Day 2 :
Cooper Medical School of Rowan University | USA
Keynote: Progesterone receptor modulation provide a safe convenient method for palliation of advanced cancers of all types
Time : 9:30-10:15
Jerome H Check is a Professor of Obstetrics and Gynecology at Cooper Medical School of Rowan University and is the Division Head of Reproductive Endocrinology & Infertility at Cooper Hospital, Camden, NJ. He is also board certified in internal medicine and medical endocrinology. His Ph.D. is in reproductive biology. He has published over 750 peer-reviewed scientific articles that include reproductive and medical endocrinology, immunology, molecular biology, internal medicine, and cancer research. His work involving palliative care includes novel treatments for pain, chronic disease, and prevention of metastases of cancer.
Statement of problem: The progesterone induced blocking factor (PIBF) is a unique intracytoplasmic protein present only in rapidly proliferating cells. PIBF helps both the fetal/placental unit and malignant tumors escape immune surveillance by natural killer (NK) cells and cytotoxic T-lymphocytes. Progesterone up-regulates and mifepristone (a progesterone receptor modulator) down-regulates PIBF. Because mifepristone is an abortafacient, most governmental agencies have restricted its off-label use. Compassionate use IND’s granted by the FDA has allowed mifepristone treatment on an individual case basis for a variety of advanced cancers not responding to conventional therapy, and significant palliation has been provided to patients with a variety of different cancers based on improved longevity and quality of life.
Methodology and theoretical orientation: The FDA granted an IND to evaluate single agent oral mifepristone 300mg for stage IIIB or IV non-small cell lung cancer that has progressed despite a minimum of at least 2 chemotherapy or immunotherapy regimens. The response of the first two cases treated is listed below.
Findings: A male and female, both age 68 failed multiple standard chemotherapy regimens for their stage IV lung cancer. The female progressed despite also receiving immunotherapy with nivolumab (PD-L1 marker present). The male (who had seizures related to brain metastases) has had no more seizures with brain lesions gone and 75% shrinkage of lung lesions. He is ECOG zero and states he feels so good it is hard to believe he has cancer after 16 months of mifepristone. The female has shown more energy and no further metastases after 6 months of therapy (ECOG-1 related to COPD).
Conclusions: Palliative care specialists should unite and petition governmental agencies to lift the ban for off-label use of mifepristone at least to patients with advanced cancer. Mifepristone is very well tolerated and has fewer side effects than anti-PD-L1 drugs.
Philadelphia University| USA
Time : 10:15-11:00
Kennedy is currently an assistant professor in the Community and Trauma Counseling Program at Philadelphia University. She has served in many capacities as an administrator, clinical therapist and supervisor, and hospice chaplain. She has served as Director of the Life Center at Hospice of the Chesapeake, which provides support services and programs for hospice patients and families, and bereavement and trauma counseling to adults, teens and children. Dr. Kennedy began her career as a case manager in the HIV/AIDS epidemic. She holds a Bachelor’s and a Master’s degree from the University of Iowa, a Master of Divinity from Harvard University, and a Ph.D. from Loyola University Maryland. She is a Licensed Professional Counselor (LPC) in Pennsylvania, and an ordained minister in the United Church of Christ denomination. Her specialty areas include grief and bereavement, life-limiting illness, trauma, spiritual alienation, gender identity, sexual orientation, and support to the LGBTQ+ community.
Research indicates complex trauma is an increasing public health concern and involves threats to personal safety; selfidentity and connection to the wider community. Despite not meeting the full criteria for PTSD, this category of trauma appears to be the most debilitating and results in secondary complications that include interpersonal violence, drug use, depression, and anxiety (Courtois & Ford, 2013; Park, Currier, Harris, & Slattery, 2017). Further, some argue the DSM-5’s definition of trauma is too narrow and does not account for other debilitating events such as major losses, including life-limiting
illness and grief that result in clinically significant symptoms (Briere, 2013). The impact of trauma on our living and our dying
is undeniable. Losing a loved one to death is one of the most painful experiences of being human. Grief, considered the normal response to bereavement, is associated with potential long-term physical and psychological sequelae such as increased mortality, cardiac disease, depression, and substance use. Complicated grief has been linked to brain abnormalities that impact functioning of the limbic system, autobiographical memory, and cognitive processing (Shear, 2015). Given these findings, therapies that focus on cognitive restructuring may be ineffective in reducing distress. Eye Movement Desensitization and Reprocessing (EMDR), has been used extensively to treat individuals with PTSD (Van der Kolk, 2015). Emerging research suggests that EMDR is an effective intervention for complex trauma, grief, chronic pain, and substance use disorders (Abel & O’Brien, 2013). The focus of the workshop is to present research on the intersectionality of trauma and grief and their impact
on brain development and function; introduce EMDR and discuss implications for use with hospice patients, families and the bereaved. An experiential segment will guide participants through EMDR exercises followed by small group discussion.