By Dr. Lucinda J. Cassells for the Daily Hampshire Gazette
As patients live longer with cancer, the National Institutes of Health (NIH) has expressed concern over their quality of life.Managing the symptoms of cancer and the side effects of various treatments is a major issue for patients as they strive to maintain their independence with the least impact on their everyday lives.
Q: What advances have been made in the treatment of side effects?
A: As treatments evolve and many patients live longer following a cancer diagnosis, doctors are increasingly aware of the need to address both short- and long- term side effects.
Much research has been done toward preventing nausea and vomiting associated with traditional chemotherapy, and control of these has continued to improve over time.
Clinical studies performed to assess the effectiveness of chemotherapy and other cancer treatments are now more likely to include the gathering of information about patients’ quality of life and symptoms. This is an important step in measuring the benefit of treatments.
Newer treatments are aimed at the immune system with the goal of harnessing our bodies’ own defenses. These treatments are an exciting new horizon, but we are still learning about their side effects and how best to avoid or manage them.
Q: Is pain a separate issue?
A: Pain is, unfortunately, not uncommon in patients with cancer and is an important focus of care.
Pain also can occur as a side effect of treatment, most commonly what is called a sensory neuropathy, which is an uncomfortable numbness in the fingers and toes. Fortunately, this side effect eventually improves or resolves completely in many patients once treatment is discontinued.
Q: Why does managing side effects take on such a great importance in the overall treatment of cancer patients?
A: There are several reasons. For patients receiving treatment that may cure their cancer, we believe it is important to deliver as much of the planned treatment as possible. Patients understandably experience delays or stop treatment if they have intolerable symptoms. So, managing side effects may contribute to a patient’s survival.
Many patients with a recurrence of cancer or more advanced cancer cannot be cured but they may be receiving treatment to control the disease. Managing and minimizing side effects is important to help them have the best possible quality of life.
At the Baystate Regional Cancer Program, the entire team of clinical staff is engaged on a daily basis providing education and guidance to patients.
Additionally, we have a supportive care clinic which is specifically focused on managing symptoms related to cancer and treatment.
Q: What is palliative care and how does it differ from hospice?
A: Palliative care is directed at symptom management and coping strategies often in patients with more advanced cancer or complicated cancer-related issues.
Patients are often, but not always, receiving active anti-cancer treatments alongside of palliative care.
Hospice care is different in that the focus of care shifts away from cancer treatments such as chemotherapy, which comes with side effects, and on to maintaining quality of life in the setting of a limited life expectancy.
Q: What roles do alternative and complementary therapies play in managing symptoms and what is the difference between the two?
A: While some of this may be semantics, the National Cancer Institute (NCI) defines complementary therapies as those that are delivered alongside standard cancer treatments and alternative therapies as those that are administered instead of/in place of standard therapies.
A patient who is using acupuncture, reiki or meditation while taking standard anti-nausea medication is using complementary therapy.
A patient who chooses not to receive standard treatment for nausea for their cancer, but uses diet or herbal remedies in an attempt to prevent or treat their nausea is using an alternative therapy.
The most important take home message is that it is important to partner with your care team and engage in open discussion about the risks/benefits of complementary and alternative treatments.
Q: What help is available for patients dealing with the overwhelming emotions that often follow a diagnosis?
A: Most cancer experts understand that the diagnosis of cancer raises many questions and concerns in patients and their loved ones. Writing these down and/or taking a support person with you to appointments may help organize your thoughts and get information you will need to help you make decisions.
If patients find themselves overwhelmed, then seeking additional counseling specific to coping with cancer may be one approach. The NCI has a website with guidance on coping with cancer and has available phone assistance, 1-800-4CANCER.
(Dr. Lucinda J. Cassells is a supportive care physician at the Baystate Regional Cancer Program)