Balancing Early Palliative Care With Active Treatment in Advanced Breast Cancer

The American Cancer Society of Oncologists recommends that concurrent palliative care be started early after cancer diagnosis. In an educational session at the 2017 San Antonio Breast Cancer Symposium (SABCS 2017), Thomas J. Smith, MD, from Johns Hopkins Sidney Kimmel Comprehensive Cancer Center discussed how to balance active treatment and palliative care in advanced breast cancer patients.

Smith recommended the TEAM approach: Time, an extra hour each month to discuss symptoms, coping distress, spirituality, and prognostic awareness with patients; Educate patients about realistic options and advanced care planning; do A formal assessment of symptoms, including spirituality, coping, and mood; get a good Management team of medical doctors, social workers, advanced practiced nurses, and even a chaplain.

These discussions might be difficult, but Dr Smith gave some suggestions including establishing a close working relationship with a trusted palliative care partner, to whom physicians can refer patients early. Referrals to palliative care at least 3 months before death helps with transitions and avoids costly hospitalizations. Physicians can also utilize some palliative care tricks in the office, by asking patients how they are coping and if they would like to discuss the meaning of results.

“There will never be enough palliative care specialists, so we must do primary palliative care alongside our oncology,” remarked Dr Smith.

References

Smith TJ. Balancing active treatment and palliative care in ABC patients. Oral presentation at: 2017 San Antonio Breast Cancer Symposium; December 6-9, 2017; San Antonio, TX. Abstract ES-11-04.