Given that uncontrolled diarrhea can be debilitating for
patients, this approval provides a ne w option for improving
their quality of life.
Hair loss is an adverse effect of treatment with many cytotoxic
chemotherapeutics that has been reported to negatively affect
quality of life, especially for women with breast cancer (186).
In April 2017, the FDA cleared the use of a medical device to
help palliate this quality of life issue for women with breast
cancer. The device—the Paxman Scalp Cooling System—is
worn by the patient while chemotherapy is administered.
The cap cools the scalp, which is thought to reduce hair loss
in two ways: First, by reducing blood flow to the scalp, which
reduces the amount of chemotherapy that reaches cells in
the hair follicles (hair roots) and second, by slowing down
multiplication of cells in the hair follicles, which makes
them less affected by chemotherapy. The cooling system was
approved after it was shown in a clinical trial to be effective
at reducing hair loss for women being treated with cytotoxic
chemotherapeutics after a breast cancer diagnosis (187). In
July 2017, the FDA expanded the number of cleared uses of
a second cooling device, the Dignitana DigniCap Cooling
System, from reducing hair loss for women with breast
cancer being treated with cytotoxic chemotherapeutics to
reducing hair loss for all patients with solid tumors being
treated with cytotoxic chemotherapeutics.
Clearly, for a symptom to be treated, a health care provider
has to know that the patient is experiencing the symptom.
However, one study found that there is frequently no
mention of a symptom in a patient’s electronic medical
record even if he or she has reported it on a patient-provided
information form, suggesting that symptoms among patients
with cancer are frequently undetected by the health care
provider (188). The results from a recent study suggest
that monitoring of electronic patient-reported symptoms
might help address this issue (189). In this study, patients
who provided self-reporting of 12 common symptoms
at and between visits via a web-based patient-reported
outcomes questionnaire platform had improved overall
survival compared with those who had usual care. A report of
a severe or worsening symptom triggered an email alert to a
nurse who would respond, for example, by calling to provide
symptom management counseling, providing supportive
medications, modifying chemotherapy dose, or referring
the patient for follow-up. Exactly how monitoring of the
electronic patient-reported symptoms improved survival is
not known, but it is possible that patients were able to tolerate
chemotherapy longer as a result of symptom palliation.
This is just one example of the potential for patient-reported outcomes to enhance clinical care. Improved
implementation of patient-reported outcomes into all
phases of clinical care and into clinical trials is essential if
we are to accelerate the pace at which we improve survival
and quality of life for cancer patients and survivors.
A cancer diagnosis does not just pose physical challenges;
it also poses behavioral, emotional, psychological, and
social challenges. Researchers and health care practitioners
working in the field of psycho-oncology are committed to
developing new approaches to address these challenges,
which include treatment-related cognitive impairment,
fear of cancer recurrence, anxiety, depression, stress,
and feelings of despair (see sidebar on Helping Patients
with Cancer through Psycho-oncology Research, p. 88).
Addressing these challenges is important not just for
improving quality of life, but also for improving outcomes
because challenges such as depression and anxiety are often
associated with decreased adherence to cancer treatment,
prolonged hospitalization during cancer treatment, and
decreased survival (190–193).
Palliative care is specialized care that provides
an extra layer of support to patients with serious
illnesses such as cancer and their families.
It is not the same as hospice care, because it can
be given throughout a patient’s experience with
cancer, beginning at diagnosis and continuing
through treatment, follow-up, survivorship,
and end-of-life care.
It can be given in addition to cancer treatment
or to those with no curative treatment options;
palliative care given near the end of life is
usually referred to as hospice care.
Palliative care addresses many of the challenges
• physical symptoms and adverse effects
that can affect quality of life after a cancer
• emotional challenges such anxiety
of the disease and its treatment,
such as pain, nausea, vomiting, fatigue,
difficulty sleeping, and loss of appetite;
• practical challenges such as navigating
the health care system; and
• spiritual challenges.
What Is Palliative Care?
Adapted from ( 30)
continued from p. 81
continued on p. 88