End-of-life care for cancer patients varies widely at Boston-area hospitals – The

#beth israel hospice

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Study says many patients enter hospice care too late

By Deborah Kotz Globe Staff September 05, 2013

Slightly more patients with terminal cancer are getting hospice care during the end of their lives, but they are still entering hospice care too late within days of death finds a new national analysis of Medicare patients conducted by Dartmouth researchers. And many are still dying in hospitals, often hooked to ventilators in an intensive care unit, despite studies showing that most cancer patients prefer to die at home.

The percentage of end-stage cancer patients who died in the hospital decreased from 29 percent on average to 25 percent from 2003 to 2010, but there are huge variations among hospitals: In Massachusetts in 2010, about 13 percent of terminally ill cancer patients treated at North Shore Medical Center in Salem died there compared with 41 percent of those treated at MetroWest Medical Center in Framingham, according to the analysis released Wednesday from the Dartmouth Atlas Project .

The project researchers receive funding from nonprofit groups to determine how medical resources are distributed and used in the United States. In the analysis, they also found that the percentage of cancer patients receiving hospice care rose nationwide from an average of 55 percent to 61 percent.

These trends can be called encouraging, but most of the hospice care received was within the last three days of life, said Dr. David Goodman, lead author of the report. What s more, the average number of days patients spent in the intensive care unit during the last month of life increased by 21 percent, which Goodman said could be driven by hospitals looking for more generous insurance payments for expensive services.

Massachusetts hospitals also had large differences in their utilization of ICU services during a patient s last month of life: A patient treated at Cape Cod Hospital spent two to three hours on average in the ICU compared with two to three days for someone treated at Lahey Clinic.

Graphic: Hospital outcomes for terminal cancer patients

There is no evidence anywhere that these variations are due to patients at these different hospitals having different preferences for their end-of-life care, said Dr. Lachlan Forrow, director of the ethics and palliative care programs at Beth Israel Deaconess Medical Center.

Even among teaching hospitals differences existed in the approach to caring for terminally ill patients, with fewer than 20 percent of patients dying in hospitals such as Maine Medical Center and Dartmouth-Hitchcock, while more than 30 percent died in Boston Medical Center and Beth Israel Deaconess.

I d like to think we do better than most places, Forrow said of Beth Israel Deaconess, but we don t do remotely as well as we should.

His institution is beginning a program to ask all patients about their end-of-life preferences and to insert that information into their electronic health record so it s easily accessible to any physician treating them.

Dr. Susan Block, chairwoman of psychosocial oncology and palliative care at Dana-Farber Cancer Institute, said it s vital for doctors to have such conversations with patients preferably when initially diagnosed with a terminal illness.

Patient goals should be the biggest determiner of care and these goals should be set early enough in the illness process that patients can have the kind of ending that they want, she said.

Far too often, doctors do not bring up the delicate issue of dying until patients are entering their last week or two of life, Block added, sometimes after they ve been hospitalized repeatedly or given aggressive chemotherapy for incurable cancers.

Dana-Farber had 29 percent of its terminal patients dying in the hospital in 2010, which was above the national average.

Nearly 60 percent of its patients were admitted to the hospital during the last month of life, and 24 percent wound up in the ICU.

About 56 percent of terminal patients at Dana-Farber were enrolled in hospice care, spending an average of nine days there.

To improve those statistics, the cancer center has been testing a communication checklist that oncologists can use to have end-of-life care conversations with patients.

We re trying to measure whether these checklists will have an impact on providing patients with the kind of care they want at the end of their lives, Block said.

Much of the success will probably depend on doctors having more truthful conversations about just how effective or ineffective aggressive treatments are for metastatic cancer.

In a study published last year in the New England Journal of Medicine. Dana-Farber researchers found that 70 percent of patients with end-stage lung cancer in a national sample and 80 percent of those with terminal colorectal cancer did not report understanding that the chemotherapy they were receiving was unlikely to be curative.

We re not doing as good a job as we should be in helping patients make informed choices, Forrow said.





Cancer Center Central Coast, California (CA), Santa Barbara – Cancer Center of

#hospice of santa barbara

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The Cancer Center of Santa Barbara

Since 1949, through the charitable giving of families and foundations, the Cancer Center has been at the forefront of comprehensive outpatient cancer care in our region. The Cancer Center of Santa Barbara joined with Sansum Clinic in 2012 to create the Cancer Center of Santa Barbara with Sansum Clinic, with a vision for further enhancing oncology care on the Central Coast. The advanced technology at the Cancer Center allows patients to be treated in a comfortable and familiar environment here in our community. The Cancer Center retains highly trained and devoted medical personnel, acquires the latest technology and treatment protocols, integrates oncology supportive programs and commits to provide every opportunity for successful treatment, recovery and a healthy return to the activities that enrich life. We know that a cancer diagnosis and treatment can bring a myriad of challenges and changes to patients, their families and friends. With this in mind, the Cancer Center sensitively integrates outpatient treatment and support disciplines including:

  • The most technologically advanced Radiation Oncology and Nuclear Medicine departments for precisely targeting and treating cancer.
  • Medical Oncology Hematology services provide the latest chemotherapy treatment with on-site participation in leading-edge national cancer research trials.
  • Integrated Patient Navigation, Genetic Counseling, and Oncology Nutrition .
  • Oncology Supportive Care Programs offer counseling, practical support and community resources to patients and families as well as innovative Wellness Programs Classes that enable patients to integrate complementary therapies such as yoga, healing touch and other healthy strategies into their cancer treatment plan.
  • A Cancer Resource Library with print and electronic cancer education and resource materials devoted to patients, their families and community members seeking information on cancer.
  • Community Outreach Prevention Programs.

Partnering with Sansum Clinic s robust Primary Care department and more than 30 specialties enables greater coordination of our doctors, nurses, and the entire patient care team. The Cancer Center s oncologists and medical staff are proud to work with Sansum Clinic s 180 physicians who provide medical care to more than 150,000 unique patients annually. Together we are committed to advancing clinical science while providing an integrated approach to oncology care. Our commitment to provide cancer care for individuals in our community, regardless of their ability to pay, has been a fundamental principle since our founding. At the same time, we have been, and continue to be, committed to the advancement of clinical science in the community. In an era where decisions about investments in new technology are often based on potential profits and losses, the Cancer Center maintains its dedication to excellent oncology care that is focused on the patient and family.

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Palliative cancer care #hotels #in #edinburgh

#palliative cancer care

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WHO Definition of Palliative Care

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

  • provides relief from pain and other distressing symptoms;
  • affirms life and regards dying as a normal process;
  • intends neither to hasten or postpone death;
  • integrates the psychological and spiritual aspects of patient care;
  • offers a support system to help patients live as actively as possible until death;
  • offers a support system to help the family cope during the patients illness and in their own bereavement;
  • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
  • will enhance quality of life, and may also positively influence the course of illness;
  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

WHO Definition of Palliative Care for Children

Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

  • Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
  • It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
  • Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
  • Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
  • It can be provided in tertiary care facilities, in community health centres and even in children’s homes.




Hospice cancer #cheap #hotels #in #chicago

#hospice cancer

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Compassion. Integrity. Excellence.

Compassus is dedicated to clinical excellence, compassionate care, and providing comfort and support to patients and their families facing end-of-life issues. Focusing on the quality of life remaining, Compassus provides effective symptom control and care that focuses on the whole individual – addressing physical, psychological, social and spiritual needs.

At Compassus, our mission is to provide hospice care to terminally ill patients and their families with Compassion, Integrity, and Excellence. The Colleagues of Compassus are committed to keeping The Hospice Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of hospice to those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments.

Compassus also provides palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Compassus palliative care services can offer relief from symptoms and pain and a care plan based on your values and needs.

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    Become a volunteer today.
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  • Cancer palliative care #hotels #in #london

    #cancer palliative care

    #

    WHO Definition of Palliative Care

    Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

    • provides relief from pain and other distressing symptoms;
    • affirms life and regards dying as a normal process;
    • intends neither to hasten or postpone death;
    • integrates the psychological and spiritual aspects of patient care;
    • offers a support system to help patients live as actively as possible until death;
    • offers a support system to help the family cope during the patients illness and in their own bereavement;
    • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
    • will enhance quality of life, and may also positively influence the course of illness;
    • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

    WHO Definition of Palliative Care for Children

    Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

    • Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
    • It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
    • Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
    • Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
    • It can be provided in tertiary care facilities, in community health centres and even in children’s homes.




    Hospice care for cancer patients #hotels #hotels

    #hospice care for cancer patients

    #

    WHO Definition of Palliative Care

    Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

    • provides relief from pain and other distressing symptoms;
    • affirms life and regards dying as a normal process;
    • intends neither to hasten or postpone death;
    • integrates the psychological and spiritual aspects of patient care;
    • offers a support system to help patients live as actively as possible until death;
    • offers a support system to help the family cope during the patients illness and in their own bereavement;
    • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
    • will enhance quality of life, and may also positively influence the course of illness;
    • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

    WHO Definition of Palliative Care for Children

    Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

    • Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
    • It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
    • Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
    • Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
    • It can be provided in tertiary care facilities, in community health centres and even in children’s homes.




    Couple marries at hospice center where groom is dying from cancer #gala

    #mjhs hospice

    #

    Brooklyn, NY He may have been completely reliant on an oxygen tank and too frail to move, but Christopher Robinson was determined to marry the love of his life.

    According to the NY Daily News. Robinson was diagnosed in August 2014 with a rare and aggressive form of renal cancer. By the time it was discovered, doctors said it had already spread to his lungs and he only had a few months left to live. Then, last week, he checked into MJHS Hospice for all-day care.

    But despite the fact that he was running out of time. Robinson was determined to make Terry Torres his bride. A kind city clerk brought him the paperwork, and hospice staff miraculously pulled together music. cake, and decorations in 24 hours. On Thursday, the ceremony was officially held.

    Christopher Robinson kissing his new bride Terry Torres (MJHS Hospice)

    “Christopher actually stood up from his wheelchair and that brought me to tears,” Terry said to the NY Daily News. She and their two-year-old son, C.J. looked amazing dressed all in white inside the hospice.

    The couple had already seen each other through several rough patches on the road to their union. Robinson had been shot five times during a burglary in 2013, and for some time, they lived through the shelter systems as they struggled to find work and a place to live.

    The new bride Terry Torres (MJHS Hospice)

    But for Robinson, the important thing for now is that his beautiful bride is now officially his wife. “She’s the love of my life, she’s my friend and my moon, my stars. my sky, she’s my everything,” he said.





    Palliative care cancer #bury #hospice

    #palliative care cancer

    #

    WHO Definition of Palliative Care

    Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

    • provides relief from pain and other distressing symptoms;
    • affirms life and regards dying as a normal process;
    • intends neither to hasten or postpone death;
    • integrates the psychological and spiritual aspects of patient care;
    • offers a support system to help patients live as actively as possible until death;
    • offers a support system to help the family cope during the patients illness and in their own bereavement;
    • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
    • will enhance quality of life, and may also positively influence the course of illness;
    • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

    WHO Definition of Palliative Care for Children

    Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

    • Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
    • It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
    • Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
    • Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
    • It can be provided in tertiary care facilities, in community health centres and even in children’s homes.




    Robert Mugabe dead rumours: Zimbabwe dictator close to death and fighting for


    #

    Cancer-stricken Robert Mugabe is ‘fighting for his life’ in Singapore hospital

    By Daily Mail Reporter 19:31 BST 09 Apr 2012, updated 01:09 BST 11 Apr 2012

    • Zimbabwean tyrant ‘close to death’
    • He is believed to be suffering from prostate cancer
    • Close family members are at his bedside
    • Mugabe has already greed to hand over power to Defence Minister Emmerson Mnangagwa

    Zimbabwean dictator Robert Mugabe was said to be close to death tonight.

    The 88-year-old, who is believed to be suffering from prostate cancer, flew to Singapore by private jet on Saturday for treatment.

    His wife, Grace, and close family members are reported to be at his bedside.

    The tyrant has undergone several bouts of therapy in Asia in recent years.

    But his condition has now deteriorated and there were claims tonight that he has agreed to hand over power to his feared henchman and defence minister, Emmerson Mnangagwa.

    Rumours over Mugabe’s health have been rife in recent weeks because of his frail appearance. There was heightened speculation today when the Zimbabwe government postponed a cabinet meeting at the last minute.

    Related Articles

    The Zimbabwe Mail, quoting a senior official of Mugabe’s ZANU-PF party, said the leader, who has ruled the country since its independence from Britain in 1980, was undergoing intensive treatment in Asia.

    Mugabe was supposedly in Singapore to oversee his daughter Bona’s enrolment at university.

    But registration does not start until September and opponents said it was unlikely he would travel abroad to deal with such a matter in person.

    Sources in Iran, which has a warm relationship with Zimbabwe, said Mugabe had agreed on his successor.

    The Tehran Times said the tyrant had entered into a ‘gentleman’s agreement’ to hand over power to 65-year-old Mnangagwa, who helped orchestrate the violent opposition to Britain in the 1970s.

    The former Zimbabwe intelligence chief was also widely blamed for the brutality following the 2008 presidential election after Mugabe’s rival, Morgan Tsvangirai, took an early lead in the voting.

    He is also thought to have played a major role in the crackdown of the opposition Zapu party in the 1980s that left thousands of civilians dead.

    There was no comment on Mugabe’s health tonight from either his family or from the Zimbabwe government.Mugabe’s aides have denied there is a medical emergency, claiming he is enjoying an Easter break in Asia with his family.

    But Zimbabwe’s vice president, Joice Mujuru, has reportedly cut short her trip to Asia to return home and prepare for the possibility of Mugabe’s death.

    The tyrant is understood to have travelled to Singapore eight times last year for medical treatment. A diplomatic cable released last year by Wikileaks said Mugabe was diagnosed with prostate cancer in 2008 and given five years to live because it had spread.

    He is said to have defied pleas from his own doctors to step down.

    His ailing health has been cited as the main reason that a hard line faction of his ZANU-PF party has pushed to rush through new elections.

    The Zimbabwe Mail quoted a British-based Zimbabwe analyst, who wished to remain anonymous, as saying: ‘Mugabe’s health impacts entirely on Zimbabwe’s political landscape. Everything revolves around his health and his age.’

    In February, Mugabe declared himself ‘fit as a fiddle’. Last month he celebrated his 88th birthday with a lavish party in the capital, Harare, reputed to have cost £650,000.

    The leader was said to have feasted on a cake in the shape of a crocodile.

    Mugabe was hailed as a hero by many Africans when he came to power 32 years ago with Zimbabwe looked on as a model for a successful transition from white rule.

    But the nation’s fortunes have plunged together with Mugabe’s reputation.

    He is now regarded as one of the world’s worst human rights abusers. He has been accused of murdering thousands of his own citizens and brutally crushing all opposition to his rule.

    His policies have also been blamed for driving Zimbabwe into bankruptcy. Mugabe’s land reforms in particular, leading to violent seizures from white farmers, have been harshly criticised by the British and American governments.

    Next Stories 1/30


    Cancer Supportive and Survivorship Care – The Fifth Dimension of Therapy #london

    #supportive care

    #

    Of all the ingredients in the will to live, hope is the most vital. Hope is the emotional and mental state that motivates you to keep on living, to accomplish things and succeed. A person who lacks hope can give up on life and lose the will to live. Without hope, there is little to live for. But with hope, a positive attitude can be maintained, determination strengthened, coping skills sharpened, and love and support more freely given and received.

    Even if a diagnosis is such that the future seems limited, hope must be maintained. Hope is what people have to live on. Take away hope and you take away a chance for the future, which leads to depression. When people fall to that low emotional state, their bodies simply turn off.

    Hope can be maintained as long as there is even a remote chance for survival. It is kindled and nurtured by even minor improvements or a remission and maintained when crises or reversals occur.

    There may be times when you will feel exhausted and drained by never-ending problems and feel ready to give up the struggle to survive. All too often it seems easier to give up than to keep on fighting. Frustrations and despair can sometimes feel overwhelming. Determination or dogged persistence is needed to accomplish the difficult task of fighting for your health.





    GBM – end stage question – Brain Tumors Forum – Cancer Forums

    #brain hospice

    #

    Thread: GBM – end stage question

    Re: GBM – end stage question

    Dear Imli, sorry to know what you are going through. As I understand, that is the way this disease progresses. The patient switches to coma later and then passes away in sleep. When death is close, breathing pattern changes and the color of urine goes darker due to lack of sufficient oxygen in the body. Death is usually painless.

    My mother is in the end stages of GBM. She is currently completely bedridden, cannot talk or comprehend and sleeps all the time. When she does open her eyes, her gaze is unfocussed and glazed. Her vitals are strong, and she is being fed via a tube. Has a catheter- Urine and stools normal. I know this is progression of the disease, but I am still at a loss and its hard to see a loved one deteriorate. We were told that the symptoms in her case were due to edema and swelling post Gamma knife, may not be the tumor. This has been going on for 5 weeks now.How long can this go on? I know a lot of you have lost loved ones to the disease, and am hoping your collective response can give me a better picture on how much more time she has. She is diisplaying symptoms ( of the timeline chart on brain hospice) of 1-2 weeks for over 1 month now.

    New User Join Date Jan 2010 Posts 14

    An update on the situation and a little confused. Mom had been sleeping and opening her eyes for a few minutes at most, occasionally-when she was physically moved. This has been the situation for approx 6 weeks. No response to any other stimuli, no recognition or cognition. Last week she had low grade temperature for a few days and still feels warm occasionaly. Since the last 3 days however, her eyes are open and gazing at the ceiling for hours. Her breathing sounds like she is snoring lightly.Her last MRI was in Nov ’09 which showed lots of Edema, post Cyber knife ( Aug 2009). CT in Dec ’09-showed heavy midline shift, when she became paralysed. bedridden and non-cognizant after which she was given steroids that only marginally helped her.
    I’m not sure what to make of this, in that she has gone from sleeping continuosly, to opening her eyes and gazing for hours. Is this a sign of improvement? Should I push for another MRI?

    Administrator Top User Join Date Oct 2005 Location Tennessee Posts 7,967 Blog Entries 5

    Hi Imli. I don’t know what it means that your mother now has her eye open for a long time but still not responding to others. Does she track? That is, if you put your finger in front of her eyes and move it, do her eyes follow your finger? If not, she is probably not really seeing anything just sleeping with her eyes opened. She needs to blink her eyes or they will dry. In hospitals, some times they go so far as to tap eyes closed when someone sleeps with their eyes open so that they do not dry.

    In terms of getting an MRI. for sure you need to make her doctor aware of this change and let him/her advise you on what needs to be done.

    New User Join Date Jan 2010 Posts 14

    Brainman- No, she does not track. Keeps Gazing and but does blink on her own though. She has been off steroids for approx a month now as well.

    Regular User Join Date Oct 2009 Posts 18

    response to your queries

    Sorry imli, as far as my experience with this disease goes, it appears that the disease is spreading within the brain and is taking away your mom slowly. I am not sure if scans can reveal anything since growth and spreading could be at microscopic level. A doctor would be able to advise you better. Sorry again, it is painful to observe the patient at this stage.

    Regular User Join Date Oct 2009 Posts 18

    Re: response to your queries

    signs of increasing body temperature are also common, as I understand. I am not sure how that connects with the disease.

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    How Is Chemotherapy Used to Treat Cancer? #hospice #care #definition

    #palliative chemotherapy

    #

    How is Chemotherapy Used to Treat Cancer?

    Chemotherapy is the use of any drug to treat any disease. But to most people, the word chemotherapy means drugs used for cancer treatment. It s often shortened to chemo.

    Surgery and radiation therapy remove, kill, or damage cancer cells in a certain area, but chemo can work throughout the whole body. This means chemo can kill cancer cells that have spread (metastasized) to parts of the body far away from the original (primary) tumor.

    Goals of chemotherapy treatment

    If your doctor has recommended chemotherapy to treat your cancer, it s important to understand the goals of treatment when making treatment decisions. There are three main goals for chemotherapy (chemo) in cancer treatment:

    Cure

    If possible, chemo is used to cure cancer, meaning that the cancer is destroyed it goes away and doesn t come back.

    Most doctors don t use the word cure except as a possibility or intention. So, when giving treatment that has a chance of curing a person s cancer, the doctor may describe it as treatment with curative intent.

    There are no guarantees, and though cure may be the goal, it doesn t always work out that way. It often takes many years to know if a person s cancer is really cured.

    Control

    If cure is not possible, the goal may be to control the disease. Chemo is used to shrink tumors and/or stop the cancer from growing and spreading. This can help the person with cancer feel better and live longer.

    In many cases, the cancer doesn t completely go away. but is controlled and managed as a chronic disease, much like heart disease or diabetes. In other cases, the cancer may even seem to have gone away for a while, but it s expected to come back. Then chemo can be given again.

    Palliation

    Chemo can also be used to ease symptoms caused by the cancer. This is called palliative chemotherapy or palliation.

    When the cancer is at an advanced stage, meaning it s not under control and has spread from where it started to other parts of the body, the goal may be to improve the quality of life or help the person feel better. For instance, chemo may be used to help shrink a tumor that s causing pain or pressure.

    It s important to know that any treatment that s used to reduce symptoms or improve comfort is called palliative care . For example, anti-nausea treatments or pain medicines are palliative, and can be used at all stages of treatment. It can be confusing when chemo is used as a palliative treatment, because it s most often used to try to cure or control the cancer. But when it s used with the goal of comfort, chemo becomes palliative care.

    Planning chemotherapy treatments

    You and your cancer doctor, called an oncologist, will decide what drug or combination of drugs you will get. Your doctor will choose the doses, how the drugs will be given, and how often and how long you ll get treatment. All of these decisions will depend on the type of cancer, where it is, how big it is, and how it affects your normal body functions and overall health.

    Cancer can be treated with a single chemo drug, but often several drugs are used in a certain order or in certain combinations (called combination chemotherapy). Different drugs that work in different ways can work together to kill more cancer cells. This can also help lower the chance that the cancer may become resistant to any one chemo drug.

    Sometimes chemo is the only treatment you need. More often, chemo is used with surgery or radiation therapy or both. Here s why:

    • Chemo may be used to shrink a tumor before surgery or radiation therapy. Chemo used in this way is called neoadjuvant therapy.
    • It may be used after surgery or radiation therapy to help kill any remaining cancer cells. Chemo used in this way is called adjuvant therapy.
    • It may be used with other treatments if your cancer comes back.

    Determining which chemotherapy drugs to use

    In some cases, the best choice of doses and schedules for each chemo drug is clear, and most doctors would recommend the same treatment. In other cases, less may be known about the single best way to treat people with certain types and stages of cancer. In these cases, different doctors might choose different drug combinations with different schedules.

    Factors to consider when choosing which drugs to use include:

    • The type of cancer
    • The stage of the cancer (how far it has spread)
    • The patient s age
    • The patient s overall health
    • Other serious health problems (such as heart, liver, or kidney diseases)
    • Types of cancer treatments given in the past

    Doctors take these factors into account, along with information published in medical journals and textbooks describing the outcomes of similar patients treated with chemo.

    Determining chemotherapy doses

    Most chemotherapy (chemo) drugs are strong medicines that have a fairly narrow range for dose safety and effectiveness. Taking too little of a drug will not treat the cancer well and taking too much may cause life-threatening side effects. For this reason, doctors must calculate chemo doses very precisely.

    Depending on the drug(s) to be given, there are different ways to determine chemo doses. Most chemo drugs are measured in milligrams (mg).

    The overall dose may be based on a person s body weight in kilograms (1 kilogram is 2.2 pounds). For instance, if the standard dose of a drug is 10 milligrams per kilogram (10 mg/kg), a person weighing 110 pounds (50 kilograms) would get 500 mg (10 mg/kg x 50 kg).

    Some chemo doses are determined based on body surface area (BSA). which are calculated using height and weight. BSA is expressed in meters squared (m 2 ).

    Because children s bodies process drugs differently, dosages for children and adults differ, even after BSA is taken into account. Children may have different levels of sensitivity to the drugs, too. For the same reasons, dosages of some drugs may also be adjusted for people who:

    • Are elderly
    • Have poor nutritional status
    • Are obese
    • Have already taken or are currently taking other medicines
    • Have already had or are currently getting radiation therapy
    • Have low blood cell counts
    • Have liver or kidney diseases

    Determining a chemotherapy schedule (cycle)

    Chemotherapy is commonly given at regular intervals called cycles. A cycle may be a dose of one or more drugs followed by several days or weeks without treatment. This gives normal cells time to recover from drug side effects. Sometimes, doses may be given a certain number of days in a row, or every other day for several days, followed by a period of rest. Some drugs work best when given continuously over a set number of days.

    Each drug is given on a schedule that makes the most of its anti-cancer actions and minimizes side effects. If more than one drug is used, the treatment plan will say how often and exactly when each drug should be given. The number of cycles given may be decided before treatment starts, based on the type and stage of cancer. In some cases, the number is flexible, and will take into account how the treatment affects the cancer and the person s overall health.

    Changing chemotherapy doses and schedules

    In most cases, the most effective doses and schedules of drugs to treat specific cancers have been found by testing them in clinical trials . It s important, when possible, to get the full course of chemo, the full dose, and keep the cycles on schedule. This gives a person the best chance of getting the maximum benefit from treatment.

    There may be times, though, when serious side effects require adjusting the chemo plan (dose and/or schedule) to allow you time to recover. Sometimes, you might be given supportive medicines to help your body recover more quickly. Again, the key is to give enough chemo to kill the cancer cells without causing other serious problems.

    To learn more

    We have a lot more information that you might find helpful. Explore www.cancer.org or call our National Cancer Information Center toll-free number, 1-800-227-2345. We re here to help you any time, day or night.

    References

    Fuchs-Tarlovsky V. Role of antioxidants in cancer therapy. Nutrition. 2013;29(1):15-21.





    Blog: Terminal Cancer #palliative #and #hospice #care

    #terminal cancer

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    Blog: Terminal Cancer

    I went skiing in the Ruby Mountains of Nevada on my day off on Monday. When your good friend with prostate cancer from out of town calls on Saturday night and says, “We’re going skiing in the Rubies on Monday and you’re coming as well”, you have no choice but to pack your stuff. Fittingly, he and mutual friend Terry picked a line called Terminal Cancer, a striking line plucked by Joe Royer back in the late 70s. Plenty of folks like to post the rad sick line they just hit. but the goal here is to convey the homework that goes into it – at home, and in the mountains. Ultimately, it’s up to you to do the work and stack the odds in your favor. Or, you can just roll the dice – it is Nevada, after all – you might get lucky after all. The gist of this post is to describe how we went through and planned the ascent and descent and how we executed it. Cancer kills you slowly. avalanche death is quick and immediate.

    Terminal Cancer is the striking line that cleaves the north face of this ridgeline. The line is north-northwest facing, topping out at 9500′. The creek you cross to access it is at 7400′. Slope angles encountered are 30-40 degrees. Is this avalanche terrain? You bet. Our concerns were not just in the chute itself, but accessing the chute and what was adjacent to it. In other words, it is easy for the eye to be drawn to the line. and overlook the steep aprons and adjacent terrain beyond. We were just as concerned about the adjacent terrain as the chute itself.

    As it turns out, not much avalanche terrain sits above the line that necessarily dumps debris into it, as noted below. I say “not much”.

    You have a little room to play with to access the couloir, but once you’re in it, you’re in the barrel of the gun. We noted avalanche debris in the apron and elected to travel up through the gulley of the apron. The idea being that that terrain had either already avalanched or the snowpack had taken a direct thump from debris from above and would likely have avalanched then. not now. Still, we traveled up in two teams of two through the apron to give each other room. Once we gained the bottom opening of the couloir, we elected to continue traveling in two teams of two, skinning 90% of the way. This tells you two things: A-it never got over 40 degrees in the elevator shaft; and B-wallowing through the powder was waist deep. and likewise felt if we moved above any isolated areas of basal weaknesses we might stay above it on skis/skins.

    Periodically through the couloir a group could tuck into little alcoves that offered some margin of safety.

    And this was our plan for the descent – one at a time, tucking in to alcoves in order to maintain visual sight with one another. It goes without saying that we had beacons, shovels, probes.

    The storm that brought a foot of snow to the Wasatch over the weekend brought 14″/1.1″ to the Rubies as indicated by the Lamoille snotel site. The storm commenced on Friday morning (February 8) and mostly wound down on the 9th. We were planning to ski it on Monday the 11th. Typically storm instabilities would settle out by then (storm snow, wind slab, loose snow), but the point here is that this was our opinion and we aimed to test it. Temps were in the 20s during the storm, but dropped to the single digits through early Monday. Wind effect was not noted in the terrain. One worry was for direct sun to hit the new snow above and in the objective, but aspect and temperature kept the new snow in check.

    We noted no cracking or collapsing. The avalanche noted likely originated higher in the apron beneath the chute. We performed multiple probe tests to determine the structure of the snow below the chute and is outlined below. It had 4 of five lemons. the four being the top four below – Of note, the faceted layer was 4F hardness and did not seem overly weak and unconsolidated.

    • Persistent weak layer (1mm facets) buried 15″ down
    • Depth of same within a meter
    • Hand hardness difference clear beneath a 3mm melt freeze crust dividing the new snow and the old faceted snow
    • Grain size difference was evident
    • Weak layer thickness was 20cm.

    Continuous probe tests while in the barrel of the gun indicated very isolated areas of basal weaknesses. most of the structure had a very strong mid and basal structure due to wind loading and sluffing from above. Structure was good.

    I hope not. We were a party of four. When heading into unfamiliar terrain and snowpack, it’s key to choose your partners wisely. Our party consisted of three very good friends ( 10 years) who have climbed and skiied together many many times.

    Terry and I worked together on Rainier years ago and he currently works as an ER doctor. He’s worked and climbed Everest many times. He’s as low key and thoughtful as they come. cool under pressure and is a good communicator. Fit beyond belief.

    “Bubba” is almost 50 and you’d never know he was sick. We joked that he brought along his personal physician in Terry. Bubba’s worked as an avalanche forecaster throughout the intermountain west and is the poster boy for the ISSW – a merging of theory and practice. He’s a great communicator, has good mountain sense, and has nothing to prove. “Summit fever” was not even part of the game.

    Craig Wolfrom – This was a surprise for me. He is a professional photographer and I did not know he was part of the plan. This was a yellow flag for me b/c I consider outings like this to be among good friends without any peripheral agendas. Still, he proved fit and low key and was a welcome addition. Many of the photos are his.

    In summary, the only way we would approach this terrain is if we had green weather and a green snowpack. I felt very confident in our ski party and knew we’d done the work to make informed decisions. It’s true that you can do everything right and still get the hook; still, our lives are made up of moments like these with friends like these. And I suspect that Bubba will be kicking for another 30 years.

    Forecaster, Utah Avalanche Center





    Terminal Breast Cancer #hospice #nursing

    #terminal cancer

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    Terminal Breast Cancer

    It is not easy for anyone to hear that they have cancer, let alone terminalbreast cancer. Breast cancer is a huge opponent in the world of women, but terminal cancer is something that just boggles the mind and heart of any man or woman.

    The Effects

    Although many women may get breast cancer and may live to tell about it, this disease continues to be the second most frequent type of cancer that kills women.

    Although it only begins from a small cell that has simply malfunctioned, its effects are devastating and not only affect the woman, but also her family and friends as she deteriorates throughout each day.

    One out of every five women that fall victim to breast cancer will die from it each year. This is a huge statistic, but it reaches into multitudes of homes throughout the USA.

    Metastasis

    Often, women will get terminal breast cancer because they fail to perform their breast self exams on a regular basis. Usually, the cancer has metastasized into other areas outside of the breasts themselves by the time terminal cancer is recognized.

    There are no known ways to treat this type of cancer, except to help the patient become more comfortable. This may be achieved by trying to reduce the number of cancer cells through radiation, chemotherapy or surgery. Usually, though, these types of treatments will only delay the inevitable.

    Stages and Progression

    There are several ways to recognize the progression of cancer, but the most common is through a staging process.

    Stage five is the most progressed and deadly. This state means that the end is soon near and that most other bodily functions have ceased.

    Stage four is used to identify terminal cancer, when it has already begun the spread to other parts of the body.

    Stages three through zero demonstrate how much control the cancer has taken over in the body in relation to the particular type of cancer involved.

    Different doctors may identify the various types of cancer in different ways, but this is a relatively objective way to declare the state of an individual’s well-being.

    Resources to Fight Cancer

    If you would like to get more information on ways to prevent terminal breast cancer, please visit Cancer Fighting Strategies. This website was created to help people learn more ways to fight against breast cancer and ways to help loved ones through this tragic time.

    Check out CancerFightingStrategies.com to find out what you can do to decrease the number of terminal cancer patients.

    Top of Terminal Breast Cancer page

    Go to Breast Cancer Treatment home





    Is Your Immune System Not Working Well? Tips on Nutrition, Exercise, and


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    Tips to Help You Manage a Weakened Immune System

    If your immune system isn’t strong, either due to medicines you take or because of a health condition, you’ll want to take special care of yourself.

    The changes you make to your daily routine don’t even have to be big ones. A few tweaks can keep you feeling on top.

    Keep an Activity Journal

    A lot of people who have a weakened immune system, especially with chemo or radiation treatment for cancer, have fatigue. Even the smallest things — going shopping or visiting friends — can wear you out.

    With a little homework, though, you can still do most of what you want to do.

    For a week, jot down notes to track how you feel at different times of the day.

    “Monitoring your own energy level [can be] a real eye-opener,” says Claudine Campbell, occupational therapy manager at Memorial Sloan Kettering Cancer Center in New York City. “There are times during the day that you might have more energy.”

    Figure out when those times are and plan activities then.

    For low-energy periods, try these three strategies:

    1. Plan ahead. Make a list for grocery shopping and map your trip through the aisles in advance. “Then you can go through the store once and not have to repeat,” says Brent Braveman, PhD, director of rehabilitation at MD Anderson Cancer Center in Houston.

    Some stores even have floor plans online. And when you do shop, get perishables last so you can take them home right away.

    2. Simplify. Knock out steps you don’t really need to do. For example, use a cart to collect everything you need from the pantry before you start to cook. This eliminates extra trips, and you don’t have to carry anything.

    3. Take a seat. Sit rather than stand when you shower or cook.

    Eat Well

    Most people with weak immune systems don’t need a special diet, as long as you get all the nutrients you need.

    The best strategy is simple: Eat a variety of foods with an emphasis on fruits and vegetables, whole grains, and lean protein.

    You may also want to:

    • Stay away from processed foods with a lot of additives.
    • Avoid foods that are raw or undercooked, as they can make you sick.
    • Don’t drink water if you don’t know where it came from or if it has been sitting in its container for a long time.
    • Skip nutritional supplements unless you first talk with your doctor. There’s no evidence they’ll “boost” your immune system, and some can even be harmful.
    • Talk to your doctor before popping extra vitamins. Too much of a good thing can hurt you.

    Continued

    Get Moving

    Exercise is key. Although it might seem surprising, “the kind of fatigue that people with immune issues have may not be improved by rest,” Braveman says.

    This doesn’t mean you need to run a marathon. You can boost your energy with simpler activities. Try walking, swimming, tai chi, or yoga.

    The important thing is to make it part of your routine.

    “You [can] customize it,” says Sara Wolfson, a geriatric nurse practitioner with the University of Nebraska Medical Center in Omaha. “Sometimes it’s 5 minutes a day, sometimes 10. We tell people to break it up and rest in between.”

    Exercise also lowers stress, which can worsen immune problems. Studies show that people who work out get sick less often than people who stay still.

    Talk to your doctor about which activities are fine for you to try. Some people with immune disorders should not play contact sports or swim in oceans and lakes.

    Protect Yourself From Infection

    One of the biggest dangers people with immune problems face is the risk of infection. Common sense can lower that risk:

    • Wash your hands often and carry hand disinfectant.
    • If someone wants to shake your hand, tell him or her you have a cold. You stay germ-free and they’re not offended.
    • Wear a surgical mask in crowded places, and avoid crowded places completely if there’s a flu outbreak.
    • Make sure your family members wash their hands, sneeze into their elbows, and take care of you by taking care of their hygiene.
    • Stay away from people who are sick.
    • Tell your doctor about any symptoms as soon as you notice them to avoid a full-blown illness.
    • Brush and floss your teeth regularly, and visit your dentist to stave off any infections caused by tooth decay.
    • Talk to your doctor before you get vaccinations (including those for travel). Some can be harmful to people with certain immune conditions.
    • Make sure your family members keep up with their vaccinations.
    • Rest up. It helps if you keep regular sleep hours, avoid long naps, and take some quiet time before you go to bed.
    • Choose pets with care. Dogs and cats are usually good choices, but reptiles and birds can carry germs and can’t be immunized.

    WebMD Feature Reviewed by Jennifer Robinson, MD on October 27, 2015

    Sources

    National Institute of Allergy and Infectious Diseases: “Disorders of the Immune System.”

    Immune Deficiency Foundation: “General Care.”

    Sara Wolfson, DNP, geriatric nurse practitioner, Home Instead Center for Successful Aging, University of Nebraska Medical Center, Omaha.

    Claudine Campbell, MOT, OTR/L, CLT, Occupational Therapy Manager, Memorial Sloan Kettering Cancer Center, New York.

    Brent Braveman, PhD, OTR/L, FAOTA, Director of Rehabilitation Services, M.D. Anderson Cancer Center, Houston.

    H.E.B. Alon Market: “Your H-E-B Alon Market Store Guide.”

    University of Iowa Hospitals and Clinics: “Food Safety For People Who Are Immunocompromised.”

    Immune Deficiency Foundation National Conference, New Orleans, June 25-27, 2015.

    International Patient Organisation for Primary Immunodeficiencies: “Primary immunodeficiencies: Stay healthy! A guide for patients and their families.”

    M.D. Anderson Cancer: “Laughter Yoga for Cancer Patients – Video Transcript.”

    Prather, A.A. Sleep. Sept. 1, 2015.

    Chronic Granulomatous Disease Association: “After Being Diagnosed.”

    American Academy of Allergy Asthma Immunology: “Chronic Granulomatous Disease.”

    Centers for Disease Control and Prevention: “Travelers With Weakened Immune Systems.”

    Shearer. W.T. The Journal of Allergy and Clinical Immunology. April 2014.

    The Ochsner Journal. Fall 2008.

    © 2015 WebMD, LLC. All rights reserved.


    Skin Cancer Treatment, Skin Cancer, Melanoma Treatment, Auckland #basal #cell #melanoma #treatment,


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    SKIN CANCER TREATMENT

    Skin Cancer Diagnosis and Process

    A thorough dermoscopic skin check is done for a melanoma skin cancers, basal cell skin cancers or sqaumous cell skin cancers. We have specialist dermoscopists and skin cancer surgeons at Eastmed Doctors, who can not only diagnose your skin cancer accurately, but also offer you to treat them here in the custom built surgical theatre. Your skin cancer surgery will by performed under local anaesthetic injections with minimal discomfort. The skin cancer that is cut out is send to the lab for the pathologist to analyse what type of skin cancer this is and whether we have removed it completely. The skin is usually repaired with absorbable sutures to give you a very neat scar.

    Melanoma Skin Cancer Treatment

    Melanoma skin cancer moles can either be dark or light or sometimes an enlarging red spot. If a skin cancer is suspected to be a melanoma the only treatment option is to remove this mole as soon as possible. If you discover a new brown, black, or red mole, please make an appointment with one of our doctors and this will be dealt with promptly.

    Basal Cell Skin Cancer Treatment

    A basal cell skin cancer arises from the basal layers of the skin. This is a very common skin cancer. It used to be known as a rodent ulcer in the past, since it eats away in the middle destroying tissue and bone on its way and enlarges when no treatment was offered. This does not happen now since we pick these up very early. They usually look like a pearl red or pink mole with lots of tiny blood vessels on the surface. Sometimes they are flat red spots on the skin. They usually break down in the middle, causing a hole in the bump, which can bleed. Many patients also have them in the ears which bleed causing stains on the pillows.

    If the basal mole is large and flat and the diagnosis is uncertain, then a punch biopsy can be done to prove what it is before cutting the whole mole out. Some we do frozen section – this is removing a small part of the mole and have this looked by the pathologist in the lab quickly, before removing more out. This is similar to Moh’s surgery

    If the punch biopsy reveals a superficial basal cell cancer, then Aldara ( imiquimod ) cream is funded. This is a immune cream, which works in conjunction with your immune system to clear this mole. This is very successful. Sometime Effudix cream can also be used.

    If the diagnosis is certain or the punch biopsy reveals an invasive basal cell cancer, then removing this entire mole is the only option.

    Squamous Skin Cancer Treatment

    Squamous cell cancers usually come in the lips or legs. There look like very rough skin on top of the mole, sometimes bleeds. They can be very large red flat scaly spots on the skin. If the area is large then punch biopsy can be done to see how bad the squamous cell mole cancer is before removing this entirely. If it is a pre-cancerous mole, then Liquid Nitrogen or Freezing Ice works very well to clear this. If the squamous cell cancers especially on the face, ears or lips or legs which are deep, they need to be removed entirely to offer complete cure.

    Sun Spots – Actinic Keratosis – Pre Skin Cancer Treatment

    Some of these are precancerous lesions. They can be effectively treated with Aldara ( imiquimod ) or Liquid Nitrogen or Efudix ( 5-Fluorouracil cream ) creams.

    Liquid Nitrogen – Freezing Ice

    Liquid Nitrogen or Freezing ice treatment is available at Eastmed Doctors. This can be effectively used to treat a variety of pre-cancerous rough spots, sun spots and superficial basal cell skin cancers.

    Anticancer Creams

    Aldara ( imiquimod ). or Efudix ( 5-Fluorouracil cream ) are used at Eastmed doctors for treatment of skin cancers which respond to them – mainly pre-cancerous sun spots, Actinic keratosis and Superficial basal cell cancers.

    Skin Cancer Checks and Treatment

    If you are new patient and wish to have a skin cancer mole check and have your skin cancer treated at the same time, book an appointment online. choose Dr. Siva Nachiappan from the list and indicate in the special instruction box you are a new patient and you are coming in to have your moles checked. Alternatively you can ring the reception on 09 585 0188.

    Click here for examples of mole surgery done at Eastmed Doctors


    Hospice Care – National Cancer Institute #providence #hospice #of #seattle

    #hospice

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    Hospice Care

    What is the difference between hospice and palliative care?

    Where can people learn more about hospice?

    What is hospice, and how is it used in cancer care?

    Hospice is a special type of care in which medical, psychological, and spiritual support are provided to patients and their loved ones when cancer therapies are no longer controlling the disease. Hospice care focuses on controlling pain and other symptoms of illness so patients can remain as comfortable as possible near the end of life. Hospice focuses on caring, not curing. The goal is to neither hasten nor postpone death. If the patient s condition improves or the cancer goes into remission. hospice care can be discontinued and active treatment may resume. Choosing hospice care doesn t mean giving up. It just means that the goal of treatment has changed.

    The hospice team usually includes doctors, nurses, home health aides, social workers, clergy or other counselors, and trained volunteers. The team may also include speech, physical, and occupational therapists, if needed. A hospice team member is on-call 24 hours a day, 7 days a week to provide support. The hospice team will work with the patient on the patient s goals for end-of-life care, not a predetermined plan or scenario. Hospice care is very individualized.

    Hospice services may include doctor or nursing care, medical supplies and equipment, home health aide services, short-term respite (relief) services for caregivers, drugs to help manage cancer-related symptoms, spiritual support and counseling, and social work services. Patients families are also an important focus of hospice care, and services are designed to give them assistance and support.

    Hospice care most often takes place at home. However, hospice care can also be delivered in special in-patient facilities, hospitals, and nursing homes.

    Who is eligible for hospice care?

    Under most insurance plans in the United States, including Medicare. acceptance into hospice care requires a statement by a doctor and the hospice medical director that the patient has a life expectancy of 6 months or less if the disease runs its normal course. The patient also signs a statement saying that he or she is choosing hospice care. (Hospice care can be continued if the patient lives longer than 6 months, as long as the hospice medical director or other hospice doctor recertifies the patient s condition.)

    The hospice team or insurance provider can answer questions about whether specific care decisions, such as getting a second opinion or participating in a clinical trial while in hospice care, would affect eligibility for hospice services.

    How can people get help paying for hospice services?

    Medicare and most Medicaid and private insurance plans cover hospice services.

    Medicare is a government health insurance program for the elderly and disabled that is administered by the Centers for Medicare Medicaid Services (CMS). The Medicare hotline can answer general questions about Medicare benefits and refer people to their regional home health intermediary for information about Medicare-certified hospice programs. The hotline number is 1 800 MEDICARE (1 800 633 4227); callers with TTY equipment can call 1 877 486 2048. The booklet Medicare Hospice Benefits is available on the Medicare website. The Hospice and Respite Care page, also on the Medicare website, has answers to frequently asked questions about Medicare coverage for hospice and respite care .

    Medicaid, a federal-state partnership program that is part of CMS and is administered by each state, is designed for people who need financial assistance for medical expenses. Information about coverage is available from local state welfare offices, state public health departments, state social services agencies, or the state Medicaid office. Information about specific state locations can also be found online .

    Information about the types of costs covered by a particular private policy is available from a hospital business office or hospice social worker, or directly from the insurance company.

    Local civic, charitable, or religious organizations may also be able to help patients and their families with hospice expenses.

    What is the difference between hospice and palliative care?

    Although hospice and palliative care share the same principles of providing comfort and support for patients, palliative care is available throughout a patient s experience with cancer, whereas hospice is offered only toward the end of life. A person s cancer treatment continues to be administered and assessed while he or she is receiving palliative care, but with hospice care the focus has shifted to just relieving symptoms and providing support. The NCI fact sheet Palliative Care in Cancer has more information about palliative care.

    Where can people learn more about hospice?

    The following organizations can provide more information about hospice.

    The National Hospice and Palliative Care Organization s Caring Connections website offers information and publications focused on improving end-of-life care for adults and children. The site includes a database of national hospice programs. Some Spanish-language publications are available.

    The Hospice Association of America distributes publications on such topics as the history of hospice, the benefits of hospice, hospice-related statistics, and locations of hospice organizations.

    The Hospice Education Institute operates HOSPICELINK, a toll-free telephone service that provides referrals to hospice and palliative care programs in the United States. HOSPICELINK also provides information about the principles and practices of good hospice and palliative care.

    Hospice Net provides information and support to patients facing life-threatening illnesses and to their families and friends.

    The American Cancer Society (ACS) provides free fact sheets and publications about hospice. The address of a local ACS chapter can be obtained by calling the organization s toll-free telephone number.





    Robert Kardashian – Kim, Khloe and Kourtney – s Father #robert #kardashian


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    Robert Kardashian Kim, Khloe and Kourtney s Father

    Robert Kardashian

    Robert Kardashian is the father of Kim, Khloe, Kourtney and Robert Jr. He is most famous for being a lawyer on OJ Simpson’s big murder case in 1995. The trial actually caused a bit of a divide in the family because Nicole Simpson, OJ’s wife, was a good friend of the family. She was murdered and OJ was the prime suspect, so when Robert Kardashian defended him, Kris Jenner and some of the others were very upset. According to Daily Mail a big reason for Kris and Robert’s divorce was her “lavish spending” though Kris has admitted on Keeping Up With the Kardashians that she had an affair with a man named Todd Waterman when she was married to Robert Kardashian. It was this affair that broke up their marriage. While going through the divorce, Kris had stated that there was verbal abuse involved and said that daughter Kim was witness to it, explaining in the divorce petition that: As a result of (Robert) and my irreconcilable differences, there is a tremendous amount of discord at the family residence. On May 3, 1990 Kimberly found me crying after a brutal conversation with (Robert) and she became so upset I had a difficult time getting her to her carpool on time. Kimberly called my office twice that afternoon crying hysterically, begging me to come home. Robert Kardashian was reportedly very angry about the affair and then upset that Kris had moved on with Bruce (now Caitlyn) Jenner.

    Robert Kardashian was born to Armenian parents, who ran the largest meat-packing business in southern California. Kardashian grew up to attain a degree in business and later in law. After divorcing Kris Jenner in 1991, he became engaged to Denice Shakarian Halicki, but later married Jan Ashley. This marriage ended in annulment and then he married Ellen Pierson just six weeks prior to his death. On Keeping Up With the Kardashians. we’ve heard Kardashian’s children talk about the bad relationship they had with Pierson and how there was no trust with her. Kardashian died of esophageal cancer at age 59 on September 30, 2003, just two months after being diagnosed with the illness. While some were suspicious as to why Kardashian and Pierson got married so close to his death, Pierson explained to In Touch : I was with Robert for almost five years total. I dated him for three years, and he proposed to me in 2001. We married two months prior to his passing in 2003 and planned a wedding — we didn’t just run right out and get married. In January 2013, Pierson released journals of Robert Kardashian’s that painted an unflattering picture of Kris Jenner. Immediately, the Kardashian brood fired back and called her a lying opportunist. Khloe Kardashian responded with this comment: How can such a piece of trash even mention my father’s name? You married him on his deathbed while he was not even aware of his surroundings. Kim Kardashian stated: This woman he married 4 2 wks before he died needs 2 get a job instead of trying 2 destroy families w fake stories. In response, Pierson told In Touch: I am simply stating the facts and the truth— their father’s truth. I simply delivered hand-written diaries from their father. They are my property at the disposal of whatever I so choose. Robert would have no problem with that. In court documents, Kim Kardashian talked about Pierson’s behavior in her father’s final days, explaining: She changed the locks on the doors when my dad was sick and told us to not come visit our dad, not come see him. We let that go for a few days, then finally we’re like, “That’s our dad, he is dying, we will come over there. Dad, open the door. We know she’s gone. We came back to the house and we got in there and we took a key. And we had to, like, force our way in the house. Pierson’s response was: At the moment Robert took his last breath, none of his children were by his side, opting instead to attend a party at Kourtney’s home.

    In an interview with Giuliana Rancic, Kris Jenner opened up about her ex-husband Robert, who she was married to from 1978 until 1991. Kris stated: It was so surreal, the knowledge he had cancer was one thing, but to think it would actually take his life, I never in a million years thought that would happen to him. As for the demise of her marriage, Kris said that she basically wasn’t mature enough to understand the hard work that goes into marriage. Bruce (Caitlyn) Jenner (Kris’ other ex-husband) stated on an episode of KUWTK that when Robert Kardashian was dying, Bruce promised to always take care of his kids. For more information on Robert Kardashian, click through our gallery of his best photos. (Instagram)

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    2 Comments

    Leave a Reply Cancel reply

    He s not the father of Khloe

    So from reading they re nobody special and love money. Trashy immoral fakes. Why people follow anybody in entertainment I don t consider reality TV entertainment. But I only love my children and fee good friends. This mess here is hearsay and what your being told to say and so petty. Money that s all. Money makes people selfish and fake shallow. No real true empathy or compassion. They have no response for life because they along with a lot just buy their feelings. Oh well. God bless em all

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    American Liver Foundation – Non-Alcoholic Fatty Liver Disease #liver, #liver #cancer, #liver


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    NAFLD

    IMPORTANCE

    The liver is the second largest organ in your body and is located under your rib cage on the right side. It weighs about three pounds and is shaped like a football that is flat on one side.

    The liver performs many jobs in your body. It processes what you eat and drink into energy and nutrients your body can use. The liver also removes harmful substances from your blood.

    WHAT IS NAFLD?

    Non-alcoholic fatty liver disease (NAFLD) is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% – 10% percent of the liver s weight is fat, then it is called a fatty liver (steatosis).

    WHO IS LIKELY TO HAVE NAFLD?

    NAFLD tends to develop in people who are overweight or obese or have diabetes, high cholesterol or high triglycerides. Rapid weight loss and poor eating habits also may lead to NAFLD.

    However, some people develop NAFLD even if they do not have any risk factors. NAFLD affects up to 25% of people in the United States.

    RISKS

    NAFLD may cause the liver to swell (steatohepatitis). A swollen liver may cause scarring (cirrhosis) over time and may even lead to liver cancer or liver failure.

    SYMPTOMS

    NAFLD often has no symptoms.

    When symptoms occur, they may include fatigue, weakness, weight loss, loss of appetite, nausea, abdominal pain, spider-like blood vessels, yellowing of the skin and eyes (jaundice), itching, fluid build up and swelling of the legs (edema) and abdomen (ascites), and mental confusion.

    DIAGNOSIS

    NAFLD is initially suspected if blood tests show high levels of liver enzymes. However, other liver diseases are first ruled out through additional tests. Often, an ultrasound is used to confirm the NAFLD diagnosis.

    TREATMENT

    There are no medical treatments yet for NAFLD. Eating a healthy diet and exercising regularly may help prevent liver damage from starting or reverse it in the early stages.

    • See a doctor who specializes in the liver regularly
    • Talk to your doctor about ways to improve your liver health
    • Lose weight, if you are overweight or obese
    • Lower your cholesterol and triglycerides
    • Control your diabetes
    • Avoid alcohol

    PREVENTION

    There are ways to prevent NAFLD:

    • Maintain a healthy weight
    • Eat a healthy diet
    • Exercise regularly
    • Limit alcohol intake
    • Only take medicines that you need and follow dosing recommendations.

    NASH

    The more severe form of NAFLD is called non-alcoholic steatohepatitis (NASH). NASH causes the liver to swell and become damaged. NASH tends to develop in people who are overweight or obese, or have diabetes, high cholesterol or high triglycerides. However, some people have NASH even if they do not have any risk factors.

    Most people with NASH are between the ages of 40 and 60 years. It is more common in women than in men. NASH often has no symptoms and people can have NASH for years before symptoms occur.

    NASH is one of the leading causes of cirrhosis in adults in the United States. Up to 25% of adults with NASH may have cirrhosis.


    Cost of Dental Implants – Winterholler Dentistry #dental #implants #and #cancer


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    Cost of Dental Implants

    What about the cost of dental implants? Dental implants can be the best investment for your long-term health and appearance.

    For this reason, our offices strive to find a dental implant plan to fit your budget. Generally, our dental implants cost lower than corporate or general dental implant centers.* And we can usually beat competitor s prices. Most cases can be finished in one visit, saving you save time and money.

    How Much Do Dental Implants Cost?

    The cost of your procedure will depend on a variety of factors, including:
    • Number of teeth being replaced
    • Number of implants required to support the replacement teeth
    • Whether or not you require a bone graft to support the implant

    At your initial FREE implant consultation, Dr. Winterholler will provide you with a more accurate estimate of your dental implant cost. Once a treatment plan is outlined, our financing co-ordinator will go over various payment options to fit your budget. Never pay corporate dental implant center prices again. We will find a solution for your budget.

    Winterholler Dentistry offers you high-quality implants that suit your style.

    Our offices accept Discover, American Express, Visa, Master Card, PayPal, cash, check, credit and flexible monthly payments with low and no-interest CareCredit financing options .

    During your free dental implant consult, you will get a complimentary 3D CT Scan of your mouth ($800 value), to show you the best treatment options. From there, you can discuss payment plans with our treatment co-ordinator.

    Dental implants are the best investment if you are missing teeth for your overall health, self-confidence and appearance. Call today or schedule online with Winterholler Dentistry, where excellence is our tradition.

    Are Cost of Dental Implants Covered by Insurance?

    In general, dental implants are not covered by a majority of dental insurance carriers at this time. Coverage may be possible, however, depending on the cause of tooth loss. Insurance often will cover a portion of the treatment, such as tooth removal, sedation, crowns and more. Winterholler Dentistry offers affordable financing options via CareCredit with low monthly payments.

    Often, out-of-pocket medical expenses are tax deductible, however, which may be a good option when replacing multiple missing teeth. Consult a tax preparation agent or accountant for options on how to deduct this procedure.

    Insurance Options at Winterholler Dentistry

    For all treatments at our offices, Winterholler Dentistry will work with most insurance plans to maximize your benefits. We are now providers for:

    SCOTTSDALE OFFICE – TDA PPO, UNITED CONCORDIA, GUARDIAN PPO, AETNA PPO, CIGNA PPO HUMANA PPO, DELTA PREMIER PPO, METLIFE, ASSURANT PPO

    PAYSON OFFICE TDA PPO, UNITED CONCORDIA, AETNA PPO, DELTA PREMIER PPO, HUMANA PPO, ASSURANT PPO

    Contacting Your Implant Dentist

    Transform your smile, transform your life with just one visit to Winterholler Dentistry. Call or schedule online today your dental visit.

    *Based on average oral care and needs of a patient, prices vary by patient. You are not covering corporate dental implant centers overhead or “team” of specialists at our office.


    ABOUT PERITONEAL MESOTHELIOMA: A FORM OF ABDOMINAL MESOTHELIOMA Mesothelioma Applied Research Foundation


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    Mesothelioma Foundation Experts Can Answer Your Questions!

    ABOUT PERITONEAL MESOTHELIOMA: A FORM OF ABDOMINAL MESOTHELIOMA

    Viewed as an asbestos related cancer, peritoneal mesothelioma, is the second most common type of mesothelioma, discovered at a rate of around 250 new cases a year, or in about 10-15% of all types of mesothelioma diagnoses.

    Where Does Peritoneal Mesothelioma Occur?

    Peritoneal mesothelioma occurs in the abdomen, on the surface of the omentum and visceral organs. Because of its relation to the abdomen, peritoneal mesothelioma is also often referred to as abdominal mesothelioma.

    Linked to asbestos exposure. the disease is thought to develop when asbestos fibers become trapped in either the trachea or lungs, before eventually being passed into the peritoneum (abdomen).

    As the disease develops around the abdominal lining, fluid accumulation occurs – which in turn leads to increased abdominal swelling.

    Due to its long latency period, symptoms for abdominal mesothelioma often will not appear for several years after a patient is exposed to asbestos. On average, this latency period can occur anywhere from 25-40 years after the exposure occurs. Contact your healthcare professional immediately if you suspect that you may be experiencing any symptoms associated of mesothelioma.

    With this type of mesothelioma, symptoms are a result of fluid accumulation and tumor expansion in and around the peritoneum (abdomen). This often results in the expansion of the abdomen. Other symptoms related to abdominal mesothelioma include:

    • Pain in the abdomen
    • Weight loss and loss of appetite
    • Elevated white blood count

    Patients with peritoneal mesothelioma often go undiagnosed until the disease is in its final stages. While treatment is mostly palliative and not curative, doctors and mesothelioma specialists can offer a number of treatment options in order to relieve symptoms of peritoneal mesothelioma and possibly extend life expectancy.

    • Peritoneal Surgery. Though not mostly not curative, extended survivals through surgery have been reported by a select group of surgeons who specialize in the treatment of peritoneal mesothelioma
    • Chemotherapy for Peritoneal. Studies have demonstrated that the most active regimen can reduce tumors in 40% of patients and extend life in those that respond to chemotherapy. While it is often no viewed as a curative option, chemotherapy has also been shown to have palliative effects, including reducing shortness of breath, reducing ascites or effusions, reducing pain and improving the quality of life
    • Radiation for Peritoneal Mesothelioma. Radiation has proved to have limited effect as a primary treatment for peritoneal or abdominal mesothelioma. However, as a palliative treatment during and after surgery, it has proven useful in preventing malignant seeding of the incision sites

    Please note that many of the signs and symptoms of peritoneal mesothelioma are often associated with other illnesses. Contact the Meso Foundation s Nurse Practitioner for expert help.


    Northwest Georgia Oncology Centers, P #georgia #cancer #doctors,cancer #treatment,northwest #georgia,marietta, #cobb #county,douglasville,bremen,canton,carrollton,cartersville,jasper,paulding,hiram,dallas,austell,power


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    Her Soul Sparkles Jaime from MariettaRead her story

    Where the Rubber Meets the Road – Russ from MariettaRead his story

    Making the Most of Life Anne from WoodstockRead her story

    Renaissance Woman Viviana from CantonRead her story

    NGOC Receives Full Accreditation by the Commission on Cancer as an Oncology Medical Home Summer 2015Read more

    A Family Circle Shaan from Powder SpringsRead her story

    Play On Denise from KennesawRead her story

    Icing on the Cake Cindy from Talking RockRead her story

    Compassionate Care – Vickie from Villa RicaRead her story

    Every Day is a Special Occasion – Rhonda from MariettaRead her story

    Celebrate Me Home – Ann from AtlantaRead her story

    Watching Her Garden Grow – Sandra from RoswellRead her story

    There s support in Loving ArmsAbout

    Public Eye, Private Fight George Bunch III from EllijayRead his story

    Renaissance Man Ricky from CantonRead his story

    Woman defies odds in battle with breast cancer

    Cancer Centers Providing Compassionate Cancer Care

    The cancer care and treatment experts at Northwest Georgia Oncology Centers, P.C. (NGOC) provide patients with the most advanced cancer treatment options and the best collaborative cancer care available in Georgia. Our cancer care team fights cancer at nine community-based cancer centers in five northwest Georgia counties and specializes in the treatment of breast cancer, lung cancer, colon cancer, and all other types of cancer. The 22 oncologists at NGOC are actively involved in cancer research through clinical trials, the treatment of difficult cancer cases and public policy to ensure people in Georgia have access to the best possible cancer care.

    Refer to NGOC

    Physicians, family or friends can start the process online or call
    678-331-3277


    Access: Strigolactone inhibition of shoot branching: Nature #nature, #science, #science #news, #biology,


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    Access

    Article

    Article Links

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    Search Pubmed for

    Strigolactone inhibition of shoot branching

    Victoria Gomez-Roldan 1. Soraya Fermas 2. Philip B. Brewer 3. Virginie Puech-Pag s 1. Elizabeth A. Dun 3. Jean-Paul Pillot 2. Fabien Letisse 4. Radoslava Matusova 5. Saida Danoun 1. Jean-Charles Portais 4. Harro Bouwmeester 5. 6. Guillaume B card 1. Christine A. Beveridge 3. 7. 8. Catherine Rameau 2. 8 Soizic F. Rochange 1. 8

    1. Universit de Toulouse; UPS; CNRS; Surface Cellulaire et Signalisation chez les V g taux, 24 chemin de Borde Rouge, F-31326 Castanet-Tolosan, France
    2. Station de G n tique et d Am lioration des Plantes, Institut J. P. Bourgin, UR254 INRA, F-78000 Versailles, France
    3. ARC Centre of Excellence for Integrative Legume Research, The University of Queensland, Brisbane 4072, Australia
    4. CNRS, UMR5504, INRA, UMR792 Ing nierie des Syst mes Biologiques et des Proc d s, INSA de Toulouse, F-31400 Toulouse, France
    5. Plant Research International, PO Box 16, 6700 AA Wageningen, the Netherlands
    6. Laboratory of Plant Physiology, Wageningen University, Arboretumlaan 4, 6703 BD Wageningen, the Netherlands
    7. School of Integrative Biology, The University of Queensland, Brisbane 4072, Australia
    8. These authors contributed equally to this work.

    Abstract

    A carotenoid-derived hormonal signal that inhibits shoot branching in plants has long escaped identification. Strigolactones are compounds thought to be derived from carotenoids and are known to trigger the germination of parasitic plant seeds and stimulate symbiotic fungi. Here we present evidence that carotenoid cleavage dioxygenase 8 shoot branching mutants of pea are strigolactone deficient and that strigolactone application restores the wild-type branching phenotype to ccd8 mutants. Moreover, we show that other branching mutants previously characterized as lacking a response to the branching inhibition signal also lack strigolactone response, and are not deficient in strigolactones. These responses are conserved in Arabidopsis. In agreement with the expected properties of the hormonal signal, exogenous strigolactone can be transported in shoots and act at low concentrations. We suggest that endogenous strigolactones or related compounds inhibit shoot branching in plants. Furthermore, ccd8 mutants demonstrate the diverse effects of strigolactones in shoot branching, mycorrhizal symbiosis and parasitic weed interaction.

    1. Universit de Toulouse; UPS; CNRS; Surface Cellulaire et Signalisation chez les V g taux, 24 chemin de Borde Rouge, F-31326 Castanet-Tolosan, France
    2. Station de G n tique et d Am lioration des Plantes, Institut J. P. Bourgin, UR254 INRA, F-78000 Versailles, France
    3. ARC Centre of Excellence for Integrative Legume Research, The University of Queensland, Brisbane 4072, Australia
    4. CNRS, UMR5504, INRA, UMR792 Ing nierie des Syst mes Biologiques et des Proc d s, INSA de Toulouse, F-31400 Toulouse, France
    5. Plant Research International, PO Box 16, 6700 AA Wageningen, the Netherlands
    6. Laboratory of Plant Physiology, Wageningen University, Arboretumlaan 4, 6703 BD Wageningen, the Netherlands
    7. School of Integrative Biology, The University of Queensland, Brisbane 4072, Australia
    8. These authors contributed equally to this work.

    To read this story in full you will need to login or make a payment (see right).

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    Hospice Care for the Pancreatic Cancer Patient #hospice #san #antonio

    #when to call hospice for cancer

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    Hospice Care for the Pancreatic Patient

    As a nurse, mom was already very familiar with hospice care agencies. They often attended her patients in the hospital and she understood the great value they offered. However, most of the family was understandably shaken when she started talking about interviewing hospice providers. We were upset, and confused by the common misconception that hospice is only for those who have given up, for the dying.

    We couldn’t, or wouldn’t accept that mom had given up.

    And mom hadn’t given up. She was just being realistic. She understood that the course of her pancreatic cancer would almost certainly bring her to death’s door at some future point, and she wanted to be ready. She also wanted her family to be ready. She knew that hospice care would provide the tools to prepare us.

    And so, after months of conversation, research, and perseverance on mom’s part, we all began to finally get the purpose of hospice. May I share with you what we’ve learned? We no longer view hospice as a necessary evil for when the time comes, but as a vital way to help mom live until she dies.

    Hospice is a concept of care, not a place. This concept of care is based on two principles:

    1) That dying people should be able to choose how they spend the time they have left, and
    2) That their remaining time should be as peaceful and comfortable as possible.

    It involves a team-oriented approach to provide expert medical care, pain management, and emotional and spiritual support for the dying person and their family. The care is expressly tailored to the person’s needs and wishes. This level of support is hospice’s greatest gift to the family.

    I have come to understand that those who work in the hospice care field are individuals full of compassion. They approach their work with great empathy and understanding, as they help to ease the transition from life through death.

    Most hospice professionals are asked about their somber choice of career. It must seem depressing to many. The following excerpt is from the book Final Gifts and is a beautiful answer to the question, Why do you do this work?

    The hospice nurse responded,

    That’s a hard question to answer. The sadness and tragedy of somebody’s dying is always there – I feel it, too. But beyond that is an opportunity for me to help a patient cherish the final chapter of her life, to use this time to resolve issues, say important things, finish unfinished business, and share important moments with people she cares about.

    My job is to keep my patients as comfortable as possible, so they can do those things and use this special time the best way they can. I also feel strongly that, like birthing, dying can be an opportunity for the whole family to share positive experiences, rather than only sadness, pain, and loss. That is the challenge of this work, and that’s the joy for me.

    Mom knows that the final days of her fight with pancreatic cancer will be difficult to say the least. We’re not there yet, and God willing it will be many years, but when the time does come, she has chosen hospice care to shepherd her through those last days.

    With that decision made, on to the facts about Hospice Care:

    1) Hospice steps in only after all efforts at treatment have been exhausted, and the patient is truly terminal. That’s why we kept seeing the motto: Hospice focuses on caring, not curing. But…

    2) A patient can stop hospice care at any time should a new treatment become available that he/she wishes to try. You are not locked in to hospice by signing a contract.

    3) Hospice care can take place in your home (the most common), the hospital, nursing home, long-term care facility or even inpatient hospice homes. This last one, hospice homes, is still fairly rare, but is becoming more common as hospice care enters mainstream status here in the states.

    4) Patients seeking hospice care early (months to go), rather than late (weeks to go) usually see an increase in their remaining quality of life. Hospice has developed wonderful strategies to alleviate so many concerns that affect late stage pancreatic cancer patients. Many patients often find tremendous relief once they turn to hospice care.

    5) Hospice staff is trained to deal with all the symptoms a patient may undergo as their illness progresses. From pain to fatigue, nausea to constipation, you will find that a system of care will be tailored to your specific needs.

    6) Hospice staff are also trained to deal with the difficult emotional, spiritual and relational issues that are so often overwhelming during this time. Family counselors, social workers, and even chaplains are available to help address any concerns.

    7) And finally, Hospice will do as much or as little as you, the patient, and your family wants. You are, and always will be, in control. Hospice is only there for support, encouragement and care, allowing you the honor and dignity to approach your death in the manner you choose.

    Here are some of the questions we are asking the hospice providers to help us decide which one will be the best fit for mom:

    1) Are you accreditated/certified/licensed? In other words, are you the real deal or do we need to check the Better Business Bureau? But seriously, if we are going to have nurses, therapists, social workers and such, coming in to mom’s home, we want to make sure they are legitimate, licensed and bonded! One other note: If the hospice program is Medicare certified then you know they have met the minimum federal requirements for patient care.

    2) Can you provide us with some references? And, yes, we will call and visit with them about their experiences.

    3) What types of services do you offer? The obvious is nursing care, but what about therapy, social workers, dietary help, family counselors, spiritual guidance, medical equipment? And does your agency require a designated family primary caregiver as a condition of admission (some do), and if so, what is expected of the family caregiver?

    4) What is your philosophy on managing the pain as the cancer progresses? This should really be question #1 – it is just that important!

    5) Are you available around the clock? Who do we call after hours? Middle of the night? Getting sick is never convenient, we want a hospice provider who is willing to be there when we need them the most.

    6) Do you offer hospice care even if mom needs to move into a nursing home or a long-term care facility? We plan on being able to keep her at home, but realize that things may change. Once we develop a bond with you we hope you’ll be there for the long haul. Along that thought, do you have your own inpatient facility, or hospice home? If so, is it covered under Medicare (Mom is on Medicare, you may want to adjust the question for your particular insurance plan.)

    7) And lastly, what do you see your role as hospice provider to be for the terminally ill patient (mom) and her family (us)? This last question will probably be the most crucial. Finding a hospice team that is compassionate and believes in giving mom the tools to handle the end of her life with grace and dignity is so important to us. We will be vulnerable and grieving as mom enters this last chapter of her life, and we believe that having an understanding, supportive team to lean on during this time will be essential.

    As our Pancreatic Cancer Journey progresses, there will be updates to the Hospice Care issue. Mom is still seeking aggressive treatment to battle the cancer, and so far, it has been successful. We are not ready yet for end of life care.

    But, she is forever the realist and wants to be prepared for all contingencies, especially the MayDay call she may one day hear that it is time to abandon ship.

    Hospice Care will guide us through the pain, chaos and grief into what we hope and pray will be blessed peace and comfort.





    Hospice palliative care resources – Canadian Cancer Society #home #health #care #nurse

    #calgary hospice

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    Hospice palliative care resources

    Hospice is a focused, team approach to providing healthcare and other needed services to patients nearing the end of life. The hospice team is comprised of physicians, nurses, social workers, therapists, pastoral representatives, home health aides, volunteers, and family caregivers. Its mission is to provide comfort care to patients and their families in less institutionalized settings and with less strict routines.

    Palliative care refers to both a program and a concept of care based on the provision of comfort. It is designed for individuals who are living with, or dying from, a progressive life threatening illness. The program enhances quality of life through pain and symptom control and provides emotional and spiritual support for both patients and families. Compassionate and specialized care is provided with specialized knowledge and skills.

    Alberta Health Services ‘ Palliative Care Program provides support to clients and families/caregivers to prepare for and manage end-of-life and the dying process and to cope with loss and grief during the illness and bereavement. Care is focused on enhancing the quality of life of the individual and family.

    Hospice Calgary Society embraces children, teens and adults coping with life-threatening illness, sudden or expected death. At Sage Centre and Rosedale Hospice, specialists provide individual counselling, group support, workshops and 24-hour end-of-life care.

    Foothills Country Hospice The Foothills Country Hospice Society is a grassroots community sponsored organization dedicated to providing expert compassionate care to people who are terminally ill and to their families.

    Edmonton Zone Palliative Care Program coordinates palliative care services in the Edmonton Zone health Region. This program sets the standards for the palliative care provided, ensures the transfer of people and information works well, provides palliative care education to the public and health care staff and supports research.

    Pilgrims Hospice Society provides supportive and compassionate family centred care to enhance the quality and dignity of life for those diagnosed with a progressive, life-threatening illness as well as solace to those who are bereaved.

    Red Deer Hospice is a home for the terminally ill and provides a quiet and caring environment for individuals who are at the end of life’s journey, a home away from home. The hospice has 10 comfortably appointed individual rooms and includes family support areas, a dining area and a sanctuary.

    Alberta Human Services offers information on personal directives legal documents which allow you to name a decision maker and/or provide written instructions to be followed when, due to illness or injury, you no longer have the capacity to make decisions such as where you will live or the medical treatment you will receive.

    The Alberta Funeral Services Regulatory Board offers information on the decisions one faces when planning for end of life.

    The GNWT Health and Social Services Home Care Program helps people remain in their homes when they are sick or in need of medical help or support with daily living activities. The program assists people to stay in their homes rather than going to a hospital or long term care facility which may not be located in their community.

    Compassionate Care Benefits are employment insurance benefits paid to people who have to be away from work temporarily to provide care or support to a family member who is gravely ill and who has a significant risk of death within 26 weeks (six months). A maximum of six weeks of compassionate care benefits may be paid to eligible people.

    The Canadian Virtual Hospice provides support and personalized information about palliative and end-of-life care to patients, family members, health care providers, researchers and educators.

    The Canadian Hospice Palliative Care Association is the national association which provides leadership in hospice palliative care in Canada. Advancing and advocating for quality end-of-life/hospice palliative care in Canada, its work includes public policy, public education and awareness.





    Parathyroid Hormone (PTH) Test #high #calcium #levels #in #cancer #patients


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    Parathyroid Hormone (PTH) Test

    What Is a Parathyroid Hormone (PTH) Test?

    The four-sectioned parathyroid glands are located in your neck, at the edge of the thyroid gland. They’re responsible for regulating calcium, vitamin D, and phosphorus levels in the blood and bones.

    The parathyroid glands release a hormone called parathyroid hormone (PTH), also known as parathormone. PTH helps regulate calcium levels in the blood.

    Calcium imbalances in the blood may be a sign of parathyroid gland or PTH issues. Calcium levels in the blood signal the parathyroid glands to release PTH. When calcium levels are low, the parathyroid glands increase PTH production. When calcium levels are high, the glands slow down the secretion of PTH.

    Some symptoms and medical conditions may cause your doctor to measure how much PTH is in your blood. Because of the relationship between calcium and PTH in the blood, both are often tested at the same time.

    Why Do I Need a Parathyroid Hormone Test?

    Healthy calcium levels are essential for your body to function properly. Your doctor may need to measure PTH if:

    • you’re having symptoms of too much calcium in the blood (fatigue, nausea, thirst, abdominal pain)
    • you’re having symptoms of too little calcium in the blood (abdominal pain, muscle cramps, tingling fingers)
    • your blood calcium test comes back abnormal
    • they need to figure out the cause of too much or too little calcium in the blood

    Too much calcium could be a sign of hyperparathyroidism. This is a condition caused by overactive parathyroid glands that produce too much PTH. Excess calcium in the blood can lead to kidney stones, irregular heartbeats, and brain abnormalities.

    Too little calcium could be a sign of hypoparathyroidism. This is a condition caused by underactive parathyroid glands that aren’t producing enough PTH. Not enough calcium in the blood could lead to:

    • osteomalacia (weakened bones)
    • muscle spasms
    • heart rhythm disturbances
    • tetany (overstimulated nerves)

    Your doctor may also order this test to:

    • check parathyroid functioning
    • distinguish between parathyroid-related and nonparathyroid-related disorders
    • monitor the effectiveness of treatment in parathyroid-related issues
    • determine the cause of low phosphorus levels in the blood
    • determine why severe osteoporosis isn’t responding to treatment
    • monitor chronic conditions, such as kidney disease

    What Is the Procedure for a Parathyroid Hormone Test?

    You’ll need to get your blood drawn for a PTH test. Your doctor will recommend a PTH test:

    • if you have signs of too much or too little calcium in your blood
    • before having hyperparathyroidism surgery
    • to assess the functioning of your parathyroid gland.

    Before the Test

    You may need to refrain from eating or drinking for a specific period of time before the blood test. Ask your doctor about specific pretest requirements. Before having this test, tell your doctor if you have hemophilia, a history of fainting, or any other condition.

    The Test

    The process of taking a blood sample for testing is called venipuncture. They usually draw blood from a vein from the inner elbow or back of the hand.

    Your doctor or a lab technician will sterilize the area with an antiseptic. Then they’ll wrap a plastic band around your arm to apply pressure and to help your veins swell with blood. After the veins swell, they’ll insert a sterile needle directly into the vein. The blood will collect in an attached vial. When there’s enough blood for the sample, they’ll untie the plastic band and remove the needle from the vein. They’ll clean and bandage the site of the needle insertion if necessary.

    Some people experience only slight pain from the needle prick, while others may feel moderate pain, especially if the vein is difficult to locate. It’s common for the spot to throb after the procedure. Some bleeding is also common, as the needle will break the skin. For most people, bleeding is slight and won’t cause any issues.

    Infants and Young Children

    The testing process may be different for infants and young children. The doctor or lab technician may make a small cut to allow blood to come to the surface. They’ll then use a test strip or slide to collect a small sample of blood. They’ll clean and bandage the area if necessary.

    What Do the Test Results Mean?

    Your doctor will evaluate your PTH and calcium test results together to assess whether your levels are within normal ranges. If PTH and calcium are in balance, your parathyroid glands are very likely functioning properly.

    If PTH levels are low, you may have a condition causing low calcium levels. Or, you may have an issue with your parathyroid glands that’s causing hypoparathyroidism.

    If PTH levels are high, you could have hyperparathyroidism. Hyperparathyroidism is commonly due to a benign parathyroid tumor. If PTH levels are normal and calcium levels are low or high, the issue may not be your parathyroid glands.

    High PTH levels could indicate:

    • conditions that cause increased phosphorus levels, like chronic kidney disease
    • the body isn’t responding to PTH (pseudohypoparathyroidism)
    • swelling or tumors in the parathyroid glands
    • pregnancy or breastfeeding in a woman (uncommon)

    High PTH levels could also indicate a lack of calcium. This could mean you’re not getting enough calcium in your diet. It can also mean that your body isn’t absorbing calcium, or you’re losing calcium through urination.

    High PTH levels also point to vitamin D disorders. Maybe you’re not getting enough sunlight, or your body has trouble breaking down, absorbing, or using this vitamin. Vitamin D deficiency can lead to muscle and bone weakness.

    Low PTH levels could indicate:

    • an autoimmune disorder
    • cancer originating from another part of the body has spread to the bones
    • you’ve ingested excess calcium over a long period of time (from milk or certain antacids)
    • hypoparathyroidism
    • low levels of magnesium in the blood
    • radiation exposure to the parathyroid glands
    • vitamin D intoxication
    • sarcoidosis (a disease causing inflammation to tissues)

    If either PTH or calcium levels are too high or too low, your doctor may want to do additional testing to more clearly identify the problem.


    Palliative cancer care #hotels #in #la

    #palliative cancer care

    #

    WHO Definition of Palliative Care

    Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

    • provides relief from pain and other distressing symptoms;
    • affirms life and regards dying as a normal process;
    • intends neither to hasten or postpone death;
    • integrates the psychological and spiritual aspects of patient care;
    • offers a support system to help patients live as actively as possible until death;
    • offers a support system to help the family cope during the patients illness and in their own bereavement;
    • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
    • will enhance quality of life, and may also positively influence the course of illness;
    • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

    WHO Definition of Palliative Care for Children

    Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

    • Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
    • It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
    • Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
    • Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
    • It can be provided in tertiary care facilities, in community health centres and even in children’s homes.




    Palliative and Supportive Care for Cancer Patients #comfort #care #hospice

    #palliative care for cancer patients

    #

    Palliative and Supportive Care

    UPMC CancerCenter utilizes the UPMC Palliative and Supportive Institute to extend its array of cancer care services. The program includes a multidisciplinary team of health care professionals dedicated to providing comprehensive and coordinated care to people with life-limiting illnesses and to their families. The palliative care team works with a person’s primary medical team to provide symptom management, family support, psychosocial care, and spiritual care, as well as to assist with discharge planning and integrate inpatient services with outpatient and home-based programs.

    Individuals and their families are given consultations regarding prognosis, care goals, and options and education on psychosocial, spiritual, and financial concerns. These consultations are shared with the person’s referring physician, as well as with the nursing staff and other health care providers.

    The team cares for people while in the hospital and works with many programs, such as home care, hospice, and nursing homes, to support people after they leave the hospital. Support and comfort are given to the person’s family while they are caring for the patient and during their bereavement.

    In addition to the inpatient consultation service, the UPMC Palliative and Supportive Institute provides care for those who are not yet hospitalized for their illness and for recently hospitalized patients. The team’s goal is to maintain the highest quality of life for the longest possible time by developing a treatment plan that may include:

    • Dealing with symptoms such as pain, nausea, and anxiety.
    • Planning for home care and hospice.
    • Coping with psychological and spiritual concerns.

    Patients may also be interested in the Outpatient Pain Program at UPMC CancerCenter.





    Hospice cancer #motel #manager #jobs

    #hospice cancer

    #

    Compassion. Integrity. Excellence.

    Compassus is dedicated to clinical excellence, compassionate care, and providing comfort and support to patients and their families facing end-of-life issues. Focusing on the quality of life remaining, Compassus provides effective symptom control and care that focuses on the whole individual – addressing physical, psychological, social and spiritual needs.

    At Compassus, our mission is to provide hospice care to terminally ill patients and their families with Compassion, Integrity, and Excellence. The Colleagues of Compassus are committed to keeping The Hospice Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of hospice to those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments.

    Compassus also provides palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Compassus palliative care services can offer relief from symptoms and pain and a care plan based on your values and needs.

    Families

    Every patient is a unique story.
    Read more.


  • Healthcare Professionals

    We support our referring physicians.
    Find out how.


  • Volunteers and donors

    Make a difference in someone s life.
    Become a volunteer today.
    Learn how.





  • Palliative Care for Cancer Patients in NY #home #health #care

    #palliative care for cancer patients

    #

    What is it?
    Cancer is a broad term that encompasses a variety of disease processes that can involve any organ in the body including the blood system. Cancer is caused by abnormal cells that start to grow out of control and destroy normal functioning cells in the process.

    What can I expect if I am diagnosed with cancer?
    Once you are diagnosed with cancer, you will likely talk to a physician who specializes in treating your type of cancer like an oncologist, hematologist and/or surgeon. They are going to use information about you and your illness such as your age, stage and type of cancer in order to come up with a prognosis and a treatment plan for you.

    What questions should I ask and what should I think about?
    It is important to make sure that you understand your diagnosis. You should not be afraid to ask your doctor questions. I recommend that you go to your appointments with a friend or loved one so that they can help you to remember what the doctor tells you. It does not hurt to take notes or even to record your visit with the Doctor. You might want to ask your medical provider the following questions:

    1. How did you confirm that this is the correct diagnosis? Is there any chance that the diagnosis is uncertain?
    2. What are my risk factors for getting this problem?
    3. What are my treatment options and how soon do we need to begin?
    4. What are the pros and cons of each treatment option? What happens if I decide to do nothing? How long do I have to decide what I want to do next?
    5. Where can I find more information about this?
    6. What can I expect from this illness?
    7. What are possible side-effects from the treatment?
    8. How will my symptoms be addressed?
    9. Where can I find help with locating counseling and support groups for myself? What about counseling and support for my family and caregivers?
    10. Will I be able to talk with a patient advocate, patient navigator or social worker? (You may want to talk with one of these professionals if you have questions about the financial implications of your diagnosis/treatment, your insurance coverage, taking leave from work, finding help with other social issues such as transportation, housing, etc.)

    How can ePalliativeCare.com help?
    Use this site to explore links in order to find additional information and resources in your area. If you are a resident of the state of New York and you would like to talk with a palliative care specialist, click on the “Schedule an Appointment” button.





    The Nightingale Cancer Support Centre #vitas #hospice #locations

    #nightingale house hospice

    #

    The Nightingale was formed by a local group of concerned individuals who felt that more could be done to support people affected by cancer in Enfield. We aim to work together with existing local services to ensure that we provide comprehensive support.

    We are here to help patients, relatives, carers, friends or those who are affected by cancer. We hope to be able to provide you with help along the way.

    Remember, you are not on your own.

    When you are facing a frightening illness it may seem that no-one can understand or help. Talk to us, we will listen, and hopefully do more, by providing advice, counselling and practical solutions to the situations you may face.

    The Nightingale relies totally on voluntary income, it can only continue to help in the community if it has community support.

    If you would like to find out more about future events, you can click here to view the Calendar

    About The Nightingale Cancer Support Centre

    The Nightingale Cancer Support Centre was launched in 2002 to help residents in the borough of Enfield whose lives have been touched by cancer and who were somehow slipping through the established care system.

    A research project was undertaken to identify services that were obviously needed and those that were already being provided.

    A steering group of health experts, social care workers and legal and business professionals came together with the aim of forming a new charity that would specifically meet the needs of Enfield borough residents.

    The Nightingale serves patients, relatives, carers, friends and those who are concerned about cancer care. We hope to be able to provide help and information to those who need it along their journey.

    We aim to work together with existing services within the borough and to co-ordinate local volunteer teams so that valuable resources are used to best effect.

    We run our services from The Lancaster Centre which is situated on Lancaster Road, a short distance from Enfield Town. Both the W8 and 191 buses run past the centre and the nearest train station is Gordon Hill.

    Top | 2011 The Nightingale Enfield





    Ayrshire Hospice – Ayrshire Cancer Network #sydney #hotels

    #ayrshire hospice

    #

    Ayrshire Hospice

    Ayrshire Hospice

    Ayrshire Hospice provides quality specialist palliative care for adults with life limiting illnesses within Ayrshire and Arran. This care not only seeks to alleviate pain and symptoms, it also allows people to stay engaged with friends, family and their community, and to get the most out of their remaining life. Ayrshire Hospice is not a place to come to die! It’s a place to come to live the last days of life, however long that may be, to its fullest potential.

    We provide a wide range of services and care in people’s homes, care homes and hospitals, as well as in the Hospice itself. This is provided at no cost to the patient and their families, but it does require extensive, on-going fund raising and NHS support to exist.

    Although mainly cancer related, Ayrshire Hospice also deals with other conditions such as lung, heart and neurological disease.

    If you are associated with this group/organisation and believe any of the details to be incorrect, please contact us .

    News Events

    Published by:

    The inclusion of details of organisations and therapists in this site does not constitute their endorsement by Ayrshire Cancer Support.
    ACS is not responsible for the accuracy or content of the websites or publications listed.





    Gemini Sun Sign – Zodiac Signs – Article by #article, #astrology, #fortune,


    #

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    • 1001 Night, Animal Lords, Bruegel, Classic, Egyptian, Gems, Karma Oracle, Lenormand, Magic Number, Marseille, Minchiate, Sweet Twilight, Visconti Tarot Images: With permission by Lo Scarabeo s.r.l, Torino, Italy, www.loscarabeo.com. Golden Rider, Diamond Tarot Images: With permission by AGM AGMüller, Switzerland, www.tarotworld.com. Aquatic Tarot Images: With permission by Andreas Schröter, www.aquatictarot.de.
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    Gemini Sun Sign – Zodiac Signs

    BY ASTROLOGY.COM NOVEMBER 20, 2009 04:51 PM EST

    Gemini is the third sign of the zodiac, and those born under this sign will be quick to tell you all about it. That’s because they love to talk! It’s not just idle chatter with these folks, either. The driving force behind a Gemini’s conversation is their mind. The Gemini-born are intellectually inclined, forever probing people and places in search of information. The more information a Gemini collects, the better. Sharing that information later on with those they love is also a lot of fun, for Geminis are supremely interested in developing their relationships. Dalliances with these folks are always enjoyable, since Geminis are bright, quick-witted and the proverbial life of the party. Even though their intellectual minds can rationalize forever and a day, Geminis also have a surplus of imagination waiting to be tapped. Can a Gemini be boring? Never!

    Since Geminis are a mix of the yin and the yang, they are represented perfectly by the Twins. The Gemini-born can easily see both sides of an issue, a wonderfully practical quality. Less practical is the fact that you’re not sure which Twin will show up half the time. Geminis may not know who’s showing up either, which can prompt others to consider them fickle and restless.

    They can be wishy-washy, too, changing their mood on a simple whim. It’s this characteristic which readily suggests the Mutable Quality assigned to this sign. Mutable folks are flexible and go with the flow. Further, the Twins are adaptable and dexterous and can tackle many things at once. It’s a good thing, too, when you consider their myriad interests. The downside of such a curious mind, however, can be a lack of follow-through. How much can any one person do, anyway?

    Ruled by Mercury, Geminis exhibit a delicious brand of mercurial energy. They are quick-thinking, quick-witted and fast on their feet, much like the messenger god of Roman mythology that rules their sign. Geminis are both curious and clever, which is why they are such a hit at cocktail parties. Although they talk a great game, they also love to listen and learn. With any kind of luck, the Twins will find themselves in interesting company, because if they don’t, they are likely to get bored and start fidgeting. Any social setting is a good one for a Gemini, however, since these folks are charming, congenial and love to share themselves with their friends. While their effusiveness may be misconstrued as scheming by some, Geminis generally have their hearts in the right place. It’s that ample energy which can also paint them as scatterbrained and unfocused, but behind all that zipping around, the Twins are busily filing all that good data away.

    The element associated with Gemini is Air. Air signs are the thinking person’s signs, and the Twins don’t disappoint. Those born under this sign prize intellect and consider it the key to all things. At work, they are the clearest of thinkers, looking at a project from all (well, at least two) sides and putting forth some logical and well-thought-out ideas. This quality makes Geminis an asset to any team, and while these folks are not inclined to take the lead, they are a most valuable component. It’s also the Gemini’s literary bent that allows them to offer a useful perspective on most any situation. The Twins also enjoy bringing their objective reasoning and big-picture ability into their personal relationships. While some may perceive all this logical thought as cold and unemotional, it’s simply how these folks tick. They want to connect, they just do it their own way. Luckily for Geminis (and their pals), their lightness of spirit and youthful exuberance help them to appear forever young. In keeping with that skip in their step, Geminis enjoy short road trips — and their agile minds and nimble hands ensure that they could change a tire (if needed) in no time flat. Is all of this Twin-energy more than any one person can handle? Ah, maybe that’s why they are two.

    When it comes to sports, Geminis would seem a natural for doubles tennis — and they are. They love the camaraderie of games and play, which is why they excel at team events. Whether it’s volleyball or a game of charades, Geminis are always ready to play. A book club would certainly stimulate their literary minds. In the game of love, Geminis are playful, flirtatious and endless fun. Physically speaking, Gemini rules the nervous system, which is why Twins should practice yoga or deep breathing techniques. Layering themselves in soft yellows and blues will also calm their mood.

    The great strength of the Gemini-born is in their ability to communicate effectively and to think clearly. Adventures of the mind are what the Twins are all about. They also love to share themselves with their friends, and they make for charming companions.


    Palliative care cancer #cheap #hotel #site

    #palliative care cancer

    #

    WHO Definition of Palliative Care

    Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

    • provides relief from pain and other distressing symptoms;
    • affirms life and regards dying as a normal process;
    • intends neither to hasten or postpone death;
    • integrates the psychological and spiritual aspects of patient care;
    • offers a support system to help patients live as actively as possible until death;
    • offers a support system to help the family cope during the patients illness and in their own bereavement;
    • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
    • will enhance quality of life, and may also positively influence the course of illness;
    • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

    WHO Definition of Palliative Care for Children

    Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

    • Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
    • It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
    • Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
    • Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
    • It can be provided in tertiary care facilities, in community health centres and even in children’s homes.




    Caring for the Symptoms of Cancer and its Treatment #motels #with #weekly

    #palliative therapy

    #

    Cancer and its treatment may cause many symptoms and side effects. Symptoms and side effects may be a source of stress for patients and their families. Besides treating the underlying cancer, the health care team will also manage cancer symptoms and the side effects of treatment. This approach is called palliative or supportive care.

    Understanding palliative care

    Palliative care is any treatment that focuses on preventing and managing the symptoms of cancer and side effects of treatment. It also provides comprehensive support to people living with cancer and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care.

    People should receive treatment for the cancer and treatment to ease side effects at the same time. When side effects and other challenges of treatment are well managed, people have better quality of life and report they are more satisfied with treatment.

    Palliative treatments often include medication, nutritional changes, relaxation techniques, spiritual support, emotional support, and other therapies. You may also receive palliative treatments similar to those used to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. For example, when radiation therapy helps control pain, it is considered a palliative treatment. That is why it is important to understand the goals of each treatment in your care plan.

    Children with cancer should also receive palliative care. Parents usually work with the health care team to manage symptoms so their children are as comfortable as possible starting from diagnosis. Family members, including siblings, may receive counseling as part of palliative care to better cope with the child’s diagnosis.

    Goals of palliative care

    The goals of palliative care include:

    Treating symptoms, including pain, nausea, breathlessness, insomnia, and other physical issues caused by cancer or its treatment

    Managing emotional and social needs, including anxiety, depression, and relationship issues

    Addressing spiritual needs or concerns

    Addressing practical needs, such as transportation and financial concerns

    Providing support for family, friends, and caregivers

    Difference between palliative care and hospice care

    Although you may hear “palliative care” and “hospice care” used in similar ways, they are not the same. Palliative care is given at every step of the treatment process. It provides an extra layer of support for people with any stage of cancer. Hospice care is a specific type of palliative care. It is only provided to people with cancer who are expected to live six months or less.

    If you have advanced cancer. your doctor may suggest treatments to improve symptoms or treatments directed at the cancer. If you choose to stop disease-directed treatment, this does not mean you have stopped “fighting” the disease. It also does not mean your health care team has given up. Instead, the focus may be on relieving burdensome symptoms and allowing for additional support in all areas of your life.

    When a person decides to begin hospice care, a member of the palliative care team helps with the transition. He or she can also help address the physical and emotional issues that come with that choice. Learn more about hospice care .

    When and where palliative care is given

    Ideally, palliative care should start at diagnosis. It should then continue throughout all stages of the disease.

    You may receive palliative care in a doctor’s office, hospital, cancer center, long-term care facility, or your home. The location depends on the treatments that have been recommended and the available resources. Talk with your doctor, nurse, or oncology social worker about your options.

    The palliative care team

    A number of people may make up your palliative care team, including:

    Oncologist. An oncologist is a doctor who specializes in treating cancer. Usually, your oncologist will serve as the leader of your health care team. He or she is in charge of designing your treatment plan and deciding on medication and dosing. Your oncologist may consult with other health care professionals, such as a palliative medicine physician or pain specialist, to create your palliative care plan.

    Palliative medicine physician. This is a doctor who specializes in hospice and palliative care. He or she works with the health care team to relieve symptoms and side effects. A palliative medicine physician will also talk with patients to align treatment to his or her goals and values.

    Nurses. The nurses on your team help manage pain and other symptoms. They also act as the main contact for the rest of your health care team. If you receive palliative care at home, nurses may visit you regularly to ensure you receive the care you need.

    Social workers. A social worker provides counseling for you and your family and arranges family meetings. A social worker may also help with practical issues like transportation and can connect you with local resources. Social workers also help with discharge from the hospital and finding in-home help, or, if necessary, hospice care.

    Pain specialist. Pain specialists, or pain medicine doctors, are experts at finding the cause of pain and treating it. They may prescribe medication, recommend a rehabilitation program, and/or perform pain-relieving procedures. An oncologist or palliative medicine physician may be able to control your pain without referring you to a pain specialist.

    Chaplain. A chaplain is usually affiliated with a specific religion. He or she is trained to listen to patients’ and family members’ concerns, especially about death and dying. Chaplains are also available to discuss other faith-related and spiritual matters.

    Dietitian. A dietitian can help address nutritional challenges, such as nausea or appetite loss. Dietitians may also provide advice about nutritional supplements and help create specialized eating plans

    Physical and occupational therapists. A physical therapist helps maintain mobility and improve how well a person moves. Physical therapists also develop exercise programs to maintain or improve physical strength during and after treatment. Occupational therapists typically focus on daily tasks and functioning, especially upper body movement.

    Child life specialists. These trained professionals specialize in helping children and their families understand a child’s serious illness. They also assist siblings through the experience.

    Volunteers. Many palliative care programs have trained volunteers that visit with patients who want companionship and emotional support. Volunteers often perform simple tasks, such as reading out loud or writing notes, or can simply sit and talk.

    Grief and bereavement coordinator. A grief coordinator counsels family members who are facing or have suffered the loss of a loved one. They have specialized training in social work or psychology. Learn more about grief and loss .

    Paying for palliative care

    Palliative care is often covered by individual health insurance plans. Medicaid and Medicare may also pay depending on the situation. A hospital social worker can help you explore payment options. Learn more about managing the cost of cancer care .

    Talking about palliative care

    An important part of palliative care is talking about your diagnosis, treatment, and needs. These conversations help clarify your goals and expectations. The best palliative care occurs when patients and their families work together with the health care team.

    Here are some practical tips to help promote good communication with your health care team:

    Ask the doctor to explain your diagnosis, treatment plan, and prognosis. Prognosis is the chance of recovery. These may change over time, so continue to have open, honest discussions with your doctor. Taking notes or bringing a family member or friend along may help you remember more of the information.

    Ask your health care team to explain if you don’t understand an explanation, description, or unfamiliar medical word.

    Tell the doctors and nurses about any pain, discomfort, or other side effects, even if you feel they are not serious. Often there are many options for relieving symptoms. However, the health care team needs to know about them to help you feel better.

    Keep track of your symptoms and side effects. Write down what they are, how often they occur, and how severe they are. This will help the doctor identify the cause and find solutions.

    Don’t be afraid to ask questions. You may want to write your questions down before appointments. It is important to ask about your social, emotional, functional, and spiritual needs, as well as questions about your health. Here is a basic list of questions to ask the doctor to help you get started.

    Talk with your doctor about the palliative care services available to you. You may want to ask to be referred to a palliative care specialist. Oncologists typically welcome the support and information palliative care specialists provide.

    More Information





    Supportive Care – Foundation for Women – s Cancer #inpatient #care

    #supportive care

    #

    Supportive Care

    Supportive Care
    Supportive care, sometimes referred to as palliative care, is specialized, whole-person care in which the main goal is relief of symptoms and suffering. Palliative care services can be provided at the same time as care that is focused on cure.

    Supportive care often is administered in parallel with active treatment by a team specifically trained to provide the services described above. There now is a medical specialty in Hospice and Palliative Medicine with an increasing number of board-certified physicians available to offer these services. In addition to physicians, the supportive care team may consist of nurses, social workers, chaplains, massage therapists, pharmacists, nutritionists and others.

    It is important to understand the difference between supportive, or palliative care, and hospice care. Supportive, or palliative, care may begin at any time during the patient’s illness and is provided in addition to life-prolonging care. The patient does not have to choose between life-prolonging care and palliative care. Hospice care is a specific type of palliative care for patients at the end of their life, usually meaning a life expectancy of six months or less.

    The following references are offered to allow you to learn more about supportive, or palliative, care.

    After surviving cancer, women look for a community of support and guidance. In a video produced by the Society of Gynecologic Oncology, survivors share how they live and thrive after endometrial cancer. As described by one survivor, “You can get better.”

    The Foundation is featured in the Sept. issues of Coping. Women and Family Circle magazines. Look out for our articles ads!

    The Foundation is proud to offer various Research Grants and Awards. Click here for more information.

    FREE Gynecologic Cancer Survivors Courses throughout the country. For more information, click here .





    Just a quick word about the Brain Hospice timeline – Brain Tumors

    #brain hospice

    #

    Thread: Just a quick word about the Brain Hospice timeline

    Just a quick word about the Brain Hospice timeline

    So, I’ve recommended the brainhospice dot com symptom timeline as a reference point to others in the past. I’m not finding it very accurate as we wind down.

    At this time it is about six weeks since my sister fulfilled the timeline’s descriptors for 2 to 5 days left, and for roughly two weeks she’s fulfilled the descriptors for just hours .

    I knew the top of that timeline was kind of iffy but now I’m finding the bottom is too.

    Thank you all for your good thoughts and kind wishes. I send ’em back atcha.

    Top User Join Date Jan 2013 Location Central Wyoming Posts 720

    This process must just be so heartbreaking for you. God bless you, pal. God bless your sister.

    64 yrs old
    March 6, 2012: Diagnosed Anaplastic Large (T-) Cell Lymphoma, Stage 1 (ALK-)
    3 rounds of CHOP unsuccessful.
    Beginning mid-June, 2012, received 6 cycles of Brentuximab at Huntsman Cancer Institute, University of Utah. Pet scans after 4th and 6th cycles showed no evidence of lymphoma.
    Autologous bone marrow transplant in November of 2012.
    17 radiation treatments for consolidation purposes between Dec. 26 and Jan.17.
    100 day post BMT check-up (2/26/13): NED. Pet scan on 7/10/13: Still NED.
    One year post transplant check-up: Still fine; NED.
    18month post-translant scans, etc. All fine, save a bit of arthritis.
    11/14/14: 24 month post transplant check-up–still NED. Scanziety still sucks.
    5/15/15: No NED this time; reactive nodes in groin; scheduling biopsy.
    Relapse confirmed/ started every 3 week brentuximab
    Allo transplant in Feb 2016.
    100 day post transplant scans in June 2016 fine.

    Sib we are going through the same thing here. I’ve been searching for a better lung cancer death timeline. Jody

    May The Odds Be Ever In Your Favour. Born 1960. Diagnosed 4/2011 with one tumor, LUL, NSCLC. Tumor size 1.1 inches. Thoracic surgery 6/1/2011. No action taken. Eight weeks of radiation and chemo. Carbo and Taxol. Follow up with four rounds of Carbo and Alimta.
    December 2011 CT scan shows all clear.
    April 2012 CT scan shows all clear. July 2012 had several x-rays taken at the chiropractor for shoulder pain. Took them to the onc and nothing suspicious noted. See them again in Oct.
    October didn’t work out. Pain in the left shoulder continued to worsen and lymph nodes in the supraclavical swelled so I called the onc and they bumped the regular scan up to September 19 and we went for the results on the 24th. The tumor is back and the spread is extensive. Option 1: Try targeting chemos that may work and then on to clinical trials. These would give me about a year or so if the cancer responds. Option 2: Do no treatment and let nature take its course. This will give me six months give or take. As good as I feel right now, I�m going for door #2 and will continue to live well and enjoy myself until I don�t. I�ll keep you posted. Live it up everyone!

    7 months into hospice and palliative care. It has been a very good relationship with the organization as a whole with a minor glitch. April 2013 spent the night at hospice facility, PICC line inserted for morphine drip. I said I wouldn�t but, had a hospital bed delivered. Started 10 rounds of palliative radiation to shrink the neck tumor. Busy month for me!

    I’ve taken a couple of nasty falls this last week. (first of mid-May) Right on the cancer shoulder. So I have a life alert necklace on me now. I wish I could get my hands on a small scooter!

    There is another node swelling on the other side of my neck. Still small.

    April51’s (Jody) daughter posted that her Mother’s journey in this world had ended on July 8th 2013.You touched so very many lives. Soar high Jody!

    Senior User Join Date Feb 2013 Posts 291

    dear sibling maybe its yours sisters age and young heart that keeps her alive. i havent read the timeline (out of fear ) and i cant imagine what she is feeling these moments. do you think she can hear you if you whisper something? i suppose it can relief her in some way

    Moderator Top User Join Date May 2011 Location Illinois Posts 717

    Sorry you are going through this (yet again). She sure is lucky to have you in her corner.





    Cancer: Palliative Care and Quality of Life #dorchester #hotel

    #palliative chemotherapy

    #

    Palliative Care Center

    “Palliative care” means care that makes you feel better but doesn’t treat your disease. It’s a term often linked to late-stage illness and hospice care. And while it can ease the way for people in the later stages of cancer, it’s something you should think about no matter what your diagnosis is.

    The goal is to help you feel better and stay active while you’re getting treatment. Your doctor and other health care professionals will work as a team to treat your cancer, pain, nausea, fatigue, breathing problems, or stress.

    Recommended Related to Palliative Care

    The body is a complex machine. Many organs and systems constantly work to keep it healthy. Some functions are so crucial that you can’t live if they stop. When they fail, special medical procedures, commonly called life support, can keep you alive until your body is ready to take over again. But sometimes the body isn’t able to resume the work.

    “Some people try to keep a stiff upper lip and not admit that they need help. Or they may panic when they find out they have cancer,” says Albert A. Rizzo, MD, chief of pulmonary and critical care at Christiana Care Health System in Newark, DE. But palliative care can reduce your symptoms so you feel as good as you can and have as high a quality of life as possible.”

    For people with non-small-cell lung cancer (NSCLC), palliative care may include:

    • Drugs or supplements to ease nausea, pain, or fatigue
    • Oxygen therapy to help with shortness of breath
    • Counseling to lower stress or anxiety
    • Nutrition advice to keep your weight and energy levels high

    Give Your Immune System a Break

    This type of care isn’t designed to fight the disease. But often it helps your cancer treatments do a better job.

    Why? Because your immune system isn’t working as hard to fight pain, stress, or nausea, says Patricia Thompson, MD, medical director of thoracic oncology at Cancer Treatment Centers of America’s Southeastern Regional Medical Center in Atlanta.

    She believes lung cancer patients should start palliative care with their first visit to a cancer doctor. “When I first talk to a patient who is newly diagnosed with lung cancer, you can see that they feel like they are in the twilight zone. Their head is spinning,” she says.

    Your oncologist will go over your symptoms and examine you to see what kind of palliative care is right for you, Thompson says. The care should be tailored to your needs. Your doctor can adjust it as they change.





    Improving supportive and palliative care for adults with cancer #motel #7

    #hospice guidelines

    #

    Improving supportive and palliative care for adults with cancer

    The NICE clinical guidance on supportive and palliative care (CSG) advises those who develop and deliver cancer services for adults with cancer about what is needed to make sure that patients, and their families and carers, are well informed, cared for and supported.

    The key recommendations are:

    • People affected by cancer should be involved in developing cancer services
    • There should be good communication, and people affected by cancer should be involved in decision making
    • Information should be available free of charge
    • People affected by cancer should be offered a range of physical, emotional, spiritual and social support
    • There should be services to help people living with the after-effects of cancer manage these for themselves
    • People with advanced cancer should have access to a range of services to improve their quality of life
    • There should be support for people dying from cancer
    • The needs of family and other carers of people with cancer should be met
    • There should be a trained workforce to provide services

    Review decision date: June 2014

    Review decision: The Improving supportive and palliative care for adults with cancer guideline should not undergo a surveillance review at this point. Please refer to the surveillance review decision for further information.

    Next review date: To be confirmed on publication of related guidance

    In February 2009 NICE published guidance on advanced breast cancer that complements the cancer service guidance.





    COPD Symptoms ?>


    COPD Symptoms Prognosis

    Cigarette smoking can be the cause of COPD; most people who have COPD smoke or used to smoke. While the term COPD refers generally to a respiratory disorder. there are two specific diseases that are most often associated with it. Those are emphysema and chronic bronchitis, both of which will worsen the patient’s ability to capture oxygen as the lungs degenerate. A COPD diagnosis in the United States assumes the presence of emphysema and/or chronic bronchitis. Most people with COPD are afflicted with both of these pulmonary disorders.

    COPD Symptoms

    The pulmonary symptoms of COPD are simple and straightforward. They are not dissimilar from those of a common chest cold, except they are not caused by a virus and are not the result of a disease that can be cured.

    • The primary symptom is shortness of breath. The chest feels tight and any level of exertion will leave the COPD patient out of breath.
    • Wheezing is common with COPD: the whistling or squeaking sound lungs make when they are congested.
    • Tightness in the chest: it feels as if the lungs have shrunk and the patient is unable to take a deep breath.
    • A persistent cough that does not come and go as a cough related to a chest cold would. The cough usually produces significant amounts of mucus; this condition usually signals the presence of bronchitis.

    Other Respiratory Disorders

    Some of the pulmonary symptoms for COPD are common to other diseases. People with asthma will recognize most of them. Respiratory disorders are a regular household occurrence; everyone encounters one occasionally in the form of short-lived afflictions:

    • Common Cold
    • Influenza
    • Sinusitis
    • Tonsillitis
    • Asthma

    Occupational Lung Diseases

    This category of illness includes afflictions that create similar symptoms due to toxins other than cigarette smoke. They are caused by exposure to hazardous inhalants in the workplace or on remote jobsites. Coal miners are not the only ones at risk for occupational lung diseases ; they are only the best known example. Employees working in a car garage, a textile factory, steel or paper mills or a power plant are often exposed to asbestos. which can lead to asbestosis or mesothelioma cancer .

    Asbestos can also be found in a wide variety of locations along with other hazardous chemicals, dusts, and fibers that may lead to a lifetime of pulmonary symptoms if not properly diagnosed and treated. Exposure to asbestos fibers or other airborne toxins can trigger COPD. especially when combined with cigarette smoking.

    • Occupational lung disorders are the number one cause of work-related illness.
    • Occupational lung diseases in general are similar to asbestos related afflictions. They are most often caused by repeated, long-term exposure, but can also be the result of a single hazardous occurrence.
    • Smoking increases the likelihood and severity of an occupational lung disease. Any respiratory toxicity will heighten the risk of lung cancer.

    A Common and Often Hidden Respiratory Disorder

    While COPD may be a relatively new term to many people, the respiratory disorders that are included in COPD are not. COPD is a widespread affliction in this country, impacting a large number of Americans – especially older Americans .

    • More than 12 million people are currently diagnosed with COPD. An additional 12 million probably have the disease and don’t know it4.
    • COPD develops slowly, as the lungs are slowly damaged by tobacco smoke and airborne toxins. Because symptoms develop gradually the diagnosis is usually made after substantial damage has been done. Eventually severe COPD may prevent a patient from basic physical activity, making this among the most debilitating of diseases.
    • Most of the time, COPD is diagnosed in middle-aged or older people. It is self-induced, in the sense that the disease isn’t passed from person to person.
    • COPD has no cure yet; nor is there a way to reverse the damage. Treatment can only slow the progression of the disease.


    Cure for terminal cancer found in game-changing drugs #heartland #home #health #care

    #terminal cancer

    #

    ‘Cure for terminal cancer’ found in game-changing drugs

    Terminally ill cancer patients have been effectively cured by a game-changing new class of drugs.

    In one trial, more than half of patients who had just months to live saw deadly tumours shrink or completely disappear.

    In recent days, the results of trials of a number of treatments which harness the body s immune system have been announced at the American Society of Clinical Oncology s annual conference in Chicago. They show promise in the fight against skin cancer and lung disease.

    But results from a slew of trials released last night at the conference showed spectacular effects against a multitude of cancers.

    Experts said the advances suggest terminally ill patients with common cancers including lung, bowel, ovarian and womb could in future be cured by the therapies.

    The evidence in favour of the radical drugs is so overwhelming that they could save tens of thousands of lives in the UK within a decade, it is claimed.

    Senior cancer doctors said the treatment, known as immunotherapy, could radically change the standard treatment for cancer, sparing some sufferers from some of the toxic effects of chemotherapy.

    Roy Herbst. chief of medical oncology at Yale Cancer Centre, described the string of results as spectacular .

    I think it s huge, he said. I think we are seeing a paradigm shift in the way oncology is being treated.

    I m seeing this work in almost every cancer, added Prof Herbst, who said the results suggested the therapy worked best on the cancers that were hardest to treat.

    The potential for long-term survival, effective cure, is definitely there, he said.

    Peter Johnson, Professor of Medical Oncology, from Cancer Research UK, said the therapies which work by re-educating the immune system are one of the greatest breakthroughs in cancer treatment in four decades.

    The evidence emerging from clinical trials suggests that we are at the beginning of a whole new era for cancer treatments, he said.

    Some of the most common types of cancer seem to be treatable with immunotherapy. Overall, cancers of the lung, kidney, bladder, head and neck, and melanoma cause about 50,000 deaths a year, or around one third of cancer deaths.

    In one British-led study, 58 per cent of patients with advanced skin cancer saw their tumours reduce significantly when given a new combination of immunotherapy drugs.

    In more than one in 10 cases, those given the drugs, called nivolumab and ipilimumab. the growths were entirely destroyed.

    Such patients could expect to live just nine months if given standard treatment. The two-year study of 950 patients has yet to publish survival data but researchers said they were hopeful that half of the patients would end up living disease-free .

    Lead author Dr James Larkin, consultant medical oncologist at the Royal Marsden Hospital, said he was excited about the prospects of the new treatments.

    We ve seen these drugs working in a wide range of cancers and I think we are at the beginning of a new era of treating cancer, he said.

    Iplimumab, the only immunotherapy in use by the NHS, costs around £100,000 for four treatments.

    The second drug, nivolumab, is expected to be licensed for use in Europe this summer.

    The study found their results, when combined, were three times as good as when iplimumab was given alone. Trials involving a treatment for the most common type of lung cancer doubled the chances of survival for some patients.

    Meanwhile trials examining the use of the drugs in womb, liver, head and neck, and bowel cancer showed remarkable results, specialists said.

    Experts said the new treatments, which use the body s immune system to stall the spread of disease, could soon become the mainstream treatment for a wide range of cancers.

    Cancers develop because they manage to hide from the immune system and disguise the danger they pose. Immunotherapy works by making the cancer visible again and alerting the body s immune system to the danger, Prof Johnston said. Patients who began some of the earliest trials 10 years ago appeared to have been cured, he added.

    Last week, scientists announced that a genetically modifed herpes virus could spark the immune system into action, in another breakthrough in skin-cancer treatment.

    Half of cancer sufferers will be ‘cured’





    Finding out you have advanced cancer #alive #hospice #nashville

    #terminal cancer

    #

    Finding out you have advanced cancer

    When cancer is advanced it means that it can’t be cured and is likely to cause death within a limited period of time. The amount of time is difficult to predict but it could be weeks to several months. Doctors might also say that the illness is terminal. This distressing news can affect you and the people close to you in different ways. This page is about how you may feel and what can help you cope. There is information about

    Your first reactions

    There is no right or wrong way to react when you are told your cancer is too advanced to cure. Everyone responds in their own way. For most of us of course, this is very shocking news. Even if you thought it may happen, hearing it from your doctor can still be very upsetting.

    Some people become silent. They can’t believe what they are hearing and don’t know what to say or do. Some start to cry and feel as though they won’t be able to stop. Others may become very angry and scared. Some people feel numb and as though they have no emotions. These are all very common reactions.

    You might find that many questions come into your mind, such as

    • Why me?
    • Do I deserve this?
    • Why can’t you find a treatment to help me?
    • There must be something that will stop this cancer – can’t you just try anything?

    It is natural to feel desperate, upset, angry, or that you don’t believe the news. Be sure to give yourself the time and space to take in what is happening. You might want to be on your own. Or you may need to spend time with your partner, family or friends to help you deal with the news. Of course they may also be very upset and feel that they don’t know what to say. Even if all you can do at first is get upset together, that can be a huge help.

    If you don’t feel like talking straight away, you don’t have to. Just let the people around you know that. As hard as it can be, try not to push your emotions aside completely. If you can manage it, it is better to express how you feel and allow your emotions to come to the surface – even if that is uncomfortable and hard to cope with.

    Feelings you may have

    Over the first few days, you may go through a range of very strong emotions. The emotions may change very quickly and sometimes you might feel numb or as though everything is happening to someone else. Some people say they feel very calm and detached when they are first told they don’t have long to live.

    At times, you will probably feel shock, anger, and sadness. These emotions can feel overwhelming at times. This news will mean that you can’t plan your future in the way you had hoped. Dying may mean leaving behind a partner, children, and other important people in your life. You may wonder how they will cope and won’t want to see them upset.

    These thoughts may be too painful to cope with at times. You might be unable to stop crying and worrying. All this is perfectly normal and understandable.

    You may find it difficult to look around and see life going on as normal for most people. It can feel very strange to watch people going about their daily lives as usual – shopping, driving and working. Coping with this roller coaster of feelings can be very exhausting. You may feel as if you are stuck under a huge black cloud and that there is no point in doing anything.

    Most people will have some or all of these emotions. This usually changes gradually. Many people say that the intensity and distress lessens in time. This doesn’t mean that you stop worrying or feeling upset. But the feelings get more bearable. You will most likely be able to think about your situation a little more calmly and plan what you want to do.

    Looking at your options

    It can be helpful to find out what support is available. Some people want to make plans about what they would like to do before they die. You may like to ask your doctor about

    • How to control cancer symptoms
    • What is likely to happen
    • Who to talk to about your concerns

    Having some idea about what to expect can help you feel less anxious. You might also want to think about where you want to be at the end of your life.

    Sharing your feelings

    Sharing your fears and sadness with people you love and trust may be a great relief for you.

    Many people say that talking about their feelings helps them to cope. It also helps your friends and family to understand more about your situation. In turn, this will help them to help and support you. Other people find sharing their thoughts and emotions too difficult, and would rather keep things to themselves. It is important to do whatever feels best for you.

    Don’t let other people pressure you into talking if you don’t feel ready. This is a very personal, emotional time. You can choose how you handle things. If you would like to talk, make sure you choose people you can talk to easily, who will understand how you feel and be able to support you.

    If, after some time, you still feel overwhelmed and that you can’t cope, try speaking to someone outside your immediate family and friends.

    Our advanced cancer organisations section lists counselling organisations that offer this kind of support. They also have information about coping with grief, terminal illness, and dying with cancer.

    If you are by yourself

    If you don’t have people nearby to help with practical things, you can ask for help. One of your health care team may be able to arrange volunteers to help out at home, or come to visit you in hospital. Ask your specialist cancer nurse or doctor about this.

    If you need help with personal care, such as washing or dressing, social services may be able to help. They can arrange a care package for you.

    You might be wary of letting people you don’t know into your life. But most people find that they do need support at some stage from other people or organisations. And the people that you are put in touch with will be understanding and aware of your feelings and need for personal space. They will want to support you in the best possible way they can.

    You might find help and support at your religious organisation or through other organisations you are involved with.

    Staying hopeful

    It is important that people nearing the end of their life, and those close to them, are aware of what is likely to happen. But only if they want to know this. Everyone needs to have some sense of hope for their future. When you are dying, this hope may be that you can visit a place that you love. Or you may hope that you can enjoy being with your family and friends for a time. Some people believe that there is life after death and find that this gives them hope.

    It may help you to share your hopes with other people, so they can help you fulfil them. Many people hope for comfort, dignity, friendship and love to surround them in their final days.

    For more information

    For general information and support

    Contact the Cancer Research UK nurses on freephone 0808 800 4040 (open 9am to 5pm, Monday to Friday)

    Share experiences on our online forum – Cancer Chat

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    Updated: 6 May 2016

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    Cancer Research UK is a registered charity in England and Wales (1089464), Scotland (SC041666) and the Isle of Man (1103). A company limited by guarantee. Registered company in England and Wales (4325234) and the Isle of Man (5713F). Registered address: Angel Building, 407 St John Street, London EC1V 4AD.





    Hospice Care – National Cancer Institute #hospice #history

    #hospice

    #

    Hospice Care

    What is the difference between hospice and palliative care?

    Where can people learn more about hospice?

    What is hospice, and how is it used in cancer care?

    Hospice is a special type of care in which medical, psychological, and spiritual support are provided to patients and their loved ones when cancer therapies are no longer controlling the disease. Hospice care focuses on controlling pain and other symptoms of illness so patients can remain as comfortable as possible near the end of life. Hospice focuses on caring, not curing. The goal is to neither hasten nor postpone death. If the patient s condition improves or the cancer goes into remission. hospice care can be discontinued and active treatment may resume. Choosing hospice care doesn t mean giving up. It just means that the goal of treatment has changed.

    The hospice team usually includes doctors, nurses, home health aides, social workers, clergy or other counselors, and trained volunteers. The team may also include speech, physical, and occupational therapists, if needed. A hospice team member is on-call 24 hours a day, 7 days a week to provide support. The hospice team will work with the patient on the patient s goals for end-of-life care, not a predetermined plan or scenario. Hospice care is very individualized.

    Hospice services may include doctor or nursing care, medical supplies and equipment, home health aide services, short-term respite (relief) services for caregivers, drugs to help manage cancer-related symptoms, spiritual support and counseling, and social work services. Patients families are also an important focus of hospice care, and services are designed to give them assistance and support.

    Hospice care most often takes place at home. However, hospice care can also be delivered in special in-patient facilities, hospitals, and nursing homes.

    Who is eligible for hospice care?

    Under most insurance plans in the United States, including Medicare. acceptance into hospice care requires a statement by a doctor and the hospice medical director that the patient has a life expectancy of 6 months or less if the disease runs its normal course. The patient also signs a statement saying that he or she is choosing hospice care. (Hospice care can be continued if the patient lives longer than 6 months, as long as the hospice medical director or other hospice doctor recertifies the patient s condition.)

    The hospice team or insurance provider can answer questions about whether specific care decisions, such as getting a second opinion or participating in a clinical trial while in hospice care, would affect eligibility for hospice services.

    How can people get help paying for hospice services?

    Medicare and most Medicaid and private insurance plans cover hospice services.

    Medicare is a government health insurance program for the elderly and disabled that is administered by the Centers for Medicare Medicaid Services (CMS). The Medicare hotline can answer general questions about Medicare benefits and refer people to their regional home health intermediary for information about Medicare-certified hospice programs. The hotline number is 1 800 MEDICARE (1 800 633 4227); callers with TTY equipment can call 1 877 486 2048. The booklet Medicare Hospice Benefits is available on the Medicare website. The Hospice and Respite Care page, also on the Medicare website, has answers to frequently asked questions about Medicare coverage for hospice and respite care .

    Medicaid, a federal-state partnership program that is part of CMS and is administered by each state, is designed for people who need financial assistance for medical expenses. Information about coverage is available from local state welfare offices, state public health departments, state social services agencies, or the state Medicaid office. Information about specific state locations can also be found online .

    Information about the types of costs covered by a particular private policy is available from a hospital business office or hospice social worker, or directly from the insurance company.

    Local civic, charitable, or religious organizations may also be able to help patients and their families with hospice expenses.

    What is the difference between hospice and palliative care?

    Although hospice and palliative care share the same principles of providing comfort and support for patients, palliative care is available throughout a patient s experience with cancer, whereas hospice is offered only toward the end of life. A person s cancer treatment continues to be administered and assessed while he or she is receiving palliative care, but with hospice care the focus has shifted to just relieving symptoms and providing support. The NCI fact sheet Palliative Care in Cancer has more information about palliative care.

    Where can people learn more about hospice?

    The following organizations can provide more information about hospice.

    The National Hospice and Palliative Care Organization s Caring Connections website offers information and publications focused on improving end-of-life care for adults and children. The site includes a database of national hospice programs. Some Spanish-language publications are available.

    The Hospice Association of America distributes publications on such topics as the history of hospice, the benefits of hospice, hospice-related statistics, and locations of hospice organizations.

    The Hospice Education Institute operates HOSPICELINK, a toll-free telephone service that provides referrals to hospice and palliative care programs in the United States. HOSPICELINK also provides information about the principles and practices of good hospice and palliative care.

    Hospice Net provides information and support to patients facing life-threatening illnesses and to their families and friends.

    The American Cancer Society (ACS) provides free fact sheets and publications about hospice. The address of a local ACS chapter can be obtained by calling the organization s toll-free telephone number.





    Mesothelioma Lawyers #mesothelioma #lawyers, #asbestos #cancer #lawsuits


    Clapper, Patti, Schweizer and Mason

    Attorneys Specializing in Mesothelioma Law

    Dedicated To Your Needs

    Our entire staff is dedicated to provide the best possible support to both mesothelioma victims and their families. When mesothelioma strikes it is a devastating diagnosis. One of the deadliest forms of cancer known today, it continues to affect not only the victim but also the lives of family members as well.

    You will find the mesothelioma lawyers at Clapper, Patti, Schweizer Mason are committed to both your care and getting the compensation your family deserves. For most families this is uncharted territory and life threatening for the victim of asbestos exposure.

    Lawyers Who Understand

    Themesothelioma lawyers in our office understand your needs and strive to make the legal process stress free. This is one of many decisions a victim of mesothelioma must make, while some do not understand the legal process and during a time of crisis is not the time to learn. Our attorneys have a system that will help you make the right decisions and feel secure while we guide you through the asbestos lawsuit process.

    Understanding the Mesothelioma Legal Process

    Since many of our clients do not know where they were exposed to the deadly asbestos particles, they question how we can help. Our expert lawyers, attorneys, paralegals and their assistants have the tools and knowledge to determine the specifics of your exposure to asbestos. Our website outlines some of the details that may go into your mesothelioma lawsuit. Listed below are a few of the links you may want to review. This may not answer all of your questions, but it is our intent to guide you through this difficult emotional process.

    • Mesothelioma Legal Process an overview of the types of cases Clapper, Patti, Schweizer Mason accepts and how we assist our clients.
    • What to Expect This is where our mesothelioma lawyers answer some of your questions regarding how to file a mesothelioma lawsuit.
    • Success Stories Learn about previous clients our lawyers have assisted, and hear in their own words what it meant for them to work with and be helped by our attorneys..

    Shaping Mesothelioma Litigation

    Clapper, Patti, Schweizer Mason mesothelioma lawyers are some of the most well-known. With proven results, they continue to be instrumental in shaping mesothelioma litigation in the U.S. today. Jack Clapper, the founder of this successful law team, filed his first mesothelioma case in 1980. Since then he has not wavered and has made asbestos-related lawsuits his expertise. We would like you to become better acquainted with each of the lawyers in our office that would handle your mesothelioma case. Their profiles include contact information for your convenience. If contacted, they will personally get back to you.

    It is our job as mesothelima lawyers to provide the link between the illness and the asbestos exposure. For someone that is not familiar with the steps, this may be a difficult and time-consuming process. Therefore, the leadership of an experienced mesothelioma law team is critical in guiding victims and their families to seek and receive financial compensation for their intense amount of suffering. We have the investigators, lawyers and paralegals to do this work for you quickly and efficiently so that your family may concentrate solely on the healing process and health care.

    Attorneys With Proven Mesothelioma Experience

    Our mesothelioma attorneys have successfully represented families coping with asbestos-related diseases for more than 30 years and have recovered hundreds of millions of dollars for mesothelioma victims. Do not hesitate. Speak with us today and find out what our lawyers can do for you and your family. Contact the mesothelioma lawyers at Clapper, Patti, Schweizer Mason for a free no obligation consultation. Fill out our simple contact form located on each page of this website or call 1 800 440 4262.

    Our lawyers have made it their mission to understand your needs as a whole person and that includes the legal aspects of this devastating disease. Visit our blog. We have pages of information on new treatments that are being developed, posts on what is happening in the news, and how to help families cope with a mesothelioma diagnosis. We want to help you cope and understand all the options.

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    What Are the Types of Mesothelioma? #mesothelioma, #cancer, #lungs, #asbestos, #chemotherapy


    #

    What Are the Types of Mesothelioma?

    Mesothelioma is a rare kind of cancer that develops in the tissue covering most of your organs. There are four different types of this disease. What kind you have depends on where in your body it develops.

    Mesothelioma in the Lungs (Pleural Mesothelioma)

    This is the most common form of the disease. It accounts for about 75% of all mesothelioma cases. There are about 2,500 to 3,000 cases of it every year in the United States.

    Symptoms. You might feel pain in your chest or when you cough. You may have shortness of breath and unexplained weight loss. Lumps often will form under the skin on your chest.

    Causes. Asbestos is the main culprit. These mineral fibers were once widely used to build houses and other products. That’s because the fibers are resistant to heat and fire. But doctors later learned that they can get stuck in your lungs when you inhale them. This can cause inflammation and scarring. Over many years, this can lead to the development of mesothelioma in your lungs. Your genes and other factors also influence your risk.

    Diagnosis. Mesothelioma shares a lot of symptoms with other diseases, so diagnosing it is tricky. Your doctor might order X-rays of your chest, or do a CT scan to look for signs of asbestos exposure. He might also do a PET scan to find out where the cancer has spread. All of these imaging tests can help him see if something is wrong. If so, he’ll have to take a small lung tissue sample (biopsy ) to know for sure if it’s mesothelioma.

    Treatment. It’ll depend on how advanced your cancer is. Your doctor may perform more imaging tests to figure out what stage of the disease you’re in. There are four stages. The higher the number, the more the cancer has spread.

    If it’s in the early stages, you might need surgery. It can sometimes cure the cancer. In other cases, it just helps reduce your symptoms. You might also need chemotherapy, or “chemo .” This can be used alone or before surgery to help shrink your cancer or to keep it from spreading as fast. It can also sometimes be used after surgery to reduce the chance of the cancer coming back. Radiation therapy after surgery might help kill any cancer cells that are still in your body.

    Most of the time, mesothelioma isn’t diagnosed until it’s advanced. If it’s too far along, doctors can’t operate. In that case, your doctor might suggest treatments to control your symptoms.

    Continued

    Mesothelioma in the Abdomen (Peritoneal Mesothelioma)

    This type accounts for about 15% to 20% of all mesothelioma cases. It affects the organs in the abdomen and the abdominal cavity.

    Symptoms: These include swelling or pain in your belly, lumps, and weight loss.

    Causes: If you swallow asbestos fibers (it’s possible; the fibers are too small to see with the naked eye), you can damage the lining of your abdominal organs and cavity. This increases your risk of getting mesothelioma there. Your genes play a role, too.

    Diagnosis: Your doctor will order imaging tests to look for things that don’t look normal. If he finds something, he’ll do a biopsy. If you have mesothelioma, he’ll order more tests to determine what stage you’re in.

    Treatment: It usually consists of a combination of things, including surgery, chemo. and radiation. If you’re diagnosed at a later stage, it may be too late for surgery. In that case, your doctor will recommend other treatments to control your symptoms.

    Mesothelioma in the Heart (Pericardial Mesothelioma)

    About 1% of all mesothelioma cases happen in the sac of tissue that surrounds the heart. Doctors call this the pericardium.

    Symptoms: You might have heart palpitations or pain in your chest. You may also be short of breath or have a cough that won’t go away.

    Causes: Doctors aren’t sure. It’s unclear whether asbestos exposure causes mesothelioma in the pericardium.

    Diagnosis: Your doctor might order a test called an echocardiography. This will allow him to see how thick your heart tissues are. But he’ll need to do a biopsy to know for sure if you have this cancer.

    Treatment: If your cancer isn’t too advanced, your doctor might recommend a procedure called pericardiectomy. During this surgery, he’ll remove some or all of the pericardium. You might also need chemo .

    Testicular Mesothelioma

    This type is extremely rare. There have only been a few hundred reported cases.

    Symptoms: Because it’s so rare, there’s not a known, standard set of symptoms. But the one seen most often is a painless mass on the scrotum.

    Causes: Most often, it happens in men between ages 55 and 75. There’s a possible link to asbestos exposure, but doctors don’t know what the exact connection is.

    Diagnosis: Your doctor will likely perform an ultrasound of your scrotum. You might get a biopsy to see if there’s a mass. Or, your doctor will remove the tumor with surgery and analyze it to confirm the diagnosis.

    Treatment: Because this form of mesothelioma is so rare, it’s not well understood. Nor is there a standard treatment.

    WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 30, 2016

    Sources

    Mayo Clinic: “Mesothelioma.”

    Mesothelioma Applied Research Foundation: “Pericardial Mesothelioma — Symptoms of Pericardial Mesothelioma.”

    National Institutes of Health, National Cancer Institute: “Asbestos Exposure and Cancer Risk.”

    Mesothelioma + Asbestos Awareness Center: “Mesothelioma Types,” “Peritoneal Mesothelioma,” “Pleural Mesothelioma.”

    MesotheliomaHelp.org: “What Is Testicular Mesothelioma?” “What Is Pericardial Mesothelioma?”

    © 2016 WebMD, LLC. All rights reserved.


    Death and denial on the cancer ward: Refusing to accept reality can

    #care of terminally ill patient

    #

    Death and denial on the cancer ward: Refusing to accept reality can be shattering to family, study finds

    Tom Blackwell
    Friday, Sept. 14, 2012

    Naomi Kogan, a social worker at Montreal’s Jewish General Hospital, speaks with a patient undergoing chemotherapy at the hospital. Terminally ill patients who refuse to acknowledge their prognosis can cause their loved ones anxiety, depression and even rage, Kogan and two co-authors found in a newly published study. Christinne Muschi for National Post

    The single parent had been in hospital for months, suffering from terminal cancer but refusing to accept that death was near.

    Even the person’s two young children were unaware of the dire prognosis, recalls Naomi Kogan, a social worker at Montreal’s Jewish General Hospital who cared for the patient. Finally, last month, a teenage daughter arrived at the hospital to learn that her only parent would not be coming home — minutes before the person died.

    “The impact has been devastating, to have only an hour to say goodbye,” said the social worker. “The child is having major difficulties.”

    Related

    Yet such entrenched denial of terminal disease is a surprisingly common occurrence on the cancer ward, said Ms. Kogan, and a new study she and colleagues have just published suggests it can have a shattering impact on the family members who care for those patients.

    Relatives struggling to play along with the alternate reality sometimes have to turn a blind eye as the patient pretends to ignore dangerous symptoms, and are unable to share their own emotional turmoil over the illness, the researchers found. Sometimes, children are left completely in the dark.

    Ms. Kogan suggests that health-care workers dealing with those people face similar angst.

    It’s been such a difficult element in my work for all these years, so challenging and causing so much frustration

    “These [patients in denial] are people who until the end are carrying this protective mechanism like a tortoise shell,” she said in an interview. “It’s been such a difficult element in my work for all these years, so challenging and causing so much frustration.”

    The patients at the heart of her study, co-authored by Robin Cohen, a McGill University oncology professor, and Michelle Dumas, an Ottawa General Hospital nurse, acknowledge that they have cancer, but tend to minimize the seriousness of the condition that appears destined to kill them.

    Despite what would seem like unequivocal evidence to the contrary, one woman in the study remained convinced she would recover, and married her common-law partner — inside the palliative-care ward.

    Christinne Muschi for National Post Entrenched denial of terminal disease is a surprisingly common occurrence on the cancer ward, says social worker Naomi Kogan, seen talking with a chemotherapy patient at Montreal s Jewish General Hospital.

    When Ms. Kogan started her career 24 years ago, the psychiatry department would be summoned in an effort to help such patients face reality, but health-care workers no longer try to disavow them of their beliefs, now considered a coping mechanism that is useful to the patient, at least.

    A Montreal woman, who asked not to be named, said she and her family have been dealing with such a situation for several weeks. A close relative has stage-four cancer and likely has less than a year to live, yet until recently has cheerfully avoided the grim truth of her prognosis. She even talked from her hospital bed about running a half-marathon next year.

    She would act as though everything was just fine. It was impossible to even acknowledge she was sick. It was very frustrating and isolating

    “She would act as though everything was just fine,” said the relative. “It was impossible to even acknowledge she was sick. It was very frustrating and isolating.”

    For the study published in the journal Palliative and Supportive Care. Ms. Kogan’s team identified dying patients at the Segal Cancer Centre who were in denial, and arranged interviews with family caregivers of 16 of them.

    All said they felt it necessary to maintain their loved ones’ sense of denial, but that keeping up the pretence of normalcy took a toll in terms of anxiety, depression and even “feeling enraged.” Some said they were forbidden to dig up more information about the disease or ask probing questions of medical staff, or felt they could not make arrangements for funerals or future finances.

    More than half the patients went so far as to not get the care they needed, masking symptoms that might have prevented them from receiving more of the chemotherapy they considered life-saving, or that would drive home the dire state of their health, the study said.

    One patient refused to disclose such problems as severe diarrhea that should have prevented him from getting chemotherapy, went ahead with the treatment and almost died, prematurely, as a result. Another actually hid weights in his clothes so he would reach the minimum requirement to continue chemo, as patients who are too emaciated are not eligible, said Ms. Kogan.

    He’s been crying for the past three days. He’s got pain in the neck, pain in the back, and he doesn’t want me to talk about it

    Others would not acknowledge escalating pain, or refused to step up their medication levels in response. “He’s been crying for the past three days. He’s got pain in the neck, pain in the back, and he doesn’t want me to talk about it,” one caregiver told the researchers.

    Ms. Kogan said there is not a lot that health-care and social workers can do in the face of such denial, though sometimes they can counsel the family members about their own anguish over the situation, and try to help make practical arrangements.

    She said she was able to convince the single-parent patient, after much prodding, to prepare a will, without actually saying the person was dying. The will was a crucial tool for the family as the children started a new life with relatives.

    Elizabeth Beddard-Huber, an advance-practice nurse specializing in pain management at the B.C. Cancer Agency, said she also encounters patients in denial, an experience that can be stressful and “hard to watch,” especially when young children are involved. In one case, two teenagers were so troubled by their inability to talk frankly to their fatally ill mother, they began acting out at school, she said.

    Like the Montreal researchers, Ms. Beddard-Huber noted that such patients will hang on desperately to the hope of chemotherapy, decline pain medication and other palliative care, and occasionally look elsewhere when conventional medical treatment reaches a dead end.

    “Sometimes it gets to a point where they have to spend quite a bit of money to seek extra treatment and go to Mexico or to China or to the States for special treatment,” said Ms. Beddard-Huber. “They’re looking for that miracle.”





    End-of-life care for cancer patients varies widely at Boston-area hospitals – The

    #beth israel hospice

    #

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    Study says many patients enter hospice care too late

    By Deborah Kotz Globe Staff September 05, 2013

    Slightly more patients with terminal cancer are getting hospice care during the end of their lives, but they are still entering hospice care too late within days of death finds a new national analysis of Medicare patients conducted by Dartmouth researchers. And many are still dying in hospitals, often hooked to ventilators in an intensive care unit, despite studies showing that most cancer patients prefer to die at home.

    The percentage of end-stage cancer patients who died in the hospital decreased from 29 percent on average to 25 percent from 2003 to 2010, but there are huge variations among hospitals: In Massachusetts in 2010, about 13 percent of terminally ill cancer patients treated at North Shore Medical Center in Salem died there compared with 41 percent of those treated at MetroWest Medical Center in Framingham, according to the analysis released Wednesday from the Dartmouth Atlas Project .

    The project researchers receive funding from nonprofit groups to determine how medical resources are distributed and used in the United States. In the analysis, they also found that the percentage of cancer patients receiving hospice care rose nationwide from an average of 55 percent to 61 percent.

    These trends can be called encouraging, but most of the hospice care received was within the last three days of life, said Dr. David Goodman, lead author of the report. What s more, the average number of days patients spent in the intensive care unit during the last month of life increased by 21 percent, which Goodman said could be driven by hospitals looking for more generous insurance payments for expensive services.

    Massachusetts hospitals also had large differences in their utilization of ICU services during a patient s last month of life: A patient treated at Cape Cod Hospital spent two to three hours on average in the ICU compared with two to three days for someone treated at Lahey Clinic.

    Graphic: Hospital outcomes for terminal cancer patients

    There is no evidence anywhere that these variations are due to patients at these different hospitals having different preferences for their end-of-life care, said Dr. Lachlan Forrow, director of the ethics and palliative care programs at Beth Israel Deaconess Medical Center.

    Even among teaching hospitals differences existed in the approach to caring for terminally ill patients, with fewer than 20 percent of patients dying in hospitals such as Maine Medical Center and Dartmouth-Hitchcock, while more than 30 percent died in Boston Medical Center and Beth Israel Deaconess.

    I d like to think we do better than most places, Forrow said of Beth Israel Deaconess, but we don t do remotely as well as we should.

    His institution is beginning a program to ask all patients about their end-of-life preferences and to insert that information into their electronic health record so it s easily accessible to any physician treating them.

    Dr. Susan Block, chairwoman of psychosocial oncology and palliative care at Dana-Farber Cancer Institute, said it s vital for doctors to have such conversations with patients preferably when initially diagnosed with a terminal illness.

    Patient goals should be the biggest determiner of care and these goals should be set early enough in the illness process that patients can have the kind of ending that they want, she said.

    Far too often, doctors do not bring up the delicate issue of dying until patients are entering their last week or two of life, Block added, sometimes after they ve been hospitalized repeatedly or given aggressive chemotherapy for incurable cancers.

    Dana-Farber had 29 percent of its terminal patients dying in the hospital in 2010, which was above the national average.

    Nearly 60 percent of its patients were admitted to the hospital during the last month of life, and 24 percent wound up in the ICU.

    About 56 percent of terminal patients at Dana-Farber were enrolled in hospice care, spending an average of nine days there.

    To improve those statistics, the cancer center has been testing a communication checklist that oncologists can use to have end-of-life care conversations with patients.

    We re trying to measure whether these checklists will have an impact on providing patients with the kind of care they want at the end of their lives, Block said.

    Much of the success will probably depend on doctors having more truthful conversations about just how effective or ineffective aggressive treatments are for metastatic cancer.

    In a study published last year in the New England Journal of Medicine. Dana-Farber researchers found that 70 percent of patients with end-stage lung cancer in a national sample and 80 percent of those with terminal colorectal cancer did not report understanding that the chemotherapy they were receiving was unlikely to be curative.

    We re not doing as good a job as we should be in helping patients make informed choices, Forrow said.





    Terminally Ill Woman Brittany Maynard Has Ended Her Own Life – Cancer,

    #what is terminally ill

    #

    Terminally Ill Woman Brittany Maynard Has Ended Her Own Life

    By Nicole Weisensee Egan

    11/02/2014 AT 07:35 PM EST

    Brittany Maynard. who became the public face of the controversial right-to-die movement over the last few weeks, ended her own life Saturday at her home in Portland, Oregon. She was 29.

    “Goodbye to all my dear friends and family that I love. Today is the day I have chosen to pass away with dignity in the face of my terminal illness, this terrible brain cancer that has taken so much from me … but would have taken so much more,” she wrote on Facebook. “The world is a beautiful place, travel has been my greatest teacher, my close friends and folks are the greatest givers. I even have a ring of support around my bed as I type … Goodbye world. Spread good energy. Pay it forward!”

    Doctors told Maynard she had six months to live last spring after she was diagnosed with a likely stage 4 glioblastoma. She made headlines around the world when she announced she intended to die under Oregon’s Death with Dignity Act by taking a fatal dose of barbiturates, prescribed to her by a doctor, when her suffering became too great.

    “My glioblastoma is going to kill me and that’s out of my control,” she told PEOPLE last month. “I’ve discussed with many experts how I would die from it and it’s a terrible, terrible way to die. So being able to choose to go with dignity is less terrifying.”

    On Oct. 6, she launched an online video campaign with Compassion Choices. an end-of-life choice advocacy organization, to fight for expanding death-with-dignity laws nationwide.

    “For people to argue against this choice for sick people really seems evil to me,” she told PEOPLE. “They try to mix it up with suicide and that’s really unfair, because there’s not a single part of me that wants to die. But I am dying.”

    A Heartbreaking Choice

    Arriving at her decision was a gradual one, she said.

    “It’s not a decision you make one day and you snap your fingers,” she told PEOPLE.

    She said she began thinking about death with dignity in January when she was first diagnosed with a malignant brain tumor after coming across an article on it while researching possible treatments.

    RELATED: PHOTOS: Brittany Maynard’s Life and Legacy

    “Really, from the beginning, all the doctors said when you have a glioma you’re going to die,” she told PEOPLE. “You can just Google it. People don’t survive this disease. Not yet.”

    Doctors removed as much of the tumor as they could, but it came back larger than ever two months later, she said.

    After researching her options, she decided not to try chemotherapy or radiation.

    “They didn’t seem to make sense for me,” she said, because of “the level of side effects I would suffer and it wouldn’t save my life. I’ve been told pretty much no matter what, I’m going to die and treatments would extend my life but affect the quality pretty negatively.”

    In June, she moved to Oregon with her husband, Dan Diaz, 43, her mother, Debbie Ziegler, 56. and her stepfather, Gary Holmes, 72, so she could have access to the state’s Death with Dignity Act, which allows physicians to prescribe life-ending medication to certain terminally ill patients.

    Maynard originally told PEOPLE she’d chosen Nov. 1 to end her life, but on Thursday she released a new video saying she might not do it that day.

    “I still smile and laugh with my family and friends enough that it doesn’t seem like the right time now,” she said in the video recorded Oct. 13 and 14, “but it will come because I feel myself getting sicker; it’s happening each week.”

    Brittany Maynard and Dan Diaz

    Courtesy Brittany Maynard

    Her Final Months

    Maynard spent the last months of her life making the most of the time she had left. She traveled to Alaska, British Columbia and Yellowstone National Park with her loved ones and explored more local attractions like Olympic National Park in Washington.

    On Oct. 21, she and her family took a helicopter ride to the Grand Canyon. a place she’d been longing to see before she died.

    “It was breathtakingly beautiful,” she said in a statement.

    The following morning, though, she had her “worst seizure” so far, she said: “The seizure was a harsh reminder that my symptoms continue to worsen as the tumor runs its course.”

    Maynard said she was deeply touched by the “outpouring of support” she got after going public with her diagnosis and her decision.

    RELATED: Inside Brittany Maynard’s Vibrant Life

    “I want to thank people for that, for the words of kindness, for the time they’ve taken in personal ways,” she told PEOPLE.

    “And then beyond that, to encourage people to make a difference,” she said. “If they can relate to my story, if they agree with this issue on a philosophical level, to get out there and do what we need to do to make a change in this country.”

    Brittany Maynard and her mother, Debbie Ziegler, in Alaska in May

    Courtesy Brittany Maynard

    Maynard also talked to PEOPLE about her legacy.

    “For me what matters most is the way I’m remembered by my family and my husband as a good woman who did my best to be a good wife and a good daughter,” she said.

    “Beyond that, getting involved with this campaign, I hope to be making a difference here,” she said. “If I’m leaving a legacy, it’s to change this health-care policy or be a part of this change of this health-care policy so it becomes available to all Americans. That would be an enormous contribution to make, even if I’m just a piece of it.”

    Before she died, Maynard asked her husband and her mother if they would carry on the work she started to get death with dignity passed in every state.

    RELATED: Brittany Maynard Realizes a Wish: Inside Her Emotional Trip to the Grand Canyon

    “I want to work on the cause,” Ziegler told PEOPLE last month. “I have so much admiration for people who are terminally ill and just fight and fight. They are so dignified and brave. This is a different choice, but it is also brave and dignified.”

    She also shared with them her hopes and dreams for their future. Upstairs in the home she shares with her family are neatly wrapped Christmas and birthday gifts for her loved ones for the next year.

    “She made it clear she wants me to live a good life,” Ziegler says.

    In her second video, Maynard, who is an only child, said she hoped her mother does not “break down” or “suffer from any kind of depression.”

    And for Diaz, “I hope he moves on and becomes a father,” she said. “There’s no part of me that wants him to live out the rest of his life just missing his wife.”

    Brittany Maynard (third from left) and her family at the Grand Canyon Oct. 21

    Courtesy Brittany Maynard

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    Colorado State University Flint Animal Cancer Center – Fort Collins, Colorado –

    #palliative radiation therapy

    #

    Radiation Therapy

    Radiation therapy, surgery and chemotherapy are the 3 most common modalities used in the treatment of cancer. Radiation therapy and surgery are the only modalities that can locally control solid tumors such as carcinomas and sarcomas. Radiation therapy can also be used to provide relief of pain, or improve function in patients suffering from advanced cancers. Radiation therapy has been used for over 100 years, but technical advancements in the last decade have vastly improved the ability to deliver dose specifically to the tumor while sparing normal tissue structures. Learn about the Varian Trilogy Radiation Therapy Machine .

    What is radiation therapy?

    Radiation therapy uses ionizing radiation to damage the DNA in tumor cells, resulting in tumor cell death. The most common type of radiation therapy is external beam radiation therapy, also known as teletherapy. Teletherapy is delivered by a radiation producing machine like a linear accelerator, or from a machine housing a radioactive source, such as a cobalt machine. The patient is precisely positioned on a table, also called a couch, near the machine. Radiation travels from the machines to the patient, where the radiation dose is delivered to the tumor and surrounding normal tissues. While the patient remains in the exact same position, the machine actually revolves around the patient so that radiation is delivered from many different angles. Each treatment takes just a few minutes and does not cause any discomfort.

    How does radiation therapy work?
    Radiation therapy kills cells by damaging the DNA. The damage is from the localized release of ionizing radiation, which can damage the DNA directly, or more commonly, through the formation of oxygen free radicals. The cells generally do not die until the cell goes to divide. This is known as mitotic cell death. One of the reasons it is effective against cancer cells is that cancer cells are routinely dividing. Radiation can also cause a more immediate death in some cancers cells, called apoptotic cell death. This is seen frequently in tumors such as lymphoma.

    What are the goals of radiation therapy?
    Radiation is usually administered with the goal of achieving long term tumor control. This is referred to as radiation therapy with curative intent . Depending on the part of the body bearing the tumor, most veterinary patients treated with curative intent protocols are treated over a 3-4 week period. A small fraction of radiation is delivered each day. Sometimes,depending on the location, there can be side effects, known as acute effects from this type of treatment. New technology is helping us minimize acute effects.

    What is palliative radiation therapy?
    Sometimes radiation is administered to relieve the patient of pain and/or improve regional function and hygiene. This is referred to as palliative radiation therapy . Palliative protocols are most commonly used when the patient has advanced cancer with tumor spread to other locations, or some other critical condition that would limit life expectancy. These protocols vary and may involve weekly treatments or treatments given over the course of a few days. Palliative radiation therapy usually relieves pain and may even cause the tumors to shrink a bit and rarely cause acute effects. Unfortunately the duration of patient response is far shorter than patients treated with more aggressive (curative) protocols.

    Which patients get acute effects and why?
    Patients treated with curative intent radiation therapy may develop side effects, called acute effects during or shortly after treatment. New radiation technological advances, such as the Varian Trilogy linear accelerator at CSU, are able to decrease the severity of, or even eliminate acute effects for tumors in some parts of the body. Nasal tumors, bladder and prostate cancers, oral tumors and brain tumors now have minimal acute effects. Unfortunately, when tumors are located close to the skin surface, it is necessary for the skin to receive radiation doses that may cause discomfort. Your clinician will discuss potential side effects with you prior to treatment.

    What is SRT and how is it different from curative intent or palliative
    radiation therapy?

    Stereotactic Radiation Therapy (SRT) is also called stereotactic radiosurgery, gamma knife therapy and cyberknife therapy. There is no surgery involved, rather it got the name because the radiation is a precise as a scalpel at focusing on the tumor. SRT protocols are generally delivered in 1-5 fractions (doses) on consecutive or alternating days. SRT requires special radiation therapy equipment including the ability to confirm the location of the patient and tumor right before therapy that is the stereotactic aspect that the Trilogy provides. For some tumors, SRT can be used with curative intent. For other tumors it is used for palliation, but for far more durable palliation than what can be achieved using traditional methods. SRT is easy on the patient and client because treatment can be completed in such a short period of time and acute radiation effects are minimal. However, it is not indicated for all tumor types/location. Ask an ACC oncologist if this is an option for your pet.

    What are the most common tumors treated with radiation therapy?
    The most common tumors treated in dogs and cats are brain tumors, pituitary tumors, tumors of the body and extremities (soft tissue sarcomas, mast cell tumors, vaccine associated sarcomas), lymphoma, nasal tumors, oral tumors, bladder tumors, prostate tumors, perianal tumors, and bone tumors.





    Role of Radiation Therapy in Palliative Care of the Patient With Cancer

    #palliative radiation therapy

    #

    • ©American Society of Clinical Oncology

    Role of Radiation Therapy in Palliative Care of the Patient With Cancer

    1. Stephen T. Lutz ⇑.
    2. Joshua Jones and
    3. Edward Chow
    1. Stephen T. Lutz, Blanchard Valley Regional Cancer Center, Findlay, OH; Joshua Jones, University of Pennsylvania, Philadelphia, PA; Edward Chow, University of Toronto, Toronto, Ontario, Canada.
    1. Corresponding author: Stephen T. Lutz, MD, Blanchard Valley Regional Cancer Center, 15990 Medical Dr South, Findlay, OH 45840; e-mail: slutzbvha.org.

    Abstract

    Radiotherapy is a successful, time-efficient, well-tolerated, and cost-effective intervention that is crucial for the appropriate delivery of palliative oncology care. The distinction between curative and palliative goals is blurred in many patients with cancer, requiring that treatments be chosen on the basis of factors related to the patient (ie, poor performance status, advanced age, significant weight loss, severe comorbid disease), the cancer (ie, metastatic disease, aggressive histology), or the treatment (ie, poor response to systemic therapy, previous radiotherapy). Goals may include symptom relief at the site of primary tumor or from metastatic lesions. Attention to a patient’s discomfort and transportation limitations requires hypofractionated courses, when feasible. Innovative approaches include rapid response palliative care clinics as well as the formation of palliative radiotherapy specialty services in academic centers. Guidelines are providing better definitions of appropriate palliative radiotherapy interventions, and bone metastases fractionation has become the first radiotherapy quality measure accepted by the National Quality Forum. Further advances in the palliative radiation oncology subspecialty will require integration of education and training between the radiotherapy and palliative care specialties.

    This Article