July 25, 2003

By Peggy Vaughn

Posted in: Clinical trials | Supportive care

Tags: chronic, death, dying, palliative care, partner, survivor, survivorship

The National Cancer Institute (NCI) funds dozens of clinical trials related to palliative care. The variety and scope of these trials reflect the important role palliative care plays in a cancer patient’s life from the moment of diagnosis and throughout the cancer trajectory. Whether investigating new drugs to control pain, testing for possible neurological effects of chemotherapy, or researching quality of life issues among cancer survivors, NCI is investigating ways to eliminate suffering due to cancer.

Databases
Since NCI-sponsored trials in palliative care are too numerous to list here and cover a wide variety of topics, this guide will only touch on a few examples of current clinical trials involving palliative care, supportive care, and survivorship. To fully explore NCI’s palliative care clinical trials, visit the following databases:

• CRISP, a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other research institutes, at http://crisp.cit.nih.gov/. The database includes work in this area funded by various NIH components, including the lead NIH Institute for end-of-life research—the National Institute for Nursing Research (NINR). Use the search terms “palliative,” “supportive,” or “survivorship.” To find just what NCI is funding, narrow the search by selecting NCI under the “Institutes and Centers” category.
• A new web page was recently added to the NCI’s cancer.gov Web site that announces funding opportunities and areas of encouraged research in the broad areas of symptom management and palliative care. This listing includes announcements from other NIH Institutes and Centers and other government agencies at Cancer.gov – Funding Opportunities in Symptom Management and Palliative Care Research.
• Current research in cancer survivorship by NCI’s Cancer Control & Population Sciences Division can be found at http://cancercontrol.cancer.gov/ocs/portfolio.asp. The list contains grants carried over from prior fiscal years and new grants awarded in the current fiscal year.
• The PDQ (Physician Data Query) is NCI’s comprehensive cancer database and contains information about over 14,000 open and closed cancer clinical trials from around the world. Visit PDQ at http://www.cancer.gov/clinical_trials. Use the “advanced search form” and narrow the search to “supportive care” type trials sponsored by NCI.

Examples of palliative care trials
Symptom management
NCI is investigating a wide variety of cancer symptoms, including weight loss or gain, fatigue, hot flashes, pain, nausea, and vomiting. For example, one trial is determining if ginger can help reduce or prevent nausea caused by chemotherapy (Study of Ginger for Chemotherapy-Related Nausea in Patients With Cancer). Another approach under investigation is evaluating the use of acupuncture in relieving chemotherapy-induced nausea among breast cancer patients (Treating Chemotherapy Induced Nausea with Acupressure).

Other investigations into symptom management include, but are by no means limited to: constipation (Reversal of Opioid Constipation), hot flashes (Study of Gabapentin for Management of Hot Flashes), wasting (Docetaxel and Wasting in Patients with Small Cell Lung Cancer), and altered taste (Zinc Sulfate for Prevention of Altered Taste).

Survivorship
Two trials are examining the quality of life of women surviving cervical cancer and breast cancer. The first is studying 144 women receiving treatment and follow-up surveillance for cervical cancer. Researchers hope to develop culturally sensitive, short-term interventions to improve sexual functioning and overall quality of life (Sexual Functioning and QOL in Women with Cervical Cancer). The second study is examining the effects of exercise and raloxifene in postmenopausal breast cancer survivors. The researchers hope to reduce the negative impact of the complications of chemotherapy, such as osteoporosis, increases in heart disease, and declines in the quality of life (Breast Cancer Survivors: Exercise and Raloxifene).

Many breast cancer patients report problems with attention span, memory, and concentration following chemotherapy. One current trial involves a treatment program to help 33 breast cancer survivors compensate for cognitive deficits; the results may help in the development of a program suitable for use in a clinical setting (Cognitive Behavioral Treatment of Memory Problems).

For more information on survivorship research at NCI, go to Survivorship Research at NCI.

Childhood cancers
Survivors of childhood cancers often face increased risk for developing subsequent cancers, so smoking cessation intervention is especially important among this group. One study to reduce smoking among childhood cancer survivors is examining the impact of peer-delivered telephone smoking cessation counseling compared to the use of a self-help manual on smoking cessation (Smoking Cessation Among Childhood Cancer Survivors).

Another trial is investigating the effectiveness of a program aimed at improving the cognitive ability of childhood cancer survivors with damaged central nervous systems. This randomized study involves children aged 6 to 17 treated for leukemia, brain tumor, or non-Hodgkin’s lymphoma. The program involves 20 two-hour training sessions aimed at improving cognitive abilities in such areas as focusing attention, memory recall, learning, school behavior and self-esteem (Cognitive Remediation for Childhood Cancer Survivors).