Cancer care continues to change. Patient centered, multidisciplinary care is gradually becoming the norm. Specialists in medical oncology, radiation oncology and surgery see the patient at the same time and in the same setting, replacing the old game of “patient pong”, in which the patient runs from doctor’s office to doctor’s office. This way, the providers come to the patient instead of the patient coming to the providers. Support services, such as social work, pastoral care, nutrition and financial counseling are available as well. Members of the care team have the opportunity to collaborate, interact and deliver a unified care plan to the patient at the end of a single visit. This improves care coordination and decreases the time from diagnosis to the start of treatment.
Nurse navigators coordinate care and serve as a touch point as patients go through diagnosis, staging and treatment of their cancer. At FMH, we are doing this routinely for our patients with breast and lung cancer. Once we build our new Cancer Center, we will have the ability to offer this care model for all of our cancer patients.
Another change beginning to take hold is the expanded role for palliative care in the management of patients with cancer. Physicians who specialize in palliative care are experts in the management of symptoms, relief of pain and are particularly skilled in helping patients navigate the issues that surround end of life. They help patients make decisions around the goals of treatment and in setting priorities. They collaborate with other members of the care team while the patient is actively undergoing treatment and, when the time comes that treatment is no longer effective, they help the patient and his or her family transition to hospice care, helping to ensure an end with dignity and without pain, in a setting of the patient’s choice.
It’s important to dispel certain disbeliefs about palliative care. First, it’s not just for patients with cancer.
Patients with end stage diseases such as congestive heart failure and COPD can benefit from palliative care. In fact, studies have shown that patients with these conditions who receive palliative care enjoy not only an improved quality of life, but actually live longer than similar patients who do not receive palliative care services. And the same is true for patients with cancer. A landmark study by Temel and associates at Massachusetts General Hospital and Harvard Medical School demonstrated that patients with advanced non-small cell lung cancer who had palliative care services introduced at the time of diagnosis enjoyed better quality of life, improved survival and a lower overall cost of care. Both patients and their families reported a meaningful improvement in their experience.
The American Society of Clinical Oncology now recommends palliative care for all patients with advanced non-small cell lung cancer, once the diagnosis is made. There is an accumulating body of data that patients with all forms of advanced cancer can benefit from this approach. It’s also important to note that introducing palliative care early on does not mean a patient cannot undergo standard cancer treatments, such as chemotherapy and radiation.
It’s not treatment OR palliative care, but treatment AND palliative care.
At FMH, we are fortunate to have a wonderful palliative care team, headed by Dr. Eric Bush. Eric and his team of nurse practitioners provide superb and compassionate care, coordinating with other treating physicians to deliver the best possible outcome and experience for patients and their families. The demand for their services has been such that we are actively recruiting for another palliative care physician to join Dr. Bush and his team. We are also working with all of our cancer physicians to incorporate palliative care into the treatment plan of all patients for whom it is appropriate. Cancer care continues to change and at FMH, we’re staying ahead of the curve.