A recent study published in The Journal of Clinical Oncology shows that some new cancer patients are having trouble remembering the details of the conversation they had with their doctor concerning their diagnosis. In fact, it was determined that many of these patients remembered less than half of what their doctor had told them. "In general, patients do not hear much of what is said after bad news is delivered," the researchers wrote.

The study consisted of 260 individuals that had been diagnosed with cancer and were attending their first appointment with their medical or radiation oncologist. The average duration of the appointment was 30 minutes and they were all tape recorded.

The study found that patients under the age of 65 were able to recall 49.5% of what they were told by the doctor. Patients over 65 were able to recall 48.4% of what they were told. Older patients were less likely to ask as many question as younger ones, and the people who asked more questions actually retained less of the information. Patients who were given a grimmer outlook on their condition tended to remember less.

Dr. Jay Brooks, chairman of hematology and oncology at Ochsner Health System, suggests that patients bring family or friends to their initial oncologist appointment as it can be an overwhelming experience. It isn’t always possible for a family or friend to be present; however, Brooks suggests that doctors provide each patient with a written copy or audio recording of their pathology reports and the specifics of their treatment plan. The patient is then able to go home and digest all of the information, and then come back 3 to 5 days later to discuss it with their doctor.

In the September issue of the International Journal of Radiation Oncology-Biology-Physics, researchers at the University of Pennsylvania Department of Radiation Oncology in Philadelphia and the Radiation Oncology Branch of the National Cancer Institute in Bethesda, Md. published an article stating that most cancer patients currently receive insufficient pain management therapy.

The conclusion was determined with information from an internet-based questionnaire given to patients of radiation treatment.  One-hundred and six patients completed the survey which evaluated their medication use, pain control and attitudes toward pain medication, including prescription and over-the-counter pain medications.

For some patients, cancer pain is caused by the disease itself or chronic inflammatory changes or infections.  In other cases, cancer treatment can be the source of pain.  When managed improperly, pain can cause unnecessary anxiety, thus perpetuating illness.

The study found that 58 percent reported pain from their cancer treatment and 46 percent of patients reported pain directly from their cancer, yet 80 percent of those patients said that they did not use medication to manage their pain.  According to Science Daily, "Most patients said the main reason they did not take pain medication was because their healthcare provider did not recommend it. This reason was followed by a fear of addiction or dependence and the inability to pay. Some patients also reported using alternative therapies for pain relief, including physical therapy, massage and acupuncture."

The researchers said the key to proper pain management is effective communication.  "To eliminate barriers to optimal pain management for cancer patients, healthcare providers should talk with their patients about pain symptoms and pain medications," said Charles Simone, M.D., a resident at the National Cancer Institute Radiation Oncology Branch in Bethesda, Md. and lead author of the study.

Next month, the nation will join together to spread the word about mesothelioma. September 26^th, 2008 is National Meso Awareness Day and we encourage everyone to help raise awareness about mesothelioma and the dangers of asbestos. The momentous day is also a time to pay honor to those currently struggling with the disease and for those who have lost their battle to this terrible disease.

Although September 26^th is more than a month away, there is still a lot people can do before the day arrives. For instance, Jordan Zevon, son of beloved musician Warren Zevon, has a radio campaign designed to bring awareness to mesothelioma. Warren Zevon was a legendary singer and songwriter who died of mesothelioma in September 2003. Between now and September 26^th, people are encouraged to contact their local radio stations and request Warren Zevon’s music, which will be followed by a 20 second segment where Jordan Zevon speaks out about mesothelioma. Secondly, individuals can help by contacting their local government officials to declare September 26^th as Meso Awareness Day in their areas.

A recent study conducted by Dr. Suzanne Audrey, at the University of Bristol, and her colleagues found that patients with incurable cancer are often not clearly informed of what they stand to gain from palliative chemotherapy. As a result, patients may lack sufficient knowledge to make a decision based on informed consent.

The researchers observed and recorded 9 oncologists and 37 patients during consultations in which palliative chemotherapy for advanced lung, pancreas, or colon cancer was first discussed. The researchers found that in all cases, patients were told that their cancer was incurable. They were also informed about treatment options, common side effects and the associated risks in the different treatment options. However, in 8 cases, survival was not discussed at all. In an additional 18 cases, information was "vague," involving comments such as "about 4 weeks, a few months extra, and buy you some time." Moreover, only 6 patients were given numerical data about how much longer they would likely live if palliative chemotherapy were used.

"If the oncologist focuses on the benefits of palliative chemotherapy in terms of control of symptoms and quality of life, but omits information about survival benefit, the patient might assume much greater potential to prolong life than is likely to be the case," Audrey and colleagues suggest.

The authors of this study believe that oncologists should not evade the subject of life expectancy. Instead, they recommend that oncologists receive coaching on how to inform patients without taking away hope.

Researchers affiliated with a multi-center U.S. trial reported in the July 20, 2008 issue of the Journal of Clinical Oncology that the combination of Alimta® (pemetrexed) and Gemzar® (gemcitabine) was active in patients with peritoneal mesothelioma.

Peritoneal mesothelioma is much less common than pleural mesothelioma, making up less than 20% of all cases. Moreover, the latency period for peritoneal mesothelioma (sometimes referred to as abdominal mesothelioma) appears to be 20-30 years, which is shorter than the latent period for pleural mesothelioma. The most common treatment strategy for peritoneal mesothelioma involves a multimodality approach with surgical debunking followed by systemic and/or intraperitoneal chemotherapy.

Due to the relative rarity of this disease, controlled trials of various treatment options are not available for peritoneal mesothelioma. Therefore, few studies of chemotherapy for peritoneal mesothelioma, treatment regimens are derived from studies in patients with pulmonary mesothelioma.

This current study involved 20 patients treated between 2002 and 2004. Patients received Alimta and Gemzar every 21 days. In addition, patients also received folic acid, vitamin B12, and dexamethasone. The results from the study are listed below.

- The overall response rate was 15%.

- The disease control rate was 50%.

- The median time to disease progression was 10.4 months.

- The median survival time was 26.8 months.

- Toxicities appeared to be tolerable but with a grade 3-4 neutropenia rate of 60%.

The researchers have concluded that Gemzar and Alimta is an active regimen that is an alternative to standard therapies. This is one of the first studies devoted to systemic chemotherapy treatment of peritoneal mesothelioma and provides important baseline information.

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