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Online Resources


The Pain Project  

A new website from the International Reporting Program of the Graduate school of Journalism of the University of British Columbia. It documents the world-wide problem of barriers to access to medications for cancer and other pain.

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Speed Grieving  

The website of a new movie on grief & grieving. A driven corporate climber struggles to balance her hectic work schedule with her father's terminal illness, only to learn that certain things in life can't be done efficiently.



Continuing Education

Schwartz Rounds 

Second Thursday of the month 12:00 PM  

Second Thursday of the month, 12:00 PM. 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)

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October 18, 5:30 - 7:00 PM 

Speaker: Kathryn Tucker, JD, Director of Legal Affairs, Compassion and Choices


October 18 

Communication in Cancer Care. 8th Annual Meeting of the Connecticut Cancer Partnership. Yale's West Campus, Orange. (CME, CNE)






October 7 & 14 

ONS Chemotherapy & Biotherapy Course.  Hospital of St. Raphael.    (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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October 20 - 23 

Cancer Survivorship for Clinicians: Helping Survivors Live Well Beyond Cancer and LIVESTRONG Survivorship Leadership Training Institute. Harvard Medical School. Boston.


November 15

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

Register Now >>


November 16 

Annual meeting of the Connecticut Coalition to Improve End-of-Life Care. Chesire. Details to be posted soon on the Coalition's website.

November 18 - 19

Primary Care Issues in Cancer Care Hartford.  Sponsored by ONS.  (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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November 4 - 5

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




October 2011          Volume 5 No 9


Cancer treatment and cardiac function

Recent articles in both the oncology and cardiology literature have called for increased collaboration between oncologists and cardiologists in the clinical care of cancer patients and additional research on the cardiac effects of various cancer treatments.


It is not news that radiation therapy to the chest and some chemotherapy agents can cause heart disease, either acutely or as a delayed effect. It is well-documented that adult survivors of pediatric cancers, especially those treated with anthracycline-based chemotherapies, have significantly higher rates of cardiovascular disease than matched controls, including siblings. As more people live longer and as more agents with known or potential cardiotoxicity come out of the pipeline and into the clinic, post-treatment cardiovascular disease has become a bigger problem for all age groups. Identifying which individuals and groups are at greatest risk may be difficult, but those with pre-existing risk factors should be screened. Even asymptomatic individuals for whom anthracyclines are indicated are routinely screened using MUGA scans or echocardiograms.


After decades of experience researchers have only recently begun to elucidate the pathophysiologic effects of chemotherapy agents that lead to dysrhythmias and heart failure. Not surprisingly, different agents have different effects based on their mechanism of action. For example, trastuzumab (Herceptin) is a monoclonal antibody that attaches to HER2 receptors that are expressed in some cancers, especially a subset of breast cancers. There are also HER2 receptors on cardiac muscle cells.


Heart failure can progress silently for months to years. Although evidence-based guidelines specific to cancer survivors are not yet in widespread use, screening for at-risk patients is essential. The most common manifestation of cardiotoxicity is asymptomatic decrease in left ventricular ejection fraction (LVEF). Oncologists, cardiologists, and primary care providers can partner in the early detection and even prevention of heart failure brought on by chemotherapy-induced left ventricular dysfunction. A recent European Society for Medical Oncology guideline recommends post-treatment screening for asymptomatic patients at 12 months, 4 years, and 10 years after anthracycline treatment. It has been recommended that the American College of Cardiology/American Heart Association guidelines be used in the treatment of patients with asymptomatic LVEF decrease. These include lifestyle interventions (i.e., optimizing nutrition and exercise) and pharmacologic interventions. A pilot study has suggested that cancer treatment-induced heart failure patients can benefit from directed exercise programs modeled after those designed for patients with non-cancer associated heart failure.


This year Smilow Cancer Hospital has added a Cardiotoxicity Program to help oncologists manage cancer in patients with cardiac co-morbidity as well as assessing at-risk patients for whom they are considering treatments with potential cardiotoxicity.  

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In the News


New accreditation standards announced by the Commission on Cancer; patient-center care emphasized. Palliative care, navigation programs, distress screening for all patients, and survivorship care plans are mandated in the 2012 standards.

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Journal Watch



Bower JE, et al. Inflammation and Behavioral Symptoms After Breast Cancer Treatment: Do Fatigue, Depression, and Sleep Disturbance Share a Common Underlying Mechanism? J Clin Oncol. 2011;29(26):3517-3522.  



Hughes DC, et al. Exercise Intervention for Cancer Survivors with Heart Failure: Two Case Reports. J Exerc Sci Fit. 2011;9(1):65-73.

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Loprinzi CL, et al. Nonestrogenic Management of Hot Flashes. J Clin Oncol. 2011; Sept 12.

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Patterson RE. Flaxseed and Breast Cancer: What Should We Tell Our Patients? J Clin Oncol. 2011; Sept 6.   





End-of-Life Care

Lundquist G, et al. Information of Imminent Death or Not: Does It Make a Difference? J Clin Oncol. 2011; Sept 12. 





Palliative and Supportive Care

Last month we highlighted recent reviews of cancer pain management.

Bakitas M, et al. Palliative Medicine and Decision Science: The Critical Need for a Shared Agenda to Foster Informed Patient Choice in Serious Illness. J Palliat Med. 2011; Sep 6.



Irvin W, Jr, et al. Symptom Management in Metastatic Breast Cancer. Oncologist. 2011; Aug 31.  

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Kagan SH. The Global Burden of Cancer Treatment: Reflecting Clinical Reality in Cancer Nursing Research. Cancer Nurs. 2011;34(5): 343-344.


Kamal, AH, et al. Dyspnea Review for the Palliative Care Professional: Assessment, Burdens, and Etiologies. J Palliat Med. 2011; Sep 6. 

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Keeney CE, Head BA. Palliative Nursing Care of the Patient With Cancer-Related Fatigue. J Hosp Palliat Nurs. 2011;13(5): 270-278.


McGrath PJ. Science is not enough: the modern history of pediatric pain. Pain. 2011; Aug 29.

Read More >> 




Other Articles of Interest

Pui CH, et al. Challenging issues in pediatric oncology.  Nat Rev Clin Oncol. 2011 Jun 28.