GRACE :: Treatments & Symptom Management

Dr Ramchandran

Is Palliative Care Right for You?

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In August of 2010, Jennifer Temel and colleagues published an article in the NEJM that showed that palliative care improves quality of life, symptoms, end of life care, and — lo and behold — overall survival. The survival benefit seen with the early intervention of palliative care for metastatic NSCLC patients was approximately 2 months, the same benefit seen with avastin. The press surrounding this news was immense, with scores of people commenting on it both in the lay press, as well as in the medical literature. As a palliative care physician and an oncologist, however, it made me stop and pause. The reason, I realized, that the Temel paper was making headlines was that survival was improved. Although survival is of tantamount importance, what was striking to me was that the other benefits of palliative care were not as touted- ie improved symptom control, improved quality of life, and improved end of life care.

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What is Hospice: Fact and Fiction

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Hospice is both an organization and a philosophy of care. It was first conceptualized in the United Kingdom in 1967 by Dame Cicely Saunders who was a nurse, physician and social worker. She advocated for a multidisciplinary approach to the care of people with advanced illness with a focus not only on the physical, but on the social, emotional, psychological and spiritual. She started the first free standing hospice called St. Christopher’s hospice. In the 1970’s, hospice was brought to the United States and the first hospice was Connecticut Hospice in New Haven. In 1982, The Medicare Hospice Benefit was passed. This entitled all patients with Medicare the right to hospice regardless of ability to pay.

Hospice is appropriate for any patient with an advanced illness who no longer benefits from curative or life prolonging therapy. The focus is quality of life with a comprehensive multidisciplinary approach including a team with a physician, nurse, social worker, and chaplain. Hospice care can be provided in a free standing hospice, at home, or in a facility.

Below are some common misconceptions about hospice, with appropriate clarification. Continue reading


Mucositis: New therapies for an old complication?

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mucositis Mucositis is commonly seen in high dose chemotherapy protocols for hematologic malignancies (ie conditioning or induction regimens for leukemia), or aggressive chemo-radiation for head and neck cancers. It is a term physicians use to describe a wide range of oral complications related to cancer treatment.This may include redness, pain, ulceration, swelling and surface lesions (pseudomembrane, hyperkeratosis, lichenoid lesions). The World Health Organization has proposed a grading scale for mucositis:

Grade 0= no change
Grade 1= soreness
Grade 2= erythema (redness), ulcers, can eat solids
Grade 3= ulcers, requires a liquid diet
Grade 4= severe ulcers prohibiting oral intake

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