Dr. Janet L. Abrahm is a palliative care oncologist from the Dana-Farber Cancer Institute. 

Janet Abrahm, MD, FACP, FAAHPM

The theme of the 2024 Annual Meeting of the American Society for Clinical Oncology, “Comfort to Cure,” has long been my motto and the focus of my career and clinical work.

I first learned of the crucial role of comfort when I tried to treat a 20-year-old man who had a curable testicular cancer. The key drug in the regimen was cisplatin, but researchers had yet to develop Zofran (ondansetron) and its relatives, such as Emend (aprepitant). Because the anti-nausea and anti-vomiting drugs we had at the time were nowhere near strong enough to counter the severe side effects of the cisplatin, my patient insisted on using only “natural” remedies to treat the disease and, tragically, died from what would have been curable cancer.

Palliative care can address the symptoms that patients face during cancer treatment, thus greatly improving quality of life.

Another patient, a gentleman with cancer of the prostate that had metastasized to his bones, came to the clinic on a stretcher, accompanied by his wife and sister. They told me that if I could not offer anything else for the pain, they wanted me to help him die. Along with ibuprofen, he took a low-dose of a form of morphine that only worked for a few hours, after which the severe pain returned.

Both patients taught me that symptom management can be lifesaving. I became obsessed with finding better therapies for my patients’ symptoms, vowing I would not lose another patient to the undertreated side effects of curative therapy or undertreated pain. I soon found a solution to both of these problems. I identified a preventive regimen that enabled my patients to tolerate curative platinum-based therapy and other therapies that otherwise would have caused severe nausea or vomiting. Additionally, I was able to relieve patients’ pain with long-acting forms of opioids.

After implementing this palliative care plan with that gentleman with prostate cancer, he regained the will to live — and even brought me souvenirs from his travels. At this time, we didn’t yet have an official subspecialty of hospice and palliative medicine. Still, in effect, I was already delivering integrated oncology care and palliative care (sometimes called supportive care) to my patients.

You can readily understand why I favor integrating palliative care from the beginning of a patient’s cancer journey. Research shows that integration can even be life-prolonging for patients with metastatic lung cancer. Patients who saw a palliative care clinician within three weeks of diagnosis lived almost three months longer than those who only saw palliative care if their oncologist asked for a consultation.

Communication Challenges With Palliative Care

Many of you will not suffer from troubling symptoms during treatment because modern treatments have fewer side effects, and the drugs now available to prevent or manage side effects and pain are so much more powerful. You and your family will have to make some tough decisions during your or a loved one’s cancer treatment, however.

Yet, you may feel reluctant to “bother” your oncology clinicians with too many questions. For one thing, the visit time is generally short; for another, most of you want to be “good patients” who demonstrate appreciation for all your oncology team has done.

A palliative care clinician who partners with your oncology team can help. Your oncology team should review the risks and benefits of treatments thoroughly, but they often don’t have time to discuss your goals, hopes, worries and the burdens that treatment may entail, such as weekly blood draws. Palliative care clinicians do. We can review your symptoms and the side effects of treatments (such as constipation from pain medications) and also tackle the questions you and your family have about the burdens and benefits of the subsequent treatments offered.

Alternately, suppose a time comes when you and your family feel the burden of another treatment for a far-advanced cancer exceeds the benefit. You may hesitate to discuss those feelings with your oncology team but might be comfortable raising the issue with your palliative care clinicians. I remember when an oncology colleague covering for me one weekend confided that my patient, Mr. A, said he was “done.”He wanted to go into a hospice program. When my colleague asked Mr. A why I hadn’t referred him, he replied that he hadn’t told me his wishes: “Dr. Abrahm has tried so hard for me over all these years. I don’t want to let her down.”

I imagine some of you might be like Mr. A: not wanting to let your oncologist down. But if you share your feelings with your palliative care clinicians, they can let your oncology team know. Together, your oncology and palliative care teams can help you and your family make plans that fit your goals.

Don’t be shy about asking for a referral to palliative care early in your cancer course. When your oncology team partners with palliative care clinicians from the beginning, it enhances your relationship with the oncology team, and the oncologist and their staff benefit from the expertise palliative care provides.

None of you will be “worrying alone” anymore. Comfort can lead to a cure — or, at the least, far greater quality of life.

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