Cancer Patient Lab Meeting #85 “Palliative & Psychosocial Services for Cancer Patients”0James Tulsky
Channel: Cancer Patient Lab
Date: 2024-02-19

February 7, 2024
Discussion forum: community.cancerpatient.org
Full transcript: https://docs.google.com/document/d/1mwEf2hEKTE-ikdGl5_lGu7UPzHoq-1eObytAtFENoCA/edit?usp=sharing

00:00:00 Introductions
00:02:25 Cancer care and supportive oncology
00:07:43 Patient-centered care and end-of-life decision-making at Dana Farber Cancer Institute
00:12:34 Cancer care, research, and communication
00:18:04 Cancer center's distress screening tool and eliciting accurate patient information
00:22:51 Palliative care for advanced cancer patients
00:27:50 Cancer treatment options and palliative care
00:33:30 Palliative care access and reimbursement for oncology patients
00:39:12 Psilocybin for palliative care and pain management

“If an oncologist recommends a palliative care clinician, it's not that they're telling you you're going to die next week. They are saying that maybe this person can help in your quality of life.” – James Tulsky

“As far as timing, all the data and all literature would suggest that earlier conversations are always good. It all depends on what you're talking about. A conversation in which you express what's most important to you, when your deepest held values are shared with somebody so they can be recorded, so they know what's going to drive your decision-making throughout. Also that we make sure that you have as clear an understanding as possible about the disease and where things are heading, what the possibilities are.” - James Tulsky

Meeting Summary
Advanced cancer patients experience many mental and physical symptoms from their disease, including pain, depression, anxiety, nausea, constipation, neuropathy, urinary problems, and sexual problems, and their families also experience distress. To relieve these symptoms and improve the quality of life for both the patient and the family, palliative care and psychosocial oncology provide medications, counseling, care coordination, relaxation techniques, and other forms of support.

Dr. James Tulsky, Poorvu Jaffe Chair, Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute, Chief, Division of Palliative Medicine, Brigham and Women’s Hospital, and Professor of Medicine at Harvard Medical School, is uniquely qualified to talk about palliative care and psychosocial services. He has a longstanding research interest in clinician-patient communication and quality of life in serious illness. He is a Founding Director of VitalTalk (www.vitaltalk.org), a non-profit devoted to nurturing healthier connections between clinicians and patients through communication skills teaching.

What are the issues that you may be facing that support services in large cancer research centers can address?

● Physical symptoms, such as pain, nausea, and fatigue
● Psychological symptoms, such as depression and anxiety

How can you access services to address these issues?

● You just need to ask.
● You may receive a “distress screening tool” – survey questions about your psychological or social symptoms, or social concerns – identifying if you are in need of help.
● You can have a conversation with an oncology social worker to identify distress and other symptoms and who you need to see (such as psychologists, psychiatrists, palliative care doctors, and nurse practitioners). 
● Your physician is trained to have “serious illness conversations” with you. The question for any given treatment is what matters most to you, about whether the benefits outweigh the burdens at that moment for that treatment for you.

What is some of the research that is being conducted in supportive care at Dana-Farber?

● Machine learning/AI in palliative care: trying to predict a patient’s symptoms before they occur, or know about them, even if they’re not expressed elsewhere
● Serious illness communication: which communication approaches are most likely to lead to the best outcomes
● Promoting resilience for patients, caregivers, clinicians
● Psychedelic-assisted therapies, e.g., psilocybin in hospice care
● Cannabinoids for cancer-related anxiety
● Cancer pain and substance use disorder
● Caregiving and stem cell transplant

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