I am happy to report that there was a lot more attention at this meeting than there has been in years past to what we refer to as “survivorship care.” However, I am not sure I like the term. I worry that it puts an emphasis on those who have completed treatment and may be “cured” and separates them from patients who are being treated for a recurrence or metastatic disease. When we think about the collateral damage that a woman can live with long after treatment, and how women can manage it, I think palliative care is a better way to discuss what we are talking about: acknowledging and alleviating short- and long-term side effects.
Many people have previously associated palliative care with end of life and hospice care. But palliative care actually involves addressing and treating the symptoms of cancer and its treatment. There were several sessions on palliative care at this ASCO meeting, which I think reflects the growing understanding that an oncologist’s job is not only to save your life but also to address, and, when possible, prevent the consequences of treatment.
There is no question that palliative care benefits cancer patients. But as one study presented at ASCO found, it can benefit caregivers, too. In this study, called ENABLE, 207 patients with advanced disease (a euphemism for metastases) were randomized to receive 24 months of phone-based palliative support immediately post-diagnosis or three months after their advanced cancer diagnosis.
The researchers reported that the caregivers caring for patients who started palliative care right away experienced less depression and had a better quality of life than the caregivers of the patients whose palliative care was delayed for three months. The patients who received the immediate palliative care also had longer survival.
This will not come as a surprise to those of us who have dealt with a cancer diagnosis or have cared for someone with cancer. Although this study only looked at patients with metastatic disease, I think we all need palliative care for our collateral damage. Palliative care should start when treatment starts.
Oncologists, surgeons, and radiation therapists are good at treating cancer, but they are not as good at dealing with the consequences of cancer and its treatments and maybe they are not the right ones to do it. Many cancer centers are starting to acknowledge this with what they call Supportive Care teams including specialists in palliative care. I can only cheer and say it is about time!