M. D. Anderson Cancer Center
Cancer Newsline Audio Podcast Series
Date: March 23, 2009
Duration: 0 / 15:13
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Welcome to Cancer Newsline, a weekly podcast series from the University of Texas M. D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention, providing the latest information on reducing your family's cancer risk. I'm your hostess Lisa Garvin. Today, we're talking with Dr. Eduardo Bruera who is a professor and chair in the Department of Palliative Care and Rehabilitation Medicine at M. D. Anderson. Dr. Bruera, welcome to the show.
Talk to us about palliative care. I think in a lot of people's minds palliative care equals end of life, but that's not really true.
That's correct. Supportive care and palliative care are terms that are used to define a number of things we can do to help our patients and their families cope with the problems brought to them by cancer or by the cancer treatment. So, we can help the way they feel physically, emotionally and as a family so that they can cope better with the treatment rather than simply dealing with the problems that has happened sometime after the treatment and as part of the end of our lives.
So, it's a cross to continue in the cancer treatment, so palliative care would theoretically start at any time during the treatment process.
That's correct. And sometimes the way we define that at M. D. Anderson in our Outpatient Center is as the Supportive Care Center that sometimes helps our patients and our families understand that supportive and palliative care start very early in the disease trajectory so that we can help them express their maximal potential, physical potential, emotional potential, social potential while they are getting treatment. And in those cases if the disease progresses we have already a relationship and we can help them cope as well as well possible.
So, you are talking about things like managing side effects of treatment and the cancer itself as well?
Yes! We are talking about pain, we are talking about fatigue, we're talking about how sometimes we get a bit of nausea and vomiting, sometimes we get shortness of breath, but sometimes we also get emotional distress from the disease. Sometimes, we don't know how to plan our care, anything from where to live or transportation, how to talk to our kids about the disease, how to talk to our families about our disease. So, there are a lot of questions and concerns that are brought to us by being diagnosed with cancer. And our center and our counsel teams address all those issues so that patients and their own oncologist can focus on the cancer treatment in the best possible way.
Because I know the Supportive Care Center, although as palliative care you guys have been around at M. D. Anderson a long time, but now there's a Supportive Care Center which is fairly new.
That's correct! We expanded a little bit the mandate and the name and we included some new services to make sure that patients who are coming to M. D. Anderson who are not feeling very well can take advantage of the center at any time in the trajectory of their illness, and so they feel more comfortable that this is not something that is an alternative to receiving the cancer treatment, but part of the overall cancer treatment plan.
Let's talk about the World Health Organization because they recently updated their description of what palliative care is. What is that new description, it seems to be more encompassing?
It is much more encompassing as you very well point out. The World Health Organization has recognized that we start having physical problems, emotional problems and when we get diagnosed with cancer, sometimes very early in the illness, not very late. And that the traditional definition of palliative care, accessed care to patients late in the history of the disease and so they have now made it a definition that encompasses all of us when we have life threatening illnesses so that we can access that care when we have problems not as a chronological moment, but linked to our distress, physical or emotional distress.
There's been a lot more focus I think also during treatment about quality of life. I think sometimes we think of quality of life as somebody who is not cured and maybe terminal having a maximum quality of life until their death, but now actually quality of life means a lot more these days apparently.
Absolutely! Quality of life is a concept that is associated with well-being and basically with feeling well. So, with or without cancer we all have attempted to improve our quality of life and basically from the basic; you know enjoying some happiness in life to minimizing distress. That's a lot of what we do on a daily basis is to try enhance our quality of life. When we have cancer our quality of life suffers. From the very moment of getting this devastating news that we have this terrible disease our quality of life takes an enormous blow and a lot of our work is trying to enhance the quality of life of our patience and families that has been affected just by knowing that they're having the burden of this illness. Of course it's worst when in addition to the burden of this illness they have the burden of the symptoms and their well being and those other problems that accompany getting cancer treatment.
Is there able to be a scientific connection between quality of life and how a person handles their illness physically? Have there been any parallels made between that?
There have been some nice parallels in the sense that if we are physically feeling better, we are able to cope with the disease and we are able to cope with the treatment better. So, if we are feeling physically and emotionally better we are much more likely to be able to receive cancer treatment and to tolerate cancer treatment than if we have our symptoms not addressed. So, that is an important component. It is also important for us to remember that our attitude is not necessarily predictive of how we are going to feel and what I mean by that is we do not have to feel guilty if we are feeling emotionally burdened by the disease. That is not going to make the cancer grow faster or make us; you know respond less to treatment, but if we really feel bad we need to address it because feeling bad is really bad for the quality of our lives. So, it doesn't allow us to enjoy life as much if you are feeling really bad. And sometimes if we feel bad enough, we might not be able to come for treatment and then we might not take advantage of the treatment because we are feeling so bad physically or emotionally.
What sorts of services does M. D. Anderson Supportive Care Center offer? I know they have like a Cachexia Clinic and other things, so what sort of specialized services would patients be able to avail themselves of?
When their doctor sends them to us from any area of the hospital the patients can come. Most of them get an appointment and they come to see us. Others, if their doctor phones us they can come at any time so the can doctor see them today and they are not feeling very we would accommodate to see them also today and together with their own oncologist or surgeon or radiation therapist. Once they come to our clinic, we measure their symptoms. We measure their emotional distress and we also help them with issues such as medicines and basically nursing care. We have social worker services we can bring down from our own team, our chaplain, our counselors, our child counselors. We have rehabilitation doctors that can help with wheelchairs, scooter. We can deal with parking placards, we can deal with advanced directives. We can deal with issues that sometimes in one stop are important for our patients and families particularly when they come from out of town or they have to drive a long time and they have difficulty making multiple appointments to see programs several days on their own.
So, you guys help pull all of that together?
That's correct! We try to address all those issues in one visit so that by the time the patient is on their way home the patient and also the family because we frequently meet with the family sometimes separately, they know a little bit more about what is happening, what might happen. We have a little bit of a plan of care.
Far as research areas for palliative care, are we doing any research here at M. D. Anderson? What are kind of the typical fields that people would be looking into for palliative research?
Yes, our hospital has quite a few studies and most of our studies are funded by the National Instituted of Health and the American Cancer Society. And our research studies look at medications for the management of fatigue when people are very tired, look at counseling techniques for the management of fatigue, looking at ways in which we can receive phone calls from a computer at home to measure how we are feeling. Look at how our feelings are, about spirituality. They look at treatments for weight loss when patients are feeling tired and are losing weight. We have treatments for depression, we have techniques for counseling, and all those are research projects that we are currently conducting in our center together with colleagues from all around M. D. Anderson.
As far as the concept of palliative care or supportive care, I think it seems to be a more popular term. We are at the forefront here at M. D. Anderson in offering a comprehensive cancer center or is everyone on the boat as well or I mean where are we in terms of the spectrum of palliative care?
I think we are very fortunate at M. D. Anderson to have the largest clinical team in the nation. We have one of the few designated in-patient palliative care units in the nation. We have the only fully comprehensive outpatient Supportive Care Center in the nation and we have the largest research initiative in palliative and supportive care in that nation. So, I think we are very grateful to the fact that we have the resources and that we are able to help so many patients on an ongoing basis.
And let's talk about end of life care. We have made a good case that supportive care means everything throughout the continuing of treatment, but that also does include end of life care. What sorts of things do we do for people who are terminal?
We are able to help in the way we cope with cancer. Cancer is not as bad on all of us. Some of us have more difficulty than others and some of us when cancer does not respond to treatment and grows can have a relatively comfortable time and some of us can have a very uncomfortable time. Our program works very hard to ensure that there is an absolutely minimal amount of physical, emotional and spiritual suffering on those of us who are going to die of cancer. So, that's one of the main emphasis we make. We have a very sophisticated in-patient palliative care unit with an interdisciplinary team that's quite unique in the nation where we can bring distress down very rapidly for patients and families, and we have a system for planning the best care in the community, meaning by that anywhere in Houston or also to help our patients who are returning back to their own communities to return in the best possible condition. So, we not only help decrease physical and emotional distress in our patients and their families and their children, but we also help with what we call transition to the community when people are willing to go back and reinstall themselves in their own communities.
Do you think that the public is aware of this shift in thinking in palliative care or I guess we're still kind of learning the new descriptions of palliative care.
I think you're absolutely correct! We are still trying to make people understand the great advantage that this brings and that palliative care and supportive care are full of hope. Hope in getting the best quality of life, hope in getting the best quantity of life and hope about making our life and the life of our family the best during these very difficult times. So, we see a lot of hopeful stories and we receive a lot of families who become very hopeful as a consequence of being able to enter in contact with our team.
Thank you! I think this was a very good interview. Do you have any like closing thoughts or parting wisdom you'd like to share before we go?
Oh, just to thank you so much for your interest in this area and to remind all our patients and families that we are in our five and we're open for business.
Great! Thank you Dr. Bruera. If you have questions about anything you've heard today on Cancer Newsline contact Ask M. D. Anderson at 1-877-MDA-6789 or online at www.mdanderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.
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