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Online Resources


The Power of Language  

Tips for using language to communicate effectively, empower people, and create change about pain and its management

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Cancer Resource Guide, 2011 edition. From Cure magazine and American Cancer Society.

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Acupuncture in Cancer Care.  

From a column in Oncology.

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Summary of IOM Report, Relieving Pain in America.  

From Pain Treatment Topics. 

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Continuing Education

Schwartz Rounds 

Second Thursday of the month 12:00 PM  

ON SUMMER BREAK, will resume September 8.  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   

77 Prospect Street, Rm A002. See website for full schedule. (CME)


September 13, 5:30 - 7:00pm. Speaker: Thomas Duffy, MD

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September 24

10 Annual Oncology Nursing Symposium: Challenges in Oncology Nursing Practice. Park Street Auditorium. (CNE) 

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Communication in Cancer Care.  

8th Annual Meeting of the Connecticut Cancer Partnership . Yale West Campus, Orange. (CME, CNE)

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September 2, 9, 16, 23, 30
Basic Oncology Core Course.  Hospital of St. Raphael.  (203) 789-3391. (CNE)

September 24

Pain Management for the Primary Care Practitioner. CT Pain Society and Hartford Hospital.  At Water's Edge Resort in Westbrook.  (CME)


October 7 & 14 

ONS Chemotherapy & Biotherapy Course.  Hospital of St. Raphael.  Registration deadline:  09/14/2011.  (203) 789-3391. (CNE)


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. (CNE)

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November 15

2nd Annual Connecticut Challenge Survivorship Summit.  New Haven Lawn Club.  Stay tuned for details. (CME, CNE)


November 18 & 19

Primary Care Issues in Cancer Care Hartford.  Sponsored by ONS.  (CNE) 

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September 7 - 10 

American Society for Pain Management Nursing Annual Conference. Tucson. (CNE)

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September 16 - 17 

2011 HPNA Clinical Practice Forum: Integrating Cancer and Palliative Care across the Lifespan. (CNE)

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September 16 - 18

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

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September 16 - 18

Second Annual Navigation & Survivorship Conference.  San Antonio.  (CME, CNE, SWCE)

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September 21

Practical Approaches to Pain Management . Judith Paice, PhD, RN, Keynote Speaker Massachusetts Pain Initiative Annual Conference.  Marlboro, MA.  (CME, CNE)

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October 16 -17

2nd National Conference on Cancer and Female Sexuality.  Sponsored by MSKCC and University of Chicago.  New York City.  Details when available. (CME)


October 27 - 29

7th Annual Chicago Supportive Oncology Conference. (CME, CNE)

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Nov 4 - 5

Quality of Life for the Children:  DC Pediatric Palliative Care Collaboration. Washington, DC.  Stay tuned for details.





ONS Symptom Management Webcourse  (CNE)

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The Hospice Foundation of America is offering discounts on pre-orders of the video presentation Beyond Kübler-Ross: New Perspectives on Death, Dying and Grief  

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August 2011          Volume 5 · No 8


Lymphedema-Beyond Breast Cancer


Lymphedema is a collection of fluid in soft tissue caused by disruption of the lymphatic drainage system. In cancer this is most commonly a result of surgical removal of lymph nodes or damage to lymph nodes and lymph vessels by radiation therapy. An estimated 30 -50% of patients who undergo axillary node dissection will develop lymphedema. Lymphedema can be an acute early effect of treatment or a late effect, sometimes not manifesting for years after treatment. Lymphedema is not curable, but can be controlled. Untreated, lymphedema is progressive and chronic lymphedema can lead to significant disability and negative impact on quality of life. Lymphedema is manifested by swelling, pain, unpleasant pressure sensations, heaviness and muscular soreness, decreased range of motion, skin breakdown, and difficulty with activities of daily living. Infection is both a risk factor for and a potentially life-threatening consequence of lymphedema.


Awareness of lymphedema following breast cancer is greater than that for most other cancers. Because breast cancer is very common, many clinicians are familiar with and comfortable providing basic instruction about same-side upper extremity lymphedema following surgery and radiation therapy for breast cancer. Less attention has been paid to edema of the trunk-chest, axilla, shoulder, breast, back-following breast cancer treatment and there is little research to document its prevalence. It is very likely to be under-reported.


In a recent small study (n = 81) of head and neck cancer patients, 75% had some form of objectively measured late-effect (at least 3 months post-treatment) lymphedema. This included internal, external, or mixed source lymphedema. Lower extremity lymphedema is encountered in patients who have had surgery or radiation therapy involving the pelvic and abdominal lymph nodes. Gynecologic, genitourinary, and anal cancers are common examples. In men, scrotal lymphedema can be devastating.


Fortunately, newer cancer treatment techniques (such as more widespread use of sentinel lymph node biopsy) have the potential to deduce-but not eliminate-the frequency and severity of lymphedema in some cases. Early detection through patient self assessment and clinical examination are essential to control. Prompt intervention by a certified lymphedema specialist is the optimal approach. Manual lymphatic drainage and compression garments are the mainstay of lymphedema management. Exercise may delay or minimize the onset and impact. In extreme or refractory cases of acute lymphedema new techniques such as subcutaneous lymphatic drainage or even microsurgical anastomosis of lymph and venous vessels have recently been reported.  




Selected references from recent lymphedema literature


Cavanaugh KM.  Effects of early exercise on the development of lymphedema in patients with breast cancer treated with axillary lymph node dissection.  J Oncol Pract. 2011 Mar;7(2):89-93.


Cemal Y, et al.  Preventative Measures for Lymphedema: Separating Fact from Fiction. J Am Coll Surg. 2011 Jul 27. [Epub ahead of print]


Deng J, et al. Prevalence of Secondary Lymphedema in Patients with Head and Neck Cancer. J Pain Symptom Manage. 2011 Jul 29. [Epub ahead of print]


Jacobsen J, Blinderman CD.  Subcutaneous lymphatic drainage (lymphcentesis) for palliation of severe refractory lymphedema in cancer patients.  J Pain Symptom Manage. 2011 Jun;41(6):1094-7.


Katz E, et al.  Weight lifting in patients with lower-extremity lymphedema secondary to cancer: a pilot and feasibility study.  Arch Phys Med Rehabil. 2010 Jul;91(7):1070-6.


Mihara M, et al.  Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-neck cancer.  J Plast Reconstr Aesthet Surg. 2011 Mar 4. [Epub ahead of print]


Sheila H. Ridner, et al. Advanced Pneumatic Therapy in Self-Care of Chronic Lymphedema of the Trunk.   Lymphat Res Biol. 2010;8(4):209-215.


Smith BG, Lewin JS.  Lymphedema management in head and neck cancer.  Curr Opin Otolaryngol Head Neck Surg. 2010 Jun;18(3):153-8.



In the News


Closer to Free Ride  

Smilow Cancer Hospital at Yale-New Haven's "Closer to Free Ride" is recruiting riders, volunteers, and donors for the September 10 ride. There is still time to sign up as an individual or team. Online donations are welcome and easy to make.

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Make a Donation >>



September is Pain Awareness Month.

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Journal Watch



Hill EK, et al. Assessing gynecologic and breast cancer survivors' sexual health care needs. Cancer. 2011 Jun 15;117(12):2643-51.  

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Patnaik JL, et al. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study.  Breast Cancer Res Treat. 2011; 13(3):R64   

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Reulen RC et al. Long-term risks of subsequent primary neoplasms among survivors of childhood cancer. JAMA 201;305(22):2311-2319.   






End-of-Life Care

Billings JA. The End-of-Life Family Meeting in Intensive Care Part I: Indications, Outcomes, and Family Needs.  J Palliat Med. 2011 Aug 10.   



Lunder U, et al. Spiritual needs assessments and measurements.  Curr Opin Support Palliat Care. 2011;5(3):273-278.  

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Palliative and Supportive Care

Last month we highlighted recent reviews of cancer pain management. 

  • The July issue of Palliative Medicine [2011;25(2)] is devoted to systematic reviews of focused cancer pain topics that will result in new European Association for Palliative Care Guidelines later this year.  
  • The August issue of Clinical Oncology [2011;23(6)] is devoted to "Pain in Patients with Cancer."


Lynch B, Paice JA. Pain and Palliative Care Needs of Cancer Survivors.   


Sharma N, et al. Sleep problems in cancer patients: prevalence and association with distress and pain. Psychooncology. 2011 July 1.  





Other Articles of Interest

Latino-Martel P, et al. Alcohol consumption and cancer risk: revisiting guidelines for sensible drinking. CMAJ. 2011 Jul 11.