Palliation   

My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...

The patient has extensive disease, and requires palliative radiation to the scapular area (proximal to the brachial plexus) in a region overlapping wi...

The patient has an asymptomatic metastasis in the left atrial appendage. Would you start off with immunotherapy then add radiation later, or visa ver...

If so, do you modify your external beam dose? 

There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?

From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated. What is the role of SBRT versus microwave ablat...

How do you counsel patients and caregivers? Do you prescribe medications (''appetite stimulants'') with the goal to improve appetite even if they do n...

In a patient with metastatic cancer to the lumbar spine and epidural disease on CT who presents back pain and leg weakness: Is a whole spine MRI in...

Do all patients with brain metastases get started on anticonvulsants?  Do you decide based on extent of edema, tumor size, or something else?&nb...

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

Notably, the patient presented with renal failure due to ureteral obstruction and hydronephrosis, receives hemodialysis, and has limited systemic opti...

A recent NCBD analysis (Rusthoven et al., PMID 27325855) suggests that the addition of prostate RT significantly improves survival compared to AD...

How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?

How can these interactions be improved? 

Is radiation effective in this case and if so, what dose would you use? Is there potential for perforation?

Are you offering patients beta-emitters (Samarium-153 lexidronam, strontium-89) to any patients?

Based on the SCORAD III trial, will you now be treating patients with spinal cord compression with single-fraction radiotherapy? Is there anyone ...

Do you prefer WBRT, IT chemo or targeted systemic therapy and what is your preference on the sequence of therapies?

If a patient has a large femoral metastasis that cannot be resected, but is to be stabilized with ORIF which will push tumor into the distal end of th...

There are many delivery methods of cannabis, including smoking, ingesting it through food, or inhaling it. Is one method more effective than another?

How do you decide between supportive care v. chemoimmunotherapy? Is there a threshold of disease burden that would push you towards recommending hospi...

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

Is there specific workup you perform? Are there preventive measures? Once established, are there non-pharmacological and pharmacological treatments yo...

Would you suspect progressive disease v. radiation necrosis vs optic neuritis due to immunotherapy. Eyes were within radiation field 8 months ago.&nbs...

Specifically, how do you explain potential cognitive decline in a way that explains what changes they can expect in their daily lives?

How about those with metastatic disease eager to maintain quality of life? Do you risk progression of disease if the TNF blocker is re-started?

Is this recommended in a certain subset of patients (EGFR positive or 1 metastasis only)? Or should we await maturation of the MD Anderson/Colorado/On...

Would this be any different for whole brain radiotherapy?

Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?

Does your management differ if the hiccups are felt to be related to chemotherapy as opposed to the disease itself?

The immediate response by patients in this situation seems almost universally to be, "But I'll starve to death!" Referencing literature about lack of ...

Does the site of palliative radiation therapy matter (i.e. femur, abdomen, pelvis vs base of skull)? How long should you wait to give palliative ...

We have a great palliative care clinic and I like to refer many patients with metastatic disease, even if I feel that they will live a year or two lon...

If the systemic agent is going to be held, how many days prior to starting radiation therapy should the agent be held and when can it be restarted aft...

I know that some would argue that healthy patients with an excellent performance status may not need an early palliative care referral, but wouldn't i...

What factors should be considered with offering SBRT to oligometastatic bone disease in prostate cancer patients? Should this been done off of a proto...

I've read about patients who were treated with concurrent bevacizumab-RT who developed lethal tracheoesophageal fistulas. How long would you have to w...