your eating schedule to fit your work hours even if that means your "breakfast" is at 11 PM and "dinner" is at 7 AM.

In the News

Call for citizen action to influence national policy on palliative care. 

The Department of Health and Human Services and the National Quality Forum (NQF) are each seeking input on major healthcare quality initiatives: NQF deadline is October 19.  The Pallimed blog has information on the issues and process, including a letter from Diane Meier and thoughts on the HHS request for comments.

October is Breast Cancer Awareness Month.

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ASTRO guideline sets standard for use of radiotherapy as palliative treatment of pain from bone metastases. 
The draft guideline is available ahead of publication.
The Connecticut Coalition to Improve End-of-Life Care (CTEOL) is holding its annual meeting at the Franciscan Center in Meriden on Friday, October 22.  The Coalition is also selling at cost ($5.00 each) its guide to advance care planning, Beginning the Conversation about Death, Dying and End-of-Life Care in Connecticut.  "This guide answers ten of the most commonly asked questions about end-of-life care. It also offers basic information to help individuals make informed choices about end-of-life care for themselves and their loved ones." (See also Sudore article in Journal Watch, below).
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Journal Watch

Editor's Note: In the June 2009 issue I asked the question, Who Is a Cancer Survivor?  Please see the Tanzman essay, below, for another take on that question.

Argyriou AA, et al.
Either Called "Chemobrain" or "Chemofog," the Long-Term Chemotherapy-Induced Cognitive Decline in Cancer Survivors Is Real. J Pain Symptom Manage. 2010 Sep 9.

David AR, Zimmerman MR. Cancer: an old disease, a new disease or something in between? Nature Reviews Cancer. 2010;10(10):728-733.

Deeken JF, Weiner LM. Supportive Treatments for Oncology Patients: Not Just Icing on the Cake. Ann Intern Med 2010;153(6):411-412.

Hamilton JB, et al. Coping Profiles Common to Older African American Cancer Survivors: Relationships with Quality of Life. J Pain Symptom Manage. 2010 Sep 14.

Holzer P. Opioid antagonists for prevention and treatment of opioid-induced gastrointestinal effects. Curr Opin Anaesthesiol. 2010;23(5):616-22.

Horace M, DeLisser HM. How Do I Conduct the Family Meeting to Discuss the Limitation of Life-Sustaining Interventions: A Recipe for Success. Blood. 2010;116(10):1648-1654.

Kwan ML, et al. Alcohol Consumption and Breast Cancer Recurrence and Survival Among Women With Early-Stage Breast Cancer: The Life After Cancer Epidemiology Study.
J Clin Oncol. 2010 Aug 30.

Lin K, Sharangpani R. Screening for Testicular Cancer: An Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153(6):396-399.

Loprinzi CL, et al. Compassionate honesty. J Palliat Med. 2010 Sep 16. Myers JS, et al. Predictors of self-reported memory problems in patients with ovarian cancer who have received chemotherapy. Oncol Nurs Forum. 2010 Sep 1;37(5):596-603.

Olsen ML, et al. Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments. Mayo Clin Proc. 2010 Aug 30. Read More >>

Prieto-Alhambra D, et al. Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort study. Breast Cancer Res Treat. 2010 Jul 28.

Schiech L. HPV-related cancer: An equal opportunity danger. Nursing. 2010;40(10):23-28. (CNE)

Starr TD, et al. Substance abuse in cancer pain. Curr Pain Headache Rep. 2010;14(4):268-75.

Sudore RL, Fried TR. Redefining the "planning" in advance care planning: preparing for end-of-life decision making. Ann Intern Med. 2010 Aug 17;153(4):256-61. (See also CTEOL booklet in Online Resources, below)

Tanzman ES. Survivor*. Ann Intern Med 2010;153(6):416-417.

Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-42.
  • Accompanying editorial: Kelley AS, Meier DE. Palliative care--a shifting paradigm. N Engl J Med. 2010;363(8):781-2.