
Woman left with third degree burns and unable to walk for a week reveals her major mistake: ‘I'll never forget this'
Chasing a summer glow? You might want to think twice.
A woman was hospitalized with third-degree burns and left unable to walk for a week after a sunny day spiraled into a nightmare — all because of one disastrous mistake.
'I most definitely will never forget this,' Taylor Faith (@.taylorfaith) said in a recent TikTok video detailing the painful experience.
4 Tiktoker Taylor Faith made a dangerous mistake while spending an afternoon in the sun.
Taylor Faith (@.taylorfaith) TikTok
On her way to paddle board, the content creator realized she was out of sunscreen. Instead of stopping to buy more, Taylor chose to go without — assuming she'd just get a tan or, at worst, a mild burn.
But after eight hours baking on the water, her legs were severely scorched, forcing her to take a trip to the hospital. Doctors diagnosed her with a rare and dangerous third-degree sunburn, which damages all three layers of the skin and often requires emergency treatment.
'I neverrrr thought this would happen to me until it did,' Taylor admitted in a comment. 'It's so bad a couple days ago I was thinking I'd rather be [dead] than feel that way.'
Sunburns happen when too much ultraviolet (UV) light penetrates the skin's deeper layers, causing cell damage over time, according to the Mayo Clinic.
The immune system reacts by increasing blood flow to the area, which leads to the inflammation we recognize as sunburn.
4 Taylor was diagnosed with a third degree sunburn.
Taylor Faith (@.taylorfaith) TikTok
Most sunburns are mild and heal within days, but third-degree burns are a different story. They can damage nerve endings, blood vessels, sweat glands, hair follicles and deep tissue, according to the Cleveland Clinic.
People with third-degree burns are also at risk of heat illness, which has symptoms such as confusion, dizziness, exhaustion, rapid breathing, fever, headache, muscle cramps and nausea.
Taylor said she spent hours violently ill after her afternoon in the sun.
'My insides are severely damaged and all my blood vessels are as well,' she said in another comment. 'I think this life lesson is gonna turn me into a sunscreen activist.'
While sunburns eventually heal, they can have negative lingering effects. Repeated sun exposure and burns speed up skin aging, causing wrinkles, sagging, discoloration, broken capillaries, uneven tone, and a rough, leathery texture.
4 People with light skin are more likely to get a sunburn, but it can happen to anyone.
Pattarisara – stock.adobe.com
Excessive sun exposure also increases your chances of developing skin cancer, including melanoma. Even sunburns sustained during childhood and adolescence can increase that risk later in life.
Anyone can get sunburned, but those most at risk include people who:
Have light skin, freckles, blue eyes, or red or blonde hair
Tan regularly or use tanning beds
Live at high altitudes or near the equator
Spend a lot of time outdoors playing sports, swimming or working
The good news? You don't have to become a vampire to protect yourself from sunburn.
The FDA recommends limiting sun exposure between 10 am and 2 pm, when UV rays are strongest.
When outside, wear protective clothing and use broad-spectrum sunscreen — most experts urge using at least SPF 30.
4 Dermatologists recommend that people wear sunscreen every day — even when it's cloudy.
sosiukin – stock.adobe.com
Apply sunscreen generously to all exposed skin, paying special attention to the nose, ears, neck, hands, feet and lips. If you have thinning hair, cover the top of your head or wear a hat.
The agency recommends reapplying sunscreen every two hours — or more often if swimming or sweating. An average adult or child needs about one ounce of sunscreen (roughly a shot glass) to cover their body evenly.
'You can't reverse sunburn damage, but once you have a burn, you can soothe your skin and give it time to heal,' Dr. Edwin Kuffner, chief medical officer for Johnson & Johnson Consumer Inc, told the company.
He recommends cool showers or baths for relief and drinking plenty of fluids to stay hydrated. Most people can also use over-the-counter pain relievers like acetaminophen to ease discomfort.
Kuffner stressed the importance of keeping burned skin moisturized to help it heal faster, like with aloe vera.
If you must go outside with a burn, it's okay to apply sunscreen to the affected areas — so long as the skin isn't blistered or raw, he noted.

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New York Post
2 hours ago
- New York Post
The 3 top-rated massage chairs to unwind and relax in 2025
Let's be real — you deserve better than sore shoulders and a stiff neck after a long day of being a responsible adult. Whether you've been grinding away at a desk, wrangling kids or just trying to survive the chaos of everyday life, one thing's for sure: you need a throne. Not just any throne, though: a massage chair that turns your living room into a personal spa, your office into a chill zone, and your bad days into distant memories. Lucky for you, we've put together the ultimate guide to finding the best massage chair that fits your style, your needs, and yes, your budget. See our picks Advertisement Of course, we know the big question: how much is this going to cost me? Massage chair price ranges from 'not bad' to 'maybe I'll sell a kidney.' That's why we've scoured massage chair reviews from real people who've actually used these things (not just marketing teams with fancy adjectives). So, if you're looking for affordable comfort or full-luxury relaxation, we'll help you find your dream chair without the buyer's remorse. Let's talk brands for a sec. If you're looking for a chair that blends futuristic tech with Instagram-worthy style, check out the Human Touch massage chair. These bad boys aren't just about looking cool (though they do look cool); they're designed to mimic real human massage techniques with scary-good accuracy. If you want a cozy massage chair recliner for Netflix marathons or a slick massage office chair that makes Monday meetings slightly less soul-crushing, brands like Relaxe bring the magic. We even found portable options for those who don't have a lot of space. Ready to treat yourself? Let's dive in — your perfect massage chair awaits. Best Massage Chairs Best Overall: Relaxe Shiatsu Massage Chair Relaxe Pros: Comes with 12 fully customizable massage modes Boasts modern Bluetooth connectivity to listen to music while you relax (or, should we say, Relaxe) Designed with space-saving technology as it's only two inches away from the wall 53-inch SL-track reaching your glutes and upper hamstrings Cons: Price point may be unreachable for some For a massage chair that has more moves than a TikTok dance challenge, it doesn't get any better than the Relaxe Shiatsu Massage Chair. The 4D Shiatsu rollers? Great! These little miracles glide up and down, in and out, and side to side. They knead, they roll, they stretch, and somehow, they find exactly where you carry your stress. Neck? Yes. Lower back? Of course. That one weird knot in your shoulder? Say goodbye. 'I had the chance to put the Relaxe shiatsu massage chair to the test for two straight weeks, and the opportunity couldn't have come at a better time, as I had just spent a whole Sunday carrying my 5-year-old daughter on my shoulders around the LA County fair grounds,' Al Murillo, senior director of commerce partnerships here at Post Wanted, shared after reviewing the chair. 'As you can imagine, my lower back and shoulders were in serious need of some deep-tissue therapy.' Al Murillo You can choose from one of their preset massages: Comfort, Stretch, Shoulders and Back, Back and Waist, or our go-to favorite, the Relax massage. If you prefer a more customized experience, the manual setting provides you with more control over roller isolation, air compression, and massage techniques. You can choose from Kneading, Rolling, Tapping, Knocking, and of course, Shiatsu. 'As someone who has never been too keen on massages, much less one not performed by an actual human, I didn't quite know what to expect when I first sat into the Relaxe massage chair,' Murillo shared. 'Luckily, the chair comes equipped with an LCD remote control that shows exactly where the rollers are placed throughout the chair. If you're a bit sensitive to pressure like I am, you are able to adjust the intensity, heat, and speed levels to better suit your comfort level.' Dimensions: 61.5 to 69.5″ (L) x 30″ (W) x 33 to 44.5″ (H) Best Budget: AYJOIR Zero Gravity Massage Chair Amazon Pros: Less than $350 Sleek and modern design Comes with intuitive controls, like a full-body air compression massage Cons: Limited deep tissue massage features, though not a dealbreaker If you've ever dreamed of sinking into a high-tech massage chair without your wallet screaming in protest, meet your new best friend: the AYJOIR Zero Gravity Massage Chair. This thing punches way above its price tag, offering features that usually come with a luxury-level bill. Let's start with the star of the show, the zero gravity mode. One button press and you're reclining like the pressure is off your spine, your stress melting faster than ice cream in July. It's a total game-changer for anyone who deals with back pain, stress or just wants to feel like royalty for 30 minutes a day. The AYJOIR doesn't stop at space-age reclining. It's loaded with full-body air compression massage. Yes: shoulders, arms, hips, calves and even your tired, aching feet. With adjustable intensity levels, it's perfect whether you want a gentle unwind or a firm 'get those knots out' session. Oh, and speaking of your feet: the roller foot massage might just be the unsung hero of this chair. After a day standing, it feels like a personal spa wrapped in tech magic. For a budget chair, this thing is absolutely stacked. And the fun extras? AYJOIR delivers. Bluetooth speakers let you zone out to your favorite playlists or podcasts while you're being massaged into a puddle of relaxation. There's even a phone holder and mood lighting because, well, why not? It's the kind of thoughtful design you'd expect from a premium chair, not something at this price point. If you're after a wallet-friendly massage chair that doesn't cut corners on comfort or cool features, the AYJOIR Zero Gravity Massage Chair is hands-down one of the smartest buys of 2025. Dimensions: 51.6″ (L) x 28.5″ (W) x 33 to 39.4″ (H) Best Full Body: Human Touch Perfect Chair PC-350 Classic Power Relaxe Pros: Ergonomic zero gravity recline Premium materials Chic design Cons: Higher price point The Human Touch Perfect Chair PC-350 Classic Power is your VIP pass to a full-body relaxation sesh. Imagine this: with one tap, the chair glides you into a zero gravity position so smooth, it's like your body just whispered, 'thank you.' Legs up, stress down — this is the sweet spot where your spine chills, your mind melts, and you briefly forget what responsibilities are. NASA-level comfort in your living room? Yes, please. Now let's talk looks, because this chair performs with style. With its hand-carved wood base and buttery-soft leather, the PC-350 gives serious 'James Bond in a spa' vibes. It's sleek, solid and fancy enough to make your other furniture feel underdressed. Plus, it's built to last, so whether you're 5'4″ or 6'5″, this chair has your back (literally) with smooth reclining power and superhero-level support. But the real magic? That's in the details. The head pillow hugs your noggin just right, the recline is smoother than jazz, and the whole experience makes Netflix marathons feel like full-on luxury retreats. Soon enough, you'll turn your living room into the coziest, chillest, most envy-inducing corner of the universe. The PC-350 convinces you that you deserve to be spoiled daily. Dimensions: 46″ (L) x 32″ (W) x 46″ (H) Other brands to consider: BestMassage: Delivers budget-friendly chairs with surprisingly powerful massage features for everyday stress relief. Delivers budget-friendly chairs with surprisingly powerful massage features for everyday stress relief. iRest: Focuses on ergonomic comfort and smart features that adapt to your body's needs for a tailored massage experience. Focuses on ergonomic comfort and smart features that adapt to your body's needs for a tailored massage experience. La-Z-Boy: Famous for legendary recliners, they bring their signature comfort and craftsmanship into the massage chair world with cozy, supportive designs. For over 200 years, the New York Post has been America's go-to source for bold news, engaging stories, in-depth reporting, and now, insightful shopping guidance. We're not just thorough reporters – we sift through mountains of information, test and compare products, and consult experts on any topics we aren't already schooled specialists in to deliver useful, realistic product recommendations based on our extensive and hands-on analysis. Here at The Post, we're known for being brutally honest – we clearly label partnership content, and whether we receive anything from affiliate links, so you always know where we stand. We routinely update content to reflect current research and expert advice, provide context (and wit) and ensure our links work. Please note that deals can expire, and all prices are subject to change. Looking for a headline-worthy haul? Keep shopping Post Wanted.


Hamilton Spectator
3 hours ago
- Hamilton Spectator
Sweaty feet, shaving rash: Sticky-summer advice from Toronto's viral hygiene expert Madame Sweat
'I tell people armpits are like rainforests — moist, dark and full of bacteria,' says Mary Futher, more famously known as Madame Sweat. If you aren't already following her, you're missing out. Madame Sweat is the internet authority on hygiene and personal care etiquette, gross grooming truths and tricks for keeping your body and home germ-free, with 1.1 million followers on Instagram and 18.3 million likes on her TikTok posts. And she happens to be Canadian. For Futher, there is no cleanliness conundrum too unpleasant to discuss, no taboo body issue that is off-limits: Recent screeds include 'The safe way to use cotton swabs,' 'The 3 filthiest everyday items,' and 'You're caring for your scab all wrong.' Before she was the internet's grand dame of hygiene, Futher worked in product development at big beauty brands, including Revlon, Shoppers Drug Mart and YSL, where she learned how active ingredient s really work, and what consumers truly want from their personal care products. Then, about a decade ago, she decided to start her own brand. Instead of pursuing luxe lipsticks or scented body lotions in pretty packaging, Futher's first launch was decidedly un-flashy: a deodorant. 'I've never been one for the sexy items, you'll notice, because I really like digging into things that nobody wants to talk about,' she says. At the time, everyone was on the hunt for a natural deodorant that actually worked, and her Kaia Naturals Charcoal Deodorant was a runaway hit. Its ensuing companion product, The Underarm Bar — for properly scrubbing away sweat before you apply a fresh layer of deodorant — remains her bestseller. Mary Futher's brand Kaia Naturals' bestseller The Underarm Bar, $26, , which contains apple cider vinegar, sea salt and activated charcoal. Madame Sweat's straightforward take on keeping things fresh is, well, refreshing. So we asked Futher to share her top hygiene tips for summer. If you've ever experienced stinky sneakers, wondered how often you need to wash your swimsuit or had your deodorant fail you on a hot day (honestly, haven't we all?), then keep reading for no-nonsense advice. 'You can't stop the sweating, but you can stop the smelling by washing your feet,' says Mary. But think beyond the shower gel you use on your arms, legs and torso. 'It's prudent to keep two different types of body cleansers in your shower,' she says. That's a gentle one for the areas that don't sweat much or get particularly dirty, and a second, more effective soap for your feet, underarms and skin folds. Futher points out that some on SkinTok recommend strong antibacterial cleansers, but those should be used with caution because they can be irritating; she says a soap containing tee tree oil or apple cider vinegar will do the job. If you're not someone who showers every day, at least wash just your feet in the bathtub or sink. Madame Sweat trick: Wash smelly areas like feet daily and scrub for a full 20 seconds using your hands or a soft silicone shower scrubber — but avoid loofahs and shower poufs because they harbour bacteria. If you notice odour coming from under your breasts or your belly button, a yeast infection could be the culprit. 'I've had two DMs this week about smelly C-section scars,' says Futher. Our skin is host to a range of fungus and bacteria — all over the body, all the time — but under certain conditions, yeast or fungus could proliferate, causing an infection. For some, all it takes is a string of particularly steamy summer day and voila, a yeast infection springs up in a skin fold. If you think you have a yeast infection on your body, talk to your doctor to verify; they may prescribe an antifungal cream or direct you to an over-the-counter option to clear it up. Madame Sweat trick: To reduce the chances of an overgrowth of yeast in skin folds anywhere on the body, clean the area daily with a mild cleanser, pat dry, then apply a moisture-absorbing powder or a barrier cream. Impromptu beach days or pool trips when you realize you need to groom stat are to blame for most shaving mishaps. 'You get into trouble when you try to do it fast,' Futher says. Instead, she recommends shaving regularly, so the hairs aren't too long and the skin becomes accustomed to the process, and taking your time as you move through the following steps. First, apply a warm, damp cloth to the area to soften the skin and open the pores. Next, use a cleanser that's exfoliating and disinfecting. Rinse, pat dry, and apply a shave oil: Futher finds these to be more effective than foams or gels, and says moringa oil (a seed oil from the moringa plant) works best. Using a new blade, shave in the direction of the hair growth, rinsing frequently to prevent clogging. Then — and this step is key — wash the area with disinfecting cleanser again, to remove any trace of bacteria that could turn into angry, red bumps. Lastly, pat dry and moisturize. Madame Sweat trick: Friction and perspiration can make shaved areas between your thighs and in your armpits prone to ingrown hairs. Exfoliate every second day with a product containing salicylic acid to keep the hair follicles from filling up with bacteria and dead skin cells. Whether you've spent a day at the beach, lounging at the lake, or doing laps in the gym pool, you need to wash your bathing suit after every use. 'Leaving it wet is the worst thing you can do,' says Futher, adding that just throwing it over a line or balcony fence to dry doesn't quite cut it, either. Laundering your swimwear removes sweat, sunscreen, chlorine, salt and debris from a dip in any kind of water. For best results, wash your suit by hand in the sink using a mild clothing detergent, rinse well, then hang to dry thoroughly. (Never put swimwear in the dryer, as this will degrade the fabric.) Madame Sweat trick: 'The same goes for sports bras,' says Futher. 'If you are prepared to take the time to wash them out by hand and hang to dry every time, you will extend their life by 50 per cent.' We shed some 30,000 skin cells every hour (!) so an old pillow could be up to 30 per cent dead skin cells, dust and dust mites, says Futher. Not only is this revolting, but sleeping on a pile of dust mites can trigger indoor allergies and symptoms like sneezing and itchy, watery eyes. Hypoallergenic pillows, which are made from synthetic materials that discourage mites from thriving, are the best option, but they are pricey. Futher has another recommendation: 'Better yet, buy the hypoallergenic covers that will protect your pillow inside.' Madame Sweat trick: Launder hypoallergenic pillow covers in hot water monthly, to kill mould and mites, and replace your pillows every two years. Baths can be wonderfully relaxing and therapeutic for sore muscles, but they're not a time for getting clean. When you're in the mood for a soak, Futher recommends pre-gaming with a quick shower — otherwise, you're just sitting in your own filth. Wash all your smelly bits, including feet, armpits and scalp, then rinse out your tub before you fill it with warm water to chill in. Madame Sweat trick: 'A shower is for hygiene; a bath is a treat.'


Medscape
4 hours ago
- Medscape
S3 Episode 1: Cancer Survivorship and Palliative Care
This transcript has been edited for clarity. For more episodes, download the Medscape app or subscribe to the podcast on Apple Podcasts, Spotify, or your preferred podcast provider. Kathryn J. Ruddy, MD, MPH: Hello. I'm Dr Kathryn Ruddy. Welcome to season 3 of the Medscape InDiscussion Cancer Survivorship podcast series. Today, we'll discuss palliative care, which refers to care that improves quality of life for patients with serious illness by mitigating symptoms and emotional distress. First, let me introduce my guest, Dr Jacob Strand. Dr Strand is currently chair of palliative care at Mayo Clinic and associate professor of medicine at Mayo Clinic College of Medicine and Sciences. He sees patients with complex symptom needs on the inpatient palliative care service and works closely with patients and their caregivers to manage complications of serious illness in the outpatient setting as well. Dr Strand, welcome to the Medscape InDiscussion Cancer Survivorship podcast. Jacob J. Strand, MD: Thank you so much, Dr Ruddy. I am delighted to be here today. Ruddy: I want to start by asking you about some basics about which patients we should be referring to see a palliative care specialist, when we would optimally make those referrals, and how frequently patients should be seeing you after they're originally referred. Strand: It's a really important question and one that continues to evolve. If we go back, even 5-10 years, outpatient referral to palliative care was done relatively late in the stage of patients with a malignancy, often in the setting of widely metastatic disease, when treatment options for that cancer were limited. That's changed quite a bit, with a number of studies showing significant benefits to patients as well as their caregivers with earlier referrals. Now we see a number of different recommendations, including those from National Comprehensive Cancer Network and the American Society of Clinical Oncology, to refer any patient with widely metastatic disease or patients with high symptom burden. Now, as you and I both know, that is a huge number of patients. And so a number of studies are ongoing, and really important implementation work continues to refine that, because we have a limited workforce in specialized palliative care, particularly in the ambulatory setting. We're continuing to try to find out which of those patients are optimally seen and then at what tempo, which is the second part of your question. That second part has changed as well because with significant improvements in targeted therapies, immunotherapy, and receptor-based inhibitors, we see patients who can live for many years without a significant disease burden despite having been diagnosed with metastatic disease. What we see now is that while we continue to advocate that patients be referred to a specialized palliative care ambulatory practice in the setting of a diagnosis of metastatic disease and high symptom burden, the tempo might extend after that. We might see what is called more stepwise palliative care, where the reintegration of palliative care after an initial visit or even several initial visits is done based on clinical trajectory. Maybe there's been a change in symptom burden, maybe a change in disease status. That then drives the follow-up visit. Ruddy: Are there also patients who are receiving curative intent therapy for their cancers who should also be seen by palliative care? Strand: Yes. That's a really important question. We see it in two main categories, certainly in cases, for example, of curative intent therapy for head and neck cancer, where patients might be receiving very intense therapy with a curative intent. We see a great deal of those patients in our outpatient practice because of their heavy symptom burden and then work to transition them back to their other care models, be that continuing with their medical oncology team or with their outpatient primary care team once they've gotten through that, initial setting of advanced, or intensive therapy. The other category of patients that are being seen more and more in an ambulatory palliative care setting, where that's available, are patients with hematologic malignancies that are undergoing curative intent therapy — for example, high-risk acute myelogenous leukemia, or allogeneic stem cell transplants. In both of those patient populations, we've seen important studies demonstrating the benefit to patients and caregivers, both during therapy and extending past therapy after the initial curative intent category. Ruddy: Can you tell us a bit more about what you and your colleagues discuss during a typical initial outpatient palliative care consultation? Strand: This has really gotten to what is in the syringe of a specialized palliative care practice. We see ourselves in palliative care as a specialty, like sending a patient to cardiology or infectious disease. So, what does it mean to be in a specialized outpatient clinic, in particular for palliative care? The first part, and this has been seen in a number of studies and qualitative analysis of early intervention palliative care, is about rapport building and symptom management. Those are the two important components of those initial visits. As we develop that relationship, we start to do a lot of work around adaptive coping. Adaptive coping also seems to be really important in mitigating some of the depressive symptomatology and anxiety that is very commonly associated with a new diagnosis of a serious malignancy. Those early visits are focused on rapport building and symptom management, adaptive coping, and then connecting with other members of an interprofessional palliative care team. That changes over time, where we start to see an increase again in symptom management as a patient's disease might progress. Based on that initial relationship building and adaptive coping, we start to see more goals of care discussions and serious illness communication, certainly driven by the patient's medical oncologist but supported by a palliative care team in those later phases of an outpatient relationship. Ruddy: Over the past 5-10 years, have there been new interventions that have changed what you see as the gold standard palliative care? Strand: Yes. I think that's been part of the really interesting story of specialized palliative care is that there haven't been specific interventions like procedures or medications that have largely changed our practice, perhaps with the widespread dissemination of medical-assisted treatment for opioid use disorder. We're seeing more and more of that in outpatient palliative care. Beyond that, this isn't a new treatment, it's really an old treatment, but we're seeing wider dissemination in broader patient populations. Outside of that, what we're seeing instead is what it means to be an early intervention palliative care team. Over the past 10 years, we've seen that because most patients used to be referred at the end of life, I think there was an association around palliative care as being a team that you would send a patient to only when disease modalities had been exhausted for that patient. And frankly, palliative care teams responded to that. So often, our conversations were focused on end-of-life decision-making, and obviously, that cycle made it really challenging to say, "Don't worry. Palliative care is not going to just talk about end-of-life when we're only referring those patients who are at the end of life." I think the push in specialty palliative care, certainly in our field, is training clinicians to understand the differences of seeing patients early on in their illness — which is focused, as I mentioned before, on symptom management, rapport building, and understanding coping skills that we can then augment and support during the course of an illness, and then also training specialized palliative care clinicians to better understand the trajectories of patients with advanced illness, particularly with the rapid advances in cancer-directed therapy. That's really been the change. It's not been something particularly new or novel from a procedural or pharmacologic perspective in our practice; it's been the training and the implementation of specialized teams who understand this patient population in a much different way than we did 10 years ago. Ruddy: Very interesting and, even if not new, are there any pharmacologic interventions that you and your team do prescribe frequently beyond opioids that perhaps oncologists might not be as frequently prescribing and maybe should know about? Strand: Among a couple of things that we're seeing, the first to mention is buprenorphine, which is an interesting partial opioid agonist that I think many listeners might be familiar with as the medication Suboxone, which is used for medication-assisted treatment in the setting of opioid use disorder. I think what we've seen in the field in palliative care, particularly for patients with cancer over the past 2-3 years, is an expansion of use of that, because I think we're better recognizing concomitant opioid use disorder or concerning behaviors that might lead to opioid use disorder in patients with advanced malignancy. I think the other piece is we're starting to see the use of that medication more frequently in patients who might not be tolerant of other opioids for cancer-related pain or have other risk factors that might make prescribing full agonist therapy more concerning. When I work with my oncology colleagues, we talk about the use of buprenorphine products as one way of providing better pain relief for those patients who might be at either higher risk for side effects or have had documented side effects in the past. The other piece we're seeing, and this certainly shouldn't be too unfamiliar to our listeners in medical oncology and hematology, is how often we can potentially use the medication olanzapine. Many people are familiar with this, of course, as it's used in highly emetogenic chemotherapy regimens. Still, we're using it quite frequently in our practice for non–chemotherapy-related nausea and vomiting in the setting of patients with cancer, because it can be quite an effective agent in helping reduce that sense of nausea even outside of documented vomiting. We're also seeing it probably expand its use in the treatment of anorexia, which certainly can occur along with low-grade nausea. But there have been some interesting studies highlighting the potential for benefit in cancer-associated anorexia of treatment with olanzapine, which we're using in that setting much more frequently than we did probably 10 years ago. The other medication that I'll comment on, because it's been on the news recently, is suzetrigine, a novel analgesic agent that has come on the market in response to concerns about the opioid epidemic and what we can we do that might not put patients at risk for opioid use disorder in the future. We're going to hear a lot more about suzetrigine in the coming years. It may not currently occupy a prominent place for patients with cancer, because of its relatively limited approval in acute pain and postoperative pain. But I think we're going to be hearing much more about medications of this class in the coming years. Ruddy: Thank you for that. I look forward to learning more. I am wondering if you can describe a bit more about what palliative care offers to caregivers. Strand: This has been an important part of the growth of earlier intervention palliative care teams, the focus on caregivers as a really critical component of caring for our patients. We know that when caregivers are struggling, there are direct impacts on our patients' ability to make it to appointments, pick up medications, and manage acute symptoms in the setting of a malignancy. In our practice, here at Mayo Clinic and in other palliative care practices, particularly those who are associated with cancer centers and other oncology practices, we are trying to focus the energy of the team on the caregiver as well as the patient. Often, that involves the use of nurses, nurse coordinators, social workers, and chaplains to focus on caregiver burnout and caregiver burden, and sometimes even having designated visits or support groups for caregivers specifically. There's been some really interesting research and pilot studies using group-based therapy for caregivers led by social workers and chaplains. We're looking forward to seeing the results of those studies here, in the coming years, to see what the optimal support structure dose is for patients and caregivers. We're understanding that when we can support caregivers more effectively, patients do better from a quality of life perspective. But also, we may prevent non–goal-concordant visits to the emergency department or the hospital setting because a caregiving structure has simply burned out. Ruddy: Can you talk a little bit about legacy work? Some of my patients have been very enthusiastic about how palliative care has facilitated that for them. Can you tell us a bit more about what it is and how and when that happens? Strand: Legacy work is really interesting, and it can sometimes be challenging to bring up to patients because the concept of legacy is based on the idea that at some point, they might die. Therefore, legacy is about what they might leave behind both in their journey through their diagnosis with cancer, but also what that means for their family afterward. Sometimes clinicians are worried about bringing that up. Patients are really interested in this, as you mentioned. They're interested in how they can leave something behind for family members, even if that might be years and years in the future. That's one version of legacy work that supports patients in talking about it. From the beginning, do you know what this looks like? What are you worried about for your family members? What sort of things are you hoping to leave for your family members? If this isn't a cancer that can be cured, what might that look like in the future? It is also interesting as a way of coping. One way that patients can cope with a diagnosis of serious illness, particularly something that is not curable, is to really think about the legacy that they might leave behind. In our practice, we do this predominantly with nurses, social workers, and chaplains. There are structured legacy interventions. There are unstructured interventions that are more conversational and free-flowing. Some of the structured interventions might take the place of asking patients structured questions around their childhood, their work history, things they're proud of, and lessons they are hoping to share with their family. We do a version of this in a program called Hear My Voice. The structured questions are led by a chaplain around a patient's life story, which is then transcribed into a book that can then be given back to the patient to share with their family members. Beyond being something that we might all consider really supportive and nice, it also has some demonstrated benefits, showing improvements in patients' quality of life and reduction in depression and anxiety symptoms. Both the structured and unstructured programs can be really helpful for patients. In practices that may not have access to a structured program led by interdisciplinary team members, engaging with community-based resources has also been a growth area where we see, both in spiritual groups and other religious communities, that some legacy practices take place. Also, with community-based grief counseling and community-based support groups, some practices are showing some interesting studies around legacy work in these maybe less medically structured formats as well. Ruddy: To build on that, when patients decide to enroll for hospice care, what does that look like currently, and what would you like to see change about end-of-life care over the next decade? Strand: Well, the wish list is long. We're still struggling in the oncology and hematology fields to really have those conversations early enough and identify transitions more upstream in a patient with advanced cancer. The length of stay in hospice for advanced cancers is less than for other diagnoses of serious illness, despite the fact that we often can see the trajectory of a patient with cancer perhaps better than we can see the trajectory of a patient with Alzheimer's dementia. Part of that is the hospice structure itself. We often know that an increasing number of therapies are coming down the pike, almost at every turn. Because of the way hospice is structured in this country, where hospice programs really are not financially able to take on patients who are continuing with any form of disease-directed treatment, it often feels to patients and to clinicians like there's a choice between either continuing to treat someone's cancer, even if it's a palliative treatment, or to transition to hospice. If I had to wave my magic wand, we'd see many more programs that would incentivize the use of concurrent disease-directed treatments, even in a palliative setting with enrollment in hospice. We see this in a pediatric patient population that has a concurrent care model built into the hospice benefit for pediatric patients, which allows pediatric patients to continue with cancer-directed therapies even while receiving hospice care. There have been some pilot programs looking at this. We just haven't seen widespread adoption. I think that's one of the greatest things that I would love to see change over the next 10 years. In the short term, for patients with hematologic malignancies, one of the biggest barriers really centers around transfusion support. Patients with hematologic malignancies often receive frequent transfusion support as part of their cancer-directed therapy and supportive care. And very often, this feels like one of those big barriers to transition to hospice interdisciplinary care outside of a medicalized setting, that they may not have access to transfusions. That's not completely true from the letter of the law in terms of what can be supported, but practically, we see that as a significant barrier. So we've seen that the American Society of Hematology has called upon legislators and policymakers to address this perceived gap, and this concern, this barrier for patients with hematologic malignancies to continue transfusion support while engaging in hospice services. Ruddy: Thank you for sharing those really insightful ideas with us. Do you have additional thoughts that you would like to share with our audience today? Strand: The biggest thing that I would share is just how much the field of palliative care is changing and how deeply connected it is with medical oncology and hematology practices. The opportunity is significant. We've really seen how specialized palliative care teams can provide significant benefits to patients with advanced cancer in terms of physical symptom burden, such as pain and nausea; non–pain symptom management, such as depression and anxiety; and support for caregivers. The other piece that we haven't talked about is support for oncology clinicians themselves. I think having a partnership between our cancer clinicians and our palliative care clinicians allows both to share in the complexity of that care. We've seen that in practices where there is structured early intervention, oncology clinicians really enjoy that work more. I certainly know that as palliative care clinicians, we see that every day in our practice, and we enjoy our work in cancer care because of that close connection with our colleagues. And so I think we need to move beyond 'this patient isn't ready for palliative care' to an idea of how palliative care could benefit my patient, particularly in those populations like we've discussed today — those patients with metastatic disease, those patients with significant symptom burden. Even though we know that the volume of those patients outstrips what our workforce can currently accommodate, it does provide us a place to start. It provides us a place where this patient has metastatic disease, maybe they're doing well and their prognosis is likely to be many years. Still, if they have a setback, if they have a worsening symptom trajectory, that's when I'm going to engage my palliative care team. Building those relationships now can be really meaningful in identifying new populations for individual practices, where there can be great work together. In my role as chair for palliative care at the enterprise level here at Mayo Clinic, I see that there are distinct different relationships at all of our sites at Mayo Clinic. There are some that have really deeply ingrained practices within the allogeneic stem cell transplant and acute myelogenous leukemia populations. There are others who have a really deep and rich engagement in solid tumor malignancies. That's where practices have an opportunity to identify the area of greatest need and potentially build that referral pathway, beyond one of last resort, including working together with you as a cancer clinician to provide the best care for patients with advanced cancer. Maybe I'll leave you with one final parting thought, which is that in a number of clinical trials over the past 2-3 years, we've had to figure out ways for cancer clinicians to introduce palliative care in a way that feels authentic and also provides patients with the information of why they're being sent to another team to help manage symptoms. Some of the verbiage that I think has been really fascinating to see come organically from our cancer clinicians has been statements like 'To make sure that we're providing you with the best care possible throughout your cancer journey, we're going to send you to some of our colleagues who will help manage symptoms that might affect your quality of life, so that you can have the best quality of life as you go through your cancer treatments.' It's been a really nice way to build that relationship not just between patients, cancer clinicians, or patients and palliative care clinicians, but from the palliative care teams and cancer care teams as well. Ruddy: Thank you, Dr Strand, for everything you do for our patients and for being here today. This has been a terrific episode. Today, we've talked to Dr Jacob Strand about palliative care. He shared his insights about which patients should be referred to see a palliative care specialist, what supportive interventions are most helpful to patients with cancer, how palliative care supports caregivers, and how oncologists can talk to patients about palliative care. Thank you for tuning in. Please take a moment to download the Medscape app to listen and subscribe to this podcast series on cancer survivorship. This is Dr Kathryn Ruddy, for the Medscape InDiscussion Cancer Survivorship podcast. Listen to additional seasons of this podcast. Cancer Survivorship — A Framework for Quality Cancer Care Bridging the Gap: Palliative Care Integration Into Survivorship Care NCCN Guidelines — Palliative Care Survivorship Care for People Affected by Advanced or Metastatic Cancer: Building on the Recent Multinational Association of Supportive Care in Cancer-ASCO Standards and Practice Recommendations Buprenorphine Use for Analgesia in Palliative Care Olanzapine in Oncology Palliative Care The Feasibility and Acceptability of a Chaplain-Led Intervention for Caregivers of Seriously Ill Patients: A Caregiver Outlook Pilot Study Legacy in End-of-Life Care: A Concept Analysis The Feasibility and Educational Value of Hear My Voice, a Chaplain-Led Spiritual Life Review Process for Patients With Brain Cancers and Progressive Neurologic Conditions ASH President Applauds Introduction of Legislation for Palliative Blood Transfusions