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Online Resources

Practical Biostatistics
Practical Biostatistics is a monthly column in Community Oncology: Clinical Issues in Community Practice. It is a great resource for those who may not be directly involved in conducting research but want to be able to interpret published research. Back issues of Community Oncology are available free.
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Resource List: nursing homes, hospice, or end-of-life challenges
A practicing psychologist, Ken Pope, has put together a resource list for those considering nursing homes, hospice, or end-of-life challenges.
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The Bioethics Channel has an archived list of podcasts, many of which relate to difficult end-of-life issues. It is sponsored by the Center for Practical Bioethics.
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Gender, Pain, and Intimacy
A discussion on the PainAction web site on communication between intimate partners about pain.
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Safe Opioid Use in Elderly Patients
A blog on Safe Opioid Use in Elderly Patients appears on the Pain Treatment Topics web site.
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Is Medical Progress Helpful or Harmful to End of Life Care?
Video of a lecture by Daniel Callahan to the Yale Bioethics Center End of Life Issues Study Group on Nov 4, 2010. Note that as a result of a technical problem the end of the lecture was cut off.
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Relaxation Tools
PainAction (free registration required) has short online resources ("tools") for The Relaxation Response and Guided Imagery.

Poster exhibition provides international perspective on hospice and palliative care.
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Continuing Education


Second Thursday of the month, 12:00N

Schwartz Rounds

Lunch is provided.  Smilow Cancer Hospital at Yale-New Haven in the Park St. Auditorium (CME)

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January 13

What Happens When a Patient is Overwhelmed with a Negative Cascade of Information and Events?

Yale Bioethics Center End of Life Issues Study Group

5:30pm - 7:00pm

Theme for 2010-2011:  "Ethical Aspects of the Advances in Modern Medicine." (CME). Audio and video of this year's presentations are available on the Center's web site.

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January 13

Doctor and Patient: Lost in Translation

Pauline Chen, MD

Cohen Auditorium

230 South Frontage Rd.

May 5

Nutrition and Cancer Survivorship:  Separating the (Whole) Wheat from the Chaff. 

5th Annual Yale Survivorship Symposium.  West Campus. 

Stay tuned for details.


April 5 - 12 / November 2 - 8

Program in Palliative Care Education and Practice. 

Includes a pediatric track.  For physician and nurse educators and those in program development.  Cambridge, MA.

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Preventing HPV-Related Disease:  Strategies for Improving Immunization Rates in Your Female and Male Patients. (CNE)

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Novel and Future Directions in Cancer Pain Management. 

Medscape (free registration required) (CME, CNE, CPE)

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December 2010          Volume 4 No 11

Cancer Survivorship Themes:  Managing (unrealistic) expectations of self and others

Beginning with the July issue of YaleCares, we have been exploring common themes identified in survivors who attend the Connecticut Challenge Survivorship Clinic at Yale cancer Center.  We end the series with this month's issue.  There are many more issues presented by survivors, but the purpose of this series has been to illustrate some of those that are very common and to highlight the interdisciplinary approach taken by Clinic staff. 

Our final theme is Expectations: assumptions about how the survivor is "supposed" to be after cancer treatment.  As with the other themes described, this one presents in various ways:

  • My family/friends are ready for me to be "over" cancer.
  • My boss expects me to pick up where I left off 6 months ago, as if nothing had happened.
  • My husband has been great-but he's getting impatient for things to get back to the way they were.
  • I've tried to shield my kids from all of this, but my defenses are wearing thin.
  • I thought I'd be back to normal by now.
  • My surgery was months ago - why am I so tired (or still in pain)?
  • The things I used to enjoy seem irrelevant now.

This theme overlaps with some of the others presented.  It represents a yearning for the comfort of what was believed to be predicable and "normal" in the individual's life before the cancer diagnosis.  Now that the crisis of diagnosis and treatment is over they want to not only be cancer-free but also free of cancer.

Our clinicians address this issue in a hypothetical survivor:

APRN:  Even though you finished treatment a few months ago, it would be unusual to have completely recovered from the treatments.  Treatment for cancer takes a physical and emotional toll that normally requires many months of recovery.  Some of the effects will not "go away" on their own, but require focused attention and sometimes the help of one or more professionals.  The issues will vary over time and may include fatigue, deconditioning, difficulty with memory, sleep disturbance, sexual desire or functioning, weight gain or loss, and so forth.  Stress, anxiety, and depression are very common in survivors.  Relationships with family members, friends, and co-workers are very likely to have changed during treatment.  In addition to physical rehabilitation, acknowledging that there will be a "new me" and new life circumstances is a part of recovery. 

Social Worker:  Communication is key, both verbal and behavioral.  It is important to speak to family members, expressing your reality.  Perhaps you are looking like you did before cancer externally; yet, this is not your internal reality.  It is also important to express your reality in action, as well as words.  If you are not up to a task, don't do it!  Remember, too, that your loved ones are also experiencing a loss-the old you, and the comfort of a healthy you in familiar family roles.  Working out this new reality requires open communication.  It might be useful to have a professional help facilitate the adjustments or to help the family develop new communication skills.


Physical Therapist:  If you exercised or were very active prior to your cancer treatments, it can take months to fully get back to your prior level of fitness, even if you "look like your old self."  Strength and stamina return slowly.  You may have had treatments that have long term effects that inhibit certain body functions (i.e. radiation treatments that scar the lungs, breast cancer surgery that limits range of motion in your shoulder), so you may not be able to fully get back to your prior level of activity.   


Being able to explain your current limitations may be helpful.  Telling people that you have a series of mini-goals or steps to get to a larger goal helps them see that you have thought the process through; it also holds you accountable to achieve these goals in order to make your ultimate long term goal.


If you need help getting your strength or endurance back, you can consult with a personal trainer at a gym.  If you are experiencing a reduction or loss of range of motion, lymphedema, or other chronic condition as a result of your cancer treatments, you can seek the professional advice of a physical therapist, lymphedema certified therapist, or a licensed massage therapist.  These professionals will be able to help you develop a plan to address barriers to your exercise plan.  Have a plan in your head (putting it down on a calendar or your Blackberry is better) and having a series of short-term, doable goals is a great strategy for mental and physical fitness.

Registered Dietician:  To continue in the spirit of the words of the social worker, you may not be able to, nor may you want to carry on your familiar family role regarding food shopping, meal planning, and cooking. The recommended predominately plant-based way of eating does not require you to prepare a special meal for yourself and a different meal for the rest of your household. All members of your household will benefit from this way of eating. Again, communicate your needs. Enlisting the help of members in your household will help you all adopt new ways of healthy eating over time. 

In the News

Nutrition for Cancer Survivors

The American Cancer Society has published the second edition of its book, Nutrition for Cancer Survivors.
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The Global Year Against Acute Pain
Every year in October the International Association for the Study of Pain (IASP) designates a theme for the year.  This year's theme is The Global Year Against Acute Pain. The American Pain Society is the United States chapter of the IASP.
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Dartmouth Atlas Report
Dartmouth Atlas Report on Cancer End-of-Life Care. Quality of End-of-Life Cancer Care for Medicare Beneficiaries.
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New Certification Process Announced
Certification process announced for pediatric hospice and palliative nurses by the National Board for Certification of Hospice and Palliative Nurses.
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Propoxyphene Withdrawn from the U.S. market
Propoxyphene (Darvon, Darvocet) has been withdrawn from the US market.  See FDA press release and Medscape News article.

Journal Watch


Ewer MS, Ewer SM.  Cardiotoxicity of anticancer treatments: what the cardiologist needs to know.  Nat Rev Cardiol. 2010 Oct;7(10):564-75. (CME)



Harrington CB, et al.  It's not over when it's over: long-term symptoms in cancer survivors--a systematic review.  Int J Psychiatry Med. 2010;40(2):163-81.


Lynch BM.  Sedentary Behavior and Cancer: A Systematic Review of the Literature and Proposed Biological Mechanisms.  Cancer Epidemiology, Biomarkers & Prevention.  2010;19(11):2691-2709. Read More >>


Morton LM et al. Second malignancy risks after non-Hodgkin's lymphoma and chronic lymphocytic leukemia: Differences by lymphoma subtype. J Clin Oncol 2010 Oct 12.

Phillips KA, et al.  Cognitive function in postmenopausal women receiving adjuvant letrozole or tamoxifen for breast cancer in the BIG 1-98 randomized trial.  The Breast.  2010;19(5): 388-395.


Rogers LQ, et al. Lessons Learned in the Trenches: Facilitating Exercise Adherence Among Breast Cancer Survivors in a Group Setting.  Cancer Nursing.  2010;33(6):E10-E17.



Yoon GJ, et al.  Left ventricular dysfunction in patients receiving cardiotoxic cancer therapies are clinicians responding optimally?  J Am Coll Cardiol. 2010 Nov 9;56(20):1644-50.



End-of-Life Care

Clary PL.  Poetry and Healing at the End of Life.  J Pain Symptom Manage.  2010;40(5):796-800.



LeGrand SB, Walsh, D.  Comfort Measures:  Practical Care of the Dying Cancer Patient. Am J Hosp Palliat Care.  2010;27(7):488-493.



Schulman-Green D, et al.  Developing and Testing a Web-Based Survey to Assess Educational Needs of Palliative and End-of-Life Health Care Professionals in Connecticut.  Am J Hosp Palliat Care. 2010 Nov 7.



Shiroma PR, et al.  Antidepressant Prescription Pattern in a Hospice Program.  Am J Hosp Pall Med.  2010; Nov 4.



Palliative and Supportive Care

A supplement-"Towards a New Therapeutics for Pain: Pathogenesis and Clinical Aspects"-to Metabolism [2010;59(Supp 1)] is devoted to pain and pain management.



Several articles in the December 2010 issue of Current Opinion in Supportive and Palliative Care[(4)4] explore anorexia and cachexia in cancer.



Goedendorp MM, et al.  Is Increasing Physical Activity Necessary to Diminish Fatigue During Cancer Treatment? Comparing Cognitive Behavior Therapy and a Brief Nursing Intervention with Usual Care in a Multicenter Randomized Controlled Trial.  Oncologist 2010;15(10):1122-1132.



Hjalte F, et al.  The Direct and Indirect Costs of Opioid-Induced Constipation.  J Pain Symptom Manage.  2010;40(5):696-703.



Howard P, et al.  Psychostimulants.  J Pain Symptom Manage. 2010 Nov;40(5):789-95.



Konno, Rie.  Cochrane Review Summary for Cancer Nursing: Acupuncture-Point Stimulation for Chemotherapy-Induced Nausea or Vomiting.  Cancer Nursing.  2010;33(6):479-480.



Librach SL, et al.  Consensus Recommendations for the Management of Constipation in Patients with Advanced, Progressive Illness.  J Pain Symptom Manage.  2010;40(5):761-773.



Lin, Chia-Chin.  Comfort: A Value Forgotten in Nursing.  Cancer Nursing.  2010;33(6):409-410.



Wells N, et al.  Cancer pain management in ambulatory care: can we link assessment and action to outcomes?  Support Care Cancer.  2010 Oct 30.



Other articles of interest

McCuaig JM, et al.  Breast and ovarian cancer: Y do we forget about dad?  Lancet Oncology.  2010; Oct 25.