Psycho-oncology: After Decades of Acceptance, Still an Emerging Field

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Michael Hoerger, PhD, MSCR

Michael Hoerger, PhD, MSCR

As the field of psycho-oncology continues to mature, new studies are being conducted to evaluate ways to better address the needs of patients with cancer and their families. The ASCO Post recently spoke with Michael Hoerger, PhD, MSCR, Assistant Professor of Psychology, Psychiatry, and Oncology at Tulane University, New Orleans. He was Tulane’s first faculty member to complete the National Institutes of Health (NIH)-sponsored Louisiana Clinical and Translational Science Center’s Roadmap Award. Dr. Hoerger is also Founding Director of the Psycho-Oncology Research Program.

Research Focus: Expanding Use of Palliative Care

What is the current focus of your research?

As a clinical psychologist, my main interests are in the field of psycho-oncology. My team and I are interested in improving patients’ quality of life by anticipating, preventing, and alleviating the physical and emotional burdens of cancer. We are particularly passionate about finding ways to increase the utilization of palliative care. To that end, we focus on patient education and documentation of the burden of end-of-life care in the Deep South. Part of what we’re doing is making abstract concepts such as palliative care seem more concrete and relatable.

Despite significant improvements, studies indicate that early initiation of palliative care is still underused. Do we have data looking at this challenge?

What we have is a pretty accurate assessment that access to palliative care programs had been rapidly improving over the past decade or so, especially in the hospital setting. However, outpatient palliative care programs for people with cancer are still less common. Moreover, there are regional challenges to access, notably in rural areas in the Deep South. One issue people often discuss is the shortage of palliative care clinicians, pointing to a need for more fellowships and training programs.

How do we address the access issue, particularly in poorer rural areas?

To begin, there’s a need to disseminate these effective early models of patient palliative care. The Patient-Centered Outcomes Research Institute is funding several large studies aimed at disseminating and comparing different models of access to palliative care. And I believe we will see a lot of valuable data coming out of these studies over the next 5 years or so.

Increasing access to palliative care is vital, especially in the Deep South. In New Orleans, we have seen a fairly dramatic transformation in access to palliative care over the past year. But we’re in a pretty unusual situation because the aftermath of Hurricane Katrina has given us the opportunity to essentially reshape our health-care model, sort of a rebirth out of desperate struggle, which isn’t the case in most areas.

“Increasing access to palliative care is vital, especially in the Deep South.”
— Michael Hoerger, PhD, MSCR

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You mentioned a lack of palliative care doctors as a barrier to care. Would the use of physician-extenders trained in palliative care help?

I favor employing any strategy that would bring palliative care services to underserved populations. I’m a psychologist, and we don’t even have an official special designation in the field of palliative care; and there are other disciplines, such as pharmacists, physical therapists, and so on. Many specialists could be brought into the field to improve care and access, which is something I think we’ll see evolve in the future.

Palliative Care Research Cooperative Group

Please tell the readers a bit about your role in the Palliative Care Research Cooperative Group.

I’m the Tulane Cancer Center’s organizational lead for the palliative care research cooperative, which is funded by the NIH. Since 2011, they have more than 400 affiliated investigators at more than 100 institutions. The overriding goal is to facilitate collaboration that will lead to high-quality research on palliative end-of-life care.

The Palliative Care Research Cooperative Group does this in a number of ways, such as being an organizing hub of multisite studies, providing resources for assisting statistical measurements, holding annual meetings that foster networking, and providing training and funding for pilot studies. I would recommend that anyone who has an interest in palliative care research to check out the Palliative Care Research Cooperative Group website and also consider becoming a member.

“The more time physicians spent with their patients on coping issues, the better the patients were doing in terms of quality of life and depression.”
— Michael Hoerger, PhD, MSCR

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Study Findings on Early Palliative Care

You led a study that looked at the effect on quality of life and end-of-life care when physicians focus on coping or advance care planning. Please describe these results.

Our study focused on determining the key elements of outpatient palliative care, and we aimed to summarize what palliative care clinicians discuss with their patients. And then we linked those findings with patient-reported outcomes in end-of-life care. ASCO recommends early initiation of palliative care for all patients with metastatic cancer or for those who have serious symptoms or side effects. One problem we identified is that many hospitals don’t know how to develop an outpatient program, and they’re looking for information about how best to serve those patients.

In our study, we looked at 350 patients in a randomized controlled study at Massachusetts General Hospital in Boston. The patients had advanced lung or gastrointestinal cancer. They were randomized to receive the usual-care or intervention arm of early outpatient palliative care, which allowed the patients to meet at least monthly with a palliative care specialist.

We discovered that patients in the intervention arm spent a lot of time talking with their physicians about symptom management issues and coping. We also found that the more time physicians spent with their patients on coping issues, the better the patients were doing in terms of quality of life and depression. Moreover, the more physicians discussed advanced care and treatment decisions the better end-of-life care patients had. Our findings may help clinicians better understand some of the key elements of palliative care and use this information to help them develop models in their own practices.

Future of Palliative Care

Palliative care is a dynamic field that has fought to become integrated into standard of cancer care. What do see as its future?

One thing that excites me about research in palliative care is that it is such an open and welcoming community. Although psychologists have not yet attained a designated specialization in palliative care, our training and skills are directly relevant to the field. And I truly believe that over the next several years, we will see further expansion of fields such as psychology into the palliative care treatment model.

I think the fundamental challenge facing palliative care research right now is developing ways to disseminate palliative care to more people. I’m approaching this from the perspective of educating patients, but there are many other ways to answer this important question. ■

DISCLOSURE: Dr. Hoerger reported no conflicts of interest.