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The big picture

Author: Laurie Wertich

Life doesn’t stop in the face of a cancer diagnosis—in fact, it often gets busier. There are doctor appointments, scans, and treatments—on top of work, carpools, laundry, meals, household maintenance, and so much more. It is a juggling act that would challenge even the most proficient multitasker.

So, how can cancer patients juggle all of these challenges? The answer boils down to one thing: quality of life.

Quality of life

Quality of life refers to an individual’s overall wellbeing— the emotional, social, and physical aspects of life and how they may be impacted over time by a disease or daily stressors.

The fundamental key to surviving and thriving with cancer is maintaining a good quality of life. Focusing only on treating cancer can leave patients feeling sick, tired, and unable to perform the activities they have to do or love doing.

Christopher M. Stephenson, DO, an osteopathic physician and hospitalist at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois, explains that when patients experience symptoms such as pain or fatigue, it can not only affect their ability to perform activities of daily living but also interfere with treatment and even the response to that treatment.

“If one of those issues is not being addressed properly or controlled or managed, then we’re not going to have compliance with treatment, and we’re not going to have success—leading to greatly diminished outcomes,” Dr. Stephenson says.

Putting quality of life first

At CTCA® cancer treatment and quality of life go hand in hand, with doctors and patients working together through all stages of treatment and follow-up care. This does not happen by accident; rather, it is an intentional, well-researched, and targeted approach that has resulted in the creation of special clinics designed to focus on the wants and the needs of patients.

The Quality of Life Centers at CTCA offer a unique, innovative approach to helping patients navigate cancer and maintain the best quality of life possible. The clinics are an integral component of each hospital and provide a central location for addressing and managing symptoms as well as coordinating treatment.

The Quality of Life Center is a place, outside of regular oncologic care, where patients can address any issues that might interfere with their daily living. The specially trained medical professionals working with patients oversee the big picture and treat the patient as a whole. The team works to resolve any concerns and regularly communicates with the patient’s entire CTCA care team to ensure immediate and continual symptom management throughout treatment and beyond.

“The goal of the Quality of Life Center is to provide comprehensive, hopeful solutions, including medical and integrative therapies and services, to enhance the physical and emotional well-being of our oncology patients at all phases of their care,” Dr. Stephenson explains. “Upon entering treatment, the patient is viewed as a survivor, and all resources are focused on improving his or her quality of life.”

The whole patient

Cancer is just one piece of the puzzle. Many patients diagnosed with cancer are living with other chronic conditions— referred to as comorbidities—such as diabetes, heart disease, osteoporosis, obesity, and many more. Patients commonly experience many symptoms as a result of cancer treatment, the most common of them being fatigue, pain, neuropathy, nausea, anxiety, depression, and sexual dysfunction.

“There are different patients who are candidates for different therapies,” explains Dr. Stephenson. “These therapies have to be monitored and modulated for the specific condition of the patient.”

For example, patients with severe cardiac disease may not be candidates for some medications used to treat cancer. Patients with diabetes may need extra support with controlling blood sugar because some cancer treatments can affect blood sugar control.

“Each one of our hospitals has an oncology-mindful, internal medicine care approach that addresses the core issues that are unique to each patient, the specific treatments for the disease, and the comorbidities affecting that particular patient,” Dr. Stephenson says. The bottom line is that the physicians and the nurses in the Quality of Life Centers have a vitally important job: to know and understand each individual patient so that they can help proactively manage any side effects or health issues that may arise during treatment.

Assessing quality of life

All care team members at CTCA continually work to monitor and assess patients’ quality of life. CTCA has implemented a new assessment protocol that nurses use every time they see a patient. “Essentially, we are having our nurses measure things that impair our patients’ well-being,” explains Dr. Stephenson. “We are measuring the things that patients tell us are important to improve their quality of life during and after the cancer is treated.”

This nurse assessment includes nine symptoms that nurses ask patients about every time they visit the clinic: pain, anxiety, depression, numbness/tingling, fatigue, nausea/vomiting, appetite changes, constipation, and diarrhea. “After 14 months of analysis and research, we came up with these key predictors of symptom management that will affect compliance with the entire oncologic therapy plan and the management of their comorbidities,” Dr. Stephenson says.

The care management team tracks the data, so that if a patient has level-4 pain (on a scale of 0 to 10) in June and that pain jumps to a level 7 in July, the issue will be addressed.

“What sets us apart is how we manage and measure these things,” says Dr. Stephenson. “If the patient’s pain level is too high, the nurse will tell the doctor. If he or she needs assistance in managing the pain, the patient is referred to the Quality of Life Center, where I will do everything within my power to bring relief to the patient. This is unique. No one else is doing this.”

An ounce of prevention

Measuring and tracking symptoms is only the starting point. The Quality of Life Center is about action, specifically preventive action. More often than not, the best defense is a good offense.

“We try to prevent complications before they arise,” Dr. Stephenson explains. The only way to do this is to know exactly what is going on with each patient.

For example, if a patient has diabetes, the physicians in the Quality of Life Center take a proactive strategy to managing both the diabetes and the cancer. Dr. Stephenson explains that they will use long-acting and short-acting insulin to counteract the negative effects that can occur as a result of some cancer treatments. What’s more, all patients have access to nutrition and naturopathic oncology providers at CTCA hospitals, who will help the patient determine what to eat to maintain an ideal weight and blood sugar during cancer treatment and what natural therapies are safe and effective to take during treatment and with the specific diagnosis.

If a patient has a prior cardiovascular condition, physicians in the Quality of Life Center use preventive strategies to ensure that the patient does not encounter heart issues during surgery. For example, they’ll optimize their heart and blood pressure medications, and they’ll also prescribe the appropriate pain medications to relieve and prevent pain because a pain response could place extra stress on the heart.

Pain management is one of the most critical factors to maintaining a good quality of life. “Pain interferes with everything,” Dr. Stephenson explains. “It is a significant health issue that affects all other issues in a patient. How can one truly enjoy life if he or she is always in pain? Many clinicians consider it the fifth vital sign.”

“We have a very aggressive pain management protocol in place at CTCA. If you are in so much pain all the time, you are not going to want to comply with your treatment plan,” Dr. Stephenson says. “If patients have pain, we are going to do something about it before they leave.”

Communication is key

Addressing quality-of-life issues is a main key to cancer treatment. The innovative nurse assessment tool at CTCA is a good starting point and can open the door to effective communication between the patient and the team physicians.

Dr. Stephenson says that it is important for patients to be open about their symptoms. “If you are empowered to speak with your doctor about these issues, you will feel more comfortable with your doctor and your treatment, and you will have a better clinical response,” he insists.

“We listen to our patients,” Dr. Stephenson says. “Then, having heard them, we solve the problems with them and give them strategies for managing their symptoms to improve their overall quality of life.”

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