Palliative care is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.
Amy Case, MD, the Clinical Chief of the Supportive and Palliative Care Program at Roswell Park Comprehensive Cancer Center, discusses the role of palliative medicine in cancer care.
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The Role of Palliative Medicine in Cancer Care
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Learn more about Amy Allen Case, MD
Amy Allen Case, MD
Dr. Amy Case is the Clinical Chief of the Supportive and Palliative Care Program at Roswell Park Comprehensive Cancer Center. She recently transitioned to Roswell Park after serving as the director of palliative medicine at the VA Western New York Healthcare System for the last 11 years. In 2005, she started and currently serves as the program director for the University at Buffalo (UB) Palliative Medicine Fellowship. She is an Associate Professor in the Division of Geriatrics and Palliative Medicine at UB.Learn more about Amy Allen Case, MD
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The Role of Palliative Medicine in Cancer Care
Bill Klaproth (Host): A cancer diagnosis changes your life and the lives of the closest people to you. It affects you physically, emotionally, socially--every way imaginable. Some people with a cancer diagnosis need an extra level care of support and supportive palliative care can provide specialized relief in care. To help us learn more is Dr. Amy Case. She is the Clinical Chief of the Supportive and Palliative Care program at Roswell Park Comprehensive Cancer Center. Dr. Case, thank you for your time. So, overall, what is the role of supportive palliative medicine in cancer care?
Dr. Amy Case (Guest): Hi, Bill. Thank you for inviting me to talk to you today. Supportive and palliative care is a medical sub-specialty where a team of trained professionals can be called in to see patients who may be struggling with serious or chronic illness and patients who have cancer, who are undergoing treatments, may have some physical symptoms such as pain, nausea, constipation, trouble sleeping, where we can help take care of them. To palliate means to help feel better, so our team really is a quality of life team and we provide treatment alongside the oncology treatments that the patient receives. We take care of both the physical, the emotional, and the spiritual parts of a patient's life. So, we provide a team-based approach with social workers, chaplains, nurses, physicians. We all meet with the patient and we try to help them with symptom management, ability to cope, and maybe some psychosocial support in the home and things like that as well as the spiritual support when they're going through a rough time.
Bill: So, supportive care at Roswell, then, is used in conjunction with treatment. I just want to be clear. A lot of people think palliative care is generally used for end of curative treatment; however, at Roswell, then, you say you use it to maintain quality of life for some people, basically from diagnosis throughout their cancer journey.
Dr. Case: Correct. I think when people hear the word palliative, they get that mixed up with hospice and the two can be a continuum but, generally, we get called earlier in the trajectory of the disease and we prefer to see patients sooner than later and when they're still quite healthy. We try to help them early on cope with having cancer and trying to provide an extra layer of support. They do not need to give up any cancer treatment. They can continue to have their chemotherapy, immunotherapy, radiation, surgery--whatever it is they are going to be having but, in addition, they can have quality of life care, which, in some of the medical literature, has been shown for people to actually have an increased survival when they receive palliative care in addition to their oncology care. In addition, patients who receive palliative care in addition to oncology care often report a better quality of life, an improved mood, and better symptom control. That's a report based on both the patients and the families report those improvements in their quality of life. So, it's a win-win as far as I'm concerned and you do not need to give up anything.
Bill: So, basically, then, it's appropriate for patients of any age and at any stage of their illness and is provided together with curative treatment and, as you say, it's got such great benefit because of the support team that's around them.
Dr. Case: Correct. Generally, we get involved with patients who have more complicated, either physical and emotional needs because, generally, if they don't have a lot of complaints or issues going on, the oncologist will manage some mild things but if the patient is having more complicated symptoms that are not able to be managed, we will get called in as experts to help provide an extra layer of support. We have 24/7 coverage, we have after hours phone support, and we have the ability to manage pretty much any symptom. One of the main ones that we focus on is pain but we also manage several other physical and emotional symptoms that may arise.
Bill: So, what are some of the techniques you use for pain for a person who is in supportive care?
Dr. Case: So, we look at patients in a holistic manner. So, when we see a patient and their family if they come with them to the clinic, we do a very comprehensive, hour-long evaluation which includes a full survey of all of the symptoms they may be having and an assessment, and a physical exam. We do a very complex intervention. We have them meet several members of our team including social work as well. So, we try to assess their physical needs, whether it be a pain or other symptoms, constipation, nausea. We have a whole arsenal of medications that we use to treat pain and other symptoms that maybe the oncologist isn't trained in, but we're trained in managing. So, for example, I'm board-certified in pain management as well as palliative care, so I'm triple board-certified in internal medicine, as well. So, our team, you know, we're experts and we manage the pain and the symptoms using many different modalities, including both medication and also non-medication methods. Sometimes we refer people for a procedure or we'll talk to them about how to cope better and how to manage with, for example, medication or we send them for psychotherapy to help speak to somebody about their emotional grieving process or their coping.
Bill: So, it's all areas of treatment that you get involved with, then?
Dr. Case: Correct.
Bill: Can you also talk about certain areas of expertise that you have including communication and palliation of cancer?
Dr. Case: Sure. Our team is specially trained in communication skills and one may think that physicians graduate from their training being very good at communication and talking to patients about their disease and what to expect, but often physicians find this very challenging and they tend to kind of talk in a way that sometimes patients don't understand. Their families may walk out feeling a little confused or like they don't really know fully what's going on. Part of our team is to help the oncologist--and we often have meetings with families and we include the oncologist because they are also part of the team. We have a social worker present and the family present and we talk just about the big picture--about everything that's going on. We try to keep it on very simple terms and not use big medical jargon or language and really just kind of talk about risks, talk about benefits of treatment, next steps, and different ways of supporting the patient no matter what is happening in their life and trying to find out what's important to them, what their goals are, and trying to meet those goals. Everybody's different and everybody has different goals and we try to tailor and individualize the treatment plan to fit the patient and their family.
Bill: Well, the treatment plan, that's so important, and what you've talked about, the planning for continuing care needs, healthcare decision-making, you said you give emotional support as well as spiritual support. So, it really is a well-rounded plan and I can see where it is very beneficial to a cancer patient that is in that type of support care. Dr. Case, can you talk about the role of supportive care, then, and growing the cancer survivor community?
Dr. Case: Yes. Actually, the program at Roswell Park encompasses the supportive and palliative service, the pain management service, and also a survivorship and wellness center. And so, all of these programs are intimately connected and so if a cancer patient is cured of their cancer and they are a survivor, they still may be left with some scars from that treatment and they are healing. They are in their healing process. So, they may follow up with our survivorship clinic, which is housed in the same clinic as the supportive clinic. So, there's a lot of overlap and if a patient is having complicated pain, for example, as a result of a surgery they have had or, you know, they've had nerve damage after their chemotherapy, many patients end up with peripheral neuropathy which is a nerve damage in their hands and feet, after they receive chemotherapy. They can send patients our way and we can help manage pain and then they can go back and see the team of people caring for them in the survivorship clinic. So, the two are intimately combined.
Bill: Right.
Dr. Case: And interactive.
Bill: Absolutely. Well, that's so good to hear and thank you for explaining that to us. Dr. Case, again, thank you for your time and talking about supportive and palliative care at Roswell Park Comprehensive Cancer Center. We really appreciate it. For more information, visit www.roswellpark.org. That's www.roswellpark.org. You're listening to Roswell Park Comprehensive Cancer Center Cancer Talk. I'm Bill Klaproth. Thanks for listening.
The Role of Palliative Medicine in Cancer Care
Bill Klaproth (Host): A cancer diagnosis changes your life and the lives of the closest people to you. It affects you physically, emotionally, socially--every way imaginable. Some people with a cancer diagnosis need an extra level care of support and supportive palliative care can provide specialized relief in care. To help us learn more is Dr. Amy Case. She is the Clinical Chief of the Supportive and Palliative Care program at Roswell Park Comprehensive Cancer Center. Dr. Case, thank you for your time. So, overall, what is the role of supportive palliative medicine in cancer care?
Dr. Amy Case (Guest): Hi, Bill. Thank you for inviting me to talk to you today. Supportive and palliative care is a medical sub-specialty where a team of trained professionals can be called in to see patients who may be struggling with serious or chronic illness and patients who have cancer, who are undergoing treatments, may have some physical symptoms such as pain, nausea, constipation, trouble sleeping, where we can help take care of them. To palliate means to help feel better, so our team really is a quality of life team and we provide treatment alongside the oncology treatments that the patient receives. We take care of both the physical, the emotional, and the spiritual parts of a patient's life. So, we provide a team-based approach with social workers, chaplains, nurses, physicians. We all meet with the patient and we try to help them with symptom management, ability to cope, and maybe some psychosocial support in the home and things like that as well as the spiritual support when they're going through a rough time.
Bill: So, supportive care at Roswell, then, is used in conjunction with treatment. I just want to be clear. A lot of people think palliative care is generally used for end of curative treatment; however, at Roswell, then, you say you use it to maintain quality of life for some people, basically from diagnosis throughout their cancer journey.
Dr. Case: Correct. I think when people hear the word palliative, they get that mixed up with hospice and the two can be a continuum but, generally, we get called earlier in the trajectory of the disease and we prefer to see patients sooner than later and when they're still quite healthy. We try to help them early on cope with having cancer and trying to provide an extra layer of support. They do not need to give up any cancer treatment. They can continue to have their chemotherapy, immunotherapy, radiation, surgery--whatever it is they are going to be having but, in addition, they can have quality of life care, which, in some of the medical literature, has been shown for people to actually have an increased survival when they receive palliative care in addition to their oncology care. In addition, patients who receive palliative care in addition to oncology care often report a better quality of life, an improved mood, and better symptom control. That's a report based on both the patients and the families report those improvements in their quality of life. So, it's a win-win as far as I'm concerned and you do not need to give up anything.
Bill: So, basically, then, it's appropriate for patients of any age and at any stage of their illness and is provided together with curative treatment and, as you say, it's got such great benefit because of the support team that's around them.
Dr. Case: Correct. Generally, we get involved with patients who have more complicated, either physical and emotional needs because, generally, if they don't have a lot of complaints or issues going on, the oncologist will manage some mild things but if the patient is having more complicated symptoms that are not able to be managed, we will get called in as experts to help provide an extra layer of support. We have 24/7 coverage, we have after hours phone support, and we have the ability to manage pretty much any symptom. One of the main ones that we focus on is pain but we also manage several other physical and emotional symptoms that may arise.
Bill: So, what are some of the techniques you use for pain for a person who is in supportive care?
Dr. Case: So, we look at patients in a holistic manner. So, when we see a patient and their family if they come with them to the clinic, we do a very comprehensive, hour-long evaluation which includes a full survey of all of the symptoms they may be having and an assessment, and a physical exam. We do a very complex intervention. We have them meet several members of our team including social work as well. So, we try to assess their physical needs, whether it be a pain or other symptoms, constipation, nausea. We have a whole arsenal of medications that we use to treat pain and other symptoms that maybe the oncologist isn't trained in, but we're trained in managing. So, for example, I'm board-certified in pain management as well as palliative care, so I'm triple board-certified in internal medicine, as well. So, our team, you know, we're experts and we manage the pain and the symptoms using many different modalities, including both medication and also non-medication methods. Sometimes we refer people for a procedure or we'll talk to them about how to cope better and how to manage with, for example, medication or we send them for psychotherapy to help speak to somebody about their emotional grieving process or their coping.
Bill: So, it's all areas of treatment that you get involved with, then?
Dr. Case: Correct.
Bill: Can you also talk about certain areas of expertise that you have including communication and palliation of cancer?
Dr. Case: Sure. Our team is specially trained in communication skills and one may think that physicians graduate from their training being very good at communication and talking to patients about their disease and what to expect, but often physicians find this very challenging and they tend to kind of talk in a way that sometimes patients don't understand. Their families may walk out feeling a little confused or like they don't really know fully what's going on. Part of our team is to help the oncologist--and we often have meetings with families and we include the oncologist because they are also part of the team. We have a social worker present and the family present and we talk just about the big picture--about everything that's going on. We try to keep it on very simple terms and not use big medical jargon or language and really just kind of talk about risks, talk about benefits of treatment, next steps, and different ways of supporting the patient no matter what is happening in their life and trying to find out what's important to them, what their goals are, and trying to meet those goals. Everybody's different and everybody has different goals and we try to tailor and individualize the treatment plan to fit the patient and their family.
Bill: Well, the treatment plan, that's so important, and what you've talked about, the planning for continuing care needs, healthcare decision-making, you said you give emotional support as well as spiritual support. So, it really is a well-rounded plan and I can see where it is very beneficial to a cancer patient that is in that type of support care. Dr. Case, can you talk about the role of supportive care, then, and growing the cancer survivor community?
Dr. Case: Yes. Actually, the program at Roswell Park encompasses the supportive and palliative service, the pain management service, and also a survivorship and wellness center. And so, all of these programs are intimately connected and so if a cancer patient is cured of their cancer and they are a survivor, they still may be left with some scars from that treatment and they are healing. They are in their healing process. So, they may follow up with our survivorship clinic, which is housed in the same clinic as the supportive clinic. So, there's a lot of overlap and if a patient is having complicated pain, for example, as a result of a surgery they have had or, you know, they've had nerve damage after their chemotherapy, many patients end up with peripheral neuropathy which is a nerve damage in their hands and feet, after they receive chemotherapy. They can send patients our way and we can help manage pain and then they can go back and see the team of people caring for them in the survivorship clinic. So, the two are intimately combined.
Bill: Right.
Dr. Case: And interactive.
Bill: Absolutely. Well, that's so good to hear and thank you for explaining that to us. Dr. Case, again, thank you for your time and talking about supportive and palliative care at Roswell Park Comprehensive Cancer Center. We really appreciate it. For more information, visit www.roswellpark.org. That's www.roswellpark.org. You're listening to Roswell Park Comprehensive Cancer Center Cancer Talk. I'm Bill Klaproth. Thanks for listening.