Role of Radiation Therapy in Palliative Care of the Patient with Cancer.

Lutz ST1, Jones J2, Chow E2. Abstract Radiotherapy is a successful, time-efficient, well-tolerated, and cost-effective intervention that is crucial for the appropriate delivery of palliative oncology care. The distinction between curative and palliative goals is blurred in many patients with cancer, requiring that treatments be chosen on the basis of factors related to the patient (ie, poor performance status, advanced age, significant weight loss, severe comorbid disease), the cancer (ie, metastatic disease, aggressive histology), or the treatment (ie, poor response to systemic therapy, previous radiotherapy). Goals may include symptom relief at the site of primary tumor or from metastatic lesions. Attention to a patient’s discomfort and transportation limitations requires hypofractionated courses, when feasible. Innovative approaches include rapid response palliative care clinics as well as the formation of palliative radiotherapy specialty services in academic centers. Guidelines are providing better definitions of appropriate palliative radiotherapy interventions, and bone metastases fractionation has become the first radiotherapy quality measure accepted by the National Quality Forum. Further advances in the palliative radiation oncology subspecialty will require integration of education and training between the radiotherapy and palliative care specialties.

© 2014 by American Society of Clinical Oncology.


 

 

A Review: The 3rd Annual Cancer Pain Conference

I recently attended the 3rd Annual Cancer Pain Conference: Integrating Interventional Pain Management and Supportive Care in Patients Diagnosed with Cancer presented by Dr. Lisa Stearns and the Valley Cancer Pain Foundation in Scottsdale, Arizona.

At this conference, I was fortunate to attend a lecture by Dr. Robert Levy, entitled, Publication Update- IDDS Safety and Best Practices. Dr. Levy did a wonderful review of the Polyanalgesic Consensus Committee (PACC) Guidelines and how they relate to best practices.

The most recent edition of the PACC Guidelines (2012) covers the following areas: drug selection, morbidity and mortality, trialing, and granuloma prevention and treatment. Dr. Levy began by stating the definition of consensus as, “Judgment arrived by those most concerned.” He said that the Committee reviewed much information and derived decisions weighing safety, appropriateness, fiscal neutrality and effectiveness (SAFE). He also discussed the various pain algorithms and how they have changed over the years, as well as how the current algorithm differentiates drug therapy as it relates to nociceptive pain and neuropathic pain.

Dr. Levy is a proponent of intrathecal drug therapy and expressed a comment that it is expensive, but the therapy provides significant savings to society. He also emphasized that physicians possess a certain liability when treating their patients with compounded medications.

Another very interesting lecture at the Cancer Pain Conference was presented by Julie Burch M. ED entitled, Complementary Therapy Care. Ms. Burch gave a great presentation relating to yoga and meditation for the relief of pain. She was very passionate about the association between immunity and emotion and how the body deals with pain and suffering. She stated emotion is produced by the brain where there is a mixture of feelings and physical response. The goals of complementary therapy are to foster and enhance current regimens employed. Dr. Burch also instructed the group to perform breathing techniques as a form of relaxation – something that I was very skeptical of, but I’m now intrigued about this new form of treatment.

I was fortunate to present at this year’s conference along with fellow pharmacists, Chuck Bell and Sarah Simmers. Our talk was entitled, Utility of Compounded Medications in 2014: Hazards and Pitfalls. As a group, we discussed the various issues affecting compounding pharmacies and, therefore, affecting pain practices. Significant time was dedicated to the new Federal regulation HR 3204, requiring pharmacies to register with the FDA. We stressed to the attendees that they must perform due diligence in choosing a qualified compounding pharmacy. There are still many issues that need to be resolved, both at the state and federal level, as it relates to regulating compounding pharmacies. One of the attendees expressed a need for additional information, and there is hope that a similar presentation can be made at future pain meetings.

Another very interesting presentation was by Dr. William Rosenberg entitled, Neurosurgical Options for Symptom Management in Cancer. I was unfamiliar with this treatment modality for chronic cancer pain. The first treatment consideration presented was a cordotomy. This is an outpatient procedure performed under a CT scanner where an electrode is inserted into the spinal thalamic tract at the base of the skull and radiofrequency is used to turn off pain fibers. This procedure has no effect on joint or motor function as well as sensory. Dr. Rosenberg stated that this is used for pain on one side of the body that is below the shoulder. Pain relief lasts about two years, and in some cases longer. The second procedure for consideration was a myelotomy – a procedure similar to the cordotomy – where a needle is inserted between the dorsal columns and replaced with electrode for nerve ablation. This interventional procedure is ideal for polysynaptic pain pathways and is optimal for patients suffering from chronic pain within the abdominal, pelvis and retroperitoneal areas. Dr. Rosenberg stated that he has had good success with patients affected with pancreas, liver, or ovarian cancer, and with those who have sacral metastases. This procedure can provide pain relief for up to two years as well.

Lastly, Dr. Rosenberg is the president and founder of Cancer Pain Research Consortium. Their mission is to generate and promote interdisciplinary, patient centered, evidence-based care for cancer related pain and suffering. Their members are comprised of oncologists, radiation oncologists, and neurosurgeons in addition to many other palliative care doctors. I encourage you to seek out this organization and become involved.

Overall, the 3rd Annual Cancer Pain Conference was very educational, and I highly recommend that you attend the conference in future years.