The Palliative Care in Oncology Symposium, held October 9–10, 2015, in Boston, Massachusetts, brought together more than 670 members of the cancer care community, including oncologists, radiologists, palliative care specialists, nurses, and patient advocates. Sessions delivered information on palliative care communication, access, and integration and placed special emphasis on the science and treatment of two common and distressing symptoms in patients with cancer: pain and cachexia.Error loading Partial View script (file: ~/Views/MacroPartials/TAP Article Portrait Widget.cshtml)
Kavita Dharmarajan, MD, MSc, presented a study initiated by Sanders Chang at Icahn School of Medicine at Mount Sinai, investigating the effect of an intervention to encourage adoption of short-course radiation therapy (RT) for symptomatic bone metastases (Abstract 110).1 After initiation of the intervention, radiation oncologists were more likely to use shorter-duration RT, including an increase in the use of single-fraction and 2- to 5-fraction RT, with a concomitant decrease in the use of courses of more than 5-fraction RT. “Increasing the use of short-course radiation treatments was associated with reduced time spent in the hospital for patients and families,” Dr. Dharmarajan said. “Patients were more likely to finish their treatment and get support from palliative care. Changing practice can lead to improved care for patients and families and greater efficiency for health systems.”Error loading Partial View script (file: ~/Views/MacroPartials/TAP Article Portrait Widget.cshtml)
A study presented by Rudolph M. Navari, MD, PhD, showed that among patients receiving highly emetogenic chemotherapy, use of olanzapine in combination with standard antiemetics improved the control of nausea and emesis compared to patients receiving placebo in combination with aprepitant and dexamethasone during the 24 hours postchemotherapy (74% vs 45%, P < .0006), 24 to 120 hours post-chemotherapy (43% vs 26%, P < .0006), and the overall period (0 to 120 hours; 39% vs 22%, P < .0006) (Abstract 176).2 Dr. Navari said that aside from transient sedation observed on day 2 post-chemotherapy, no significant adverse effects were noted with the use of olanzapine.Error loading Partial View script (file: ~/Views/MacroPartials/TAP Article Portrait Widget.cshtml)
In his presentation on “Neural Mechanisms of Cancer Pain,” Brian L. Schmidt, DDS, MD, PhD, FACS, demonstrated that pain in patients with cancer is caused by a multitude of factors and is far more complex than previously appreciated. Whereas classical thinking about cancer pain is that it is a function of destruction of tissue and nerve invasion, recent research highlights that cancer causes pain through many different mechanisms and that different cancer types may have separate and distinct biochemical pathways underlying the pain response.
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Eduardo Bruera, MD, FAAHPM, provided a comprehensive overview of the evolving understanding of the metabolic influences and implications of cachexia. Importantly, Dr. Bruera noted that classical thinking defining cachexia as necessarily related to nutritional deficits needs to be abandoned in light of research showing that body mass index and weight alone are insufficient for a diagnosis. Instead, several relevant prognostic factors have been identified and are the subject of ongoing research, especially testosterone and CRP level, low albumin levels, and vitamin D deficiency (especially in patients with darker skin tone). Furthermore, cachexia leads not only to a loss of muscle tone, but also to muscle mass and functionality.
For more highlights from the Palliative Care in Oncology Symposium, visit pallonc.org/dn. To view recorded presentations from the Symposium and other ASCO meetings, visit asco.org/vm. ■
Select portions originally printed in ASCO Connection. © American Society of Clinical Oncology. “2015 Palliative Care in Oncology Symposium Highlights.” connection.asco.org. December 15, 2015. All rights reserved.
1. Chang S, Smith CB, Morrison RS, et al: A palliative radiation oncology consult service’s impact on care of advanced cancer research patients with symptomatic bone metastases. 2015 Palliative Care in Oncology Symposium. Abstract 110.
2. Navari RM, Qin R, Ruddy KJ, et al: Olanzapine for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC): Alliance A221301, a randomized, double-blind, placebo-controlled trial. 2015 Palliative Care in Oncology Symposium. Abstract 176.