The Journal of Community and Supportive Oncology

Talking about end-of-life planning might not be so simple. Data suggests that patients want to know more about their prognosis, but sometimes physicians aren't sure how to bring up the discussion. Four supportive oncology experts discuss the importance and challenges of end-of-life planning during the 7th annual Chicago Supportive Oncology Conference.

Talking about end-of-life planning might not be so simple. Data suggests that patients want to know more about their prognosis, but sometimes physicians aren't sure how to bring up the discussion. Four supportive oncology experts discuss the importance and challenges of end-of-life planning during the 7th annual Chicago Supportive Oncology Conference.

Talking about end-of-life planning might not be so simple. Data suggests that patients want to know more about their prognosis, but sometimes physicians aren't sure how to bring up the discussion. Four supportive oncology experts discuss the importance and challenges of end-of-life planning during the 7th annual Chicago Supportive Oncology Conference.

n this roundtable discussion from the Chicago Supportive Oncology Conference, Dr. Michael J. Fisch and Dr. Anthony Back discuss the importance of effective communication with cancer patients and some exciting studies that are underway.

n this roundtable discussion from the Chicago Supportive Oncology Conference, Dr. Michael J. Fisch and Dr. Anthony Back discuss the importance of effective communication with cancer patients and some exciting studies that are underway.

n this roundtable discussion from the Chicago Supportive Oncology Conference, Dr. Michael J. Fisch and Dr. Anthony Back discuss the importance of effective communication with cancer patients and some exciting studies that are underway.

Bone is the most common site of metastases in men with advanced prostate cancer, one of the most prevalent cancers in the United States and the second leading cause of cancer death after lung cancer.^1–3 The median survival from diagnosis of bone metastases is 30–40 months.² During this time, skeletal-related events (SREs), including pathologic fractures, surgery or radiation to the bone, spinal cord compression, or hypercalcemia of malignancy, can occur. SREs are associated with considerable morbidity, impaired health-related quality of life, reduced survival, and increased costs.^4–10

Although studies have examined the impact of SREs on costs in patients with advanced cancers and bone metastases,^5–9,11 the effects of bone metastases without SREs on healthcare costs in prostate cancer patients have not been studied. The magnitude of these costs may be important in economic evaluations of treatments to prevent or delay bone metastases in prostate cancer patients. The objective of this study was to estimate the effects on healthcare costs of bone metastases in the presence and absence of SREs in men with prostate cancer who were receiving hormonal therapy.

* For a PDF of the full article, click in the link to the left of this introduction.

Bone is the most common site of metastases in men with advanced prostate cancer, one of the most prevalent cancers in the United States and the second leading cause of cancer death after lung cancer.^1–3 The median survival from diagnosis of bone metastases is 30–40 months.² During this time, skeletal-related events (SREs), including pathologic fractures, surgery or radiation to the bone, spinal cord compression, or hypercalcemia of malignancy, can occur. SREs are associated with considerable morbidity, impaired health-related quality of life, reduced survival, and increased costs.^4–10

Although studies have examined the impact of SREs on costs in patients with advanced cancers and bone metastases,^5–9,11 the effects of bone metastases without SREs on healthcare costs in prostate cancer patients have not been studied. The magnitude of these costs may be important in economic evaluations of treatments to prevent or delay bone metastases in prostate cancer patients. The objective of this study was to estimate the effects on healthcare costs of bone metastases in the presence and absence of SREs in men with prostate cancer who were receiving hormonal therapy.

* For a PDF of the full article, click in the link to the left of this introduction.

Bone is the most common site of metastases in men with advanced prostate cancer, one of the most prevalent cancers in the United States and the second leading cause of cancer death after lung cancer.^1–3 The median survival from diagnosis of bone metastases is 30–40 months.² During this time, skeletal-related events (SREs), including pathologic fractures, surgery or radiation to the bone, spinal cord compression, or hypercalcemia of malignancy, can occur. SREs are associated with considerable morbidity, impaired health-related quality of life, reduced survival, and increased costs.^4–10

Although studies have examined the impact of SREs on costs in patients with advanced cancers and bone metastases,^5–9,11 the effects of bone metastases without SREs on healthcare costs in prostate cancer patients have not been studied. The magnitude of these costs may be important in economic evaluations of treatments to prevent or delay bone metastases in prostate cancer patients. The objective of this study was to estimate the effects on healthcare costs of bone metastases in the presence and absence of SREs in men with prostate cancer who were receiving hormonal therapy.

* For a PDF of the full article, click in the link to the left of this introduction.

The psychological and social consequences of cancer treatment were largely neglected until the latter part of the 20th century, despite the awareness that cancer patients often struggled with anxiety, depression, and emotional upheaval so severe as to jeopardize adherence to treatment. These psychological and emotional states were attributed to patients’ subjective responses to their condition, which were deemed unmeasurable and therefore not easily assessed in routine cancer care. Nevertheless, a study in the early 1980s¹ showed that if newly diagnosed patients were screened for distress, those identified as being distressed could be helped to cope better.

To improve the recognition and treatment of distress in cancer patients, the National Comprehensive Cancer Network (NCCN) created a panel of experts in 1997 to formulate clinical practice guidelines for distress management.² The guidelines, which were based on the evidence and consensus of an expert panel, were the first in the United States designed for clinicians. The term “distress” was chosen because it suggests a normal response, which can vary from an expected level to a severe one (eg, anxiety, depression).³ The term also reduces the stigma attached to words such as “psychiatric.”

The NCCN Distress Management Guidelines, which are updated annually, recommend that each new patient be rapidly assessed for distress in the office or clinic waiting room using a brief screening tool.^3,4 Based on the lessons learned from the success of pain management, the panel suggested using the Distress Thermometer (DT), a self-report  measure with a 0–10 scale in which 0 indicates “no distress” and 10, “extreme distress.” Patients who score 4 or more are identified as having clinically significant distress, based on validity studies showing sensitivity and specificity.⁵ They are then asked to check off the domains they identify as causing the distress in a separate Problem List. Depending on the nature of the problem elicited by the nurse or oncologist, patients can be referred to a professional, such as a social worker, nurse, psychologist, chaplain, or psychiatrist.^6,7 The screen should be repeated at points of transition during clinical treatment.⁷

* For a PDF of the full article, click in the link to the left of this introduction.

The psychological and social consequences of cancer treatment were largely neglected until the latter part of the 20th century, despite the awareness that cancer patients often struggled with anxiety, depression, and emotional upheaval so severe as to jeopardize adherence to treatment. These psychological and emotional states were attributed to patients’ subjective responses to their condition, which were deemed unmeasurable and therefore not easily assessed in routine cancer care. Nevertheless, a study in the early 1980s¹ showed that if newly diagnosed patients were screened for distress, those identified as being distressed could be helped to cope better.

To improve the recognition and treatment of distress in cancer patients, the National Comprehensive Cancer Network (NCCN) created a panel of experts in 1997 to formulate clinical practice guidelines for distress management.² The guidelines, which were based on the evidence and consensus of an expert panel, were the first in the United States designed for clinicians. The term “distress” was chosen because it suggests a normal response, which can vary from an expected level to a severe one (eg, anxiety, depression).³ The term also reduces the stigma attached to words such as “psychiatric.”

The NCCN Distress Management Guidelines, which are updated annually, recommend that each new patient be rapidly assessed for distress in the office or clinic waiting room using a brief screening tool.^3,4 Based on the lessons learned from the success of pain management, the panel suggested using the Distress Thermometer (DT), a self-report  measure with a 0–10 scale in which 0 indicates “no distress” and 10, “extreme distress.” Patients who score 4 or more are identified as having clinically significant distress, based on validity studies showing sensitivity and specificity.⁵ They are then asked to check off the domains they identify as causing the distress in a separate Problem List. Depending on the nature of the problem elicited by the nurse or oncologist, patients can be referred to a professional, such as a social worker, nurse, psychologist, chaplain, or psychiatrist.^6,7 The screen should be repeated at points of transition during clinical treatment.⁷

* For a PDF of the full article, click in the link to the left of this introduction.

The psychological and social consequences of cancer treatment were largely neglected until the latter part of the 20th century, despite the awareness that cancer patients often struggled with anxiety, depression, and emotional upheaval so severe as to jeopardize adherence to treatment. These psychological and emotional states were attributed to patients’ subjective responses to their condition, which were deemed unmeasurable and therefore not easily assessed in routine cancer care. Nevertheless, a study in the early 1980s¹ showed that if newly diagnosed patients were screened for distress, those identified as being distressed could be helped to cope better.

To improve the recognition and treatment of distress in cancer patients, the National Comprehensive Cancer Network (NCCN) created a panel of experts in 1997 to formulate clinical practice guidelines for distress management.² The guidelines, which were based on the evidence and consensus of an expert panel, were the first in the United States designed for clinicians. The term “distress” was chosen because it suggests a normal response, which can vary from an expected level to a severe one (eg, anxiety, depression).³ The term also reduces the stigma attached to words such as “psychiatric.”

The NCCN Distress Management Guidelines, which are updated annually, recommend that each new patient be rapidly assessed for distress in the office or clinic waiting room using a brief screening tool.^3,4 Based on the lessons learned from the success of pain management, the panel suggested using the Distress Thermometer (DT), a self-report  measure with a 0–10 scale in which 0 indicates “no distress” and 10, “extreme distress.” Patients who score 4 or more are identified as having clinically significant distress, based on validity studies showing sensitivity and specificity.⁵ They are then asked to check off the domains they identify as causing the distress in a separate Problem List. Depending on the nature of the problem elicited by the nurse or oncologist, patients can be referred to a professional, such as a social worker, nurse, psychologist, chaplain, or psychiatrist.^6,7 The screen should be repeated at points of transition during clinical treatment.⁷

* For a PDF of the full article, click in the link to the left of this introduction.