Primary Care: Clinics in Office Practice RSS feed: Current Issue. Primary Care: Clinics in Office Practice updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in primay care in office practice and is presented under the direction of an experienced guest editor.http://www.primarycare.theclinics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Primary Care: Clinics in Office Practice0095-4543364December 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.primarycare.theclinics.com/article/PIIS0095454309000992/abstract?rss=yesContents10.1016/S0095-4543(09)00099-2Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9viixhttp://www.primarycare.theclinics.com/article/PIIS0095454309001006/abstract?rss=yesForthcoming issues10.1016/S0095-4543(09)00100-6Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9xixihttp://www.primarycare.theclinics.com/article/PIIS0095454309000797/abstract?rss=yesIn an era where the buzz term “patient-centered medical home” commands significant attention in medical and political arenas, now greater than ever is the importance of recognizing the vital role that the primary care team plays in caring for the patient with cancer. Over the past decades, our role as primary care physicians (PCPs) has progressed. Earlier, we simply preached cancer prevention and followed clinical guidelines to prompt early cancer screening and diagnosis, referring our patients with cancer to specialists, with the result that we often “lost track” of them and left their final stages of health care to the specialists. In many of today's practices, the role of the PCP has expanded to a more dynamic one, in which we integrate care for our patients who will survive their cancer and coordinate care of the dying cancer patient via palliative and hospice care. On an educational level, we are training more PCPs than ever before to be adept at such clinical management through dedicated residency curricula and specialized postgraduate fellowships. Interest and research in palliative and hospice care is rapidly gaining in both popularity and demand.ForewordJoel J. Heidelbaugh10.1016/j.pop.2009.08.002Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9xiiixivhttp://www.primarycare.theclinics.com/article/PIIS0095454309000785/abstract?rss=yes Our nation is making progress in the war on cancer. Survival for virtually every type of cancer is increasing, and mortality rates are declining for those cancers amenable to prevention and early detection. But our progress has been frustratingly slow. Although we celebrate the fact that the number of cancer survivors is growing, each year we mourn the loss of more than 500,000 individuals in this country alone. Coping with a cancer diagnosis and cancer treatment constitutes, for most patients and their families, a life-altering event. Physical manifestations of a diagnosis are far-ranging and often persist for the remainder of one's life. Emotional reactions range from joy to despair. Caregivers ride this roller coaster right next to their loved ones. Being diagnosed with cancer can be an enriching experience, but it can also be a devastating one. A death from cancer often becomes a defining moment in the lives of loved ones and families.PrefaceRichard Wender, Danielle Snyderman10.1016/j.pop.2009.08.003Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9xvxvihttp://www.primarycare.theclinics.com/article/PIIS0095454309000736/abstract?rss=yesFinding cancer at its earliest, most treatable stage gives patients the greatest chance of survival. For a number of cancers, screening tests allow for early detection and treatment, and thereby, reduce cancer-related mortality. However, many cancers are discovered by symptomatic presentation rather than screening. This article addresses several symptoms commonly reported in the primary care setting, including rectal bleeding, a breast lump, cough, lymphadenopathy, and weight loss, and offers an evidence-based approach to the consideration and possibly the diagnosis of cancer.Diagnosing Cancer in the Symptomatic PatientBrooke E. Salzman, Kathleen Lamb, Robert F. Olszewski, Amber Tully, James Studdiford10.1016/j.pop.2009.07.005Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9651670http://www.primarycare.theclinics.com/article/PIIS0095454309000682/abstract?rss=yesMaking the diagnosis of a childhood malignancy is often very difficult in the early stages of disease. Many of the presenting symptoms are common and typically not caused by cancer, making a delay a frequent occurrence. This article describes the epidemiology and common presenting complaints of childhood malignancies. It contains guidance on diagnostic testing and when to refer to pediatric cancer specialists.Diagnosis of Childhood CancerChristopher P. Raab, J. Carlton Gartner10.1016/j.pop.2009.07.002Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9671684http://www.primarycare.theclinics.com/article/PIIS0095454309000694/abstract?rss=yesPerspectives on the role of the primary care physician during the active treatment phase of cancer are discussed. Common health issues of concern during cancer treatment are reviewed including fertility, contraception, sexual concerns, and some nutrition issues. The common cancer-related symptoms of fatigue, pain, and distress are reviewed, along with the adverse effects of chemotherapy and radiation therapy and the signs and symptoms of cancer-related emergencies.The Role of the Primary Care Physician During the Active Treatment PhaseGeorge F. Smith, Timothy R. Toonen10.1016/j.pop.2009.07.001Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9685702http://www.primarycare.theclinics.com/article/PIIS0095454309000748/abstract?rss=yesDepression adversely affects cancer patients' quality of life, compliance with treatment, and relationship with their caretakers and may have an effect on mortality. There are many challenges in diagnosing depression in cancer patients, and treatment strategies may differ from usual approaches. This article highlights the prevalence and risk of depression in cancer patients, the available screening tools and associated difficulties in making a diagnosis, and specific approaches to treatment.Depression in Cancer PatientsDanielle Snyderman, Daisy Wynn10.1016/j.pop.2009.07.008Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9703719http://www.primarycare.theclinics.com/article/PIIS0095454309000773/abstract?rss=yesThe aging of the United States population in the next 2 decades will rapidly expand the number of incident and prevalent cancer cases. At present there are more than 11 million cancer survivors, with the majority being older than 65 years. There is an increasing need to develop new models of care to ensure that cancer survivors will receive the best cancer treatment in coordination with their primary care providers. This article provides insights into the epidemiology of cancer survivorship and the strategies that can be used to improve the quality and coordination of survivorship care.Survivorship: Adult Cancer SurvivorsPatricia A. Ganz10.1016/j.pop.2009.08.001Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9721741http://www.primarycare.theclinics.com/article/PIIS0095454309000712/abstract?rss=yesLong-term survivors of childhood and adolescent cancer are a high-risk population of patients who often seek acute or preventive health care with a primary care clinician. Of importance is that the curative therapy administered for the cancer also affects growing and developing organ systems. Following chemotherapy, radiotherapy, and surgery, many survivors will experience chronic or late-occurring health problems, often not becoming clinically apparent until decades after therapy. Survivors face an increase in risk of serious morbidity, premature mortality, and diminished health status associated with their previous cancer therapy. Risk is further modified by the survivor's genetics, lifestyle habits, and comorbid health conditions. The aims of this review are threefold: (1) to provide an overview of the risks faced by long-term survivors of pediatric cancer; (2) to highlight the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and encourage use of these guidelines when following long-term survivors; and (3) to provide a brief overview of key late effects of childhood cancer therapy.Survivorship: Childhood Cancer SurvivorsKevin C. Oeffinger, Melissa M. Hudson, Wendy Landier10.1016/j.pop.2009.07.007Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9743780http://www.primarycare.theclinics.com/article/PIIS009545430900075X/abstract?rss=yesPalliative care focuses on prevention and relief of suffering to optimize quality of life for patients with serious illness. The National Comprehensive Cancer Network standards of care recommend the introduction of palliative care to cancer patients at the time of initial diagnosis. This article reviews symptom assessment and management for 6 of the most common symptoms presenting in this patient population.Palliative Care for the Cancer PatientBarbara Reville, David Axelrod, Rebecca Maury10.1016/j.pop.2009.07.010Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9781810http://www.primarycare.theclinics.com/article/PIIS0095454309000724/abstract?rss=yesThis article reviews research on end-of-life (EOL) decision-making in general and published guidelines on communicating with patients about EOL treatment options. The literature on EOL decision-making, most of which concerns advance care planning decisions, has identified several factors that influence treatment choices including race, religiosity, current health, and family conflict. This literature also documents widespread lack of understanding about dying and palliative care and fears of abandonment by health care providers. This article reviews guidelines for communicating with patients, stresses the role of prognostication in good decision-making, and provides numerous suggestions for initiating and structuring conversations with patients and families about EOL care.End of Life Decision-Making for Cancer PatientsSusan Mockus Parks, Laraine Winter10.1016/j.pop.2009.07.006Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9811823http://www.primarycare.theclinics.com/article/PIIS0095454309000700/abstract?rss=yesEnd-of-life cancer patients and their families typically experience an array of responses that are associated with loss or impending loss. These responses are often labeled as grief, and are considered to be a normal part of the bereavement process. The health care team is responsible for normalizing the grief process and helping the patient and family view death as a natural part of life that can lead to an enhancement of relationships and personal growth. Additionally, the loss or impending death of a patient can be challenging for the physician. Physicians must acknowledge their feelings of grief and loss and pursue healthy venues that promote adaptive processing of the emotions associated with caring for those at the end of life.Bereavement: Addressing Challenges Faced by Advanced Cancer Patients, Their Caregivers, and Their PhysiciansJean S. Kutner, Kristin M. Kilbourn10.1016/j.pop.2009.07.004Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9825844http://www.primarycare.theclinics.com/article/PIIS0095454309000761/abstract?rss=yesAddressing our current health care crisis will demand 2 forms of health care reform: reform of health care coverage and transformation of health care delivery. Most policy makers have accepted that primary care must play a prominent role in a new health care delivery vehicle. A new concept, the medical home, has emerged as a possible model of how primary care can improve performance and help control costs. Although the medical home concept has not yet been applied to cancer care, elements of the concept have the potential to improve cancer prevention efforts and to help coordinate care of individuals diagnosed with cancer. This article explores the possible role of the medical home in the war on cancer.Can the Medical Home Reduce Cancer Morbidity and Mortality?Richard C. Wender, Marc Altshuler10.1016/j.pop.2009.07.009Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9845858http://www.primarycare.theclinics.com/article/PIIS0095454309000670/abstract?rss=yesEarly in the 21st century, control of cancer is considered a major public health issue. Research advances are rapidly unraveling molecular genetic changes, which are the basis of human cancer. These advances are changing the way primary care providers will practice in the future. New genetic screening tools, early detection tests, and cancer prevention intervention will become routinely used in primary care.Winning the Cancer Fight: A Look at the FutureHarmon J. Eyre10.1016/j.pop.2009.07.003Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9859865http://www.primarycare.theclinics.com/article/PIIS0095454309001018/abstract?rss=yesIndex10.1016/S0095-4543(09)00101-8Primary Care: Clinics in Office Practice 36, 4 (2009)2009-12-01Primary Care: Clinics in Office Practice2009-12-01364S0095-4543(09)X0005-9867883