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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
292 Comments, last 1 day ago
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
304 Comments, last 22 hours ago
Eduardo Bruera, MD
Chair, Department of Palliative Care and Rehabilitation Medicine, University of Texas M.D. Anderson Cancer Center
288 Comments, last 1 day ago
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
213 Comments, last 1 day ago
Charles L. Loprinzi, MD
Professor of Oncology, Mayo Clinic, Rochester MN
Latest Comments
"This was an exceptional, well-organized succinct presentation entitled “Cancer-Related Fatigue” in your series on Cancer QoL: MGT and S/S and TX of S/E.  You defined fatigue, reviewed epidemiology, the prevalence including the various stages and high impact of the patterns of fatigue resulting from therapy from chemotherapy and radiotherapy.  A thorough evaluation of the pathophysiology including the multifactorial and the emphasis that fatigue is real related to the metabolism increased cytokine productions, contributing factors i.e. depression, sleep disorders, and muscular dysfunction. On your first question regarding anemia, I would select depression for fatigue as the answer. 

Yes, I definitely agree the use of a fatigue screening assessment similar to a pain screening tool criteria is a great method of measuring one’s level of fatigue.  Knowing the H&P, HX of CA primary site etc. are vital elements to have available when assessing a pt for fatigue.

You methodically reviewed fatigue MGT etiologies treatable include anemia, depression, pain, hypothyroidism and hypogonadism.  In addition, you explored non-pharmacological therapies, including:  educating the patient on patterns of fatigue, clarifying the role of underlying illness, reviewing treatments available, encouraging optimize fluid intake, emphasizing importance of a proper electrolyte and nutritional intake.  Similarly, your examined pharmacological MGT for the TX of fatigue.  Additionally, you analyzed the necessity in promoting physical activity and including other disciplines in the care of the pt.  Energy conservation strategies were discussed in reference to randomized controlled trial data which revealed clearly that exercise makes pts feel better.

Research reveals that engaging in a low-intensity workout routine helps boost energy levels in people suffering from fatigue and pain. Since fatigue is one of the most common health symptoms and can be a sign of a variety of medical problems after completing a laboratory analysis negative for anemia, hypothyroidism, hypoglycemia etc, why don’t more PCPs offer exercise as an alternative to the problem instead of having the pt complete a depression screen and automatically placing them on an SSRI? 

Since exercise, releases endorphins into the body triggering a sensation of feeling good all over (happy and cheerful), PCPs should offer this as a solution for fatigue.  We all know that endorphins interact with the receptors in your brain that reduce one’s perception of pain.  I have read that endorphins are similar to that of morphine and yes, I have experienced a runner‘s high and at one time I would actually insist on attending to my aerobic's class instead of going out to eat with my husband.  I guess, it can be somewhat addicting too. 


Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
304 Comments, last 22 hours ago
"I said BID, but actually ordered on Magace 400mg daily.


Valerie Ting, APRN-BC
Nurse Practitioner, Comprehensive Health Center
292 Comments, last 1 day ago
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