本帖最後由 goodcat1111 於 2009-3-29 06:54 編輯
作者：Nick Mulcahy
出處：WebMD醫學新聞
March 13, 2009(佛州好萊塢) — 一個由臨床專家、有名之癌症病患、國際記者組成的多元小組在國家綜合癌症網絡(NCCN)第14屆年會中表示，多種癌症的成功治療，可改善存活，朝向多種與生存相關的挑戰。
小組成員、紐約市Sloan-Kettering紀念癌症中心的Mary S. McCabe表示，診斷與治療的進步，造成了一群需要我們提供有品質照護的病患。其中有些挑戰是新的，像是與治療有關的骨骼健康問題，其他有些是由來已久的，如臨終諮商。
McCabe小姐向Medscape Oncology表示，現在是對生存提高關注的時候了，她相信，2005年的醫學研究中心報告「從癌症病患到癌症存活：轉變中所失去的(From Cancer Patient to Cancer Survivor: Lost in Transition)」是聚焦於此議題的最佳催化劑之一。
第3期黑色素瘤存活者、ABC新聞資深主播Sam Donaldson主持的此一小組將廣泛討論此一行動。
Donaldson先生詢問小組成員密西根大學綜合癌症照護中心的Douglas W. Blayney醫師，當你告訴我們治療看來有效時，快樂的日子來臨，但是你如何幫助我們更進步？
Blayney醫師表示，密西根大學聚焦在 「轉變時的訪視」，將它視為癌症治療與生存期之間的橋樑。他指出，轉變訪視是病患於診斷後，第二段非常緊張的時間。
他表示，轉變訪視確認存活者須諮商的所有事情，例如運動、骨骼健康，若有需要，還包括戒菸，適度協助病患朝向自我管理性生活與壓力等事務；但是我們不知道應該是腫瘤科醫師來告知，還是執業護士、醫師助手、一線照護醫師來進行癌症病患的轉變訪視。
Blayney醫師表示，美國臨床腫瘤協會目前正遊說Medicare給付轉變照護。
兩位病患強調，照護者須改變面對存活者的態度。
乳癌存活者、參議員John Edwards的妻子Elizabeth Edwards表示，身為一名癌症病患，你需要的醫師，除了時間與資訊之外，還要對你尊重，是在疾病威脅仍然存在的這幾年間，而不是只有在你治療結束時興高采烈。
癌症存活者國家聯盟的Ellen L. Stovall表示，癌症診斷是創傷，但是醫療專業人士的治療訓練並非如此；我們需要被尊重、被愛、被關懷。
Edwards女士也指出，儘管她無法治癒乳癌惡化，她從未和醫師討論過死亡，她表示，這種對話未曾發生。
小組成員、紐約時報健康版的記者Jane Brody插話表示，這也是我撰寫《Jane Brody's Guide to the Great Beyond》這本關於臨終與死亡新書的原因。
Blayney醫師反對將腫瘤病患在第2或第3次門診時就提出個別的預後視為理所當然，因為需考慮到有效的溝通，禮貌上也該如此。
【NCCN在指引中加入有關生存的段落】
NCCN已經開始將生存加入指引中，今年在大腸直腸癌與非小細胞肺癌指引中新增有關存活的段落。
臨床資訊與出版物資深副總裁Joan McClure在聲明中表示，存活是NCCN的一個新焦點，這是令人振奮的，因為對腫瘤科醫師帶來挑戰。NCCN大腸癌小組主席歡迎這些觀點。
Fox Chase癌症中心的Paul F. Engstrom醫師在發表指引中有關生存段落的最新資料前表示，我樂於見到此小組於稍早有關生存的討論。
在NCNN大腸直腸癌指引更新版中，Engstrom醫師描述這一群病患的生存原則，包括需要持續的大腸直腸癌監控以及乳癌、子宮頸癌、前列腺癌篩檢。
他表示，有關存活者之長期腹瀉與神經病變、骨盆放射線相關骨骼健康問題以及性功能不佳等，醫師處置後遺症已經成為一門藝術。
Engstrom醫師也強調，健康可顯著改善大腸癌病患的存活，活動力較高者比活動力較低者佳。我們需要告訴所有病患，運動有助於癌症特定與整體死亡率之改善。
研究者宣告沒有相關財務關係。
國家綜合癌症網絡第14屆年會：發表於2009年3月12日。
NCCN 2009: Cancer Survivorship Takes Center Stage
By Nick Mulcahy
Medscape Medical News
March 13, 2009 (Hollywood, Florida) — The successful treatment of many forms of cancer has improved survival to such an extent that it is has bred myriad challenges associated with survivorship, said a diverse panel of clinician experts, well-known cancer patients, and national journalists here at the National Comprehensive Cancer Network (NCCN) 14th Annual Conference.
"Advances in diagnosis and treatment have created a population that we need to figure out how to provide quality care for," said panel member Mary S. McCabe, RN, from Memorial Sloan-Kettering Cancer Center, in New York City.
Some of the challenges are relatively new, such as bone-health issues associated with treatments, whereas others are long-standing, such as end-of-life discussions.
"Now is the time for significant action [on survivorship]," Ms. McCabe told Medscape Oncology. She believes that the 2005 Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition, has been one of the prime catalysts for focusing attention on the issue.
The action needed was extensively discussed by the panel, which was moderated by Sam Donaldson, a stage?3 melanoma survivor and ABC news veteran anchor.
"The happy day comes when you tell us that the treatment appears to be efficacious, but what do you do to help us move on?," Mr. Donaldson asked panel member Douglas W. Blayney, MD, from the University of Michigan Comprehensive Cancer Care Center, in Ann Arbor.
Dr. Blayney said that the University of Michigan focuses on the "transition visit" as a bridge between the treatment and survivorship phases of cancer. The transition visit is the "second most stressful time" for the patient after diagnosis, he added.
The transition visit is the defining episode for all things that survivors need.
"The transition visit is the defining episode for all things that survivors need [counseling in], such as exercise, bone health, and if appropriate, smoking cessation, and is the time to nudge patients toward self-management of sexual health, stress, [and other matters]. But we don't know if the oncologist is the person to do that," he said, noting that nurse practitioners, physician assistants, and primary-care physicians are also candidates for the task of managing a cancer patient's transition visit.
The American Society for Clinical Oncology is currently lobbying to get Medicare to pay for this transition care, said Dr. Blayney.
Two patient advocates emphasized a need for changes in attitude toward survivors among caregivers.
As a cancer patient, you need a physician that has time and information and respect for you — not just on the celebratory day that your treatment is over.
"As a cancer patient, you need a physician who has time and information and respect for you — not just on the celebratory day that your treatment is over, but in the years ahead when the sword of Damocles still hangs over your head," said Elizabeth Edwards, a breast cancer survivor and wife of Senator John Edwards (D-South Carolina).
"A diagnosis of cancer is a trauma, but medical professionals are not trained to treat it that way," said Ellen L. Stovall, from the National Coalition for Cancer Survivorship. "We need to be respected, loved, and cared for," she said.
Ms. Edwards also noted that, despite the progression of her incurable breast cancer, she has never had a discussion about death with a clinician. "That conversation does not take place," she said.
"That's why I wrote Jane Brody's Guide to the Great Beyond," chimed in panel member Jane Brody, a health columnist for The New York Times, in reference to her new book on death and dying.
Dr. Blayney countered that he "proactively" introduces the subject of an individual's prognosis during a second or third clinic visit with oncology patients as a matter of course because it allows for effective communication and it is the "polite thing to do."
NCCN Adds Survivorship Sections to Guidelines
The NCCN has begun to incorporate survivorship into its guidelines, starting with new survivorship sections this year in the colorectal cancer and nonsmall-cell lung cancer guidelines.
"Survivorship is a new focus for NCCN," said Joan McClure, MS, senior vice president of clinician information and publications, in a statement, adding that it was "exciting" because of the "challenges" that it presented oncologists.
The chair of the NCCN Colon Cancer Panel welcomed the emphasis.
"I was pleased to see the panel discussion [of survivorship] this morning," said Paul F. Engstrom, MD, from the Fox Chase Cancer Center, in Philadelphia, Pennsylvania, before delivering the update of his panel's guidelines, including the survivorship section.
In his presentation, NCCN Colon and Rectal Cancers Guidelines Update, Dr. Engstrom outlined the principles of survivorship in this population, including the need for ongoing colorectal cancer surveillance and screening for breast, cervical, and prostate cancer.
"Managing late sequelae has become an art," he said about clinicians' experiences with the chronic diarrhea and neuropathy of survivors, as well as pelvic radiation-induced bone-health problems and sexual dysfunction.
Dr. Engstrom also emphasized the finding that exercise can significantly improve survival among colon cancer patients and that higher levels of activity are better than lower levels. "We need to tell all patients that exercise will help with cancer-specific and overall mortality," he said.
The researchers have disclosed no relevant financial relationships.
National Comprehensive Cancer Network (NCCN) 14th Annual Conference: Presented March 12, 2009. |
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