Thomas J. Smith, MD

We review here the recommendations of the American Society of Clinical Oncology, as well as some new and promising approaches to neuropathy, including new neuromodulation techniques.

In this podcast we discuss integrating palliative care into standard oncology care with Thomas J. Smith, director of palliative medicine at Sidney Kimmel Comprehensive Cancer Center.

Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.

Twenty years of research in controlling symptoms such as pain and
nausea have shown persistent suboptimal performance by the US oncology
system. The data suggest that some of the tools of palliative care
programs can improve physical symptoms of seriously ill patients at a
cost society can afford. To fix these problems will require recognition
of the symptoms or concerns, a system such as an algorithm or care
plan for addressing each, measurement of the change, and accountability
for the change. Symptom assessment scales such as the Edmonton
Symptom Assessment Scale or Rotterdam Symptom Check List work to
make symptoms manifest. Listing symptoms on a problem list is a necessary
step in addressing them. Physical symptoms such as pain can be
improved by use of computer prompts, algorithms, dedicated staff time,
team management, or combinations of these strategies. Less concrete
problems such as medically appropriate goal-setting, integrating palliative
care into anticancer care sooner, and informing patients about
the benefits and risks of chemotherapy near the end of life require more
complex solutions. We review what is known about symptom control in
oncology, how and why some programs do better, and make suggestions
for practice. Finally, we suggest a practical plan for using symptom
assessment scales, listing the problems, and managing them according
to algorithms or other predetermined plans.