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OncOlOgy Times The Independent

Hem/Onc News Source

November 10, 2012 ] Vol. 34 ] No. 21[ News ] Analysis ] Commentary ] Controversy ]

Publishing for

34 Years

oncology-times.com

[ A L S O ] SHOP TALK � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �5

Lymphedema’s Emotional Challenges � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 9

Breast Cancer: New Data for Calculating Cardiotoxicity Risk � � � � � � � � � � � � � � � � � � � � � � � � � � � �22

JOE SIMONE: Pogo and American Health Care � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �28

GEORGE SLEDGE: On Cross Training� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �30

Esophageal Cancer: Gefitinib Second-Line Therapy for Select Patients � � � � � � � � � � � � � � � � � � � � �31

BOOKS: ‘Planned Bullyhood’� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �34

How Health IT is Changing the Practice of Oncology: Clinical Decision Support � � � � � � � � � � � �35

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Controlling Spiraling Costs of Cancer Called Moral Imperative

BY PEGGY EASTMAN

Holding down costs is both a professional and moral responsibility, said

speakers at an Institute of Medicine National Cancer Policy Forum meeting

on delivering affordable cancer care while improving quality�

Page 18

Best Practices & Teamwork Help Reduce Pediatric Central Line Infections p.24

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Breast Cancer Symposium: Predictive Updates pp.20, 23

The Survivorship Care Gap: Psychosocial Care—Making It the Standard p.10

9oncology tim

es • november 10, 2012 • oncology-tim

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DALLAS—Lymphedema contin-ues to be a side effect of cancer treatment, and even with the best therapy available it is a

chronic condition� Dealing with a condi-tion that can be disfiguring as well as dis-abling weighs so heavily on some patients that they can become noncompliant with

therapy, says a clinical psychologist who specializes in the problem�

“Patients consistently say that lymphedema is harder to deal with than the cancer was,” Elizabeth McMahon, PhD, of Kaiser Permanente in San Francisco, said here at the National Lymphedema Network

(NLN) Conference, co-sponsored by NLN and the University of Chicago Pritzker School of Medicine�

In an interview after her presentation, she noted that although cancer patients typically have social support and the dis-ease is usually time limited—i�e�, in the sense that “you have it or you don’t, and

Lymphedema’s Emotional ChallengesBY ROBERT H. CARLSON

everyone knows what it is—most people don’t know what lymph-edema is, and it’s not life threat-ening the way that cancer is; you survive the cancer and everybody says that’s wonderful, but then they want you to move on�”

Lymphedema, though, is pro-gressive if not treated, it can’t be cured, it can be visible and dis-abling, it requires constant self care, and is a daily reminder that the patient has had breast cancer—“It reminds patients that they have a chronic illness, and it carries a nega-tive emotion�

“And so there are patients who don’t comply because they feel over-whelmed—It can feel easier to just give up,” said McMahon, who wrote a book on the topic several years ago called Overcoming the Emotional Challenges of Lymphedema�

NLN Founder and Executive Director Saskia Thiadens, RN, though, said that the majority of patients are compliant with therapy: “Once they really understand the consequences of untreated lymph-edema, they are compliant, they listen to the therapist,” she said� “If they don’t [adhere to therapy] then obviously the limb becomes worse and they have to see a therapist again�”

Oncologists are in an ideal po-sition to give patients information about lymphedema risk reduction and the importance of adherence to treatment, but they rarely have time to educate patients, said Thiadens, who advocates comprehensive pro-grams for patient education as well as early detection of lymphedema when it is in the subclinical stage and the risk of becoming chronic or progressive can be reduced or avoided�

“In the real world, physicians see the patients quickly, they don’t have the time for that�”

McMahon said breast cancer pa-tients who are not warned of the risk and who develop lymphedema feel “incredibly angry and betrayed by their surgeons and their physi-cians”—another reason it is so im-portant for physicians to provide the information� O

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