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Bridging the Gap in Oncology Care

This year’s meeting highlighted the whole-patient perspective in the continuum of care from cancer diagnosis to end-of-life challenges.


The third annual Palliative Care in Oncology Symposium, held on September 9–10, 2016, in San Francisco, California, brought together more than 650 attendees from multiple countries, including the United States, Canada, the United Kingdom, France, Italy, and China. It featured over 250 study abstracts, covering a diverse range of topics from the impact of early integration of palliative and oncology care1 to the unique challenges caregivers experience.2

Sponsored by ASCO, the American Academy of Hospice and Palliative Medicine, the American Society for Radiation Oncology (ASTRO), and the Multinational Association of Supportive Care in Cancer (MASCC), this year’s meeting included six general sessions, two oral abstract sessions, and two poster sessions. The general sessions highlighted the challenges in immunotherapeutics, cancer caregiver needs, cancer symptom assessment and management, issues in caring for patients with hematologic malignancies, challenges and disparities for underserved populations with palliative care needs, and controversies in the care of patients with advanced cancer.

Lynn M. Schuchter, MD, FASCO

Lynn M. Schuchter, MD, FASCO

In the conference’s opening session on the Challenges of Immuotherapeutics, Lynn M. Schuchter, MD, FASCO, Chief of the Division of Hematology-Oncology and the C. Willard Robinson Professor of Hematology-Oncology at the Perelman School of Medicine at the University of Pennsylvania, spoke about how essential palliative care specialists are helping to manage the toxicities associated with immunotherapeutics, such as ipilimumab (Yervoy) and nivolumab (Opdivo). These adverse effects can be mild or so severe that they cause death, especially when these agents are combined. (See more details from this opening session on page 9 of this issue of The ASCO Post.)


Right now, it’s hard to know who is going to be the one to respond to immunotherapy. And it’s more difficult for us to know how our patients are going to do, making conversations about prognosis even more difficult.
— Jennifer S. Temel, MD

Also on the session’s panel was Jennifer S. Temel, MD, Associate Professor of Medicine at Harvard Medical School and Clinical Director of Thoracic Oncology at Massachusetts General Hospital. Dr. Temel discussed the results of her study on the challenges of prognostic uncertainty in this era of targeted cancer therapeutics,3 which are prolonging survival in some patients with cancer, complicating clinicians’ ability to accurately estimate prognosis and to counsel patients on their end-of-life-care options. (See more details on this study on page 7 of this issue of The ASCO Post.)

“Right now, it’s hard to know who is going to be the one to respond to immunotherapy. And it’s more difficult for us to know how our patients are going to do, making conversations about prognosis even more difficult,” said Dr. Temel. “Despite the uncertainty, be honest with your patients and make sure they understand the goals of treatment. Is the goal to cure the cancer or only to help the patient live longer? Revisit these conversations over time and do not approach them as a one-time event. So as patients become more ill or do better and respond to these exciting therapies, make sure you continue to readdress their prognosis despite these challenges.”


In the end, medicine is about taking care of people. And people have lives and families and stories, and remembering that helps us center our care on the patients and families as opposed to the diseases.
— Jamie H. Von Roenn, MD

“What was important about this meeting was the respectful bidirectional education that took place,” said Jamie H. Von Roenn, MD, ASCO’s Senior Director of Education, Science, and Professional Development Department. “The discussion about the lack of clarity around prognosis with immunotherapeutics in the setting of advanced malignancies and the lack of biologic markers to select which patients will benefit from these treatments improved the understanding by palliative care physicians about why medial oncologists might offer immunotherapy to a patient with advanced disease and a poor performance status. The uncertainty about prognosis for patients who appear very ill reminds me of the stunning changes in outcome for patients with HIV/AIDS when effective treatment first became available. Patients were suddenly rising from the dead. Prognosis was dramatically improved in that case for many patients.”

Improving Outcomes in Hematologic Cancers

Areej El-Jawahri, MD

Areej El-Jawahri, MD

Among the important studies presented during the 2-day symposium was a randomized trial showing the benefits of palliative care among patients with hematologic malignancies undergoing autologous or allogeneic stem cell transplantation.4 Although palliative care approaches are used routinely to improve the quality of life of patients with solid tumors, they are not commonly used for patients with blood cancers. This study by Areej El-Jawahri, MD, Director of the Bone Marrow Transplant Survivorship Program at Massachusetts General Hospital in Boston, and her colleagues investigated the physical and psychological impact of bone marrow transplantation on patients’ quality of life and whether palliative care interventions could improve patients’ symptom burden and mood during transplantation and at 3 months posttransplant. The findings showed that palliative care led to improvements in quality of life, depression, anxiety, and symptom burden within 2 weeks following the transplant and were sustained 3 months later.

“There is uncertainty around prognosis for many of these patients, yet bone marrow transplantation may offer cure. Transplanters do not always recognize the benefit of integrating palliative care into transplant care, and palliative care specialists don’t always recognize the potential benefit of transplant for some of these patients,” revealed Dr. Von Roenn. “For me, the biggest take-home message is that we are beginning to bridge the gap in understanding between oncologists and palliative care specialists. This is essential if we are to successfully integrate palliative care into oncology care.”

Humanistic Approach to Oncology

Margaret Edson

Margaret Edson

Lucy Kalanithi, MD

Lucy Kalanithi, MD

Among the highlights of this year’s meeting were the keynote lecture by Margaret Edson, the author of the Pulitzer Prize–winning play Wit, which tells the story of Professor Vivian Bearing, who is dying of ovarian cancer, and a book discussion of When Breath Becomes Air by Paul Kalanithi, led by his widow Lucy Kalanithi, MD. Both sessions emphasized the importance of a humanistic approach to the practice of oncology.

“In the end, medicine is about taking care of people,” said Dr. Von Roenn. “And people have lives and families and stories, and remembering that helps us center our care on the patients and families as opposed to the diseases. What was so inspiring to me about this conference is that it felt like we had turned the corner in our understanding of the importance of the humanistic aspect of cancer care and that understanding will make a difference in how we care for patients in the future.”

Save the Date

Next year’s Palliative Care in Oncology Symposium will be held on October 27–28, 2017, in San Diego, California. ■

Disclosure: Drs. Temel and Von Roenn reported no potential conflicts of interest.

References

1. Greer JA, El-Jawahri A, Pirl WF, et al: Randomized trial of early integrated palliative and oncology care. 2016 Palliative Care in Oncology Symposium. Abstract 104. Presented September 9, 2016.

2. Kent EE, Longacre M, Weber-Raley L, et al: Cancer versus non-cancer caregivers: An analysis of communication needs from the 2015 Caregivers in the U.S. study. 2016 Palliative Care in Oncology Symposium. Abstract 04. Presented September 9, 2016.

3. Temel JS, Shaw AT, Greer JA: Challenge of prognostic uncertainty in the modern era of cancer therapeutics. J Clin Oncol. August 22, 2016 (early release
online).

4. El-Jawahri A, LeBlanc TW, VanDusen H, et al: Randomized trial of inpatient palliative care in patients hospitalized for hematopoietic stem cell transplantation. 2016 Palliative Care in Oncology Symposium. Abstract 103. Presented September 9, 2016.



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