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MIAMISBURG, Ohio, Sept. 25 /PRNewswire/ -- Sexuality and cancer and breaking bad news to cancer patients are two featured articles in the current issue (Vol. 5, Number 4, 2000) of The Oncologist, an international peer-reviewed journal for physicians entrusted with the care of cancer patients.
Both articles address the increasing importance of understanding the various psychosocial issues that affect both the clinician and the patient when discussing information deemed uncomfortable to both parties. The articles also offer practical guidelines for overcoming these hurdles to assure the most effective comprehensive care for patients.
"Sexuality and Cancer: Conversation Comfort Zone" focuses on discussions from the Schwartz Center Rounds at Massachusetts General Hospital. The Rounds are a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced both by patients and their families as well as the caregivers themselves. The Oncologist presents these discussions as a regular feature.
According to lead author Dr. Richard T. Penson and colleagues from Mass General's hematology-oncology department, discussing sexuality with cancer patients is probably the single-most uncomfortable topic for the medical profession. Yet, many cancers and treatments significantly affect sexual function and the psychosocial dimensions may be profound.
The multidisciplinary Schwartz team of oncologists, urologists, nurses and social workers conducted two separate rounds to look at ways of discussing male and female sexuality with the patient without jeopardizing other aspects of the patient-physician relationship.
The first case dealt with a prostate cancer patient considering treatment options for early stage disease. The second discussion involved two patients with gynecological cancers, one of whom had a colostomy following ovarian cancer surgery and one who was not eligible for vaginal reconstruction after treatment for recurrent squamous cell carcinoma of the vagina.
The authors noted that since patients do not generally volunteer information about sexual problems, it is incumbent upon health professionals to inquire about sexual function. They found that patients -- especially those who had significant apprehensions and problems -- often reacted with relief rather than embarrassment.
The Schwartz team concluded that a sensitive and informed approach to discussing sexuality provided effective support and that successful dialogue could be fostered using the PLSSIT (Permission; Limited Information; Specific Suggestions; Intensive Therapy) model of counseling for sexual assessment and rehabilitation in cancer care.
"SPIKES -- A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer" is an original paper by Dr. Walter F. Baile of University of Texas MD Anderson Cancer and colleagues from MD Anderson and Toronto-Sunnybrook Regional Cancer Centre.
Developed by the authors, the protocol offers healthcare providers specific guidelines for delivering unfavorable news to cancer patients about their illness. It also recognizes that from 1950-1980 -- when treatment prospects for cancer were bleak -- many physicians considered it inhumane to patients to discuss bad news about their diagnosis; while, today -- with the clinical advances made during the last two decades -- it has become more important than ever to develop effective communication skills to discuss other bad news such as recurrence, spread of illness and serious drug side-effects.
The goal of the SPIKES protocol is to enable the clinician to fulfill the four most important objectives of the interview during which bad news is revealed: gathering information from the patient; transmitting the medical information; providing support to the patient; eliciting the patient's help in developing a plan for the future.
A survey of 500 participants at the 1998 meeting of the American Society of Clinical Oncology (ASCO) showed that 99 percent of respondents found the SPIKES protocol to be practical and easy to understand.
According to the paper, healthcare providers using the protocol reported increased confidence in their ability to deliver bad news to a patient. The authors suggest that oncology training include essential communications skills for physicians. They are subsequently looking at how physicians delivering bad news are affected psychologically and physiologically and how reducing the stress for the bad-news bearer can also improve the interview and support of the patient.
Other articles in this issue of The Oncologist include highlights from the ASCO 2000 meeting on ovarian, lung and breast cancers and hematologic malignancies; several clinical articles on prophylactic cranial irradiation in patients with small-cell lung cancer, intracranial germ cell tumors, prognostic features in treating childhood acute lymphoblastic leukemia; and a molecular perspective on the mechanism whereby the taxanes (e.g., chemotherapies like Taxol and Taxotere) kill cancer cells by disrupting the cell's scaffolding, its microtubules.
The Oncologist is an international, bimonthly peer-reviewed journal published by AlphaMed Press. It is devoted to medical and practice issues for surgical, radiation and medical oncologists and is designed specifically for the busy practitioner entrusted with the care of adult or pediatric cancer patients. The Oncologist was established by oncologists to help physicians better manage their practices in a changing and challenging environment and to ensure their patient's rights to the best healthcare possible.
Peer-reviewed by an international editorial board of world-class oncologists led by editor-in-chief Bruce A. Chabner, MD (Massachusetts General), the journal's senior editors include: Gregory A. Curt, MD (National Cancer Institute), H.M. Pinedo MD, PhD (Free University, Amsterdam), Eli Glatstein MD (University of Pennsylvania), Frank M. Balis, MD (National Cancer Institute), John E. Niederhuber, MD (University of Wisconsin), and Raphael E. Pollock, MD, PhD (MD Anderson Cancer Center).
09/25/00
Full-text of all articles published in The Oncologist are available online at www.TheOncologist.com
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