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Online Resources


Patient-Clinician Communication: Basic Principles and Expectations. 

The inaugural Institute of Medicine Discussion Paper, a new IOM series.

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Patient-Centered Cancer Treatment Planning: Improving the Quality of Oncology Care.  

Report from a National Coalition for Cancer Survivorship and Institute of Medicine workshop.

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Cancer and Careers.  

A web site providing legal and practical advice on employment during and after cancer.

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Supplements During Cancer: Help or Hype?  

Think twice before taking nutritional supplements.

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Palliative Care Throughout the Cancer Continuum.

Interview on OncologySTAT web site.

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"EPEC™-O (Education in Palliative and End-of-Life Care for Oncology) is a FREE comprehensive multimedia curriculum available in CD-ROM format for health professionals caring for persons with cancer."



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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November 15

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

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November 16 

10:00am - 1:30pm
Annual meeting of the Connecticut Coalition to Improve End-of-Life Care. Elim Park Place, Cheshire. 
Eileen O'Shea, DNP, RN:  "Understanding Pediatric Palliative Care:  What it is and What it Should be"

November 18 - 19

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

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February 16 - 17 

Best Practices and Strategies for Oncology Nurse Navigators.   




Diet and Exercise: Assessing and Assisting Client Readiness to Change. (CNE) Learn More >> 

Exercise Across the Cancer Continuum. (CNE)

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November 2011          Volume 5 No 10


Patient-Clinician Communication


The Institute of Medicine (IOM) recently published two documents on patient-centered communication. Patient-Clinician Communication: Basic Principles and Expectations is the inaugural IOM Discussion Paper, a new IOM series. Patient-Centered Cancer Treatment Planning: Improving the Quality of Oncology Care is the report of a workshop jointly sponsored by the National Coalition for Cancer Survivorship and IOM. Both of these publications grew out of the IOM emphasis on patient-centered care that was highlighted in the 2001 consensus report, Crossing the Quality Chasm: A New Health System for the 21st Century. In that report patient-centeredness was identified as one of six key characteristics of quality care.


Patients are the "ultimate stakeholders" in an increasingly complex delivery system, often with poor coordination and unclear roles. "The effectiveness of patient-clinician communication can be as important as that of a diagnostic or treatment tool." Basic principles of patient-clinician communication are enumerated: mutual respect, harmonized goals, a supportive environment, appropriate decision partners, the right information, transparency and full disclosure, and continuous learning. In cancer care the last point might be illustrated by the follow-up/reassessment visit before the next in a series of treatments and the transition visit between treatment modalities or at the end of treatment.


Applying these principles to cancer treatment planning is a challenge. 80% of cancer patients are treated in the community where fragmentation of services is inherent, but even academic medical centers are subject to communication hurdles. The average cancer patient sees three specialists who may each be in a different location and has multiple treatments across time and space. Imaging and blood tests might also be in different locations. Each setting and even different departments within an institution may have documentation systems that don't link with each other. Tumor Boards, designed to improve multidisciplinary care, may not insert their conclusions into the patient record and don't include the patient in the discussion of treatment recommendations. Meanwhile, patients may access information from friends or the Internet that adds further complexity and confusion, despite the availability of high-quality websites such as those provided by the Agency for Healthcare Research and Quality (AHRQ), American Cancer Society (ACS) and American Society of Clinical Oncology (ASCO). Many patients also lose touch with their primary care practitioner.


The major recommendations of the conference were that a patient-empowering shared decision-making model be used and that each patient be given a written treatment plan. Shared decision-making includes an active partnership between patient and physician in which shared treatment goals are agreed upon, risks and benefits of various alternatives are discussed, and the values and preferences of each are honored. A written treatment plan includes collaborative input from each discipline and specialty involved, incorporates patient preferences, and identifies the responsible clinician(s) for each phase of care. The treatment plan is organic and may need to be revised as the patient progresses through treatment. The treatment plan then becomes the basis for the treatment summary and survivorship care plan, documents advocated by a previous influential IOM report, From Cancer Patient to Cancer Survivor: Lost in Transition. A good summary of the treatment planning publication can be found in the Oct 10 issue of Oncology Times.




In the News


Number of Elderly Cancer Survivors to Increase Significantly.

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 Vitamin E increases prostate cancer risk in a study of 35,000 men. [see Klein article, below]

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Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement.  

Draft recommends against routine prostate-specific antigen (PSA)-based screening for prostate cancer.

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The promise and pitfalls of palliative care.  

A very good, balanced feature article from the Los Angeles Times.

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Journal Watch



Campo RA, et al. Cancer Prevention after Cancer: Changing the Paradigm--a Report from the American Society of Preventive Oncology.  Cancer Epidemiol Biomarkers Prev. 2011 Oct;20(10):2317-24.  

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Knobf MT, et al. Needs assessment of cancer survivors in Connecticut.   J Cancer Surviv. 2011 Oct 9.  

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Jansen L, et al. Benefit finding and post-traumatic growth in long-term colorectal cancer survivors: prevalence, determinants, and associations with quality of life.  Br J Cancer. 2011 Oct 11;105(8):1158-65.  



Parry C, Kent EE, Mariotto AB, Alfano CM, Rowland JH. Cancer survivors: a booming population.  Cancer Epidemiol Biomarkers Prev. 2011 Oct;20(10):1996-2005. Read More >> 



End-of-Life Care

Gillick MR, Sabin JE. No place like the hospital. J Pain Symptom Manage. 2011 Oct;42(4):643-8.  



Yuen JK, et al. Hospital do-not-resuscitate orders: why they have failed and how to fix them.  J Gen Intern Med. 2011 Jul;26(7):791-7.  




Palliative and Supportive Care

Blum D, et al. Cancer cachexia: A systematic literature review of items and domains associated with involuntary weight loss in cancer. Crit Rev Oncol Hematol.2011;80(1):114-144.  



Schulman-Green D, et al. Self-management and transitions in women with advanced breast cancer.  J Pain Symptom Manage. 2011 Oct;42(4):517-25.  




Other Articles of Interest 

Klein EA et al. Vitamin E and the risk of prostate cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2011 Oct 12; 306:1549.   

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Langton JM, et al. The quality of web-based oncology guidelines and protocols: how do international sites stack up?  Br J Cancer. 2011 Oct 11;105(8):1166-72.  



Ligibel, J, Obesity and breast cancer. Oncology. 2011;25(11):994-1000. [Free full text with free registration] (See also accompanying reviews).  

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Ornish D. ...And the only side-effects are good ones.  Lancet Oncol. 2011 Sep;12(10):924-5.  



Weitzel JN, et al. Genetics, genomics, and cancer risk assessment: State of the Art and Future Directions in the Era of Personalized Medicine. CA Cancer J Clin.2011 Aug 19.