Supportive care in cancer patients: a unifying concept


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Jean A Klastersky1
1Institut Jules Bordet - ULB, Brussels, Belgium

Abstract

Since the earliest conceptualisation of what supportive care in cancer patients should encompass, we supported the idea that supportive care was a comprehensive approach of the cancer patient in order to minimise the burden of the neoplastic disease and of its therapy as much as possible and at all stages of the cancer, be it curable, palliable or terminal; the concept was that of an umbrella which would protect the cancer patients from the earliest stages of the disease until its end, in order to maintain a 'quality of life' as desirable as possible.

This unifying concept was not easily accepted since 'supportive care' was opposed to 'palliative care' and still is to some extent; in a recent editorial, it was stated that 'supportive care refers to symptom management while a person is receiving treatment to potentially cure his or her disease...' and at the same time that 'palliative care is symptom management and special care of a person whose disease cannot be cured'.

This is misleading as many - if not most - patients with advanced cancer will not be cured but nonetheless receive, and often benefit from, relatively aggressive anti-cancer therapies, requiring a substantial amount of supportive care.

As far as palliative care is concerned, the concept introduced by Temel et al. of early palliative care gives another dimension to the definition of palliative care, as classically accepted, posing the question of whether we are dealing with several kinds of palliative care.

Fortunately, there have been attempts at unifying terms like 'supportive care', 'best supportive care', 'palliative care', 'early palliative care' and 'hospice care' recently. Rather than separating patient care into different services, these newer models support the concept of patient care by a single discipline with expertise in symptom management, psychosocial care, communication and complex decision-making skills as well as end-of-life care. This special expertise is necessarily a part of the overall supportive care approach and unavoidably overlaps with all the specific techniques that are required to make supportive care a really comprehensive approach and a unifying management concept.

Now, the question is how to make it work. In this issue of the Supportive Care Section of Current Opinion in Oncology, Gaertner et al. tackle that very question. They stress that the concept of early palliative care is an essential component of cancer care for patients at any stage of advanced cancer and provide guidelines for its implementation, through the full cooperation of all involved partners: the patients, their families, the physicians (cancer specialists and family doctors), and the nursing teams. Clearly, besides guidance from guidelines, we need practical recommendations derived from in-field clinical experience. It is highly desirable that further similar experiences are reported in the future.