During WCLC 2022, an educational session, “Think, Think, Think? …The Importance of Thinking Holistically When Caring for Lung Cancer Patients” challenged attendees to not only think holistically, but also to act holistically when approaching patient care.
Session Co-chair Andreas Charalambous, of Cyprus University of Technology, explained that the term holistic is another term for providing individualized, personalized, or person-centered care.
“They refer to the same thing and the idea is about removing filters when we look to the other person,” Dr. Charalambous said. “We need to be looking and taking a 360-degree approach when we care for any person.”
For many clinicians, this approach may require a shift in mindset. During the session, four speakers addressed some of the important areas of care that require such focus.
Simon Dunne, PhD, Dublin City University, presented qualitative research on the information needs of caregivers of people with lung cancer in Ireland.
Many patients diagnosed with lung cancer are at an advanced stage with a high burden of care. Because of this, lung cancer caregivers often face considerable duties and responsibilities, Dr. Dunne explained.
“Lung cancer caregivers often cope with the uncertainty in their role by seeking relevant information to aid in decision-making and enable the caregiver to manage practical challenges associated with their caring role,” Dr. Dunne said.
Dr. Dunne and colleagues conducted in-depth interviews with caregivers and found that while lung cancer patients and survivors had many of their needs met through the health system in Ireland, virtually nothing was in place to support the needs of caregivers.
The caregivers identified a range of information needs and Dr. Dunne and colleagues grouped these into four key themes: (1) information gathering during appointments, (2) discordant information needs between caregiver and the person with lung cancer, (3) seeking information beyond the hospital, and (4) learning to adjust to changing roles and circumstances.
According to Dr. Dunne, these issues point to a need for more systematic approaches to ensure that caregivers feel supported, including the provision of appropriate and timely information within clinical encounters and beyond.
The second speaker, Marianne Davies, DNP, MSN, RN, Yale University, presented information on some of the interventions that have been developed to improve cancer survivorship among indigenous peoples and communities. In the US, there are about 9.7 million American Indian or Alaska Natives (AI/AN); continued systemic racism has resulted in limited access to healthcare, high-quality education, and economic opportunity for this population.
Additionally, Dr. Davies said cancer incidence is higher in AI/AN communities and cancer is often diagnosed at later stages. Lung cancer is the second most common cancer in this population.
More than a decade ago, the US Center for Disease Control and Prevention developed a National Action Plan for Cancer Survivorship, but it did not originally incorporate any targeted effort to support Native American priorities. More recently, interventions focused on AI/AN communities have been added. They include an increase in access to culturally relevant care and services and cultural competency training for medical providers. Importantly, the CDC’s plan also includes a framework for the development of infrastructure to support prevention, screening, treatment, and end-of-life and survivorship programs.
Effect of Lung Cancer on Children
Next, Elena Schiena, social worker and parent support worker at Peter MacCallum Cancer Centre, Victoria, Australia, discussed interventions to limit the psychological and emotional impact of parental lung cancer on children. Peter MacCallum Cancer Centre has an established support service for parents with cancer designed to support the unique needs of those families. The program offers psychoeducation resources and specialized interventions, including guidance about talking to children about cancer.
Ms. Schiena indicated that cancer often affects the whole family, not just the patient, but there are some interventions to consider that could help to minimize this disruption in their lives. . Early access to support is one crucial way of helping.
“Having the opportunity to talk about their children’s adjustment and explore pathways of support that will best meet their child’s needs is fundamental to working holistically with our families,” Ms. Schiena said. “The role of health professionals in identifying parents with cancer is crucial for the referral pathway to occur.”
Schiena also discussed the importance of having children visit the hospital or treatment center, of engaging with the child’s school or institution for support, and trying to maintain a routine.
Dealing with Dementia
Finally, Lorna McWilliams, PhD, University of Manchester, discussed treating people with cancer and comorbid dementia.
People with dementia are more likely to be diagnosed at a later stage, Dr. McWilliams said. And they are less likely to receive cancer treatment. Their cancer-related pain is more poorly managed, and they are more likely to use healthcare resources. Additionally, patients with cancer and dementia are at a greater risk of death and poorer survival.
As a degenerative, progressive disease, there is no cure for dementia and patients often have significant memory problems. These patients have difficulty concentrating, there may be an impact on mood and behavior, and they need support to deal with activities of daily living as the dementia progresses.
Dr. McWilliams discussed the importance of healthcare professionals receiving information about the patient’s dementia, how long they have had it, and the impact it has had on their pre-morbid lives. The Alzheimer’s Society has developed a “This is me” leaflet that someone living with dementia can use as a support tool to record important personal information and enable person-centered care.
Also important is the adaptation of treatment delivery, Dr. McWilliams said. When possible, these patients could benefit from longer appointment times, having appointments at a time of day when they are functioning at their best, continuity of staff, and even receiving support in waiting rooms if possible.