Palliative and Emotional Support Services for Cancer Patients

“Palliative and Psychosocial Services for Cancer Patients” (James Tulsky) [#85] Brad Power February 7, 2024 “If an oncologist recommends a palliative care clinician, it's not that they're telling you you're going to die next week. They are saying that maybe this person can help in your quality of life.

” – James Tulsky “As far as timing, all the data and all literature would suggest that earlier conversations are always good. It all depends on what you're talking about. A conversation in which you express what's most important to you, when your deepest held values are shared with somebody so they can be recorded, so they know what's going to drive your decision-making throughout.

Also that we make sure that you have as clear an understanding as possible about the disease and where things are heading, what the possibilities are.

” - James Tulsky Meeting Summary Advanced cancer patients experience many mental and physical symptoms from their disease, including pain, depression, anxiety, nausea, constipation, neuropathy, urinary problems, and sexual problems, and their families also experience distress.

To relieve these symptoms and improve the quality of life for both the patient and the family, palliative care and psychosocial oncology provide medications, counseling, care coordination, relaxation techniques, and other forms of support. Dr.

James Tulsky, Poorvu Jaffe Chair, Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute, Chief, Division of Palliative Medicine, Brigham and Women’s Hospital, and Professor of Medicine at Harvard Medical School, is uniquely qualified to talk about palliative care and psychosocial services.

He has a longstanding research interest in clinician-patient communication and quality of life in serious illness. He is a Founding Director of VitalTalk (www.vitaltalk.org), a non-profit devoted to nurturing healthier connections between clinicians and patients through communication skills teaching.

What are the issues that you may be facing that support services in large cancer research centers can address? ●Physical symptoms, such as pain, nausea, and fatigue ●Psychological symptoms, such as depression and anxiety How can you access services to address these issues? ●You just need to ask.

●You may receive a “distress screening tool” – survey questions about your psychological or social symptoms, or social concerns – identifying if you are in need of help.

“Palliative and Psychosocial Services for Cancer Patients” (James Tulsky) [#85] ●You can have a conversation with an oncology social worker to identify distress and other symptoms and who you need to see (such as psychologists, psychiatrists, palliative care doctors, and nurse practitioners). ●Your physician is trained to have “serious illness conversations” with you.

ogists, psychiatrists, palliative care doctors, and nurse practitioners). ●Your physician is trained to have “serious illness conversations” with you. The question for any given treatment is what matters most to you, about whether the benefits outweigh the burdens at that moment for that treatment for you. What is some of the research that is being conducted in supportive care at Dana-Farber?

●Machine learning/AI in palliative care: trying to predict a patient’s symptoms before they occur, or know about them, even if they’re not expressed elsewhere ●Serious illness communication: which communication approaches are most likely to lead to the best outcomes ●Promoting resilience for patients, caregivers, clinicians ●Psychedelic-assisted therapies, e.g.

, psilocybin in hospice care ●Cannabinoids for cancer-related anxiety ●Cancer pain and substance use disorder ●Caregiving and stem cell transplant The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action.

You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health.

“Palliative and Psychosocial Services for Cancer Patients” (James Tulsky) [#85] Meeting Notes KEYWORDS patients, palliative care, psilocybin, dana farber, call, cancer, care, work, pain, psychosocial oncology, oncologist, cancer patients, conversation, symptoms, cancer centers, clinicians, mentioned, oncology, treatment, issues SPEAKERS James Tulsky (69%), Brian McCloskey (12%), Jeff Krolick (10%), Amit Gattani (6%), Rick Stanton (3%), Jeff Waldron (1%) OUTLINE 1.

Introductions. (0:00) 2.Cancer care and supportive oncology. (2:25) 3.Patient-centered care and end-of-life decision-making at Dana Farber Cancer Institute. (7:43) 4.Cancer care, research, and communication. (12:34) 5.Cancer center's distress screening tool and eliciting accurate patient information. (18:04) 6.Palliative care for advanced cancer patients. (22:51) 7.

Cancer treatment options and palliative care. (27:50) 8.Palliative care access and reimbursement for oncology patients. (33:30) 9.Psilocybin for palliative care and pain management. (39:12) SUMMARY ●Cancer care and supportive oncology. 2:25 ○Dr. James Tulsky introduces himself and his department, Psychosocial Oncology and Palliative Care at Dana Farber Cancer Institute.

○He provides an overview of his department's work, including their focus on supportive care in cancer treatment.

t's work, including their focus on supportive care in cancer treatment. ○Psychosocial oncology addresses psychological, behavioral, emotional, and social issues for cancer patients and their loved ones, while palliative care focuses on relieving suffering from symptoms and the stress of living with cancer. It also helps patients match their treatment options to their goals.

○Palliative care professionals, including social workers, pharmacists, and chaplains, work alongside oncologists to provide extra support and help patients live as well as possible with cancer. ●Patient-centered care. 7:43 ○Dr.

Tulsky discusses Dana Farber's approach to supportive oncology, which involves identifying symptoms and distress in patients and caregivers, and collaborating with oncology social workers, psychiatrists, and palliative care physicians to provide effective care.

“Palliative and Psychosocial Services for Cancer Patients” (James Tulsky) [#85] palliative care physicians to provide comprehensive care and address symptoms and distress in a collaborative manner. ○Dana Farber and other cancer centers are part of a network working together to ensure patients receive care that reflects their preferences, particularly as their cancer advances.

○The project aims to identify patients who would benefit from conversations about their goals of care, and enhance clinician skills in communication through evidence-based training. ●Cancer care, research, and communication. 12:34 ○Dana Farber is training nearly 300 oncology clinicians in communication skills and researching the "science of caring" to improve patient outcomes.

○Dana Farber is using machine learning and AI in palliative care to predict patient symptoms, develop personalized treatment plans, and promote resilience. ○Dr. Tulsky discusses the complex issue of managing cancer pain.

○Brian McCloskey raises the issue of stoicism among cancer patients and the difficulty of addressing cognitive dysfunction and brain fog in men, as they may be less likely to seek help. ●Cancer center's distress screening tool and eliciting accurate patient information. 18:04 ○Cancer center screens for distress using validated surveys and assessments with social workers. ○Dr.

Tulsky mentions that caregivers can provide valuable insights into a patient's condition, and eliciting more accurate information from them can be helpful (0:21:30). ○Amit Gattani wonders when the right time is to have the conversation with the patient, as having it too early or too late can impact the patient's experience (0:22:09). ●Palliative care for advanced cancer patients.

22:51 ○Palliative care clinicians help improve quality of life, not just focus on death. ○Early conversations about end-of-life care can help avoid harm from delayed discussions.

tani wonders when the right time is to have the conversation with the patient, as having it too early or too late can impact the patient's experience (0:22:09). ●Palliative care for advanced cancer patients. 22:51 ○Palliative care clinicians help improve quality of life, not just focus on death. ○Early conversations about end-of-life care can help avoid harm from delayed discussions.

●Cancer treatment options and palliative care. 27:50 ○Amit Gattani emphasizes the importance of considering a patient's quality of life and treatment burden when making decisions about cancer treatment. ○Dr. Tulsky highlights the individualized nature of cancer care, where providers recommend treatments that align with a patient's unique values and priorities.

○Brian McCloskey and Tom Smith discussed their experience with palliative care, with Brian mentioning their training in the program from 1995 to 1998. ○Rick Stanton expressed interest in palliative care at UCLA and asked if it was available for wider group participation. ●Palliative care access and reimbursement for oncology patients.

33:30 ○Rick Stanton suggests asking oncologists about palliative care options, as they may not always be aware of available resources. ○Oncologists may hold misconceptions about palliative care, and social workers can help triage needs for psychiatry or psychology. ○Dr.

Tulsky discusses challenges with reimbursement for psychosocial care in oncology, mentioning that Dana Farber loses money on social work services but is subsidized by the hospital. ○Dr. Tulsky and Jeff Waldron discuss the value of improved outcomes and the potential for changing the equation through payment reform. ●Psilocybin for palliative care and pain management.

“Palliative and Psychosocial Services for Cancer Patients” (James Tulsky) [#85] ○Jeff Krolick discusses challenges with long-term androgen deprivation therapy and psilocybin trials for cancer patients. ○Jeff Krolick highlights the benefits of psilocybin therapy for cognition and acceptance of death, citing personal experience and familiarity with advanced cancer patients. ○Dr.

Tulsky discusses the legal and therapeutic use of psilocybin, emphasizing its potential as an adjunct to psychotherapy and the need for more research on microdosing. ○Dr. Tulsky discusses psilocybin-assisted therapy for opioid-resistant cancer pain, highlighting the complex nature of pain and the potential for existential exploration through psilocybin.

○Brian McCloskey and Jeff Krolick discuss potential collaboration on writing a grant for cancer communication research. ○Dr. Tulsky expresses support for patient involvement in research projects and mentions the expectation for some grants to have patient representatives working with the research team.

“Palliative and Psychosocial Services for Cancer Patients” (James Tulsky) [#85] TRANSCRIPT Brian McCloskey Welcome everybody to the Cancer Patient Lab. I am Brian McCloskey, a co-founder of the

e can impact the patient's experience (0:22:09). ●Palliative care for advanced cancer patients. 22:51 ○Palliative care clinicians help improve quality of life, not just focus on death. ○Early conversations about end-of-life care can help avoid harm from delayed discussions. ●Cancer treatment options and palliative care.

27:50 ○Amit Gattani emphasizes the importance of considering a patient's quality of life and treatment burden when making decisions about cancer treatment. ○Dr. Tulsky highlights the individualized nature of cancer care, where providers recommend treatments that align with a patient's unique values and priorities.

○Brian McCloskey and Tom Smith discussed their experience with palliative care, with Brian mentioning their training in the program from 1995 to 1998. ○Rick Stanton expressed interest in palliative care at UCLA and asked if it was available for wider group participation. ●Palliative care access and reimbursement for oncology patients.

33:30 ○Rick Stanton suggests asking oncologists about palliative care options, as they may not always be aware of available resources. ○Oncologists may hold misconceptions about palliative care, and social workers can help triage needs for psychiatry or psychology. ○Dr.

Tulsky discusses challenges with reimbursement for psychosocial care in oncology, mentioning that Dana Farber loses money on social work services but is subsidized by the hospital. ○Dr. Tulsky and Jeff Waldron discuss the value of improved outcomes and the potential for changing the equation through payment reform. ●Psilocybin for palliative care and pain management.

“Palliative and Psychosocial Services for Cancer Patients” (James Tulsky) [#85] ○Jeff Krolick discusses challenges with long-term androgen deprivation therapy and psilocybin trials for cancer patients. ○Jeff Krolick highlights the benefits of psilocybin therapy for cognition and acceptance of death, citing personal experience and familiarity with advanced cancer patients. ○Dr.

Tulsky discusses the legal and therapeutic use of psilocybin, emphasizing its potential as an adjunct to psychotherapy and the need for more research on microdosing. ○Dr. Tulsky discusses psilocybin-assisted therapy for opioid-resistant cancer pain, highlighting the complex nature of pain and the potential for existential exploration through psilocybin.

○Brian McCloskey and Jeff Krolick discuss potential collaboration on writing a grant for cancer communication research. ○Dr. Tulsky expresses support for patient involvement in research projects and mentions the expectation for some grants to have patient representatives working with the research team.

“Palliative and Psychosocial Services for Cancer Patients” (James Tulsky) [#85] TRANSCRIPT Brian McCloskey Welcome everybody to the Cancer Patient Lab. I am Brian McCloskey, a co-founder of the Cancer Patient Lab. We are excited to have Dr. James Tulsky here with us. He is the chair of the Department of Psy