Reassessing Palliative Care: MSK Emphasizes Supportive Care for All People with Cancer

Judith Nelson with a patient

MSK physician Judith Nelson says that all people with cancer can benefit from supportive care services.

The doctors, nurses, and other staff at Memorial Sloan Kettering are focused on all aspects of cancer care. This means that in addition to the most-advanced therapies for treating cancer, we deliver care that tends to the physical, emotional, and spiritual needs that come up during and after cancer treatment.

“We feel strongly that supportive care is compatible with the most-aggressive, state-of-the-art cancer care,” says physician Judith Nelson. “It’s not an either-or situation: Supportive care and cancer care go together. We emphasize the importance of the supportive services that are available from a patient’s very first appointment.”

We feel strongly that supportive care is compatible with the most-aggressive, state-of-the-art cancer care.
Judith Nelson physician

“Supportive care is based on a person’s needs, not on their prognosis. People with all types and stages of cancer can benefit from it,” Dr. Nelson adds. “The goal of our service is to help patients live maximally and to have every day for them be the best day possible, for as many days — or weeks, years, or decades — as possible.”

A Mission of Supporting People with Cancer

Although the terms “palliative” and “supportive” can be used interchangeably, MSK wanted to emphasize the supportive part of our mission. About a year ago MSK renamed the Palliative Medicine Service in the Department of Medicine. It is now called the Supportive Care Service.

Supportive care covers a range of services for people with cancer. This includes medical care to address physical symptoms, such as pain, nausea, or fatigue. It also consists of care to help people address their emotions, such as anxiety, stress, and depression. These services can incorporate support for the spiritual distress that people may face after their diagnosis as well. And supportive care can help people with cancer ensure that their care matches their values and goals.

Members of MSK’s supportive care team train oncology doctors and nurses to notice when people need more support and to provide the care that can help them. Supportive care assessments are an ongoing part of the care that people receive at MSK, whether in the hospital or as an outpatient.

“The best way to know if patients are in distress is to ask,” Dr. Nelson says. “Moving forward, we are making sure that all of our healthcare providers are empowered to do assessments from the very beginning of treatment. Based on these assessments, patients and their families will get the help they need from their oncology team and a supportive care specialist if needed.”

A Growing, Interdisciplinary Field

Robert Sidlow leads MSK’s Division of Survivorship and Supportive Care. The group was launched about three years ago within the Department of Medicine. It bolsters and advances a number of services across MSK. These include the General Internal Medicine, Hospital Medicine, Geriatrics, Integrative Medicine, Employee Health and Wellness, Urgent Care, and Supportive Care services.

“It’s important to emphasize the interdisciplinary nature of supportive care,” Dr. Sidlow says. “In addition to members of the specialized Supportive Care Service, many MSK doctors are part of the extended supportive care team. Psycho-oncologists are tremendously helpful to patients and their families. The robust Integrative Medicine Service delivers complementary treatments, such as acupuncture and mind-body therapies. The Department of Rehabilitation Medicine is wonderfully helpful at getting people back to their regular lives as much as possible.”

People with all types and stages of cancer can benefit from supportive care.
Judith Nelson physician

MSK also has a unique supportive care fellowship program, in which doctors and nurse practitioners train side by side. “We are the standard bearer for cancer care and training across the country and around the world,” Dr. Nelson says. Applications to the training program have tripled in the past few years, and the program’s graduates have gone on to work at many leading institutions around the country.

Continuing to Improve End-of-Life Care

Despite the focus on supporting all people with cancer, end-of-life care is still a key part of supportive care services.

“We help people plan in advance so important decisions are not made in a time of crisis,” Dr. Nelson explains. “Doctors need to hear from patients and their families about what’s important to them in their lives and what their priorities are.”

Dr. Sidlow adds, “With the constant stream of new treatments available, people with cancer and their care teams now have much more prognostic uncertainty than in the past. Twenty years ago when someone had an advanced cancer, by and large everyone anticipated an inevitable downward path. But today, the course of advanced cancer can be less obvious. Often the experience of having cancer is more like congestive heart failure. People alternate between periods of relative stability and periods of greater need for supportive care.”

Supportive Care
MSK’s supportive care specialists are dedicated to improving your quality of life during and after treatment. You can get supportive care anytime during your treatment. It is not the same as hospice care.

He says that although many people with cancer are living longer than in the past, “the burdens that they and their caregivers face — physically, emotionally, and financially — can be quite significant and worsen everyone’s quality of life. This underscores the importance of understanding patients’ values and integrating supportive care early in cancer treatment.”

MSK patients and their families who feel they may benefit from specialized supportive care services can speak to their care team.