Doctors look for ways to boost quality of cancer patients' lives

As cancer treatments improve, physicians are increasingly discussing not just how to save lives but also how to ensure that the life is of highest quality possible both during the treatment and after.

"People want the best care possible," said Michael J. Fisch, MD, MPH, medical director of the community clinical oncology program at the University of Texas MD Anderson Cancer Center in Houston. "But they also want quality of life and to maintain their roles as parents, friends and neighbors."

He was speaking at last month's second annual Chicago Supportive Oncology Conference organized by the Journal of Supportive Oncology. This meeting brings together oncologists, palliative care physicians and other health professionals who work with cancer patients around the country to discuss strategies for dealing with the challenges associated with patients being treated for this disease.

"This is really groundbreaking to have a whole conference dedicated to quality of life, because it's something that patients are very concerned about," said Tony L. Back, MD, associate professor in the division of oncology at the University of Washington, Seattle.

The issues are numerous. Fatigue is by far the most common complaint. Others, including anxiety, depression, appetite problems, nausea, vomiting, sexual dysfunction and memory loss also can surface because of treatment or the cancer itself.

But although the list of complaints is long, experts suggest attacking the one or two that are most bothersome to the patient, because other problems might resolve themselves as these are addressed.

"We have to know what we want to pick a fight with and what's worthwhile," said Dr. Fisch, one of the conference's organizers.

The treatment choices, however, may not be obvious because of how different life can be for those being treated for cancer. Sleep problems, for instance, could be caused by depression but also might be linked to the reality of receiving cancer care.

"Don't jump to the conclusion that the cause of [disturbed sleep] is depression," said John L. Shuster, MD, clinical professor of psychiatry at the University of Alabama at Birmingham, who spoke on insomnia. "Cancer treatments can often disturb sleep.

"Are they having a lot of breakthrough pain at night? Is the patient sleeping in an unfamiliar place?" Dr. Shuster asked. "Many patients travel for treatment, and they may be staying with relatives or in a hotel. When you're sick, it's very easy for the sleep cycle to become fairly fragmented."

The experts also warned to be aware of the interaction between the drugs used to treat the ancillary issues and the chemotherapy medicines that are fighting the cancer. For example, several studies have suggested that antidepressants can interfere with tamoxifen in patients who have a particular genotype.

"This does remind us to pay attention to what the goals of therapy are and the impact of supportive therapeutics," Dr. Fisch said.

Some research presented at the conference suggested that lifestyle interventions sometimes might be better options.

One study found that fatigue in breast cancer patients could be ameliorated with increased exercise. Another found that an educational program could help patients cope with cognitive changes after therapy.

While oncologists and other specialties increasingly are taking an interest in the quality of cancer patients' lives, many experts expect this kind of care to become even more important to primary care physicians. Many of these symptoms are common primary care issues, and, particularly once the cancer has been treated, patients often return to their medical home.

"They don't want to hang around the cancer center," Dr. Fisch said.