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Online Resources


Loss, Grief, and Bereavement in the Setting of Cancer. 
Medscape.  Adaptation of EPEC content.
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Fast Facts and Concepts provides concise, practical, peer-reviewed, and evidence-based summaries on key topics important to clinicians and trainees caring for patients facing life-limiting illnesses.
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Fast Article Critical Summaries for Clinicians in Palliative Care (PC-FACS) provides palliative care clinicians with concise summaries of the most important findings from more than 50 medical and scientific journals each month. PC-FACS is free to AAHPM members and members can earn up to 3 CME credits quarterly.
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Online Resources for Patients

Prostate Cancer Resources
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Getting back on a bike. 
Advice for fitness with one of the best exercise tools. From American Institute for Cancer Research.
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Articles from painACTION (free registration required) 
Continuing Education

Schwartz Rounds 

Second Thursday of the month 12:00 PM  

ON SUMMER BREAK, will resume in September.  Lunch is provided.  Smilow Cancer Hospital at Yale-New Haven in the Park St. Auditorium (CME)  

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October 20-21 

End-of-Life Nursing Education Consortium (ELNEC):  Geriatric Train the Trainer Course.  Cromwell, CT.  Sponsored by Connecticut Coalition to Improve End-of-Life Care and CT Department of Public Health.  Stay tuned for details.  (CNE)

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August 11 - 12

The Science of Compassion: Future Directions in Palliative and End-of-Life Care.  National Institute of Nursing Research, Bethesda, MD.

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August 19 - 20

Survivorship Issues in Cancer Care.  Baltimore, MD. (CNE)


September 16 - 18

Practical Aspects of Palliative Care:  Integrating Palliative Care into Clinical Practice.  Cambridge, MA.

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September 21

Massachusetts Pain Initiative Annual Conference.  Judith Paice, PhD, Keynote Speaker.  Marlborough, MA.   

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October 16 -17

2nd National Conference on Cancer and Female Sexuality.   

Sponsored by Memorial Sloan-Kettering Cancer Center and University of Chicago.  New York City.   


October 27 - 29

Seventh Annual Chicago Supportive Oncology Conference.  Chicago, IL.

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ONS University offers in-depth CNE courses on a wide variety of cancer-related topics.

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July 2011          Volume 5 No 7


Cancer pain management - still an issue


In the past few months a number of reviews have been published on management of cancer-related pain, some in mildly surprising places like The Lancet and Current Pain and Headache Reports (see list of selected review articles below). Despite considerable progress in development of concepts, practices, guidelines, and treatments for cancer-related pain, we still lag in delivery, and even defining good outcomes. In addition, many cancer survivors have pain, often as a result of treatment, too often persistent, too often disabling. There is very little research on pain in survivors. Elders and children require special attention, especially with pharmacologic treatments. Research consistently shows an "unequal burden" of cancer pain in ethnic minorities. Another area of special attention, not seen in reviews of an earlier era, is balancing the need for appropriate treatment with the public health threat of diversion of prescription opioids to illicit uses. Continued societal, patient, and clinician misinformation and exaggeration of the risks of "iatrogenic addiction" complicate this.


The prevalence of cancer pain across the disease trajectory has not changed: as many as 25% of patients have pain at diagnosis. This rises to 33% during active treatment and 75-90% for those with advanced disease. Prevalence among disease-free survivors is unknown.


A great deal of attention in recent years has been devoted to the phenomenon of breakthrough pain. While not very difficult to define (a flare or exacerbation of acute pain in the setting of relatively well-controlled chronic pain), there is great variation in individual presentation, subtypes delineated by trigger (or lack thereof), and a low success rate in prevention and treatment, especially the rapid-onset, short-duration types. Oral transmucosal and intranasal analgesics have been developed for rapid-onset breakthrough pain, but they are expensive and effectiveness is still suboptimal for many patients.


Recognition that different pain syndromes respond to different therapies drives both assessment/diagnosis and treatment selection. Further, recognition that pain can be part of a symptom cluster (e.g., pain, fatigue, and depression) suggests both the complexity of cancer pain and the potential utility of multimodal interventions. Interventions tend to be concentrated in the pharmacologic realm despite clear evidence of the multifactorial nature of cancer-related pain. Comprehensive cancer rehabilitation programs, cognitive-behavioral and other psychological treatments, and complementary/integrative approaches could benefit most people with cancer-related pain. Unfortunately, access to these services is limited for many patients due to insurance restrictions or logistical issues.


Managing the pain of cancer and its treatments remains a challenge for patients, families, and clinicians. Continued work on elimination of barriers to optimal management as well as development of treatment models that address the complexity and individuality of cancer pain will remain on the agenda for some time to come.



In the News


From Pyramid to Plate: the educational image for the government's nutrition recommendations have changed from a food pyramid to a dinner plate. This is conceptually similar to the American Institute for Cancer Research's  "New American Plate."  

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Law on End-of-Life Care Rankles Doctors 

Column by Jane Brody in New York Times on a controversial law in New York state requiring that doctors discuss end-of-life options with patients.

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New study on colon cancer and diet.

The most comprehensive and authoritative report on colorectal cancer risk ever published has concluded that red and processed meat increase risk of the disease and found that the evidence that foods containing fiber offer protection against colorectal cancer has become stronger.

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Sunscreen guideline, claims, and labeling updated by FDA.

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FDA provides updated safety data on silicone gel-filled breast implants.

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Call for Preventive Palliative Care (from the Journal of Palliative Medicine blog: "In summary, the current National Prevention Strategy will be a 'comprehensive plan that will help increase the number of Americans who are healthy at every stage of life' as the document claims to be if and only if it addresses prevention of pain and other sources of distress and promotes dignity conserving care and the best possible quality of life for all Americans, including those with serious illnesses and their families."

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Selected recent review articles on cancer-related pain.


The Lancet. 2011;377(9784)

Portenoy RK. Treatment of cancer pain.  Lancet. 2011;377(9784):2236-47.


Managing pain effectively.  Lancet. 2011;377(9784):2151. (editorial)


CA:  A Cancer Journal for Clinicians.

Paice JA, Ferrell B. The management of cancer

pain. CA Cancer J Clin. 2011;61(3):157-82.  


Current Pain and Headache Reports.  2011;15(4)

Cope DK, Zhao Z.

Interventional management for cancer pain. Curr Pain Headache Rep. 2011 Aug;15(4):237-43.


Marcus DA. Epidemiology of cancer pain.  Curr Pain Headache Rep. 2011 Aug;15(4):231-4.


Vallerand AH, Musto S, Polomano RC. Nursing's role in cancer pain management.  Curr Pain Headache Rep. 2011 Aug;15(4):250-62.


Leppert W. Pain management in patients with cancer: focus on opioid analgesics.Curr Pain Headache Rep. 2011 Aug;15(4):271-9.


Mercadante S. Managing breakthrough pain.  Curr Pain Headache Rep. 2011 Aug;15(4):244-9.


Porter LS, Keefe FJ. Psychosocial issues in cancer pain.  Curr Pain Headache Rep. 2011 Aug;15(4):263-70.



Cleveland Clinic Journal of Medicine.  2011;78(7) 

Induru RR, Lagman RL.  Managing cancer pain: Frequently asked questions.  Cleve Clin J Med. 2011 Jul;78(7):449-64.


Journal Watch


Kelly KM, et al. Living post treatment: definitions of those with history and no history of cancer. J. Cancer Surviv. 2011;5(2):158-66.  

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Campbell MK, et al. Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network. J Cancer Surviv. 2011 May 10. 

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Gage EA, et al. Structuring survivorship care: discipline-specific clinician perspectives. J Cancer Surviv. 2011 Feb 11.  

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Lopez-Class M, et al. A contextual approach to understanding breast cancer survivorship among Latinas. Psychooncology. 2011 Jun 14.
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Reulen RC, et al. Long-term risks of subsequent primary neoplasms among survivors of childhood cancer. JAMA. 2011;305(22):2311.  

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End-of-Life Care

Widera EW, et al. Approaching patients and family members who hope for a miracle. J Pain Symptom Manage. 2011;42(1): 119-125.

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van Laarhoven HWM, et al. When hope is all there is left. Oncologist . 2011;16(6):914-916. 

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Zeytinoglu M. Talking it out: Helping our patients live better while dying. Ann Intern Med. 2011;154(12):830-832. Learn More >>  




Palliative and Supportive Care

The June issue of Primary Care:Clinics in Office Practice (2011;38(2)) is devoted to Palliative Care.   

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Kirkova J, et al. The relationship between symptom prevalence and severity and cancer primary site in 796 patients with advanced cancer.  Am J Hosp Palliat Care. 2010 Dec 8.  

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Simone CB 2nd, et al. Cancer patient attitudes toward analgesic usage and pain intervention. Clin J Pain. 2011 Jun 29.  

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Smith HS. The metabolism of opioid agents and the clinical impact of their active metabolites. Clin J Pain. 2011 Jun 14.  

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Watanabe SM, et al. The Edmonton Symptom Assessment System, a proposed tool for distress screening in cancer patients: development and refinement.  Psychooncology. 2011 Jun 13.  

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