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Cancer QOL: Managing Symptoms & Treatment Side Effects

Quality Of Life issues are an essential consideration in cancer care today. Patients frequently have symptoms related to their cancer and to their therapy. Today's oncologists need to have expertise in symptom management to fully support their patients from diagnosis, through treatment, and to the end of life. More medical options are becoming available every day to keep patients comfortable and relieve suffering. Are you up to date on the latest medications and interventions to give your patients maximal quality of life?

Moderated By:
Susan Urba, MD
Professor, Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical Center
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Expert Practice Series Presentations
Susan Urba, MD
Professor, Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical Center
Pamela S. Becker, MD, PhD
Associate Professor of Medicine, Division of Hematology, Univ. of Washington School of Medicine, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
Charles F. von Gunten, MD, PhD
Provost, Institute for Palliative Medicine, San Diego Hospice, Medical Director, Doris A. Howell Service, UCSD Moore’s Cancer Center, Professor of Clinical Medicine, UCSD
Eduardo Bruera, MD
Chair, Department of Palliative Care and Rehabilitation Medicine, University of Texas M.D. Anderson Cancer Center
Douglas E. Peterson, DMD, PhD
Professor, Oral Medicine, Co-chair, Head and Neck/Oral Oncology Program, School of Dental Medicine, University of Connecticut Health Center
Gary Lyman, MD, MPH, FRCP
Professor of Medicine and Director, Health Services, Effectiveness and Outcomes Research, Duke University School of Medicine and the Duke Comprehensive Cancer Center
Mark G Kris, MD
Chief, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY
Michael H. Levy, MD, PhD
Director, Pain and Palliative Care Program, Vice-Chair, Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA
Charles L. Loprinzi, MD
Professor of Oncology, Mayo Clinic, Rochester MN
Latest Comments
"This was an exceptional evidence-based well-organized succinct presentation entitled “Chemotherapy-Induced and Cancer-Related Anemia,” in your series on Cancer QoL: MGT and S/S and TX of S/E.  You thoroughly described the causes of CA associated anemia.  You explained what laboratory analysis are necessary to order and why which included a wonderful flow chart on diagnostic evaluation for anemia

An explanation regarding chemotherapy associated anemia due to myelo- suppression from chemotherapy agents and the treatment necessary were thoroughly discussed.  In 2008, the FDA set up an ESA plan of action regarding who could receive ESAs.  The rationale of as the why the FDA set up ESAs guidelines revealed a reduced survival in CA pts no chemotherapy, radiation therapy alone, chemotherapy alone, and reduced survival in renal failure pts with Hgb ~ 14 due to CV events.

Again, a thorough review of the approved indications for ESAs which included dosing guidelines.  You explained in detail where to go if there isn’t an effect from the ESA.  Individualization of pt care with a discussion regarding the risks and benefits was analyzed.  In addition, you reviewed the NCCN guidelines which included the risk assessment and indications for transfusing a pt.  The fact that potential iron is preferred to oral iron was discussed.  Functional iron deficiency and required potential iron therapy to optimize response to ESAs were examined. 

Once more, an excellent review of the cause of cancer associated anemia, the necessary laboratory analysis, TX i.e. ESAs and when to transfuse a pt were all examined in detail.


Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
"This was a wonderful evidence-based well-organized succinct presentation entitled Oral Mucositis Secondary to Cancer Therapy in your series on Cancer QoL: MGT and S/S and TX of S/E.  Traditional MGT of oral mucositis was thoroughly described.  You explained the evolution and MGT of oral mucositis from 1980 through 2010.  In addition the risk and choices of drug treatment, pt reported toxicities impacting hematopoietic cell transplantation, the incidence of oral mucositis CA therapy, incidence and grade were reviewed.  Additionally, an  analysis of the clinical practice guidelines from the Multinational Association of Supportive Care in CA and International and the Society of Oral Oncology 2004 and 2007 guidelines were explored.  An emphasis on the importance of pt and staff education were stressed.  Furthermore, multidisciplinary protocol development, measurement of impact of interventions regarding pt controlled analgesia with MSO4 were explored.  A review of the updated clinical practice guidelines for oral mucositis prevention suggestion in using low-level laser therapy disclosed a reduction in oral mucositis and its related pain in the Phase III trial research 2004 were explored.  Demonstrating that Palifermin therapy reduced severe oral mucositis, improvement in overall QoL, and validated a reduction in health resource usage.

It is good to know that a variety of societies are working together to focus on overall quality with regard to the pt’s QoL.  The field in mucosal injury in CA pts updates in two years with guidelines from various organizations including the National Comprehensive CA Network, Oncology Nursing Society and Cochrane Collaboration among other organizations.  They all work to produce a set of guidelines for mucositiis MGT.

Yes, I agree that it is vital that we continue to coordinate and dissimilate and utilize guidelines and periodically reevaluate and revised necessary changes as deemed appropriate in the future with all of the new treatments available and potential S/E with regard to mucosal injury.  Again, we need to stay focused and continue to research areas directed to mucosal injury in CA pts increasing emphasis in understanding genetic and non-genetic and the risk oral mucosa mucositis.  Complementary and alternative medicines may play a role to assist pts with this condition.  As well as, trajectory of oral mucositis caused by emerging targeted CA therapies was be evaluated.

I look forward to reviewing the rest of the series as my time allows between my case load.  Thought provoking questions, great photograph, flow chart, graphs and review of the literature studies. 


Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
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