Supportive Care In Cancer: A Handbook For Oncologists PDF

Preface

It is expected that the number of people afflicted with cancer will increase substantially over the next decades. However, it is not expected that significant progress in presently available antineoplastic therapies will take place rapidly enough to substantially alter their prognostic outlook. This is especially true for the vast number of middle-aged and elderly cancer patients with epithelial neoplasias, for whom truly curative therapeutic options are not, and in all likelihood will not be, available during the years to come. Even if the present boom in molecular biology and preclinical gene-therapy projects in the laboratory lends to real progress at the clinical level, it will take many years for significant prognostic gains to ‘‘pay off'' in community oncology practice.

In other words, more patients in the near future will be receiving presentday, mostly intensive antineoplastic therapies from surgeons, radiotherapists, and medical oncologists, and at least half of them will finally die from various lifethreatening complications of their ultimately ‘‘incurable'' disease. These patients will often pass through a more or less prolonged phase of chronic cancer characterized not only by the manifestations of the illness itself, but by repeated episodes of side effects from various therapies. The emotional burden of the potentially fatal outcome, preceded by episodes of mostly partial and transient remissions, as well as the progressive deterioration of physical and social capabilities, are additional reasons for concern. This reality, faced by too many of our adult cancer patients, is why we developed this text.

Supportive care is difficult to define. It is the totality of medical, nursing, psychosocial, and rehabilitative support that our patients need from the onset of their disease through various active therapeutic phases for long-term cure—or until death. The scope of supportive care is therefore inevitably very wide and heterogeneous, as it encompasses care of cancer manifestations, prevention and management of therapeutic side effects, and psychological and spiritual support, in the broadest sense.

Supportive care is part of the management of cancer and other presently incurable diseases, such as chronic neurological diseases, AIDS, and so on. One could argue that basic supportive care is part of any general practitioner's, and at least practicing oncologist's, medical armamentarium: every internist and medical oncologist treats infections and other complications or manifestations of cancer or its therapies, diagnoses hypercalcemia, and provides pain therapy and some kind of psychosocial assistance.

Given the importance of supportive care (in many instances more than specific antineoplastic therapy itself ), extensive clinical research and specialized teaching are necessary for its improvement and success, and require motivated specialists involved in active investigation, professionalization, and teaching of its various areas.

These areas are extremely heterogeneous and, as such, extremely challenging! Supportive care branches out to many subspecialties of the traditional medical and nursing care system and encompasses a broad and highly interesting variety of facets, such as those discussed in this book.

Supportive care differs considerably from palliative care, although these fields may overlap, and semantics may play a role. Palliation of symptoms, by either active prevention or therapeutic intervention, is certainly a main goal of any supportive care strategy. However, the term palliative care, as used today by its proponents and in the literature, is normally reserved for the approach to the terminal, and especially dying, patient. Thus, palliative care addresses only the ‘‘terminal'' aspect (although clearly an important one) of the broad umbrella of supportive care, which is concerned with the optimal well-being of the cancer patient in all stages of this usually long and complicated disease.

Such a definition carries many practical difficulties, as it brings under a ‘‘common hat'' many different specialties that differ considerably in approach, technique, and health care personnel. The infectious disease specialist might not be interested in pain control, and the nurse providing stomach care might not necessarily be attentive to research on bisphosphonates in patients with osteolytic bone metastases. Nevertheless, all these approaches are applicable to a patient with neoplastic disease, be it limited or extensive, early or late, curable or not! A common—interdisciplinary and multiprofessional—forum is thus necessary to bridge these various aspects, all of which have one common aim: comprehensive supportive care in cancer.

Early attempts to bring together on a multiprofessional level those who are interested in oncological supportive care have been made through various international meetings. These meetings have been attended by hundreds of doctors, oncology nurses, and other health care workers interested in cancer patients' wellbeing.

Another constructive step was taken in 1991 by creating a new interdisciplinary society, the Multinational Association of Supportive Care in Cancer (MASCC). MASCC aims to provide the common ground on which people with different expertise and interest meet with the basic goal of improving supportive care in cancer through mutual education and common research. MASCC plans to achieve its goals by organizing annual supportive care symposia where specialized and also more general information will be exchanged at an international, multiprofessional level. MASCC has also created its own official journal, Supportive Care in Cancer, which is open to important contributions from any field of supportive care in oncology.

Finally, the board of the young and dynamic MASCC society and several additional international experts felt the need to publish an authoritative handbook on supportive care in cancer. This textbook should complete the educational structures already available for scientific and professional interaction and cooperation in this essential field of cancer medicine. The chapters were provided by internationally known experts, who have attempted to cover all relevant aspects of supportive care in cancer, mainly from the viewpoint of medical oncology and oncology nursing.

The second edition is justified not only by the overall excellent performance of the first edition but also by the need for continuously updated information in the broad field of supportive care in oncology. Our concept of supportive care continues to encompass all the aspects that make life more tolerable for the patients who undergo curative or palliative treatment for cancer. Terminal care— too often improperly called palliative care—is a part of supportive care, but the latter goes well beyond it. Following this conception of supportive care, we are dealing with a very broad spectrum and heterogeneous group of activities and individuals, whose interest in the various aspects of supportive care may overlap— although rarely completely. A comprehensive book such as this will be useful to many professionals engaged in the management of cancer patients provided it is didactic and easily accessible.

For the second edition, we have increased the readability by including clear summaries for each chapter and by increasing the number of tables, figures, and algorithms. The content of the handbook has also been changed by the addition of new chapters dealing with fatigue, home care, complementary approaches, hospices, and terminal care.

This second issue of the handbook will be useful for oncologists, general physicians, nurses, psychologists, social workers, pharmacists, and all who provide care to cancer patients because it tries to mirror what supportive care is: a combination of multiple approaches aimed at maintaining an adequate quality of life for the patient suffering from a neoplasia. It is our hope, and that of all the dedicated contributors to this handbook, that our message cuts across the traditional professional boundaries of specialized care in cancer, in order to truly optimize comprehensive supportive care for all cancer patients.