By Dr Haryana Dhillon – University of Sydney for oncologynews.com.au
The psychosocial and supportive care content presented during this years’ COSA Annual Scientific Meeting was stellar.
Some sessions have been detailed in other updates.
COSA makes two specific psycho-oncology awards each year. Dr Addie Wootten was named the Psycho-Oncology New Investigator of the Year Award. Addie is a Clinical Psychologist in the Department of Urology, Royal Melbourne Hospital and eHealth Research Manager, Australian Prostate Cancer Research, and Director of Clinical and Allied Health research at the Epworth Prostate Centre. Addie has been developing an ehealth intervention to provide psychological support program for men with prostate cancer. Her work is clinically relevant and will potentially benefit a large number of men after their prostate cancer diagnosis.
A/Prof. Jane Turner was named the Psycho-Oncology Researcher of the Year. Jane has been a longstanding and significant contributor to the Australian psycho-oncology world and, indeed, has made important contributions internationally. Jane is well known for her work on interventions to improve communication at end of life, with people experience high levels of fear of cancer recurrence, and survivorship challenges in head and neck cancer. Jane has done much to promote the COSA Psycho-Oncology Group, OZPOS, and the work of its members.
Wellness and Integrative Oncology Services, Breakfast session
Interest in wellness and integrative oncology services has been growing rapidly around the world. This session brought together three of the Australian oncology services offering integrative services to their patients, Solaris Centre, Chris O’Brien Lifehouse, and the Olivia Newtown-John Cancer and Wellness Centre.
David Joske from the Solaris Centre, Sir Charles Gairdner Hospital, gave an overview of the philosophy underpinning this centre, the services offered, and his insights into how this has contributed to patient empowerment. Interestingly, the ‘Chemo Club’ has empowered patients to become more engaged in their cancer care, facilitating more question asking and increased connection between patients. David strongly advocated for incorporation of physical activity or exercise into the lifestyles of all cancer patients, indicating that exercise has substantially improved the outcomes of patients.
Suzanne Grant from The Lifehouse described the approach taken to incorporate wellness programs into the newest of the three centres. It is very early in the development of the programs but there are regular sessions ranging from mediation to education as well as a very visible arts program.
While Tammy Boatman from the Olivia Newtown-John Cancer and Wellness Centre described some of the innovative pager system for patients that frees them to use the hospital and wellness centre space while waiting. Again programs range from education to music therapy, cooking classes to acupuncture.
All three services are highly valued by the patients and their caregivers, with a high level of demand for services. However, the label of wellness has provoked strong reactions in some patients and health professionals. Despite concerns about the limited evidence-base for some therapies, these services are meeting a need for many people.
Mary McCabe, international speaker from Memorial Sloan Kettering Cancer Centre, talked generously about her experience establishing survivorship services. Her key messages where the importance of working with clinical champions who could lead change in the hospital environment. The first survivorship clinic she established was a lung cancer clinic, chosen as the lead clinician wanted to address the unmet needs of her patients.
Listening to the patient voice, asking them what they wanted from their care and what was lacking really helped determine where to focus services. Similarly, listening to health professionals completed the picture identifying areas of concern and potential barriers to change. Understanding the needs of all stakeholders is essential to developing effective, sustainable services.
Embedding nurse-led survivorship care within existing clinical services provided a bridge between acute care teams and survivorship care. It also allowed other clinicians to retain a connection with their patients during the survivorship phase rather than feeling as though they had ‘lost’ them. This was also an effective approach to redirecting existing resources to survivorship rather than trying to identify new resources.
Nurses, particularly nurse practitioners, are well positioned to manage survivorship care with their skill in communicating with patients and health professionals. In order to maximise their impact and ability to deliver effective care, many health professionals require training in motivational interviewing.
Late effects of cancer and its treatment.
The presence of late effects from a cancer and treatments used has been increasingly recognised, although not always well managed. Richard Cohn presented the results of a survey of 272 survivors of paediatric cancers. This identified groups of survivors, some of whom attended follow-up clinics and some who did not. Of the 44% of non-attending survivors, 53% are dissatisfied with their follow-up care. Cost of attending clinic was most commonly endorsed barrier to follow-up care.
Kylie Lewis provided a very personal and moving account of life as a young adult cancer survivor. Kylie greatly valued her a General Practitioner who listened to her and was able to take the time to explore her concerns and symptoms, ultimately providing referral to an allied health professional able to address her symptoms.
The question of whether or not chemotherapy causes cognitive impairment in men diagnosed with testicular care was addressed by Ian Olver. It seems that the role of chemotherapy in causing cognitive changes remains unclear in this population, however the etiology is likely to be multifactorial, including cancer itself, sex hormones, and other treatments. The final results of this study will be forthcoming in the next few months.
Two presentations addressed aspects of lymphoedema. Prof. Sharon Kilbreath reported risk factors for developing lymphoedema. It is clear that lymph node dissection in which >/= 5 lymph nodes are removed increases the likelihood of developing lymphoedema. However, only six percent of survey respondents reported experiencing severe lymphoedema. Dr Ramin Shayan discussed the role of imaging in determining lymphoedema risk and suitability for surgical intervention.
Dr Haryana Dhillon is Research Fellow, Survivorship Research Group and Deputy Director, CeMPED Central Clinical School at the University of Sydney.