In patients with colorectal cancer (CRC) that metastasizes to the liver, there are several key goals for improving outcomes including early detection, effective prognostic indicators of treatment response, and accurate identification of patients at high risk for recurrence. Although new therapeutic regimens developed over the past decade have increased survival, there is substantial room for improvement in selecting targeted treatment regimens for the patients who will derive the most benefit. Recently, there have been exciting developments in identifying high-risk patient cohorts, refinements in the understanding of systemic vs localized drug delivery to metastatic niches, liquid biomarker development, and dramatic advances in tumor immune therapy, all of which promise new and innovative approaches to tackling the problem of detecting and treating the metastatic spread of CRC to the liver. Our multidisciplinary group held a state-of-the-science symposium this past year to review advances in this rapidly evolving field. Herein, we present a discussion around the issues facing treatment of patients with CRC liver metastases, including the relationship of discrete gene signatures with prognosis. We also discuss the latest advances to maximize regional and systemic therapies aimed at decreasing intrahepatic recurrence, review recent insights into the tumor microenvironment, and summarize advances in noninvasive multimodal biomarkers for early detection of primary and recurrent disease. As we continue to advance clinically and technologically in the field of colorectal tumor biology, our goal should be continued refinement of predictive and prognostic studies to decrease recurrence after curative resection and minimize treatment toxicity to patients through a tailored multidisciplinary approach to cancer care.

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IMPORTANCE Palliative care is a patient-centered approach associated with improvements in quality of life; however, results regarding its association with a survival benefit have been mixed, which may be a factor in its underuse.OBJECTIVE To assess whether early palliative care is associated with a survival benefit among patients with advanced lung cancer. DESIGN, SETTING, AND PARTICIPANTSThis retrospective population-based cohort study was conducted among patients with lung cancer who were diagnosed with cancer between

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Background High quality communication is a key determinant and facilitator of patient-centered care. Nurses engage in the vast majority of communication with patients and families in the intensive care unit (ICU). Objective To perform a qualitative analysis of nurses' communication. Methods The study was conducted in a 26-bed cardiac/medical ICU in an academic hospital and a 26-bed general ICU in a Veterans Affairs hospital in Portland, OR. We reviewed 315 hours of ICU interactions and 53 interviews with 33 nurses to categorize communication interactions into five patient-centered care domains. Interviews were analyzed to identify major themes regarding nurses’ roles and preferences for communicating with patients and families within the domains. Results Most nursing communication occurred in the biopsychosocial information exchange, “patient-as-person”, and “clinician-as-person” domains. Nurses endorsed the importance of the shared power and responsibility and therapeutic alliance domains but had relatively few communication interactions in these areas. Communication behaviors were strongly influenced by the nurses’ roles as translators of information between physicians with patients and families and what they were and were not willing to communicate to patients and families. Conclusions Critical care, including communication, is a collaborative effort. Understanding how nurses engage in patient-centered communication in the ICU can guide future interventions to improve patient-centered care.