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Cancer supportive care improves quality of life and symptom management

Supportive care
Cancer supportive care uses evidence-informed modalities to prevent and manage the side effects of cancer treatment and to improve patients’ quality of life.

Cancer supportive care uses evidence-informed modalities to prevent and manage the side effects of cancer treatment. It’s not meant to directly treat cancer. Instead, the approach is designed to support patients during conventional treatment. Its goal is to address the physical, psychosocial and spiritual needs of patients throughout treatment to improve their quality of life. Therapies may include nutritional support, pain management, behavioral health services and oncology rehabilitation. Anyone on the continuum of cancer—from early stages to survivorship—may benefit from supportive care.

Supportive care also includes palliative care or comfort care. However, patients often misinterpret these terms. When they hear “palliative care” or “comfort care,” some people mistakenly believe they are synonymous with end-of-life care or are only meant for those with advanced cancer. Some patients believe that supportive care is used in lieu of conventional cancer treatment. These misconceptions often keep people from seeking and using beneficial resources designed to prevent and manage side effects of cancer treatment.

At Cancer Treatment Centers of America® (CTCA), we refer to our supportive care services as integrative care because that term more accurately represents how we use evidence-informed therapies to help manage side effects in conjunction with conventional cancer treatments such as chemotherapy, radiation and surgery.

Integrative supportive care is typically interdisciplinary. For example, if you’re experiencing pain during treatment, your provider may prescribe medication or nerve-block therapy. At the same time, behavioral therapy, such as guided imagery and breathing and relaxation techniques, may be used to help reduce the amount of pain medication you need. Stretching and strength exercises available through oncology rehabilitation may also help target the source of the pain. 

In this post, we explore some common types of supportive care therapies and discuss how they may help you before, during and even after cancer treatment. We cover:

Throughout this post, we draw on examples from our long history of providing integrative care to cancer patients undergoing treatment at CTCA®. If you’re interested in learning more about getting cancer care from our team of experts, call us or chat online with a member of our team.

How and when does supportive care benefit patients?

Patients who are aware of supportive care may think they only need it when they’re experiencing some kind of complication or difficult side effect related to their cancer treatment, such as severe pain or extreme weight loss. Other times, they only find out about supportive care because their care team notices a need during treatment and recommends some sort of therapy. But early access to supportive care care may not only improve your quality of life throughout your treatment, it may provide future benefits as well.

Benefits of early access to supportive care

Early access to supportive care may help you take preventative measures to avoid or reduce the severity of side effects or complications that may interfere with or delay your treatment. 

If you meet with providers who know which side effects and complications are common in patients with your specific cancer type and treatment, they may inform you of warning signs and help you develop a plan to intervene before the situation becomes critical. For example, if you know that nausea is a common side effect of your chemotherapy treatment, addressing that early on with nutritional or other support may lessen the risk of hospitalization due to dehydration and malnutrition. And if you do need to be hospitalized for some reason, you’re more likely to have a shorter stay.

An integrative-minded oncology care team may screen new cancer patients for other health concerns that threaten to interfere with treatment or quality of life, referring the patients to appropriate supportive care services as needed. If you’re already suffering from depression or anxiety, for instance, a behavioral health therapist may help you develop the skills necessary to cope with your new diagnosis and treatment. In fact, some researchers report that early access to supportive care may also improve the mental health and quality of life of patients’ family caregivers

Get a head start on your future

Using supportive care during treatment may also give you a head start on survivorship.

A cancer diagnosis often changes patients’ mindset about their habits in general. They’re sometimes motivated to make significant lifestyle changes, not only to get through treatment but for a healthier future. Working with supportive care providers to improve your diet, exercise habits and stress management may reduce the risk of cancer recurrence or of being diagnosed with another chronic illness in the future. If you already have a comorbidity, healthier habits may help you better manage that illness as well.

Researchers have also found that early access to supportive care and rehabilitation for those who have physical, psychological or cognitive impairment may have the additional benefit of reducing employment-related absences and disability.

Sometimes, the effects of cancer and treatment linger into survivorship. Fatigue, pain, bowel or bladder changes, sexual dysfunction and anxiety are common in cancer survivors. Access to oncology rehabilitation and other integrative care therapies during treatment may lessen these long-term impacts in patients.

What are some common types of supportive care therapies?

Supportive care

The types of modalities or services that fall under the supportive care umbrella are too numerous to detail in this post, so instead, we’ll discuss categories of therapies. At CTCA, we have six major categories of supportive care therapies. In this section, we’ll elaborate on each category and provide some examples of how those therapies may benefit patients. 

As we noted earlier, many of these modalities are interdisciplinary. Services from several different modalities may help you deal with one side effect, like pain or nausea. Alternatively, one modality may help you manage multiple side effects. 

To be clear, we at CTCA don’t advocate using any of these modalities in lieu of standard treatment. We believe their purpose is to empower cancer patients and to help them tolerate treatment-related side effects, not to treat the cancer itself. Supportive care is ultimately designed to not just help patients feel better, but to reduce treatment delays and improve their quality of life. 

Behavioral health

Behavioral health addresses emotional, mental and social issues surrounding a cancer diagnosis and treatment.

Patients commonly ask us:

  • Why did I get cancer? What did I do wrong?
  • How do I talk to my kids about cancer?
  • How do I talk to my significant other about intimacy problems?
  • How can I sleep at night when I can’t seem to stop worrying?

You may experience  a wide range of feelings after a cancer diagnosis. You may also find yourself struggling in ways you never have before.

Anxiety, stress and depression are common among cancer patients. 

Sexual health issues are also common for some cancer types and treatments, though they are not talked about a lot. Cancer, surgery or medication may impact your desire for intimacy or make it physically painful. Many patients are unsure of how to talk to their partners about these issues. 

Dealing with a serious illness such as cancer when the patient also has a pre-existing mental health diagnosis often brings its own set of challenges. Those with mental health conditions may be less likely to follow their treatment plans or to make beneficial lifestyle changes. However, being treated for mental health disorders while being treated for cancer has been shown to improve outcomes for both conditions.

A variety of behavioral modalities are available to help cancer patients. Therapists will work with you to form a plan of action for the challenges you’re struggling with and give you tools to help you move forward. Cognitive behavioral therapy, for example, may help with anxiety and depression. Relaxation and breathing techniques may help you reduce stress. Other therapies include animal-assisted therapy, art therapy and music therapy.

Oncology rehabilitation

Oncology rehabilitation includes services such as physical therapy, occupational therapy and speech therapy to help patients with complications and side effects of their cancer and its treatment. 

When used prior to certain treatments, oncology rehabilitation may reduce the possibility of infection or lessen the length of hospitalization. Lymphedema, for example, is a common side effect of a treatment that removes or damages lymph nodes. At CTCA, certified lymphedema therapists meet with patients before surgery to inform them about techniques, such as light exercises or gentle massage, that may help prevent or reduce swelling associated with the condition. Educating patients about the warning signs of infection may encourage patients to alert their provider and seek assistance before the condition worsens.

Physical therapists, meanwhile, may help you overcome cancer-related fatigue and balance issues. They may help you increase your strength, flexibility and mobility. Occupational therapists may help you manage activities of daily living such as bathing and dressing after surgery. If surgery or another treatment has affected your ability to swallow or to form words, speech therapy may be able to help you recover those functions.

Nutritional support

Supportive care 

Many patients struggle with getting enough nutrition in their diets. Well-meaning family, friends and neighbors often freely offer advice. And if you’re like most cancer patients, you spend a lot of time reading about cancer and nutrition. Information may be overwhelming, and even conflicting. 

Patients often ask us:

  • Should I eat meat? What about dairy?
  • What about a ketogenic diet?
  • Is a vegan diet best?
  • Does sugar feed cancer?
  • Should I only eat organic food?

What you should and shouldn’t eat (and in what amounts) again depends on your specific cancer type and your treatment plan. For example, we often hear that we need to increase the amount of fiber in our diet, but fiber may cause problems if you have a bowel obstruction in your gastrointestinal tract. 

A dietitian may help you get the nutrients you need so that you don't risk your ability to complete treatment on time because of malnutrition.

Patients who don’t get proper nutritional support often experience significant weight loss—sometimes up to 50 pounds—that results in a disruption of treatment. The complication begins when they have trouble eating because of nausea, mucositis, difficulty swallowing or some other challenge. They start losing energy and become weak. They don’t move around much and begin to lose muscle mass. Sometimes, they become so dehydrated that they have to be hospitalized. Other times, treatment has to be delayed or changed because they’re too weak or have lost too much weight. A nutritional support team may address the cause of their inability to eat. Once they start eating again, we typically see that their energy increases, strength returns, and they get back on the right track.

A dietitian may also help you address or change a particular lifestyle that makes getting the nutrients you need a challenge. If you travel a lot for work, for example, you probably don’t have access to a kitchen, and you may need help making healthy choices at restaurants. If you have a comorbidity such as diabetes, you may need some help planning meals that are appetizing and will satisfy the dietary needs of both conditions. 

Pain management

Pain is one of the most common side effects of cancer and its treatment. Tumors, blockages and poor blood circulation may cause pain. Pain may also be a side effect of surgery, chemotherapy, radiation therapy or other therapies to treat your cancer. The discomfort sometimes continues after treatment ends.

Unmanaged pain may inhibit your ability to function and negatively affect your quality of life. It may also increase anxiety and depression. 

A pain management physician has access to options beyond prescription and over-the-counter medications. A nerve block may help with peripheral neuropathy. Botox® or nerve stimulation may be recommended to treat severe headaches. 

Using evidence-informed therapies to manage pain with an integrative approach may provide you with more options. Mindfulness and relaxation techniques may reduce not just pain but also anxiety. Nutritional support may help relieve pain associated with digestive issues, while physical therapy may be used to target a source of pain with stretching, strengthening and manipulation.

Spiritual support

Supportive care 

A cancer diagnosis often causes patients to reevaluate priorities, relationships and beliefs. Spiritual support may help you explore questions such as:

  • Why did God let this happen to me?
  • Is God punishing me?
  • What does life mean to me now?
  • What is my purpose in life?

In its document about spirituality in cancer care, the National Cancer Institute states that spiritual well-being provides physiological and psychological benefits to those living with cancer and improves patients’ quality of life in general. 

Whether you consider yourself a religious person or not, having someone to discuss these types of issues with may help you deal with them in a constructive way and may help you find meaning in your cancer experience.

You may find spiritual support through your personal faith-based community. Alternatives may include counseling with a hospital chaplain or clergy member, prayer groups, ecumenical worship services or meditation. 

Naturopathic support

Naturopathic support uses natural and traditional modalities to promote wellness. While some choose to rely solely on these methods to treat cancer, at CTCA, we believe that cancer must be treated with conventional treatments, like surgery, chemotherapy and precision medicine techniques like immunotherapy. Meanwhile, naturopathic support may benefit patients by helping them manage side effects.

Cancer patients often come to us already using herbs, botanicals and dietary supplements for many reasons. Some are trying to find natural ways to reduce anxiety or to help them sleep. Others are trying to control nausea or to support their immune system. But they’re often unaware of potentially dangerous interactions between these products and medications, chemotherapy, radiation and even anesthesia. 

Some herbs and supplements that we normally think of as helpful sometimes have the potential to make cancer therapy less effective. Probiotics, for example, may interfere with immunotherapy. The components of green tea may neutralize the chemotherapy drug bortezomib, commonly known as Velcade®. It’s important to communicate what you’re using to all your care providers to help them identify and prevent harmful interactions.

What you should and shouldn’t take depends on your specific type of cancer and treatment. We’ve seen patients spending large amounts of money on supplements that may not actually be helping them. A naturopathic support team may advise you on what (and in what amounts) may be beneficial.

Where to find supportive care for cancer patients

So where do you find supportive care? Sometimes you just have to ask. You may be unaware that some of these therapies are available where you’re being treated. Or maybe you’ve already recognized a need and sought out a few on your own. Your geographical location and financial situation, however, may limit your ability to take sufficient advantage of supportive therapies.

Centralized access to supportive care

Sometimes, community cancer centers provide some supportive care services. You’re less likely to find them at outpatient treatment centers.

Larger academic medical centers and cancer hospitals are more likely to have these resources available for patients. How they deliver those services, however, depends on the facility. 

Those services may be spread out over multiple locations, requiring you to travel to each appointment. You may have to schedule your own appointments and handle all the logistics yourself. Ideally, the providers communicate with one another so that they’re all up to date with every aspect of your care. If not, the burden falls on you.

At CTCA, we strive to make it as easy as possible for patients at our cancer centers to access the supportive care they need before, during and after treatment. Every patient has a designated care manager to help manage the logistics involved in their care, including making their appointments, getting their test results and seeing that their questions are answered. We only treat cancer, so our providers are experts in detecting and managing cancer and treatment side effects. They may refer you to therapy when either you or they perceive a need. Because all our services are located under one roof, you don’t have to worry about going from one place to another. Because our services are part of the overall care plan, individual referrals are not needed to meet insurance requirements--another benefit of an integrative care plan.

Putting it together by yourself

If you don’t currently have access to a supportive care program, you may have to piece it together yourself. Because this may be challenging, we’d like to offer a few suggestions: 

  • Ask your oncologist for recommendations. He or she may know of therapists with experience working with cancer patients. These providers are more likely to be aware of specific side effects and potential interactions between medications and therapies for your specific cancer type and treatment.
  • Get information from reputable nonprofit organizations specific to your type of cancer. They recognize common needs and provide resources to patients and doctors. Examples are the Leukemia & Lymphoma Society®, the Pancreatic Cancer Action Network® and breastcancer.org®.
  • National cancer organizations such as the National Cancer Institute and the American Cancer Society® are also reputable sources of information.
  • Find a local or online support group. Other patients and their caregivers may be valuable sources of information, and they understand what you’re going through. CTCA sponsors an online community called CancerCompass®, which helps you connect with other cancer patients and find resources for cancer information, including recent cancer news. 
  • If options are limited in your geographical location, investigate virtual options. Telemedicine has been made increasingly available, especially as a result of COVID-19. Nutritional and behavioral therapy are good candidates for virtual support; however, licensing regulations may complicate access.
  • Check with your insurance provider about the documentation necessary to receive supportive care. Some services may or may not be covered by your health insurance. If you have coverage, you may need a referral from your attending physician as a condition of coverage. Otherwise, you may have to pay for these therapies out of pocket.

If you do meet with providers independent of your cancer treatment team, find a way to communicate important therapy information to your oncologist. 

Finally, sometimes, you have to advocate for yourself. When you go somewhere for treatment, ask your care team if resources are available to help you if you experience any side effects. Speak up if a particular symptom is disturbing you; there’s no benefit to suffering unnecessarily. Access to oncology supportive care when you need it is important for the outcomes for your treatment and your quality of life. 

If you’re interested in learning more about our patient-centered approach to cancer care at Cancer Treatment Centers of America, call us or click here to speak with a member of our team.