Photo - Ann Fonfa & Annie Brandt, (Best Answer for Cancer)
Multinational Association of Supportive Care in Cancer (MASCC), by Ann Fonfa, president, The Annie Appleseed Project
Athens, Greece June 2011
The opening session was terrific – including talks on Social Exclusion and Supportive Care presented by K. Syrigos of Greece. His discussion was powerful and moving – images of homeless people, mentally ill, undocumented folks and those in prison. He also talked about the needs of the elderly, thought to be the group most likely to develop cancer. He mentioned that the median number of drugs taken by the elderly is 6.
The next speaker, E. Bruera, USA covered Research in Patients with Advance Cancer: The Ethical Issues.
What is ethical and what is not? Unfinished trials, underpowered, or asking the wrong question were some of the examples. There is a need for palliative care trials – many patients are glad to be included. We need stronger evidence and this could be tremendously impactful.
The final speaker of the first session, D. Tzanninis, Greece covered Dignity in the Terminally Ill.
There is a Social Dignity inventory in which permission to examine is asked of the patient, they are asked before other medical staff are brought into a consult, etc. It was also pointed out that there is lots of unrecognized depression in the terminally ill.
Finally a discussion of the work of Dr. Cicely Saunders who founded the first hospice in 1967 at St. Christopher’s in South London.
The second plenary featured M. Aapro, Switzerland talking about Supporting the Elderly Patient. It was pointed out that “elderly persons, even those who seem quite fit, have in general a decreased tolerance to physical stress, and thus deserve even more supportive care than the younger patients”.
The next talk by V. Pace, UK was Place of Death: Past Trends and Future Projections. Death is a social experience not medical. Surveys show that 80% of healthy people state that they want to die at home. Between 49 -100% of people with cancer express that desire.
About half the people at home end up wanting to go to a hospice (or Care Home), people often change their mind between home and hospice, in part because of the difficulties in managing illness. There are variations between countries in this. People in developing countries are actually more likely to die in hospital. Hematological cancers are predictors of hospital death as well, due to treatments and complexities.
Day 2 – Supportive Care in Radiotherapy
J. Epstein, USA discussed Radiation-induced Xerostomia in Cancer Patients, pointing out that saliva has many roles – it is antimicrobial, is involved in taste, dental health, and oral mucosa.
Excessive saliva is also a problem – with pooling/control issues as well as drooling. Surgical treatment has been suggested for lip incompetence. Speech therapy is done to help, also suction is used, reconstruction, prostheses, and more. Pharmaceutical methods include botox. Investigational methods include acupuncture, n-acetylcysteine, amifostine, hyperthermia, tens and gene therapy.
N. Yarom, Israel discussed Healing of Dental Extraction Sites in Irradiated Patients. He mentioned the use of hyperbaric oxygen, stating there were not really enough studies so it remains controversial although shows some efficacy. Two locations in Israel are using hyperbaric oxygen currently.
H. Hansen, USA in her discussion estimated the incidence of osteonecrosis as between 2.1 – 34.4%. This is absurd and unfair. Such an important adverse effect needs to be much more clearly understood.
Abstract 192, about the use of frozen gloves to reduce neuropathy caused by docetaxel, was presented by H. Ishiguro, Japan. He mentioned that he raised the temperature so it was not so cold as he personally tried the gloves on. Thus they could be frozen in a home refrigerator and worn 15 minutes after dose of chemotherapy. This was an interesting and humane approach.
Abstract 814 (Italy) discussed the use of oral alpha-lipoic acid (ALA) (an over-the-counter OTC supplement). Conclusion: “In our experience oral administration of ALA demonstrated an interesting activity in reducing oxaliplatin-related (peripheral neuropathy). Studies on the Annie Appleseed Project website support this idea. Would it be more useful to take during treatment instead of after PN occurs?
Abstract 819 (India) supported research presented at the American Society for Clinical Oncology in prior years concluding: “Ginger root powder was effective at reducing severity of acute and delayed chemo-induced nausea and vomiting as an additional therapy to palanosetron and dexamethasone and/or aprepitant in patients… It is easily available and a relatively cheaper substitute in developing countries”.
Abstract 60 (Norway) discussed quality of life in breast cancer patients using anti-estrogens 2 years after acupuncture treatment. “Women previously treated with sham acupuncture still complained of hot flashes, those previously treated with traditional acupuncture found them less of a problem and generally had a more positive outlook on life”. But most women were troubled by 2 or more adverse effects from the medication, “negatively affecting their life quality”.
Abstract 68 (USA) discussed a randomized trial of Tai Chi among elderly breast cancer survivors. The Tai Chi group improved upper body flexibility, and the Health Education control group improved their mindfulness. A win-win. Conclusion was that it was feasible to use TCC for health benefits.
Abstract 582 (Brazil) discussed the effect of a commercial acai beverage on cancer cachexia. Absurdly they used a sweetened version with “a high concentration of glucose syrup, which could be responsible for the hypertriacylglycerolemia found in” study animals. Acai in its unsweetened version was referred to as “rich in phytochemicals with anti-oxidant, anti-inflammatory and anti-cancer properties”.
Abstract 585 (Italy) looked at the long-term L-carnitine supplementation in cachexic rats. Conclusion: “the results indicate that long-term L-carnitine supplementation improves liver lipid metabolism in cachexia.
Abstract 390 (Australia) looked at the value of Emu oil to promote repair from chemo induced intestinal mucositis. The conclusion was that there was indeed evidence of promotion of repair of injury.
Abstract 381 (UK) discussed use of hyperbaric oxygen to treat recurrent subacute bowel obstruction after previous pelvic radiotherapy. Looking at case series with up to 24 month follow up, the conclusion was the this method may be an effective treatment of radiation-induced problems.
Abstract 349 (Brazil) discussed the use of low level laser therapy to prevent or reduce oral mucositis in head/neck patients. Their results showed “51% of pts did not have ulcers” (in the laser group), versus 17% in the placebo arm. These people also had less severe pain and used less narcotic analgesics.
(We currently cannot locate the Abstract number for this one, but it was all about caregivers) “Caregivers who do not receive adequate information and support in the early stages of cancer disease, have greater needs, less trust and confidence in the healthcare team and cope more poorly in advanced stages than caregivers who have been informed and supported throughout the course of the illness. Intervention strategies for the caregivers should include psycho-educational programs, therapeutic counseling and problem-solving intervention which may affect in reducing burden, increasing their self-efficacy and improving quality of life”.
Multinational Association on Supportive Care in Cancer, online at www.mascc.org is an international, multi-disciplinary organization with members representing over sixty countries and five continents. The group was founded in 1990 and is dedicated to research and education in all aspects of supportive care for patients with cancer, regardless of the stage of their disease. It’s multi-professional membership profile includes “oncology medical, surgical, and radiology physicians, nurses, dentists, dental hygienists, pharmacists, social workers, dieticians, outcomes specialists, psychologists, statisticians, infectious disease specialists, educators, and representatives from industry and non-profit sectors.
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