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OHSU Knight Cancer Institute researchers share results of 18 studies at international radiation oncology conference

Findings offer insights into crucial patient care issues, including symptom management and the need for more bereavement training for physicians

Oregon Health & Science University Knight Cancer Institute physicians shared the results of 18 studies at the 53nd annual conference for the American Society for Radiation Oncology (ASTRO).

The research presented included two significant patient care issues: improving management of symptoms for patients receiving radiation treatments and the need for bereavement training for physicians.

ASTRO’s annual meeting, which was held in Miami the first week of October, is the premier, international conference for radiation oncologists. ASTRO is the largest radiation oncology society in the world, with more than 10,000 members who specialize in treating patients with radiation therapies.

“The number of studies presented reflects the significant commitment to research in radiation oncology at the OHSU Knight Cancer Institute,” said Charles Thomas Jr., M.D., chairman of the OHSU Knight Cancer Institute’s Department of Radiation Medicine.

“Along with putting a high priority on studies that advance medical treatment for cancer patients, we believe that it’s imperative that we do what we can to also improve their quality of life as they receive care,” Thomas said. “That emphasis on care extends to the patient’s family, especially in the event of a loss.”

One of the studies presented explored the actions that physicians take when a patient dies. That study found that a vast majority, 70 percent, of surveyed cancer-care physicians initiate contact with the bereaved family and caregivers of their patients who have died. However, two-thirds of those physicians said they do not feel they have received adequate training in how to handle this outreach.
This study — which involved a survey of 162 attending radiation oncologists, medical oncologists, surgical oncologists and palliative care physicians who were directly involved in patient care in fall 2010 — found that sending a condolence letter was by far the most common form of follow-up. Other physicians said they made telephone calls to families or attended a funeral service following a patient’s death. Among the most commonly cited barriers to bereavement follow-up was a lack of time and uncertainty about which family member to contact.

“Empathy doesn’t necessarily translate into an inherent ability to lead difficult conversations or comfortably express grief,” said Aaron S. Kusano, M.D., a radiation oncology resident at the University of Washington School of Medicine in Seattle, who collaborated on the study with researchers at the OHSU Knight Cancer Institute.

Funded in part by the Deanne and Dick Rubinstein, the study indicates the need for formal instruction in bereavement practices as part of physicians’ post-graduate training, Kusano said.

A separate study explored the potential effectiveness of a computer application designed to improve communication between cancer patients and their radiation oncologist.

There have been several studies of how to best assess the symptoms that chemotherapy patients are experiencing. But, there has not been the same level of attention to improving quality of life issues for patients receiving radiation.

To address that gap, an OHSU Knight Cancer Institute team of researchers created the first research-validated, touch-screen computer application that makes it possible for patients to quickly share subjective information about what they are experiencing with treatment. The application then takes that input and creates a printed summary of a patient’s symptoms and quality of life issues. That information is then provided to the radiation oncology physician at the point of care.

The need for this kind of patient feedback was highlighted in an earlier study which found that physicians were unaware of about half of the symptoms patients reported. More surprising, this study also found that about half of the symptoms that physicians reported in their logs weren’t noted by the patient.

“In clinical medicine, physicians and patients are under tremendous pressure to communicate expediently,” said Erik K. Fromme, M.D., who specializes in palliative medicine for cancer patients at the OHSU Knight Cancer Institute. “It would be helpful for the physician to have access to patients’ subjective data at the time of the office visit, so that the physician could incorporate these findings into the plan of care and have the chance to improve symptom management.”

Fromme’s research was funded by the National Cancer Institute, a branch of the National Institutes of Health.

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