Palliative care, also called supportive care, is an important part of cancer care. For someone with cancer, the goals of palliative care include treating symptoms, managing emotional and social needs, and addressing spiritual and practical concerns. Anyone, regardless of age or type and stage of cancer, may receive palliative care before, during, and after treatment.
The 2017 Palliative and Supportive Care in Oncology Symposium, held October 27 and 28 in San Diego, brings together experts to share strategies and methods for integrating palliative care into every point in the patient’s cancer care. Here are summaries of 4 highlighted studies that will be presented at this meeting. You can read more research news from this symposium by following the #PallOnc hashtag on Twitter.
Patients prefer that their doctors not use computers in the exam room
Many doctors now use computer programs to manage the electronic health records of their patients. This means that doctors must interact with a computer while they are meeting with patients. In this study, researchers examined whether having a computer in the exam room might affect interactions between doctors and patients.
In this study, people with localized, recurrent, or metastatic cancer were divided into 4 groups of 30 people. They were then shown 2 videos of similar, in-person appointments: one in which a doctor used a computer and another in which a different doctor used a paper notepad facing the patient. After watching each video, the patients were asked to complete a questionnaire that rated the doctor’s communication skills, professionalism, and compassion. After watching both videos, 72% of people in the study preferred the face-to-face interaction. Patients felt that the doctors who communicated face to face were more compassionate, more professional, and had better communication skills.
What does this mean? As electronic health records become an important part of patient care, it is important to know how having a computer in the exam room affects the doctor-patient interaction. This study examined patients’ perceptions of a computer in the exam room, but it did not suggest how to address this issue. The study authors also noted that patients who are more comfortable with computers might not have the same reaction.
“We know that having a good rapport with patients can be extremely beneficial for their health. Patients with advanced disease need the cues that come with direct interaction to help them along with their care.”
—lead study author Ali Haider, MD
University of Texas MD Anderson Cancer Center
Patients and doctors have different perceptions of prognosis and cure
Acute myeloid leukemia (AML) is a cancer of the blood that can worsen quickly, so when it is diagnosed, treatment must begin soon after, usually with chemotherapy. A study of 100 people with AML who were receiving chemotherapy found that patients tended to overestimate both their risk of dying from the treatment and their prognosis, which is the chance of recovery.
This study included 50 patients who were receiving intensive care for AML and 50 patients who were receiving non-intensive care. Intensive care usually required 4 to 6 weeks in the hospital. Non-intensive care was usually given as outpatient treatment. Of these 100 patients, 92% were white, more than half had a college education, and most were from higher income brackets. The median age was 71 years, meaning half of the patients were older than 71 and half were younger than 71.
Within 3 days after starting treatment, both the patients and their doctors were given a questionnaire to assess whether they thought the patient would die from the treatment. A month later, they completed a follow-up questionnaire to judge their views on the patient’s chance of recovery, or prognosis.
Regardless of whether they received intensive or non-intensive care, most of the patients thought they would die from treatment. Specifically, 63% of patients thought it was somewhat likely they would die, and 28% thought it was extremely likely they would die. In contrast, most oncologists (80%) thought it was very unlikely that their patients would die due to treatment.
AML is a challenging disease to treat successfully, although cure is sometimes possible with chemotherapy and/or bone marrow transplant. The 5-year survival rate for adults with AML is estimated at 27%. In this study, one month after the first questionnaire, the same people received a second survey. Nearly all (90%) of patients thought it was somewhat or very likely they would be cured of their AML. However, 74% of their oncologists thought it was unlikely or very unlikely that their patients would be cured. The gap between patient and doctor perceptions was greatest for patients receiving non-intensive therapy, with 44% of patients believing they would very likely be cured, while none of their oncologists thought this was very likely.
“Patients with AML face very challenging treatment decisions that are often placed upon them within days after being diagnosed. Because they face a grave decision, they need to understand what the risks of treatment are versus the possibility of a cure.”
—senior study author Areej El-Jawahri, MD
Massachusetts General Hospital
Yoga can help people with lung cancer and their caregivers
A study looked at whether providing yoga classes to people with advanced lung cancer and their caregivers helped improve well-being. These patients were receiving radiation therapy to the chest to treat cancer that could not be removed with surgery. Most had also received chemotherapy. Yoga was chosen as the exercise regimen because it is gentle, can be adjusted to the needs of the patients, and because it has a focus on breathing and many people with lung cancer have shortness of breath. It was also easy to include caregivers in the same yoga practices.
There were 26 patient-caregiver pairs in this study. More than half of the patients were men in their 60s, and two-thirds of the caregivers were women around 60 years old. Each yoga session was 60 minutes long, and the study included 15 sessions. The sessions included yoga poses that emphasized stretching the chest area along with deep breathing. Everyone who joined the study took a survey about their quality of life. Then, people were surveyed when the patient finished radiation therapy and again 3 months later. The pairs were randomly assigned to either yoga classes or a waitlist for yoga classes.
Patients who practiced yoga had better physical function that was measured by a 6-minute walking test, better stamina, and improved mental health compared to those who were on the waitlist for yoga classes. Caregivers who took yoga classes had more energy to handle their caregiving tasks. Patients reported that it was good to be away from their cancer experience during the yoga sessions, and the patients and caregivers both noted that they enjoyed learning something new together.
What does this mean? When patients and their caregivers practice yoga together, they both can benefit physically and mentally.
“There is currently very little research on behavioral supportive care for people with lung cancer. We tried to look at one way to boost patient and caregiver well-being, both physically and mentally, as a means to enhance supportive care.”
—lead study author Kathrin Milbury, PhD
University of Texas MD Anderson Cancer Center
One-on-one resilience intervention helps adolescents and young adults with cancer
A new research study of a psychosocial support tool found that a brief in-person intervention can improve psychosocial health. in adolescents and young adults living with cancer. The program, called Promoting Resilience in Stress Management (PRISM), improved resilience and quality of life, increased hope, and lowered distress in the majority of patients. Many programs provide some psychosocial support for patients and families, but very few provide standardized tools to manage this type of stress like PRISM.
PRISM is based on a theory of resilience that suggests that there are 3 sets of resources that can help a person manage adversity:
Internal resources, such as stress-management and goal-setting skills
Community resources, such as social support
Existential resources, such as spirituality and the search for purpose and meaning
Previous research by the study authors showed that internal resources and existential resources are more easily taught to patients than community resources.
This study enrolled 100 English-speaking patients who were 12 to 25 years old and who were diagnosed with new or newly recurrent cancer. Patients were randomly assigned to receive PRISM or usual psychosocial care. PRISM was delivered in 4 one-on-one sessions that were 30 minutes to 60 minutes long, with a trained research associate, followed by a family meeting. PRISM helped develop patients’ internal resources and existential resources. All participants received standard psychosocial supportive care, including a dedicated social worker and access to psychologists, child-life specialists, and other experts in adolescent and young adult oncology care.
Patients completed surveys when they joined the study and 6 months later. Among the 74 patients who were able to complete the 6-month survey (36 in the PRISM group and 38 in the usual-care group), those who received PRISM had improved resilience and quality of life, increased hope, and less distress.
What does this mean? Resilience-building tools like PRISM can help improve well-being in adolescents and young adults with cancer.
“The experience of cancer is stressful in all realms, but we tend to focus more on physical symptoms than the equally important social and emotional challenges. This is particularly true for adolescents and young adults who already struggle with normal developmental changes. When you throw cancer into the mix, it can become much harder.”
—lead study author Abby R. Rosenberg, MD
Seattle Children’s Research Institute