Well, it's finally happened. I've been attacked in the scientific literature (Salander, 2006). Well, just to clarify, it wasn't a personal attack, but rather an attack of the highest and most noble order: an attack on the scientific rigor of the conceptual underpinnings of my recent work on meaning and spirituality in advanced cancer patients (e.g., Breitbart, 2002). To be honest, and a bit less grandiose, it was not an attack against me alone, but rather a set of critical comments aimed at a growing number of investigators who have been publishing papers (a 600% increase over the past 10 years) dealing with religious or spiritual aspects of life-threatening illness (Stefanek et al., 2005). The critical comments by Dr. Par Salander of the Department of Social Welfare, Umea University, Sweden, in a recent issue of the journal Psycho-oncology (Salander, 2006) challenge the need for and the validity of the concept of spirituality.

Objective: To examine the potential impact of elderly age on response to participation in a structured, multidisciplinary quality-of-life (QOL) intervention for patients with advanced cancer undergoing radiation therapy.

Methods: Study design was a randomized stratified, two group, controlled clinical trial in the setting of a tertiary care comprehensive cancer center. Subjects with newly diagnosed cancer and an estimated 5-year survival rate of 0%–50% who required radiation therapy were recruited and randomly assigned to either an intervention group or a standard care group. The intervention consisted of eight 90-min sessions designed to address the five QOL domains of cognitive, physical, emotional, spiritual, and social functioning. QOL was measured using Spitzer uniscale and linear analogue self-assessment (LASA) at baseline and weeks 4, 8, and 27.

Results: Of the 103 study participants, 33 were geriatric (65 years or older), of which 16 (mean age 72.4 years) received the intervention and 17 (mean age 71.4 years) were assigned to the standard medical care. The geriatric participants who completed the intervention had higher QOL scores at baseline, at week 4 and at week 8, compared to the control participants.

Significance of results: Our results demonstrate that geriatric patients with advanced cancer undergoing radiation therapy will benefit from participation in a structured multidisciplinary QOL intervention. Therefore, geriatric individuals should not be excluded from participating in a cancer QOL intervention, and, in fact, elderly age may be an indicator of strong response to a QOL intervention. Future research should further explore this finding.

Objectives: Research on the health-related quality of life (HRQL) among women of color (i.e., Hispanics and African Americans) with breast cancer suggests that they may be at elevated risk for a variety of physical and psychosocial sequelae. The context in which these women perceive, experience, and respond to these HRQL challenges can provide important information for planning a culturally appropriate palliative care treatment plan.

Methods: In an effort to understand the quality of life experience after breast cancer among women of color, this study describes the nature and impact of physical, emotional, and menopausal symptoms among African American (n = 8) and Hispanic (n = 12) breast cancer survivors based on qualitative data gathered through semistructured interviews. Themes were identified and categorized into six HRQL domains: physical (e.g., pain, nausea), psychological (e.g., sadness, irritability), cognitive (e.g., memory problems), sexual (e.g., decreased desire), social/functional (e.g., financial strain, social distress), and spiritual/existential (e.g., increased faith, spiritual coping), with high interrater reliability (kappa = .81).

Results: For both groups, physical issues had a major impact on HRQL, with psychological issues being additionally salient for Hispanic women. Most (88%) African American women voiced positive changes in their faith after diagnosis whereas 50% of Hispanic women viewed faith as an important way of coping with breast cancer.

Significance of results: This research broadens our understanding of the experience of breast cancer among ethnic minority women, and in turn, offers some key directions for guiding the development of culturally tailored HRQL interventions.

Objective: Adolescents with cancer pose a unique challenge to current health systems and the professional working with them. Throughout the world, it is increasingly recognized that the needs of this particular group of patients may not be met through existing services within either the pediatric or adult systems. In Australia, this is a new area of research, and little is known about the unmet physical, psychological, and social needs of this patient group. This study reports the outcomes of a focus group conducted to explore these issues.

Methods: Six young people, with a mean age at diagnosis of 17 years and 6 months, participated in a 2-h focus group. A qualitative analytic approach was utilized to examine themes.

Results: The participants identified a number of concerns relating to three broad categories: information provision, treatment processes, and survivorship.

Significance of results: The research findings support previously documented evidence that indicate gaps in cancer services provided to this age group. Importantly, these gaps can be narrowed by improving access to adolescent multidisciplinary teams and introducing specific training for health care professionals.

Objective: Parents coping with a diagnosis of advanced cancer experience distress and guilt about the impact of the disease on their children but report that there are few resources specific to advanced disease to guide and support them in discussions with their children. Although some resources have been developed to assist parents with advanced cancer, it appears that these are not widely disseminated.

Methods: To determine the need for a brief resource that could be given to parents at the point of diagnosis of advanced cancer, including its content, in-depth interviews were conducted with eight women with advanced breast cancer.

Results: Women confirmed that they had received minimal assistance from health professionals in discussing the diagnosis with their children, and even when professional counselors were accessed they were not always attuned to the specific needs of parents with advanced cancer. Women felt frustrated that information they did access focused on early disease and lacked the details women felt they needed in coping with advanced cancer. Women felt that there was a need for a brief resource that reassured parents about the impact of the cancer on their children, including practical strategies to help them cope and examples of the ways other parents had responded to difficult questions such as about parental death. A draft resource was developed, critically reviewed by the participants, and their comments incorporated into a final version.

Significance of results: This article expands on the themes highlighted by women as important to assist parents with advanced cancer, including the final resource that was developed.

Objective: Hypnosis is an adjunctive, noninvasive treatment with few side effects that can be useful in the management of chronic pain. However, it has fallen into disfavor in recent years and is often perceived by physicians as simple charlatanism. We evaluated the efficacy of this treatment as used clinically in a large, mostly rural, pain management center.

Methods: We conducted a chart review of 300 pain patients from the Pain Treatment Center of the Bluegrass who had undergone hypnosis for their pain concerns. A chart audit tool was developed consisting of basic demographics, pre- and posthypnosis pain ratings, a rating of relaxation achieved posthypnosis, and scores on the Beck Depression Inventory, Perceived Disability Scale, and the Pain Anxiety Symptom Scale.

Results: The sample consisted of 79 men (26.3%) and 221 women (73.7%) with a mean age of 46.3 years (SD = 9.9, range = 19–78). Pain levels recorded pre- and posthypnosis revealed significant improvement as a result of the intervention (mean difference = 2.5, t(1,298) = 25.9, p < .001). Patients reported an average of 49.8% improvement in relaxation level posthypnosis (SD = 24.2%) and had a mean score of 19.0 on the Beck Depression Inventory (SD = 9.9), indicating moderate levels of depression. Also, patients saw themselves as severely disabled regarding their ability to engage in physical (8.3/10) or job-related (7.7/10) activities. Attempts to identify predictors of hypnosis success were not fruitful with one exception. “Poor” responders to hypnosis reported greater levels of perceived dysfunction in their sexual functioning compared to the “good” responders, F(1,187) = 7.2, p < .01.

Significance of results: Hypnosis appears to be a viable adjunct for pain management patients, including those from rural and relatively disadvantaged backgrounds. Prospective trials are needed to examine the utility of this modality in end-of-life and palliative care patients.

Objective: The study compared the qualitative aspects of the loneliness experience of the dying, their caregivers, and the general population.

Method: The patients were recruited in an oncological hospice in Israel, and, despite being on their deathbed, agreed to participate in the study. Thirty-seven cancer-stricken patients, 78 caregivers, and 128 participants from the general population volunteered to partake in the study. They answered, anonymously, a 30-item questionnaire and were asked to endorse those items that described their experience of loneliness.

Results: Results suggested that the three populations did, indeed, differ in their experience of loneliness. More specifically, dying patients and their caregivers had significantly higher subscale scores on the Growth and Discovery and the Self-alienation subscales than the general population did. It was also found that the number of hospitalization days was significantly negatively correlated to the Emotional Distress and Self-alienation subscales.

Significance of results: The present results indicate that loneliness is experienced differently in or out of the hospice and by the dying patient, his or her caregiver, and the general population. This may be the first study to examine the qualitative aspects of the loneliness experienced by the dying and by their caregivers. More research is needed to replicate the present study, using larger samples.

Objectives: Opioid medications are frequently used in pain and palliative care patients with malignancy to manage symptoms such as pain and dyspnea. However, opiates are associated with various side effects. Constipation is a particularly problematic and common side effect of opioid pharmacology. Opioid antagonists have been studied in the management of opioid-induced constipation. Methylnaltrexone (MNTX) is a peripheral opioid antagonist currently under clinical investigation. It offers the potential to reverse undesirable side effects without reversing analgesia.

Methods: This article attempts to review existing clinical data, focusing on antagonism of opioid-induced adverse effects on the gastrointestinal system.

Results: MNTX seems to be well tolerated with limited or transient side effects. MNTX has been shown to improve oral-cecal transit times in opioid treated patients, induce laxation in chronic opioid users, and neither reverses the analgesic effects of morphine nor cause withdrawal symptoms.

Significance of results: Larger clinical trials of MNTX are still necessary to support its use as a standard for treatment of opioid-induced constipation.

We set out to discuss the psychological barriers that exist in the treatment of pain. Specifically, we argue that clinicians have several innate mechanisms at play that can hinder their judgment and lead to erroneous assumptions about their patients. Issues are discussed from social psychological and psychodynamic perspectives. A focus is placed on the issue of empathy and how this, too, can act as a barrier to rational judgment when evaluating patients. In the face of growing scrutiny on pain management in the United States, it is important to understand the barriers to providing care that already exist on an intrinsic level. Through the exploration of these barriers, clinicians might be better able to reflect on their own practice. Ultimately, we hope to push forward an agenda of rational therapy in pain management that utilizes safeguards against abuse and addiction while also preserving treatment modalities for patients in need of services.

Adolescence and young adulthood is a time of enormous change. For many young people, the profound shift from dependence to autonomy that is the hallmark of this period is physically, emotionally, and spiritually demanding. On the other hand, this phase of life is generally marked by an exuberant optimism that is the envy of jaded adulthood. This optimism, when coupled with intelligence, lack of respect for established forms, and iconoclastic energy, may be the source of a lifetime's achievement.

George Budabin is a cancer survivor. What follows are his remarks commemorating Survivors Day 2006 at New York Presbyterian Hospital in New York City.

As a general practitioner with an interest in palliative medicine, occasionally patients with end-stage malignancies are referred to me. For these people the search for a panacea is well and truly over. Rather than searching for a cure for cancer they are now mostly searching for control of their “pain,” with all that that implies. One of my roles is to protect my patients from those peddling a panacea who in the process may impose burdensome costs, be they physical, psychological, or financial. The motives of those selling a “cure” may be altruism or greed, or indeed both.

There are certain things that you learn about people when you sleep in their beds, eat from their cupboards, commiserate with their family and friends. There are things that we waltz around and others that are apparent: that you were good, and raised your son with the utmost care. That you loved your husband. That you loved being a wife and mother.

Warp & Woof.

Stone Tears.

In Summer.

Clinical update: Literature abstracts.

Calendar of events.