Edward Chow

Joav Merrick

Natalie Pulenzas

Breanne Lechner

Nemica Thavarajah

Bone metastases are a common event for cancer patients. We have developed an innovative and unique clinical research program dedicated to palliative radiation oncology at the Odette Cancer Centre, Sunnybrook Health Sciences Centre and specifically a multidisciplinary clinic for bone metastases. The development of this program introduces an effective strategy to conduct research in palliative radiation oncology. Symptom control is very important for the quality of life for bone and brain metastases patients. This is an evolving active field of research as greater emphasis is being placed into understanding the goals of improving not only a patients survival, but the ability for therapies to improve the quality of a patient's life. In this book we present the EORTC QLQ-C30 questionnaire, which was used in a multi-center study with patients recruited from Edmonton, Alberta, Canada; Kaohsiung, Taiwan; Kerala, India; Nicosia, Cyprus; Sao Paulo, Brazil; Taipei, Taiwan; Tanta, Egypt; and Toronto, Ontario, Canada, with brain and bone metastases. It was found that the difficulties bone and brain metastases patients experience are different in several ways. Patients with bone metastases have more pain and reduced physical functioning. However, patients with brain metastases have more severe role functioning deficits. With use of the QLQ-C30, it was also found that there is ambiguity regarding the root of patient issues. Future studies that require more comprehensive disease-specific findings should include disease-specific assessment modules such as the QLQ-BM22 and QLQ-BN20. Important domains such as the minimal clinically important difference should also be established in individual subgroups of patients to assist in clinical trial design.

Managing Symptoms and Quality of Life

Advanced Cancer

Leila Malek

Fiona Lim

Bo Angela Wan

Patrick L. Diaz

With advances in knowledge and technology, the proportion of cancer patients who have been cured or survive with cancers is growing, but a certain proportion of patients will still have disease recurrence or progression to palliative care. During the entirety of cancer progression, significant adverse impacts on physical and psychological aspects have been observed due to both diseases themselves and the associated treatments. Exercise-oncology is an emerging field of research that has gained increasing attention since the term was first publicly introduced during the 1980s, showing improved functional capacity, body composition and treatment-related nausea with aerobic exercise. In this book, the authors review the current evidence on the application of exercise in various time points during cancer care, including as a preventive measure before cancer development, as a treatment during cancer treatments, as a rehabilitation measure during the recovery phase, and as a supportive measure during palliative care. Proposed mechanisms and published data from various studies will be evaluated, and finally guidelines on exercise prescription during cancer care will also be discussed.

Cancer and Exercise

Ronald Chow

Marko Popovic

Xiaojing Zhang

In early stages of cancer, patients are often presented with treatment options and encouraged to have shared treatment decisions with their oncologists. Shared decision making becomes particularly important, as several treatment options with different possible outcomes and adverse events exist. For example, women with early breast cancer are counseled on the options of mastectomy versus lumpectomy and radiation. The same principle should also apply in late stages of cancer, where cure is usually not possible in patients with widespread metastases. In these cases, the aim of treatment should be to relieve symptoms and suffering. Improving quality of life (QOL) rather than tumor control takes priority in palliative care. QOL has also been identified as an important endpoint for new cancer drugs, as determined by the Food and Drug Administration (FDA); as such, cancer drug approval can be based on improvement of QOL. The use of patient-reported QOL instrument tools help clinicians determine if certain treatments improve QOL. The research of palliative interventions should have QOL assessment to assist clinicians, patients and their family members in shared decision making.

Treatment, Decision Making and Quality of Life

Cancer

Dimitrios Kardamakis

Vassilios Vassiliou

The second edition of this book serves both as an introductory and reference book focusing on the field of metastatic bone disease. Featuring contributions from experts in the field, this volume describes the molecular and cellular mechanisms involved in the formation of bone metastases, presents the newer advances made in the understanding of the clinical picture and symptoms of patients, analyses the role of bone markers in research and clinical practice and deals with all aspects of imaging modalities applied for the detection and evaluation of bone metastases. Moreover, the use of all available treatment methods, such as radiotherapy, surgery and systemic treatments for the management of patients with metastatic bone disease is discussed in detail. Overall this volume presents a thorough overview of all aspects of metastatic bone disease and provides a comprehensive and concise information resource for researchers, oncologists, orthopaedic surgeons and clinicians dealing with patients with metastatic bone disease.

A translational and Clinical Approach

Bone Metastases

Edward Chow

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