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Post by NCCS CEO Shelley Fuld Nasso

We are nearing the end of the 2016 ASCO Annual Meeting in Chicago and looking forward to Vice President Joe Biden’s address on the National Cancer Moonshot Initiative this afternoon. The ASCO Annual Meeting provides updates on treatment advances and is followed by patients, physicians, biotech companies, and investors. Immuno-oncology is once again the hot topic here, with about a third of the abstracts being presented.

While advances in treatment options are exciting and good news for patients, we at NCCS are also interested in advances in symptom management for cancer survivors during and after their treatment. I want to share news you probably didn’t hear about from two sessions I attended yesterday that addressed palliative care and survivorship care.

Dr. Areej El-Jawahri from Massachusetts General Hospital shared the results of a randomized controlled trial where palliative care was incorporated for bone marrow transplant (BMT) patients. Incorporation of palliative care helped patients on a particularly difficult treatment path by improving quality of life and reducing depression, anxiety, and other symptoms. It was one of the first studies to show that palliative care was effective in a curative setting – other palliative care studies have shown improvements for patients with advanced cancer. This study further disproves the misconception that palliative care is just for people who are at or near the end of life. Instead, the study is another reminder that palliative care can improve quality of life for anyone with a serious illness.

Furthering attendees’ understanding of palliative care, Dr. Arif Kamal discussed the history of palliative care in oncology, the role of palliative care specialists in ensuring that patients’ goals are met, and the communication skills needed to provide quality cancer care. He pointed out that effective doctor-patient communication is a learned, not innate skill; that we have a shortage of trained palliative care specialists; and that elements of palliative care must be included in oncology practice. This is critically important, as not all cancer patients will have access to a palliative care specialist.

Dr. Kamal joined us in April for our Cancer Policy Roundtable, and I am grateful for his approach to communicating with patients about their disease with empathy and compassion. He ended his presentation on a high note with the question, “What if I told you that talking about the hard stuff IS high quality care?”

Dr. Michael Halpern opened the survivorship session by addressing the question, “Is every patient’s journey the same?” He answered that with a definitive “no”, showing that there is wide variation in individuals’ experience of survivorship, the level of support they need, and the availability of that care.

Mary McCabe, RN, MA, Director of the Cancer Survivorship Initiative at Memorial Sloan Kettering Cancer Center and an NCCS Cancer Policy Advisor, talked about models of care for survivorship, based on both the needs of different survivors and the settings for care. She pointed out that there is often finger-pointing and lack of accountability between the oncology team and the primary care provider for a patient’s survivorship care.

Dr. Mary Ann Burg, an oncology social worker, discussed disparities in survivorship care related to financial constraints for cancer survivors. She warned that if we only apply value frameworks and cost/benefit analyses to patients with high risk of financial issues, we will increase the disparities in outcomes between people with high and low levels of financial resources.

Dr. Halpern wrapped up the session by discussing barriers to survivorship care, including reimbursement, a shortage of trained workforce to deliver survivorship care, and the lack of a cohesive health care system resulting in fragmented, uncoordinated care.

The ASCO Annual Meeting is a busy and exciting time, and it is gratifying to have the opportunity to hear from researchers and clinicians who are working to improve patients’ experience with cancer, both during treatment and afterward.


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