Beyond the tumor: Here, lung cancer treatment is about the person
Typical care for lung cancer focuses on the tumor. Patients must confront pain, fatigue, depression and other symptoms, which tend to intensify with chemotherapy, surgery and radiation and as their disease progresses.
Their symptoms often may be uncontrolled, and they may have delayed or no access to palliative care – care that focuses on their quality of life, including pain management, psychological and spiritual care.
City of Hope researchers are studying what early results already indicate is a better way: offering lung cancer patients comprehensive palliative care from the beginning of their treatment. Funded by the National Cancer Institute, the program on which their study is based is now entering its final year but is already being considered for patients with other diseases.
“We started with the toughest cancer in some ways,” said Betty Ferrell, Ph.D., R.N., director of the Division of Nursing Research and Education at City of Hope. “There are so many things that make lung cancer really challenging. Often, patients have late stage disease and often they’re facing poor prognosis.”
The first phase of the study – which examined the typical care focusing on the tumor – yielded nine scientific papers. The current phase of the study offers comprehensive interventions for patients and their families.
In this phase, patients are first assessed not just for the status of their tumor, but other factors affecting quality of life. A nurse takes stock of all their symptoms, other conditions or illnesses, their family situation, their mental health and any major life events – such as the loss of a close family member – that may have occurred.
In weekly meetings, nurses present the patients' cases to a team that includes the patients’ doctors, rehabilitation and pulmonary rehabilitation staff members, social workers and others. The team focuses on four key areas: physical, psychological, social and spiritual well-being. From finances to family issues, pain management to nutritional needs, the team identifies areas of need for the patient and takes action to support the patient and family.
Separately, family caregivers are coached in each of these four key areas as well. Their curriculum focuses not just on taking care of their loved one, but also themselves.
As Ferrell and her team continue to present new findings gleaned from this model of care, they frequently receive requests from other institutions to share what they’ve learned and help develop similar programs.
“This is an ongoing dialogue,” Ferrell said. “It’s really had an impact on practice here at City of Hope, and there is a huge interest in people here and elsewhere taking what we’re doing and running with it.”
In the video above, patient Vicki Graham – a lung cancer survivor – discusses how the program helped her.
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