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Online Resources

Opioid safety resources for patients
  • PainSAFE (American Pain Foundation)
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  • Opioids 911-Safety: Help for Safely Using Opioid Pain Relievers. (Pain Treatment Topics)
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  • PainAction.com. Register (free), then navigate to Medication Safety Library. There are also 3 printable PDF's: "Facts about Opioid Medications;" "How to Safely Start a New Medication;" "How to Fill and Refill an Opioid Prescription."
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Cancer Survivorship: Role of Healthcare Providers.
A Medscape Nurses adaptation of the Survivorship Module of the EPEC-O curriculum.
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Cancer and nutrition blogs:

Continuing Education

December 9; 12p
Schwartz Rounds
55 Park Street Auditorium
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May 5, 2011
Annual Yale Survivorship Symposium
Nutrition and Cancer Survivorship-Separating the (Whole) Wheat from the Chaff. 
West Campus. 
CME, CNE, SWCE, Nutrition CE.

April 5-12, 2011 &
November 2-8, 2011
The Program in Palliative Care Education and Practice
Cambridge, MA. 
Adult and pediatric tracks available.
Application deadline:  Feb 11, 2010.


Advances in Bone Cancer Treatment
Preventing Metastasis and Bone Loss (CME)
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The Cancer Survivor's Prescription for Living (CNE)
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PainEDU approved CE case-based course for nurses, physicians, pharmacists and psychologists.
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November 2010          Volume 4 No 10

Cancer Survivorship Themes: Guilt

Over the past three months we have explored some of the survivorship themes identified by the staff of the Connecticut Challenge Survivorship Clinic at Yale Cancer Center.This month we'll take a brief look at a complex and difficult theme: Guilt.  As with the other themes it is manifested in various ways:

  • I must have brought this (cancer) on myself somehow.
  • I know my cancer was caused by eating  . . . . (red meat, fast food, dairy, etc.).
  • If only I could have had a more positive attitude!
  • Being a couch potato sure didn't help.
  • I'm grateful to be a survivor, but I feel bad that I did well while some of the people I got to know in the treatment center had a much harder time.
  • I can't believe what I put my family through!

Our clinicians address this phenomenon in a hypothetical patient:


APRN:  There is a tendency to find someone to blame when something bad happens to us; too often we turn that blame in on ourselves, a cultural characteristic in the West.  In reality no one can know what "caused" a specific cancer in a specific individual.  Cancer is a very complex process that takes years to develop and requires several metabolic steps to occur in the right sequence.  It's helpful to recognize that specific behaviors and attitudes neither cause nor cure cancer.  Risk factors (which in themselves are not "causes") are identified in studies of large heterogeneous groups.  Many, perhaps most, cases of cancer arise without being able to identify risk factors in an individual.  Providing some self-empathy, acknowledging that this has been a frightening and difficult experience, and giving ourselves credit for having come through it - being a survivor! - is a step toward emotional healing. 


Physical Therapist:  Research shows that regular exercise may decrease one's risk of developing certain cancers.  However, it addresses only one of many variables or risk factors for developing cancer.  Even the most active individuals are still at risk of developing cancer. 


If you did not exercise prior to your cancer diagnosis, then your post-cancer treatment life is a great time to start exercising to help you physically and mentally recover from your treatments.  Many people report that they are actually healthier after cancer because their diagnosis was a 'wake-up call' to make changes in their life (such as exercising).  If you did exercise prior to your cancer diagnosis, this is also a chance for a 'redo.'  People who exercised prior to cancer may have only done one or two types of exercises or done the same machine at the gym every day; now is the opportunity to try new activities, establish new challenges, and exercise with a greater clarity and purpose.  If you used to run on the treadmill 4 or 5 times a week but never did a road race before your cancer diagnosis, this is your chance to try something new.  And exercise makes you feel better!

Social Worker:  We seem to have a "little voice" that whispers in our ear, "you did something to cause the cancer."  There is no evidence to back this up.  Cancer survivors are a diverse group:  all ages, all races and religions, and socio-economic groups.   We are omnivores and vegetarians, alcohol consumers and teetotalers, coach potatoes and fitness buffs, and everyone in between.  (It is also true that some nonsmokers get cancer and some smokers do not.)  That said, good habits serve us well-eating healthy foods, regular exercise, adequate sleep and relaxation, laughter, light alcohol consumption, loving relationships, and having fun-will improve quality of life and assist us in staying healthy.


Nutritionist:  Just as there is no one food that will trigger a recurrence, there is no one food that caused your cancer. As previously explained, there are many variables or risk factors for developing cancer.  Even individuals whose customary diet has been very nutritious are still at risk for developing cancer. But continuing, or putting into place, nutritious eating habits will improve energy levels and boost the immune system.  Let's not forget eating food is fun and delicious!

In the News

November is...

Lung Cancer Awareness Month

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The American Medicine Chest Challenge, sponsored by a coalition of health care, advocacy, industry, and law enforcement organizations is sponsoring a campaign to clean out medicine chests and safely dispose of old and unneeded medications.The objective of the campaign is to remove (or secure) medications that can be abused or accidentally taken by children and adolescents.  Between 2003 and 2006 almost 10,000 young children ingested opioid medications prescribed for another family member; a friend or family member is the primary source of illicit use of prescription drugs by adolescents.  When a disposal site is not available, recommendations for home disposal can be followed.

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Nutrition Counseling Study

 "Adjuvant nutritional intervention is an essential addition to the multidisciplinary care of patients with cancer."  From a news report of an individualized nutrition counseling study presented at a European radiation oncology conference.The study found personal counseling more effective and had more durable results than nutritional supplements. 

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 The National Comprehensive Cancer Network has published the Adult Pain Management Guidelines 2010 (free registration required).

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New FDA Requirement

The FDA is now requiring that patients be informed of a possible increased risk of femoral fractures in patients using bisphosphonates for prevention of osteoporosis.  The FDA notes that the risk is low and that it is not clear that bisphosphonates are the cause. They are further recommending that patients be evaluated for need for continued use after 5 years.  The labels on oral bisphosphonates and the injectable agent Reclast will be changed to include this warning. 

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Journal Watch


Campfield Bonadies D, et al.  What I wish I'd known before surgery: BRCA carriers' perspectives after bilateral salpingo-oophorectomy.  Fam Cancer. 2010 Sep 18.


Franklin D, et al.  Facing Forward: Meeting the Rehabilitation Needs of Cancer Surviviors.   Oncology: Nurse Edition.  2010;24(10):21-23,29-32.


Review of Franklin et al article:  Mitchell, SA.  Framing the Challenges of Cancer Rehabilitation.  Oncology: Nurse Edition.  2010;24(10):33-34.


Moryl N, et al.  Chronic Pain Management in Cancer Survivors.  J Natl Compr Canc Netw 2010;8(9):1104-1110. Read More >>

Nathan PC, et al.  Screening and Surveillance for Second Malignant Neoplasms in Adult Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.  Ann Intern Med.  2010;153(7):442-451.


Senior K.  Lifelong battle for childhood cancer survivors.  Lancet Oncol. 2010;11(10): 924.


Smith LK.  Sexual Function of the Gynecologic Cancer Survivor.  Oncology: Nurse Edition.  2010;24(10):41-44. 


End-of-Life Care

Olson ML, et al.  Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments.  Mayo Clinic Proceedings.  2010;85(10):949-954.


Palliative and Supportive Care

Gartner R et al.  Multimodal prevention of pain, nausea and vomiting after breast cancer surgery.  Minerva Anestesiologica.  2010;76(10):805-813.


Jones LW, et al.  Pre-exercise screening and prescription guidelines for cancer patients. Lancet Oncol. 2010;11(10):914-916.


Mao J, et al.  Combination Drug Therapy for Chronic Pain: A Call for More Clinical Studies.  J Pain. 2010 Sep 16. Read More >>

McCorkle R.  Interdisciplinary collaboration in the pursuit of science to improve psychosocial cancer care.  Psychooncology. 2010 May 25.


Storey DJ, et al.  Capecitabine combined with oxaliplatin (CapOx) in clinical practice: how significant is peripheral neuropathy?  Ann Oncol. 2010;21(8):1657-61.


Other articles of interest

George SM, et al.  Beyond Recreational Physical Activity: Examining Occupational and Household Activity, Transportation Activity, and Sedentary Behavior in Relation to Postmenopausal Breast Cancer Risk.  Am J Public Health. 2010 Sep 23.


Jemal A, et al.  Cancer statistics, 2010.  CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300. Epub 2010 Jul 7. 

Penson R, et al.  Connection: Schwartz Center Rounds at Massachusetts General Hospital Cancer Center.  Oncologist.  2010;15(7):760-764.