Supportive Cancer Care

Treating the patient, not the disease

Even when it's confined to one part of the body, cancer has a bad habit of taking over entire lives. Pain, fatigue, and anxiety can all be part of the cancer package. Doctors have made incredible progress in treating the disease, but patients can't thrive on chemotherapy or radiation alone. Most will need extra help to cope with the symptoms of their disease and the side effects of their treatments. Supportive care -- treatments that help the patient feel better but don't fight the disease -- can greatly improve quality of life during a difficult time.

Naturally, different patients will need different types of supportive care. Some will need pain relief above all else, while others may simply need someone to talk to. Many cancer centers and hospitals can link you up with a clinical social worker who can help figure out what you need to live as comfortably as possible; your oncologist may also be able to set you up with visits to a nutritionist or other specialists.

Whatever the situation, it's important to realize that supportive care can be just as important as any other type of cancer treatment. Chemotherapy, surgery, and radiation can save or prolong lives, but supportive care may be the crucial element that keeps those lives worth living.

Pain control

All too often, pain and cancer go together. The disease itself can cause pain, but so can the treatments. Chemotherapy, for example, can damage nerves and trigger pain throughout the body, usually temporarily but sometimes even on a long-term basis. Whatever the cause of pain, relief -- or some reduction in severity -- has to be a top priority. Its impossible for patients to fully enjoy their lives or put their all into fighting their disease if they're wracked with pain.

The good news is that even the most severe cancer pain can usually be relieved or significantly reduced with medications, including opioid (narcotic) drugs such as codeine, morphine, fentanyl, or oxycodone. It often takes more than one medication at a time to keep pain under control, and your doctor may have to keep gradually increasing the doses as your body becomes accustomed to the medication or the pain becomes more severe due to progression of the cancer. Needing larger doses for relief is not the same as becoming "addicted." Don't be afraid to ask for more medication or higher doses if your current program isn't doing the job. You are unlikely to get hooked -- according to a report from the M.D. Anderson Cancer Center, very few cancer patients ever become addicted to pain medication -- but there's a good chance you'll get some relief.

Good pain control requires even better communication. You'll have to tell your doctor about all of your aches, even if they don't seem directly related to the disease. You should also tell your doctor if pain is keeping you awake or distracting you from your everyday life. The doctor will also want to know about any changes in the intensity, location, or basic nature of your pains. And be sure to mention any side effects such as dizziness, drowsiness, or constipation. These problems can often be minimized or avoided completely, so they shouldn't be ignored.

Family members can help by asking about pain, especially when they notice grimaces or other red flags. In many cases, family members are the ones who take the lead in getting patients the pain relief they need. Those around the patient can also watch for signs of confusion or other side effects that the patient may overlook or have trouble describing. Perhaps most important of all, family caregivers can provide the kind of conversation and company that makes it possible to forget about pain for a while.

Psychological counseling

Cancer is a traumatic experience, and many patients suffer from bouts of anxiety or depression that are just as real and debilitating as their physical symptoms. Mental distress can make it hard for patients to stick to their treatment plan or finish daily tasks. They may have trouble making small decisions or finding the will to even get out of bed. Fortunately, more doctors are taking depression and anxiety seriously, and more treatment options are available to assist patients in getting the help that they need.

If you feel like anxiety or depression has taken over your life, be sure to tell your medical provider. As a first step, your doctor can refer you to a psychologist or a counselor for further treatment. Good counseling -- whether it's one-on-one or in a group -- can ease distress by helping patients feel less isolated and more hopeful. Counseling can also help patients find the energy and motivation to take care of themselves and cope with their disease.

Many distressed patients have also found real relief with the help of medications. Antidepressant drugs such as buproprion (Welbutrin), venlafaxine (Effexor), and sertraline (Zoloft) have a track record of helping cancer patients without serious negative drug interactions. Lorazepam (Ativan) is often used for treating anxiety. Often the best treatment will be a combination of counseling and medication.

Fighting fatigue

Many cancer patients feel tired, and for good reason. Chemotherapy, medications, seemingly endless doctor appointments, the effects of the disease itself -- all this can add up to exhaustion. Your doctor can't run any tests to measure your energy levels, so you'll have to speak up if you're feeling run-down. A simple change of medications may be enough to give you renewed enthusiasm for life. Your doctor can also check for anemia, a common but treatable cause of tiredness in cancer patients. You can help yourself by getting regular exercise. Surprising as it may seem, regular walks or other forms of exercise can actually give you more energy for the rest of the day. On the other hand, spending the day in bed can make you feel more tired than you were before.

Appetite for recovery

Like anyone fighting a chronic disease, cancer patients need good nutrition. Unfortunately, the disease and the treatments can often upset the stomach and ruin appetite, while related hormonal and metabolic abnormalities can lead to a loss of muscle. As many as 80 percent of patients with advanced cancer end up losing pounds without trying to, and they pay a price. Studies show that cancer patients who can maintain their weight generally have a brighter future than those who lose weight.

For this reason, your doctor may refer you to a nutritionist for counseling or write a prescription. If you've lost your appetite, a prescription of megestrol acetate (Megace) may help you get it back. Many studies have shown that cancer patients feel hungrier, eat more calories, and have a better sense of well-being while taking the drug. You may also need ondansetron (Zofran) or a similar drug to fight nausea. You can do your part to overcome nausea and get the nutrition you need by adapting your eating habits: Have several small meals throughout the day and avoid fatty or fried foods, but try to find things that you really enjoy eating.

Home medical equipment

The disease and cancer treatments can take their toll on your body. As a result of aches and pain, you may find your favorite chair or mattress extremely uncomfortable. If your skin is very sensitive, for example, or you can't get comfortable in your bed, be sure to tell your doctor. He or she may write a prescription for durable medical equipment such as a hospital bed or pressure-relieving air mattress (also known as a medical air bed), which is designed to prevent bedsores for cancer patients and others who need prolonged bedrest. If you're eligible for Medicare, it will usually cover most or all of the cost (you will generally pay 20 percent) after you've met your deductible for the year. Your doctor can also write prescriptions for portable commodes, wheelchairs, walkers or canes, and other equipment that makes it easier for you to get around and live comfortably at home.

Hospice services

At any time during a life-threatening illness, you may want to discuss all your options, including hospice. By entering hospice, you usually agree to stop treating that illness while being given medication and other services to relieve pain and other troublesome symptoms. The goal is to provide comfort and peace for patients at the end of life. However, if your condition improves and your disease appears to go into remission, you can be discharged from hospice to resume treatment and return to your daily life.

By law, the decision to enter hospice is yours alone. Most hospices accept patients who have a life expectancy of six months or less if they are referred by their physician. Hospice allows you to stay at home, if you wish, while being cared for by a team consisting of a physician, a nurse, social workers, counselors, home health aides, clergy, therapists, and volunteers. Coverage is provided by Medicare nationwide and Medicaid pays for hospice in nearly all states and the District of Columbia. (Check with your employer or health insurance provider to make sure.)

References

Side Effects of Cancer Treatment.www.cancer.gov, 2017. Retrieved from https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq#cit/section_1.3

Brazil, K. et al. Providing supportive care to cancer patients: A study on inter-organizational relationships. International Journal of Integrated Care, 8(11).

Cleary, James. Cancer Pain Management. Cancer Control. Vol. 7(2): 132-141.

De Leon, Darcy. Treatment for chemotherapy side effects. The University of Texas MD Anderson Cancer Center.

American Cancer Society. Pain.

Kash, K.M. et al. Psychosocial oncology: supportive care for the cancer patient. Seminars in Oncology,32: 211-218.

American Cancer Society. Psychological Services are Integral to Cancer Care.

Von Roenn, J.H. and J.A. Paice. Control of common, non-pain cancer symptoms. Seminars in Oncology,32: 200-210

Mayo Clinic. Chemotherapy nausea and vomiting: Prevention is the best defense.

Department of Health & Human Services. Medicare Coverage of Durable Medical Equipment and Other Devices. Centers for Medicare & Medicaid Services.

Hospice Net. Hospice: Frequently Asked Questions.

Hospice Net. The Hospice Concept.

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