Abstract
Letters to the Editor
Medical pain scales, such as those that use the numbers 0–10, are based on patients' perception of what they are experiencing, the results of which are then used to determine the effectiveness of the treatment. A simple, numeric spiritual pain scale in hospice care, which is generally accepted by spiritual care providers, would be a positive step toward quality improvement. (page 910)
Brief Reports
Antiemetics are being used both in treatment and prophylaxis for opioid-induced nausea and vomiting (OINV) in clinical practice, despite the lack of evidence for the prophylactic benefit. Data regarding status of prophylactic antiemetic use for OINV remain to be elucidated. (page 977)
Fast Facts and Concepts
Total Artificial Heart #296 (page 985)
Personal Reflection
The support offered by a strong patient-oncologist relationship is especially important to our disadvantaged patients. Despite our best efforts to give them access to the same clinical trials, drugs, surgeries, and doctors, these patients are not receiving equitable care. Although the ideal continuity-based oncologist-patient relationship is hampered by the scheduling constraints of our busy public hospitals, we must take ownership of our patients and make an effort to invest in a doctor-patient relationship even if we do not expect to see them again. (page 987)
Book and Media Reviews
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Recent Literature
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Reduction in 30-Day Readmissions
David Casarett and colleagues analyzed more than 34,000 hospitalizations and found palliative care consultations involving goals-of-care discussions were associated with reduced rates of 30-day readmissions. (page 956)
Costly Palliative Radiation for Prostate Cancer
Between 2000 and 2007, palliative radiation therapy for bony prostate cancer metastases was characterized by the use of more advanced treatment technologies and prolonged treatment courses despite an absence of data to suggest a clinical benefit. (page 933)
Bereavement Program Development
Susan Block and colleagues describe the development of a bereavement program at Dana-Farber Cancer Institute as a preventive model of care. The essential components included formal acknowledgment by the cancer center of a patient's death, information about grief and what to expect, individual visits to assess coping, and staff support and education. (page 915)
Effects of Multidisciplinary Care Coordination
Researchers demonstrated that patients with newly diagnosed, late-stage cancer who were managed by disease-specific multidisciplinary teams had stable or improved symptoms, depression, and functional status. (page 962)
Incidence of Oropharyngeal Candidiasis
Among 52 terminally ill patients, more than half had positive cultures for oropharyngeal candidiasis that included an isolate with decreased fluconazole susceptibility. The authors suggest that susceptibility testing might be recommended for patients with clinical signs of oropharyngeal candidiasis. (page 940)
Prevalence of Cancer Pain
In this cross-sectional study of more than 1000 adults with cancer, 55% reported pain. Pain was less frequent in outpatients than inpatients, although median pain duration was longer in outpatients (20 versus 6 weeks). In both groups, patients with multiple myeloma (73%), breast (65%), and lung cancer (61%) were most likely to report pain. (page 923)
Decision Making Guide for Parents
The authors describe a handbook and website they developed for parents facing end-of-life decisions for a seriously ill child. Pilot study parents found the resources helpful and comforting, and most clinicians viewed them as ideal for training purposes. (page 945)