Supportive Care Intervention for Cancer Patients
What is Supportive Care?
Supportive care involves addressing symptoms, side effects, and mental health concerns to enhance comfort in all areas of life throughout the cancer journey.
Why is Supportive Care Important for Patients with Cancer?
Supportive care is often viewed as secondary to traditional cancer treatment yet is actually one of the most important aspects of care for patients with cancer. This is because it can greatly ease the burden of treatment-related discomfort and be immensely empowering. Incorporating supportive care that addresses elements core to the patient’s identity into treatment plans, provides patients with autonomy, purpose and drive that can greatly enhance overall quality of life. Supportive care should be implemented from diagnosis. While at times, life-threatening issues must take precedence, supportive care should always be considered and integrated thoughtfully into treatment plans.
Who Provides Supportive Care?
Supportive care measures should be provided by each member of the multidisciplinary care team and prioritized throughout each stage of the cancer journey. Multidisciplinary care team members include physicians, nurses, case managers, social workers, dietitians, mental health practitioners, religious leaders and anyone else who provides patient care. The nurse is often the clinician facilitating supportive care. This is because nurses typically spend a substantial amount of time with patients, and on-going assessment of needs is a large part of nursing practice. Through careful assessment, nurses identify patient needs and addresse them to promote care of the whole patient. Nurses can provide supportive care through direct delivery and by coordinating involvement of other practitioners to provide care.
Examples of Supportive Care
Supportive care is specific to the patient and can include side effect management, mental health care, easily accessible communication with providers, alternative therapies, nutrition therapy, advocacy for funding of relevant studies, peer support, exercise, meditation, pain management and managing symptoms of the cancer itself.
Facilitating Supportive Care
Open communication between members of the multidisciplinary team and the patient is essential for optimizing supportive care measures. Every patient is different, so it is of utmost importance for healthcare practitioners to use assessment tools that allow for the full scope of the patient’s needs to be addressed. Several factors can make it challenging for patients to feel comfortable expressing their concerns, making communicating in a way that is tailored to individual needs a vital component of optimizing quality of life.
Peer support can be a critical aspect of supportive care. It is important that peers are in a space where they can support the individual’s needs and that the patient can relate to the peers within the group.
Journaling can also be very helpful when it comes to allocating supportive care. This is because it can be easy to forget symptoms or other concerns that are necessary to address in between doctor’s visits. Journaling also allows for enhanced thought processing which can be very cathartic and revealing.
Rapport between patients and the care team is another important part of supportive care because “good rapport” allows patients to feel comfortable addressing concerns.
It’s recognized that supportive care is not often a high priority research focus. There is evidence that shows that supportive care can have a greater benefit to survivability than FDA-approved treatments that target cancer in certain circumstances.
Traditional Therapies & New Therapies
Both newer treatment options and older treatment options have pros and cons. Different medications are often given with certain types of chemotherapy to minimize side effects and thus provide more comfort to the patient. Open communication about side effects, concerns, and needs is important so that supportive and individualized care can be provided.
5-Fluorouracil (5-FU), Gemcitabine, Taxotere are all traditional therapies that can cause many side effects but also work well to treat a variety of cancers. Immunotherapies or checkpoint inhibitors are newer therapies and can offer few to no side effects for many patients, though are not devoid of risk. These therapies can cause the immune system to become overly activated, resulting in diarrhea, colitis, and liver damage. Steroids can be used to combat these side effects. Another category of cancer treatment is called “targeted therapies.” These therapies target a specific protein or gene to treat cancer. Peeling and dryness of the hands and mouth sores can be caused by targeted therapies. CAR-T cell therapy is another newer therapy that utilizes the patient’s own immune system to attack the cancer cells by removing the patient’s T-cells through apheresis and genetically modify them to specifically target the person’s cancer. This type of therapy is particularly useful in treating many of the blood cancers like leukemia and lymphoma. If CAR-T cell therapy causes the immune system to “over attack,” it can cause a cytokine storm which causes the body to become quite ill, requiring hospitalization.
It is important for providers to be able to differentiate between side effects from chemo and cancer symptoms so that the appropriate treatment can be provided. There are a variety of options to mitigate side effects of various cancer treatments including scalp cooling to reduce hair loss and medications to combat nausea, vomiting, diarrhea, and low blood counts.
There are also a variety of pain management options including injections, spinal taps, and pills that can help alleviate pain from treatment side effects and cancer itself.
Supportive Care Resources
https://www.cancer.org/cancer/caregivers.html
www.cancercare.org/helpinghand
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Meet the Panelists:
Leah Evert
Leah Evert is a registered dietitian, breast cancer survivor and co-founder of The Willow Foundation— a non-profit organization that funds research in alternative practices to enhance quality of life for patients with cancer. She is also a former exercise physiologist, former division one athlete and avid runner who directs a corporate health program for a large pharmaceutical company. Leah was diagnosed with stage four breast cancer in 2017 at the age of 36 and quickly learned that the cancer had spread to her liver, lymph nodes, and lung. She has received over 109 rounds of chemotherapy and 19 rounds of radiation to date. Her inspiring story depicts the essential nature of supportive care when it comes to the overall health of patients with cancer.
Dr. Diane Reidy-Lagunes
Dr. Diane Reidy-Lagunes is a gastrointestinal oncologist at Memorial Sloan Kettering who cares for patients with a variety of gastrointestinal and endocrine cancers including cancers of the large intestine, small intestine, pancreas and adrenal cancer. She is currently involved in neuroendocrine cancer research with a focus on enhancing treatment outcomes for patients. Her experience as an oncologist provides a unique perspective on the importance of supportive care and how it can best be facilitated to optimize quality of life for patients with cancer.