Pioneer of Supportive Care Highlights Additional Needs in The Space

Declan Walsh, MD, highlighted how the supportive and palliative care space has evolved since he first began working in the field.

The supportive care space is an essential part of oncology care, as it helps patients during and after their cancer treatment. Declan Walsh, MD, a pioneer in the field, spoke with CancerNetwork® regarding the current unmet needs of the space.

Walsh, chair ofthe Department of Supportive Oncology at Atrium Health Levine Cancer, also became a 2025 Multinational Association forSupportive Care in Cancer (MASCC) Fellow. According to the MASCC, this award is given to clinicians who have made a “sustained contribution to MASCC and demonstrated a continued high level of excellence in cancer supportive care practice and/or research.”

Having a supportive care team is a necessity, as Walsh discussed how different institutions can create and adapt a department that is specific to their needs. He also noted how the multidisciplinary team comes together to work on various patient cases.

There are important areas of research that Walsh believes need to be studied in the supportive care space. Most importantly, it is the area of nutrition and malnutrition, of which there is little research or results to back up the questions many patients have.

CancerNetwork: How did the theme of this year’s MASCC meeting, “Informed decisions in supportive cancer care,” help with discussing relevant topics in the supportive care space?

Walsh: The structure and the content of the meeting were very thoughtfully put together. It covered the landscape of modern supportive oncology, including things like nurse navigation and survivorship, as well as lots of other things that were included in the meeting. It showed the breadth and the depth of the field. It’s still an emerging and developing field, but it’s a very exciting one. One of the real strengths of the last meeting is the fact that it’s truly multidisciplinary and interdisciplinary. That was very evident throughout the meeting.

Congratulations on your recent award as a Fellow of MASCC, which is given to those who have made an impact in the supportive care space. What are some career achievements that have led you here?

I made lots of mistakes along the way, so that helps in some regards! I was very fortunate to have had some great teachers and mentors. I worked in St Christopher’s Hospice in London with Cicely Saunders, who was the founder of the modern hospice and palliative care movement, and I had a wonderful medical oncology fellowship at Memorial Sloan Kettering Cancer Center in New York. I was very fortunate to have the people who taught me and who shaped my thinking about many of the aspects that have emerged in the field of supportive oncology. The institutions I’ve worked with, like the Cleveland Clinic Cancer Center and more recently with Atrium Health Levine Cancer, are organizations that embrace innovation, welcome new thinking about how to approach common clinical problems, and are very supportive of the idea that we should improve cancer care and whole person cancer care. Ruben Mesa, MD, FACP, who is our president of the cancer center, has advocated that we approach cancer care on the“loved one”standard. If you had a family member who was [affected by] cancer, how would you want them to be looked after? That is the North Star by which we’re developing our services and programs.

At the MASCC meeting, you spoke about the development and management of supportive care oncology in major cancer centers. What is the importance of this, and how can this be adapted across the nation?

We started in 2017. Based on the experience, we feel that what we’ve seen here is transferable and scalable to other cancer centers; not just in the US, but internationally. We would hope that this will become the standard of care over the next decade or so, realistically. One important point to make is that many cancer centers already have a lot of supportive services being provided. For example, counseling, support groups, nutrition, and palliative care for patients with cancer. They’re not organized in a [proper] manner, and they’re not necessarily readily accessible to patients. The insight that we had here was that we could restructure, reorganize, and coordinate these services and programs much more effectively within a formal department of supportive oncology in the same way that you would have a department of radiation oncology or surgical oncology. Bringing these things together was a great insight. That gives us hope that many other cancer centers could do the same thing. It’s notable over the recent years that there are a good number of cancer centers that have very fine programs already in place or are developing new programs that are structured along similar lines.

Supportive care is one piece of the multidisciplinary team. How can clinicians work with supportive care specialists to ensure that patients are receiving the help they need?

It’s a 2-way street. Those of us who are interested in providing supportive oncology services should be very willing to engage in the sharp end of cancer care so that we are accessible, we respond quickly, and we are part of the comprehensive clinical care team. [We are] building these ideas into, for example, tumor boards, where at a tumor board meeting, not only is radiation oncology represented with medical oncology, but also supportiveoncology. We take a comprehensive view of that person’s case and of their management of that disease. Then, from our colleagues’ point of view, whether they’re surgical oncologists or medical oncologists, there’s been a cultural change. People are much more appreciative of the services now and much more understanding of their importance. What we would like to see is early recognition of the patient’s needs by our clinician colleagues so that the support of oncology services can get in right at the beginning of the illness trajectory and we can have the greatest impact and the best collaboration with all our clinical colleagues, irrespective of what their discipline may be.

What is an area of supportive care that needs additional attention?

There are lots of them, because some of these areas have been quite neglected over the years. The one that I would pick most prominently is the area of nutrition and malnutrition. A huge proportion of patients with cancer in the US who are diagnosed this year will be either overweight or obese. That is a major issue in terms of, first, why somebody gets cancer. It also complicates the management of the disease if they, for example, have diabetes because of obesity, and it affects other outcomes in many ways. There’s also the issue of undernutrition; people are losing weight. These are not uncommon problems. The majority of people now diagnosed [with cancer] are overweight or obese. Weight loss and severe weight loss are very common complications of cancer and of cancer treatment, and they significantly change the outcome. I would be advocating for a major change in how we view the issues of nutrition and malnutrition in cancer care. Patients recognize this already, as a very common question when somebody’s diagnosed with cancer is, “What should I eat?” We don’t have a very good answer for that, unfortunately, even though these issues are highly prevalent and highly impactful in the trajectory of the illness.

Where do you envision the supportive care field is headed?

The good news is that to my perspective, as somebody who’s been involved in various aspects of this for a good number of years, there’s been a significant cultural change in physicians and cancer clinicians. The vast majority of [health care professionals] who are involved in day-to-day clinical cancer care now recognize and value the importance of supportive care services across the board, and there’s a number of reasons for that.

There’s increasing evidence that these services can make a big difference to patients with cancer, and we’ve come to recognize that cancer is a very complex illness. It needs a team of people to deliver the best care, and that team should include expert clinicians and supportive oncology, as well as all the other disciplines that come in managing a very complex and challenging illness.

What do you hope your colleagues take away from this conversation?

Hopefully, they would recognize the added value that supportive oncology brings to the care trajectory. [I hope] that they would recognize that there’s an emerging evidence base, that important aspects of supportive oncology not only make the patient feel better, but there’s increasing evidence that they affect the actual trajectory of the illness. The latest example of that is the evidence that was presented at the 2025 American Society of Clinical Oncology [ASCO] Annual Meeting around the importance of exercise therapy in patients with cancer. We’re going to hear a lot more about this. This is not an insignificant effect. All the exercise therapy in cancer rehabilitation is moving the needle in the natural history of the illness, and this needs a lot more attention, investigation, and education. It’s critical to the future of cancer care and to the future of supportive oncology.

Is there anything else you’d like to highlight?

When we’re thinking about supportive oncology issues—whether it’s the problem of financial toxicity, nutrition, or modern high-quality symptom control—these are all addressing common cancer problems that most patients with cancer experience. These are common, they’re severe, they’re complicated, and they need expert help, attention, and expert clinical practitioners. One other important aspect of the development of the field is to improve both education and research in all aspects of supportive oncology. A rising tide will lift all boats if we make people feel better, if they’re better supported, if their symptom control is better, and their families are strengthened. As caregivers, all those things are surely going to improve cancer outcomes.

Reference

2025 MASCC Fellows. Multinational Association of Supportive Care in Cancer. Accessed August 11, 2025. https://tinyurl.com/45k5ukhv