Most Cancer Docs Reach Out to Bereaved

Seventy percent of cancer physicians contact bereaved family members and caregivers of their patients who die.  But of the 162 physicians surveyed, more than two thirds do not feel adequately trained to do this sort of reaching out.  These were the results of a study presented at the 53rd Annual Meeting of the American Society for Radiation Oncology (ASTRO).

Most of those surveyed sent condolence letters, and some called or attended funeral services.  One perceived barrier to bereavement follow-up is lack of time.  Another factor was uncertainty about which family member was the most appropriate person to contract.

“This study highlights the need to more clearly define the physicians’ role in bereavement activities and address bereavement activities in providers’ postgraduate training as we work to improve the multidisciplinary treatment of cancer patients and their families,” said lead author Aaron S. Kusano, MD, a radiation oncology resident at the University of Washington School of Medicine in Seattle. 

Source:  www.medicexchange.com/ASTRO-2011/most-cancer-physicians-reach-out-to-bereaved-family-caregivers-astro-2011.html.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Breaking Bad News to Asian Patients

Cultural Differences

Only 30% of Asian patients want to discuss life expectancy, whereas 60% of Western patients do.  Of Japanese patients, 78% want a family member present when learning news about a bad prognosis, starkly contrasting with US patients, 81% of whom prefer to be alone.

These are examples of the widely varying cultural preferences highlighted in “Breaking Bad News to Asian Patients,” an article subtitled “A Primer on Asian Bioethics,” by Desiree Lie at Medscape (http://www.medscape.com/viewarticle/744651_2).  She cites several studies about communicating bad news to patients, noting the contrast in preferences of Asian patients.

The author notes that although both Asian and Western bioethics stress truth-telling and autonomy, the Asian conception of autonomy considers the family as the autonomous unit whereas the Western application of the ethical principle in medicine generally refers to the individual.  Lie states that in Asian culture, the first person to be told about a diagnosis of cancer is the head of the household—not the patient.  Lie acknowledges that traditions vary within cultures and within the same cultural group in different geographic regions.

Lie suggests 1) asking the patient what he or she prefers when having a diagnosis presented, 2) finding out who is the center of decision-making in the family, and 3) inviting the patient to share “ancestral values” about illness, the role of family members and spiritual beliefs.  These kinds of conversations may furnish you with clues to the best routes of communication.

Author Lie says, “Allowing [the patient] to make the initial decision of how to be given news about her diagnosis gives her and her family ‘face’ and is likely to improve follow-up, communication, satisfaction, adherence, and future management of her disease.”

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Hospice Facts & Figures: 2010 Snapshot

The National Hospice and Palliative Care Organization (NHPCO) has released facts and figures for 2010. Key statistics in the report, which mainly compares data from 2009 to 2010, include:

• 1.58 million hospice patients served
• Average length of service was 67.4 days
• Median length of service 19.7 days
• 66.7 % patients died at home
• 21.9% died in hospice inpatient facilities
• 11.4% died in acute care hospitals
• 87.2% of hospice patients were 65 or older: 38% were 85 or older
• 35.6% deaths with diagnosis cancer; 13% deaths with diagnosis dementia

The percentage of non-white Caucasian patients increased in every category: 11% multiracial or other race in 2010, compared to 8.7% in 2009; 8.9% v. 8.7% Black/African American; 2.5% v. 1.9% Asian, Hawaiian, other Pacific Islander; and 0.3% v. 0.2% American Indian or Alaskan native. 
 

Source: www.nhpco.org/files/public/Statistics_research/2011_Facts_Figures.pdf

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Alzheimer's Tracks Mapped

Surprising results of recent research show that Alzheimer’s disease (AD) seems to spread from one brain cell to the next.  Instead of a virus or bacteria, a distorted protein known as tau is being spread.

Theoretically the disease could be stopped in its tracks by halting transmission from cell to cell—maybe with a tau-blocking antibody.  The study results will have immediate implications for developing new treatments, according to researchers working independently at Columbia and Harvard.  They likened imagined treatments for halting the disease to treating cancer while in its early stages before it has spread.

For many years researcher tried to unravel the mystery of how AD spreads.  Did lesions pop up independently of one another throughout the brain, or did AD spread outward like contagion from the memory center where it first emerges?

The means to the solution was provided by genetically engineering mice to accumulate abnormal human tau proteins in the entorhinal cortex, where cells first start to die in AD.  Following the mice over two years yielded the information they were looking for.  Since human tau proteins could not spontaneously appear in isolated pockets of mouse brains, they could only arrive at other areas via transmission from cell to cell.

As researchers mapped the path of the human tau protein they saw it spread outward from the entorhinal cortex to hippocampus to neocortex—the same progression as seen in humans. Researchers are now asking whether other degenerative brain diseases, such as Parkinson’s, may spread the same way.

The Columbia University study was done by Karen Duff and Dr. Scott A. Small and their colleagues at the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University Medical Center and was published in the journal “PLoS One”.  Another study was led by Dr. Bradley T. Hyman, Director of the Alzheimer’s Disease Research Center at Massachusetts General Hospital and was published in the journal “Neuron”.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.