How Supportive and Palliative Oncology Partnerships Provide Lifesaving Answers

Caring for patients with cancer can be satisfying and traumatic. We can feel on top of the world when someone’s cancer responds to treatment and helpless trying to get another patient’s illness—and their resulting pain, nausea and vomiting—under control. Oncologists have extensive training and receive daily email and social media updates on what to do for cancer. But we receive very little education or support in managing really tough symptoms, handling difficult conversations with patients and their families, or avoiding the burnout that caring for cancer patients can engender.

As an oncology fellow, I never processed the emotionally challenging parts of my job during the day; there wasn’t time. Instead, during evenings at the orchestra, I silently wept through the symphonies’ slow movements. My lack of training in dealing with the emotional challenges in my oncology practice meant moral distress and burnout were inevitable.

Later, as a practicing oncologist, I was losing my young patients to germ cell cancers because they couldn’t tolerate the cis-platinum with antiemetics we then had available: dexamethasone, lorazepam and prochlorperazine. Other patients told me their uncontrolled pain made them wish they could die. One wonderful gentleman with metastatic prostate cancer was rolled into my office on a gurney, accompanied by his wife and sister, and he asked me to kill him; his pain was just so terrible.

These experiences drew me to become an expert in symptom management. I discovered the work of RichardGralla, MD, and used the massive doses of metoclopramide, along with diphenhydramine and lorazepam, that he recommended to get my 20-somethings through their curative cis-platinum–containing germ cell treatments.(We had no ondansetron, let alone NK-1 [neurokinin-1] inhibitors!) I did a sabbatical with Kathy Foley, MD, atMemorial Sloan Kettering Cancer Center and learned how to manage patients’ severe cancer pain. My prostate cancer patient told an auditorium full of first- and second-year medical students that he’d just gotten back fromAtlantic City, N.J. “What are you taking for the pain?” they asked him. He answered matter-of-factly: “100 mg of MS Contin three times a day.” The air went out of the room!

As I matured in my practice, I found resources to combat burnout and moral distress. I learned to share bad news skillfully, realizing that the goal was not to have the patient and family feeling “fine” afterward but to ensure they would continue to trust me. They needed to know that I wouldn’t abandon them: Even if there were no more medicines to offer, I would always care for them. My years on oncology’s front lines taught me that expert symptom management and communication aren’t just “nice to haves”; they can be lifesaving. My belief in this truth led me to build a supportive and palliative care program at the Dana-Farber Cancer Institute (DFCI). This program offers partnerships to oncologists, enabling them to give the curative or life-prolonging therapies their patients demand.

Over the years, I’ve enjoyed speaking about supportive and palliative oncology as part of the DFCI Master Course of Updates in Oncology. I still enjoy giving talks on these topics whenever I get the chance, but to make the information as accessible as possible, I’ve developed a website (www.janetabrahm.com). The site aims to provide up-to-date supportive and palliative care resources for oncologists and oncology nurse practitioners throughout the United States, most of whom don’t have a local palliative care partner.

It is my hope that the information, videos and advice on symptom management, communication, grief and bereavement, prevention of moral distress, and other special topics—including patients’ hopes for miracles and the unique needs of LGBTQ+ patients—will help my colleagues feel more supported and empowered as they care for cancer patients and their families.