Management of Symptoms and Psychosocial Issues Is Crucial in Cancer Care
By Jeffrey Norris, UCSF Today | November 21, 2006
"Treating illness means treating the whole patient," says Steven Pantilat, the physician who directs the UCSF Adult Palliative Care Service at the UCSF Medical Center at Parnassus. About half of the patients who consult with members of the service are cancer patients.
Palliative care is aimed at making patients more comfortable and at improving their quality of life through symptom management, counseling and caregiving. At UCSF, palliative care is available to patients undergoing active treatment, as well as to patients who have exhausted all curative treatment options.
Physical symptoms are not the only quality-of-life concerns in cancer. Cancer raises fear-provoking psychosocial issues. Coping with pain and debility or with thoughts of possible death commonly triggers anxiety, depression or a spiritual crisis for the patient and family.
UCSF is one of six Robert Wood Johnson Foundation-supported Palliative Care Leadership Centers nationwide. Groups from hospitals across the country come to UCSF to spend two days learning how to set up their own palliative care services. The leadership center also offers mentoring by email and occasional in-person meetings to members of these hospital groups as they develop their new services.
Outpatient Palliative Care Pilot
Over the past two years, Cancer Center member and palliative care physician Michael Rabow has developed and put into operation a symptom management consultation service at the UCSF Comprehensive Cancer Center to help outpatients with cancer cope with both symptoms and psychosocial issues. Rabow began the pilot program by teaming up with UCSF urologic surgeons and oncologists to provide services for patients who are undergoing aggressive treatment for cancer, as well as for patients who have exhausted curative options.
For example, a prostate cancer patient may be coping with incontinence or sexual dysfunction. Surprisingly, Rabow has found that men with localized prostate cancer are as likely to be depressed and anxious as men with metastatic prostate cancer, which has a much worse prognosis.
"There's no one who walks through the doors of the Cancer Center who isn't worried about what the disease means for their lives, their livelihood and their survival," Rabow says. "We have the chance to do leading work nationally to make sure that outpatients have the option to receive these services."
Symptom Management Research
Christine Miaskowski and Marylin Dodd, both Cancer Center members and professors of physiological nursing, have been conducting National Institutes of Health (NIH)-funded studies on pain and symptom management for many years.
In a study of women with breast cancer, Dodd recently found that exercise can help reduce fatigue symptoms even when patients start exercising before chemotherapy treatments have been completed.