Communication in Cancer Care

Communication in Cancer Care is a PDQ (Physician Data Query) summary** which outlines good communication skills among patients, family members, and health care providers. Good communication in all phases of cancer care contributes to the well being of the patient and improves quality of life.

The Communication in Cancer Care Web site has a patient version, a health professional version, and a Spanish language version.

The patient version addresses issues as the roles of family givers and parents, how to talk with the health care team (including the importance of checklists and record keeping)
and where to find more information on communicating effectively in cancer care settings.

The health professional version outlines factors and outcomes related to communicating effectively, how to communicate effectively in cancer care settings, and information on training programs and clinical trials.

On a related note, this is an example of why good communication is important in cancer care…

The Perils of Taking Experimental Cancer Drugs [Reuters Health, Oct 26,2010, by Frederik Joelving]

[Excerpt]

NEW YORK (Reuters Health) – Trying a new, experimental cancer drug may offer a glimpse of hope for very sick patients, but often does more harm than good, a new study shows.

Researchers said cancer doctors regularly resort to drugs still undergoing testing, as long as they have been approved for other diseases or in different combinations or doses.

But because the science is still up in the air, nobody really knows what the consequences of taking such drugs are.

“Many of these drugs end up not being the tremendous improvement that we hoped they would be,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who was not involved in the new study.

“People need to realize that because the trials have not been completed there is a great deal that is not known about the treatments,” he told Reuters Health. “There are people who get these treatments and get hurt.”

The new study, published in the Journal of Clinical Oncology, looked at 172 clinical trials published over two years. [Editor Flahiff's note : Ask a reference librarian at a local public, academic, or medical library for availability and if any fee is involved]

Less than a third of the clinical trials showed the experimental drugs improved patient survival, and less than half found the drugs helped other clinical outcomes…..

……

Sometimes, of course, new drugs do work, and no one argues that doctors shouldn’t be allowed to prescribe medications they think will help patients.

But doctors should be very clear about the high risks involved. One way to do that, said Peppercorn, would be to require that cancer doctors get informed consent from patients before they start them on experimental drugs.

In the end, Brawley said, the decision to use such treatment should be left to the patient and his or her doctor.

“There are times when it can be justified,” he noted, “but it is done far more often than it should be.”

 

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**PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI’s Web site athttp://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

Clinical Trials and Systematic Reviews: Managing Information Overload

From the blog Open Medicine dated October 4th, 2010

Bastian H, Glasziou P, Chalmers I (2010) Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med 7(9): e1000326. doi:10.1371/journal.pmed.1000326

Published: September 21, 2010

• When Archie Cochrane reproached the medical profession for not having critical summaries of all randomised controlled trials, about 14 reports of trials were being published per day. There are now 75 trials, and 11 systematic reviews of trials, per day and a plateau in growth has not yet been reached.
• Although trials, reviews, and health technology assessments have undoubtedly had major impacts, the staple of medical literature synthesis remains the non-systematic narrative review. Only a small minority of trial reports are being analysed in up-to-date systematic reviews. Given the constraints, Archie Cochrane’s vision will not be achieved without some serious changes in course.
• To meet the needs of patients, clinicians, and policymakers, unnecessary trials need to be reduced, and systematic reviews need to be prioritised. Streamlining and innovation in methods of systematic reviewing are necessary to enable valid answers to be found for most patient questions. Finally, clinicians and patients require open access to these important resources. [editor Flahiff's emphasis]
  

If the results of a clinical study are published in a scientific journal, PubMed is the best way to search for information about the article. If you are having challenges searching PubMed, consider the tutorial at the home page of PubMed. You may also ask a reference librarian at a local public, academic, or medical library. Call ahead to see what level of assistance they offer.

Clinicaltrials.gov has the voluntary summaries of some clinical trials. Advanced search has the option Study results (select Studies With Results). Some results may be labelled “proprietary” (information not released to the public, sometimes called “industry secrets” ).

Tropical Disease Research

Tropical diseases affect millions of people with effects ranging from extreme pain to permanent disability to death.
Currently the National Institute of Allergy and Infectious Diseases (NIAID) conducts research and clinical studies for many of these diseases (examples of tropical diseases may be found here).

If you would like to volunteer for clinical trials on tropical diseases, go here for further information.

Additional Information on Tropical Diseases

**Control of Neglected Tropical Diseases (World Health Organization)
**Traveler’s Health(Centers for Disease Control and Prevention)

How to Read a Research Paper (and also Understand Health News Research Items)

Biomedical research results are increasingly available to the public. However, caution is urged in interpreting results. For example, be very careful to not confuse causation with association.

(A recent news item about insulin use and cancer is very controversial. Some say insulin use can cause cancer, while others insist insulin users are predisposed to cancers.)

The MedlinePlus Topic Page Understanding Medical Research has links to tutorials, overviews, and more

A sampling of links

**Increasing Knowledge — How to Read a Research Paper(Lewy Body Dementia Association)

** Clinical Research & Clinical Trials(National Institute of Child Health and Human Development)

**Making Sense of Medical News (Nemours Foundation)

Related Blog Items

“Summaries for Patients” and other plain language summaries help patients and others understand medical studies and guidelines

Related articles

• NLM released several exciting enhancements that improve users’ ability to share and consume MedlinePlus content: (jflahiff.wordpress.com)
• Improving Health Care Decisions By Putting Research Into Practice (jflahiff.wordpress.com)

Cancer Docs ‘Frustrated’ By Lack of Useful Info in Journal Articles

 

 

 

Excerpts from the news article:

Medical journals should include more clinical details in cancer research studies to help doctors better understand and utilize results, according to U.S. researchers.

[The researchers] analyzed 262 articles published from 2005 to 2008 in the Journal of Clinical Oncology, The New England Journal of Medicine, the Journal of the National Cancer Institute, and the journals Cancer and Blood.

Only 11 percent of the articles offered all the information required by doctors in order to prescribe and monitor new cancer therapies, said the researchers at the University of Florida in Gainesville.

The dose of the drug was almost always reported in the articles, but only 43 percent reported what premedication was necessary, and only 42 percent provided details about adjusting dosages if the therapy proved toxic to patients.

Challenges to FDA’s Ability To Monitor and Inspect Foreign Clinical Trials

In fiscal year 2008,  80 percent of approved marketing applications for drugs and biologics contained data from foreign clinical trials. Over half of clinical trial subjects and sites were located outside the United States. 

This poses major challenges to the US Food and Drug Administration (FDA) in monitoring and inspecting clinical trials worldwide.
Report’s findings include the following:

•  FDA should require standardized electronic clinical trial data and create an internal database
• FDA should monitor trends in foreign clinical trials not conducted under INDs.
• FDA should continue to explore ways to expand its oversight of clinical foreign trials.

A related news item may be found here. 

The complete report may be found here.