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Gabrielle Goldberg, MD
GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified) )| Communities: All Cancers | Answers: 8 |
| Member Since: Feb. 2012 |
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Professional Statement
Dr. Goldberg is an Assistant Professor of Geriatrics, Palliative Medicine, and Oncology at Mount Sinai School of Medicine. Dr. Goldberg was the Education Director of the Lilian and Benjamin Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine from 2006-2012. She has been Medical Director of the Wiener Family Inpatient Palliative Care Unit at the Mount Sinai Hospital since the opening in June 2011. She completed her residency in Internal Medicine and fellowship in Hematology and Medical Oncology at Mount Sinai School of Medicine, where she also served as a chief fellow. She is board certified in Internal Medicine, Hematology, Medical Oncology and Hospice and Palliative Medicine.
Dr. Goldberg’s career interests include medical student and resident education in palliative medicine and the management of pain in cancer patients. She helped to establish, and is the physician leader of, the Schwartz Center Rounds at the Mount Sinai Hospital. She has presented at national scientific meetings of the American Society of Clinical Oncology Annual Meeting (ASCO), American Academy of Hospice and Palliative Medicine (AAHPM), and the American Association of Medical Colleges (AAMC). She has published in the Journal of Clinical Oncology, the Journal of the American Geriatrics Society and has written several book chapters.
Dr. Goldberg’s career interests include medical student and resident education in palliative medicine and the management of pain in cancer patients. She helped to establish, and is the physician leader of, the Schwartz Center Rounds at the Mount Sinai Hospital. She has presented at national scientific meetings of the American Society of Clinical Oncology Annual Meeting (ASCO), American Academy of Hospice and Palliative Medicine (AAHPM), and the American Association of Medical Colleges (AAMC). She has published in the Journal of Clinical Oncology, the Journal of the American Geriatrics Society and has written several book chapters.
Professional Info
Credential: MD
Primary specialty: Hospice / Palliative Care
Secondary specialty: Oncology - Hematology/Oncology
Medical school: Mount Sinai School of Medicine
Residency: Mount Sinai Hospital
Fellowship: Mount Sinai Hospital
Areas of expertise:
Anorexia
Anxiety
Cancer Fatigue
Cancer Pain Syndromes
Constipation
Delirium
Depression
Failure-To-Thrive
Insomnia
Hospital affiliation: Mount Sinai School of Medicine
Practice address:
1440 Madison Avenue
New York, NY
10029
Practice phone number: 212-241-1446
GabrielleGoldbergMD Activities
A cancer pain syndrome is a group of related signs and symptoms that are experienced as a result of the cancer itself (via direct effect of growth of the tumor or due to substances produced by the tumor) or as a result of anticancer treatments such as surgery, radiation therapy or chemotherapy. There are a variety of cancer pain syndromes that a clinician can diagnose on the basis of a detailed medical and pain history and a thorough physical examination. Identification of the cancer pain syndrome will allow the physician to tailor treatment plans and communicate with patients about expectations for duration of symptoms and efficacy of treatments.
New answer by GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified))
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1 year ago
GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified)) asked the question
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1 year ago
When assessing pain in a cancer patient a palliative care doctor will ask the patient to rate the severity of their pain, to describe the location and quality of the pain (is it sharp, stabbing, burning, etc.), and to describe the onset and timing of the pain. They will also ask whether the pain radiates to other parts of the body, about exacerbating and alleviating factors. A thorough evaluation should also include an assessment of how the pain is impacting the patient’s quality of life and ability to perform day-to-day functions. Taking a thorough pain history will allow the doctor to consider the etiology of the pain and guide treatment accordingly. Assessment of the severity of pain also allows the physician to determine the efficacy of treatments over time.
New answer by GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified))
1
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1 year ago
GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified)) asked the question
1
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1 year ago
Constipation is an expected and predictable side effect of opioid medications. It is one of the few side effects to which a patient will never develop tolerance, in other words, this side effect will never go away. For these reasons it is most important that a patient is provided with a prescription for a bowel regimen to prevent constipation whenever they are started on an opioid medication. In general, patients are started on a laxative such as sennakot, and a stool softener, such as docusate. If patients become constipated despite the prophylaxis they may be started on additional laxatives such as lactulose, dulcolax or miralax. Patients who are taking opioids and do not have a bowel movement for >48 hours despite being on a bowel regimen should be in contact with their physician for further recommendations and treatment.
New answer by GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified)) in topic(s) Narcotics, Narcotics Side Effects, Constipation Treatments, Side Effects, Treatments, Constipation
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1 year ago
It is important that we have a common understanding of what hospice care is before answering this question. Hospice provides care for a patient who has a terminal diagnosis, with expectation of a prognosis of 6 months or less, and is usually no longer seeking curative treatment. Hospice focuses on relieving symptoms and supporting patients and is provided in the home, in a residential setting, or in the hospital. Another way of looking at it, is that hospice care provides palliative care for those approaching the last stages of life. I find that the best first step in addressing discussions about hospice with patients and families is to first understand what they know about their underlying diagnosis, their treatment options and how their illness is impacting their quality of life. I want to also understand what is most important to a patient and family when the prognosis is limited. Once I know what a patient and family hope to achieve and what is most important to them I can best help to guide treatment and make use of hospice services to help maximize their quality of life and help them to achieve their goals.
New answer by GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified)) in topic(s) Palliative Care, Hospice Care, Hospice, Doctor-Patient Communication, Patient Communication, End Of Life, Doctor Communication
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1 year ago
Patients may not address “end-of-life issues” because of stress and anxiety. In my experience, I have found that patients are often under more stress and anxiety when discussions about prognosis and goals of care have not occurred. People approach a cancer diagnosis and treatment differently, influenced by their personalities, life experiences, education as well as personal and spiritual beliefs. It is important to first understand how a patient is coping with and understanding their illness and prognosis. Stress and anxiety often arise from misunderstanding and/or fear about the underlying illness. If this is the case, starting a dialogue with the patient, to clarify misconceptions and openly address patient and family fears, will help to dissipate stress and anxiety and allow an open discourse about prognosis and patient wishes for care at the end of life.
New answer by GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified)) in topic(s) Palliative Care, End Of Life Decisions, Stress, Anxiety, End Of Life
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1 year ago
When approaching a patient with pain, the first step is to do a very thorough pain history to determine the etiology of pain, severity of pain, duration of the pain and the impact of the pain on the patient’s life and physical functioning. The etiology of the pain will guide us to understand the expected duration of the pain and the approaches that are most likely to be effective in treatment. For cancer patients in moderate to severe pain, opioid pain medications are often effective. We may use opioid pain medications in conjunction with acetaminophen or non-steroidal anti-inflammatories (NSAIDs). Our goal in treating patients is to get a stable control of pain with a standing medication regimen, with the availability of “breakthrough” or “rescue” medications for acute exacerbations of pain that may occur. When starting patients on new pain medication regimens we make sure to have close follow-up with patients to assess for efficacy as well as side effects of the regimen. We also make use of other members of the interdisciplinary palliative care team, including our massage therapists to assist in pain management. Certain cancer pain syndromes may also be amenable to interventional procedures such as nerve blocks, in which case we work with and make referrals to our colleagues in Anesthesiology who specialize in interventional pain management.
New answer by GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified)) in topic(s) Palliative Care, Palliative Care Treatment Options, Cancer Side Effects, Pain Treatment Options, Side Effects, Chronic Pain, Cancer
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1 year ago
As stated in another answer (http://talkabouthealth.com/where-can-we-learn-more-about-the-current-standards-for-palliative-care-for-oncology), palliative care is specialized medical care for patients and families facing a serious illness and is appropriate throughout the continuum of a serious illness starting from the point of diagnosis. Palliative care can be provided by the oncology team, in the form of assessment and treatment of physical symptoms related to the cancer diagnosis or as a result of the anti-cancer therapies themselves. Excellent control of symptoms such as nausea and pain can help a patient to maintain adherence to anti-cancer treatment regimens. Palliative care specialty level consultation services should be utilized in situations where the symptom presentation is complex or the patient and family would particularly benefit from an interdisciplinary palliative care team.
New answer by GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified)) in topic(s) Palliative Care, Palliative Care Treatment Options, Less Advanced Cancers, Less Advanced Cancer Treatments, Treament Options, Palliative Care Treatments, Cancer
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1 year ago
I should start with clarifying the definition of palliative medicine. Palliative medicine is care for patients and families facing serious illness. Palliative care makes use of an interdisciplinary team to address the impact of a serious illness on a patient’s physical, psychosocial and spiritual well-being. Palliative care is appropriate throughout the continuum of a serious illness, starting at the point of diagnosis. Unfortunately, all too often physicians and patients believe that palliative care is “end-of-life” care and that one must make a choice between active cancer therapy and palliative care. We know that palliative care relieves suffering through detailed attention to the assessment and treatment of pain and non-pain symptoms and consequently improves patient and family quality of life.
When provided concomitantly with anti-cancer therapy, palliative care may prolong life. In a study of patients with advanced lung cancer those who received palliative care with anticancer-therapy from the time of diagnosis actually lived longer than patients with advanced lung cancer who received anti-cancer therapy alone. Largely due to the results in this lung cancer study, as of February 2012, The American Society of Clinical Oncology ASCO now recommends “combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden”
Getpalliativecare.org (http://www.getpalliativecare.org) is a wonderful resource for patients and families to learn more about palliative care. The website provides clear and comprehensive information for patients and families facing serious illnesses including cancer. The site provides information about palliative care and advanced care planning and assists patients and families in identifying palliative care providers in their communities. It also provides resources and references for more disease specific information.
When provided concomitantly with anti-cancer therapy, palliative care may prolong life. In a study of patients with advanced lung cancer those who received palliative care with anticancer-therapy from the time of diagnosis actually lived longer than patients with advanced lung cancer who received anti-cancer therapy alone. Largely due to the results in this lung cancer study, as of February 2012, The American Society of Clinical Oncology ASCO now recommends “combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden”
Getpalliativecare.org (http://www.getpalliativecare.org) is a wonderful resource for patients and families to learn more about palliative care. The website provides clear and comprehensive information for patients and families facing serious illnesses including cancer. The site provides information about palliative care and advanced care planning and assists patients and families in identifying palliative care providers in their communities. It also provides resources and references for more disease specific information.
New answer by GabrielleGoldbergMD (Physician - Hospice / Palliative Care (Verified)) in topic(s) Palliative Care, Oncology Palliative Care, Palliative Care Standards
1
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1 year ago
GabrielleGoldbergMD's Profile
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