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Presentation Abstract
Management of Symptoms in Cancer Patients
GOAL: Describe the complexity of the symptom experience and therapy. Cancer symptoms are complex, poorly understood, under treated and difficult to manage. The three dominant symptoms are anorexia, fatigue and pain. Symptoms vary in prevalence and severity across the illness trajectory but usually present at diagnosis and into survivorship. The profile is characterized by multiple moderate/severe symptoms, chronic and more problematic with disease progression and/or therapeutic interventions. Consequently, they may prevent or slow effective antitumor management. Typically they include both physical and psychological symptoms (gastrointestinal particularly). Symptoms vary between tumor primary sites and between hematologic malignancies and solid tumors. Further complexity arises from frequent comorbidities in cancer patients and common physical complications from the cancer/cancer therapy. This makes for a complex symptom experience (influenced by age and gender) and a burden of perhaps 10 to 12 in advanced disease. Systematic symptom assessment often identifies unrecognized problems, which significantly degrade quality of life. Detailed symptom analysis is time-consuming and challenging in busy clinical environments, but enhanced by modern information technology, particularly for “orphan” symptoms. Sophisticated biostatistical techniques reveal many symptoms occur in predictable patterns; “clusters”. They are important for clinical practice but also reflect cancer pathophysiology. This has also led to identification of Nutrition Impact Symptoms. There is increased interest in “Symptom Science”. Advances in clinical practice have structured approaches to analysis and principles of symptom control as a therapeutic end in itself. This was based on better management of cancer pain and generalization of the lessons learned to other common patient symptoms. New clinical services based on palliative medicine, or more recently supportive oncology, are important delivery models to address these complex challenges. SUMMARY: The cancer symptom experience is poorly understood. Major gaps exist in understanding pathophysiology. Information technology holds the key.
About Dr. Walsh
Dr. Declan Walsh trained in internal medicine, medical oncology, and—what later became the field of palliative medicine—in Ireland, the United Kingdom, and the United States. In 1987, he established the first palliative medicine program in the United States at the Cleveland Clinic Cancer Center in Ohio. By 1994, this included a fully integrated dedicated inpatient unit, consultation service, outpatient clinics, and hospice home service. In addition, the first U.S. Chair and training fellowship in palliative medicine were established. In 2012, he was appointed the founding Chair of an academic Department of Palliative Medicine between Trinity and University Colleges Dublin. Dr. Walsh is now the Chair of a new department of Supportive Oncology at the Levine Cancer Institute in Charlotte, NC. He holds the Hemby Family Endowed Chair in Supportive Oncology, is Editor-in-Chief of BMJ Supportive & Palliative Care, and is a Fellow Emeritus of Trinity College, the University of Dublin. He has authored more than 300 peer-reviewed publications.
Dr. Walsh disclosed the following conflict of interest for this workshop:consulting for HELSINN Pharmaceuticals.