Differences in Attitudes and Practices of Cancer Pain Management between Medical Oncologists and Palliative Care Physicians.

This study aimed to evaluate whether there are differences in the attitudes and practices of cancer pain manage-ment between medical oncologists and palliative care physicians. An online nationwide survey was used to collect responses from board-certified medical oncologists and palliative care physicians in Japan. The survey questionnaire comprised 30 questions. The differences in responses between medical oncologists and palliative care physicians were examined. Out of the 1,227 questionnaires sent, 522 (42.5%) were returned. After apply-ing the exclusion criteria, 445 questionnaires (medical oncologists: n = 283; palliative care physicians: n = 162) were retained for analysis. Among the questions about potential barriers to optimal cancer pain man-agement, both medical oncologists and palliative care physicians considered the reluctance of patients to take opioids due to fear of adverse effects as the greatest barrier. Significantly different ratings between medical oncologists and palliative care physicians were observed on 5 of the 8 questions in this area. Significantly differ-ent ratings were observed for all questions concerning pain specialists and their knowledge. For effective cancer pain management, it is important to account for differences in attitudes and practice between medical oncolo-gists and palliative care physicians.

Advance care planning in metastatic breast cancer.

End-of-life care requires improvement. For a good death, patients consider five factors important: managing physical symptoms, avoiding a useless prolongation of dying, having good self-esteem, relieving burdens on the family, and deepening ties with loved ones. Four out of those 5 are accomplished by the implementation of advance care planning (ACP). ACP is not simply a formal writing of a patient's preferences about end-of-life treatment, but it is a process of communication between a patient, their family and care providers. There are few studies on ACP for patients with metastatic breast cancer. However, data on seriously ill patients support ACP's favorable effects on end of life care outcomes for not only patients, but family members and care providers as well. The observed keys to success for ACP were trained facilitators, education of the medical staff, inclusion of family and surrogate members, and a system to support ACP. ACP should be regarded as a standard of care to improve the quality of life of patients with metastatic breast cancer.