Richard T. Lee, MD, Associate Professor at Case Comprehensive Cancer Center and University Hospitals Seidman Cancer Center, discussed the abstract by Galloway et al at the 2019 Supportive Care in Oncology Symposium. He remarked that starting a new palliative care consultation can sometimes feel like parachuting into a jungle, given the world of emotions and symptoms a patient is experiencing.

Richard T. Lee, MD

“Our job is to try to understand patients, figure out what they’re experiencing, and then help guide them out of the jungle and into the light of day,” said Dr. Lee. He noted that, given the complex interplay of factors, systematic symptom assessment involving validated questionnaires and tablet-based screening is valuable. “It’s important to understand how all of these different symptoms interact with each other and that social support can modulate the impact of anxiety and depression.”

Dr. Lee also noted that the course of pain management can often be unpredictable. “Sometimes, pain management can be pretty straightforward, but other times, even though the patient says the pain is worsening, it’s really anxiety or depression that’s driving the pain,” he explained. “Other times, the driving factor may be related to financial problems or social isolation. There are many factors to keep in mind.”

According to Dr. Lee, it’s also important for clinicians to consider symptom clusters when treating patients, as these symptoms do not generally occur by themselves. “We can no longer think about these symptoms individually; we must consider how they interact because all these symptoms may be correlated,” he observed. “We also have to think about our patients’ backgrounds and how that may influence the symptoms we’re hearing about.”

More Than Identifying Symptoms

Finally, said Dr. Lee, simply identifying symptoms is not enough. Instead, clinicians must determine the optimal intervention to help reduce the symptom burden and coordinate these interventions within complex cancer care.

“Whatever the symptom burden may be, we have to keep in mind that these patients are also undergoing active cancer treatment,” Dr. Lee concluded. “The interventions we decide to pursue may have an impact both in the short term and long term for our patients, which is why I’m looking forward to more research in this area.” 

DISCLOSURE: Dr. Lee reported no conflicts of interest.