YaleCares Newsletter - January 2011

Online Resources

Presentations and proceedings of the Connecticut Cancer Partnership Annual Meeting, Nov 30, 2010.
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Cancer and Obesity
From Obesity Society
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Energy Balance
from National Cancer Institute (NCI).
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Oklahoma Palliative Care Resource Center
Video presentations on ethical questions.
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Online Resources for Patients

Chemobrain! Is it Real?
One of a series of webcasts from Blood and Bone Marrow Information Network (BMTInfonet).
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Pain medications after surgery.
From the Mayo Clinic.
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Discussion of new Vitamin D recommendations: Part 1; Part 2. From Julie Langford, the "Cancer Dietitian."

American Institute for Cancer Research

Cancer Patient and Survivorship News
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Reduce Your Cancer Risk
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New Books of Note

McPherson ML. (2009)
Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing.
Bethesda, MD: American Society of Health-System Pharmacists.

Puchalski CM. Ferrell B. (2010) Making Health Care Whole: Integrating Spirituality Into Patient Care.
West Conshohocken, PA: Templeton Press.

Continuing Education

Yale

Second Thursday of the month, 12:00 PM

Schwartz Rounds

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

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Yale Bioethics Center End of Life Issues Study Group

5:30 PM - 7:00 PM

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 website.

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May 5

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

5th Annual Yale Survivorship Symposium. West Campus.

Stay tuned for details.

Elsewhere

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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Online

Two of the Top 10 CE offerings in 2010 on the Medscape Nurses site focus on end-of-life care:

The Last Hours of Living: Practical Advice for Clinicians (CME, CNE)
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End-of-Life Care in the Setting of Cancer: Withdrawing Nutrition and Hydration (CME, CNE)
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January 2011 Volume 5 · No 1

Beginning Our Fifth Year!

Energy Balance and Cancer: Size Matters

In the past three decades there has been considerable interest in the relationship between diet and cancer. For much of that time researchers have studied the impact of various food groups and specific nutrients such as vitamin C, beta carotene, selenium, folic acid, and vitamin D, hoping to find a "chemoprotectant" effect. In all cases, the results have been disappointing, in that no or only weak to moderate protective associations have been found. In some cases, higher doses of nutritional supplements have actually been found to increase risk.

More recently, in part because of the dramatic increase in rates of obesity in the United States and other countries, dietary researchers have been looking at associations among diet, exercise, obesity, metabolic syndrome, diabetes, and cancer. The many associations, and the multiple variables within each category, make this a very broad and challenging area of research. Metabolic syndrome is a condition defined by increased abdominal girth, elevated triglyceride and lipid levels, hypertension, and elevated fasting glucose levels. Recent research in multiple countries has begun to clarify the relationships. For example, there are associations between diabetes and breast and other cancers; obesity and breast, colorectal (in both men and women), and ovarian cancer and several other solid tumors and hematologic malignancies; and metabolic syndrome and multiple cancers. Risks include not only the initial risk of developing a cancer, but the risk of recurrence and distant metastases.

Targets of investigation include insulin response; various sex hormones; inflammatory response to body fat as well as various foods; rate of digestion of various foods, especially carbohydrates; various cytokines; and, more broadly, dietary patterns and exercise.

The risk of cancer and cancer recurrence aside, there are strong associations between metabolic syndrome and the development of type 2 diabetes and cardiovascular disease. In contrast to many other cancers, women with early breast cancer tend to gain weight during cancer treatment and have difficulty reducing weight after treatment. Both male and female survivors receiving hormone treatment are at increased risk of developing metabolic syndrome and its associated comorbidities. Metabolic syndrome is treated comprehensively by dietary changes, exercise (calorie intake and exercise constitute the "energy balance" equation), and medication.

Barriers to treating obesity include the paradoxical societal prejudice against "fat people" and the belated attention to the obesity epidemic among the general public. In addition, too few clinicians fail to approach obesity as a treatable disease. It is clearly in the best interests of individuals and public health to address our collective "waist problem" aggressively.

NOTE: The Annual Yale Spring Survivorship Symposium on May 5, 2011 will be devoted to the topic of "Nutrition and Cancer Survivorship." Follow future issues of YaleCares and the Yale CME website for details.

In the News

January is...

January is Cervical Health Awareness Month, commemorated by the National Cervical Cancer Coalition.

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Healthy People 2020

The Department of Health and Humans Services (HHS) has released Healthy People 2020, the nation's new 10-year goals and objectives for health promotion and disease prevention.

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New Medicare Regulation on Advance Care Planning

Beginning January 1, 2011, Medicare will reimburse physicians for discussing advanced care planning with their patients during an annual wellness visit. These discussions are voluntary.

Journal Watch

The November issue of Seminars in Oncology Nursing [2010;26(4)] is devoted to palliative care, with one interesting article on integrating survivor and palliative care (see Griffith reference below).

Survivorship

Bordeleau L, et al. Multicenter, Randomized, Cross-Over Clinical Trial of Venlafaxine Versus Gabapentin for the Management of Hot Flashes in Breast Cancer Survivors. J Clin Oncol. 2010; 28(35):5147-5152.