http://connection.asco.org RSS feeds for ASCO Connection – professional networking for ASCO’s worldwide oncology community 60 http://connection.asco.org/Commentary/Article/ID/2721/Im-an-Oncologist.aspx#Comments 2 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=2721 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=2721&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/2721/Im-an-Oncologist.aspx When I am at the check-out line in the grocery store, and someone asks me what I do for a living, it's always a bit of a challenge to listen to their response when I say, "I’m an oncologist." The response is usually some version of one of three responses: 1) Oh, that must be so hard 2) My mother had cancer or 3) Are they closer to a cure? Interestingly, I’m never asked about the things we oncologists talk about: What is the "best" treatment? How do I break bad news to someone who isn’t ready to hear it? Or we talk about being too busy, unrealistic expectations of patients and families, declining reimbursement, lack of research dollars, accrual to clinical trials . . . My answers to the "grocery store" questions aren’t overly scientific ones; they are human ones: 1) My work is challenging, but meaningful to me, and I wouldn’t want to do anything else 2) I’m so sorry to hear it and 3) We cure some kinds of cancers, and not others. Just like with patients, I keep it simple, direct, and personal, rather than complex, oblique, or detailed. I leave the casual encounter feeling like it’s a nice connection. I find myself wondering if that isn’t what we as an organized Society need to do as well; keep it simple, direct, and personal. Cancer still scares so many people, and there are going to be more people with cancer in the coming years simply because so many people are living longer. ASCO needs to have a collective voice that’s not defensive nor strident. Simple, direct, personal. I take care of patients that way; I think ASCO should talk that way, too.   Jamie H. Von Roenn, MD Mon, 08 Nov 2010 14:18:57 GMT f1397696-738c-4295-afcd-943feb885714:2721 http://connection.asco.org/Commentary/Article/ID/2699/Overcoming-Barriers-to-Early-Palliative-Care.aspx#Comments 2 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/RssComments.aspx?TabID=117&ModuleID=478&ArticleID=2699 http://connection.asco.org/DesktopModules/DnnForge%20-%20NewsArticles/Tracking/Trackback.aspx?ArticleID=2699&PortalID=0&TabID=117 http://connection.asco.org/Commentary/Article/ID/2699/Overcoming-Barriers-to-Early-Palliative-Care.aspx I have been reflecting on language. Both ASCO and the World Health Organization say palliative care is applicable early in the course of disease in combination with life-prolonging therapies. That fits with what my patients seem to want; to live as well as possible for as long as possible. Yet, as I practice breast oncology, my patients think the term “palliative care” means care near the end of life when no more chemotherapy is given—a synonym for hospice care. This seems to be the case even if it is euphemistically called supportive care or symptom-oriented care. I wonder why we persist with an “either/or,” “win or lose,” “cure or care” model, which separates the disease continuum into a time for cancer treatment and a separate, later time for “comfort” care”? As I reflect, so much of what we do for patients, is, in fact, palliative care; we try to make bad things better and help patients live as well as possible with their cancer and its treatment. The efforts to relieve suffering and improve quality of life are integrated into our treatment regimens and our long-term follow-up of patients. These days, there isn’t an oncologist who wouldn’t prescribe platinum-based treatment without prescribing anti-emetics. What is survivorship care focused on? The prevention and treatment of disease and treatment-related symptoms are key goals.   Dr Schilsky, a former ASCO President, commented recently that “supportive care is never an ‘alternative’ [to anti-tumor therapy] because it should always be a component of every treatment program. The ‘alternative’ is to add evidence-based cancer-directed treatment to best supportive care.” Statements like this and the recent study published by Jennifer Temel, MD, and colleagues in the New England Journal of Medicine suggest that the time for oncology care to embrace the full integration of palliative care throughout the trajectory of cancer care has arrived. Dr. Temel’s study randomized patients with newly diagnosed metastatic lung cancer to receive standard oncology care or standard oncology care integrated with early palliative care. Patients randomized to the early palliative care arm reported better quality of life and less depression, were less likely to receive inappropriate end-of-life care and lived longer than patients who received standard oncology alone. At last, high-quality evidence that integration of palliative care early in the continuum of oncology care improves patient outcomes.   What are the barriers to an integrated model? Of course, there are financial, practical, and education barriers to overcome. The NEJM study provides a solid evidence base for moving forward, but I fear it’s not just a cognitive issue. The win/lose military model for cancer care as a fight to the death certainly doesn’t help; it’s a referendum on a person’s character: are you a fighter (or a loser)? If we keep that metaphor, then we have to believe patients can always be fighters—but they can be fighting for comfort and quality of life at the same time they are fighting to live longer; they never are ‘losers.’ But, more importantly, I wonder if we struggle with the complexity of a blended model; it’s simpler to work in an either/or, black or white, on or off, dichotomous world. Yet, the best patient care comes from discerning what is right for this person in the context of his or her family. I find myself hoping that oncologists together, and ASCO, our Society, will embrace the science of comfort as much as they embrace the science of cancer. It seems to me that the best oncology practice of the future requires it. Jamie H. Von Roenn, MD Tue, 28 Sep 2010 14:28:20 GMT f1397696-738c-4295-afcd-943feb885714:2699