Wellness

Palliative or Supportive Care Can Improve Quality of Life for Cancer Patients

palliative cancer careI have been a dedicated palliative and supportive care specialist for the last seven years. When people ask me about palliative care, they often wonder if it is reserved for those patients who are dying. Nothing could be further from the truth. The Center for Palliative Care Excellence explains it this way: “palliative care provides relief from the symptoms and stress of a serious illness—whatever the diagnosis.” Simply put, I help people do and keep doing the things they love best for as long as they can.

People with cancer are more than their illness. They have lives with responsibilities, hopes, fears, and dreams beyond their diagnosis. As supportive care specialists, we are trained to recognize and partner with individuals to help them cope with and manage the physical, emotional and spiritual distress that can arise during and after cancer treatment. Our team-based approach focuses on the person as a whole.

An important concern we address is symptom management. Whether the goal is to cure or slow the progression of a disease, a cancer journey often can be fraught with distressing symptoms of pain, shortness of breath, nausea, anxiety and fatigue. Supportive care specialists work with the healthcare team to aggressively manage these symptoms. Our goal is to help a patient maintain quality of life while managing the disease, so we work closely with a person’s oncologist to develop an individualized symptom management plan that complements the patient’s treatment plan. The supportive care team can provide access to expert symptom management resources in the hospital, through clinics, and in some programs in the home. Most insurance companies typically cover referrals to supportive care specialists.

Supportive care can also provide symptom management after cancer treatment is completed or discontinued. Supportive care is available no matter where patients are in their illness, whether at diagnosis or late in the disease process. We also recognize the role of caregivers and families in providing support and try to add to this support by filling in the gaps.

Supportive care teams bring together doctors, nurses, social workers and a chaplain, to help a patient define and clarify his or her goals for care and treatment. The care team does this by helping a patient figure out what is most important and how that fits with a treatment plan. Supportive care can help individuals continue to have comprehensive care when disease targeted cancer treatment is no longer beneficial or what the individual wants.

If you are having symptoms from your illness or treatment that are difficult to control, or if you feel you are needing more support, talk to your doctor about getting a referral to a supportive care specialist. You deserve the best care that the medical system has to offer. Improving your quality of life by having an extra layer of support during your cancer journey can be an invaluable addition to your treatment plan.

About Dr. Kimberly A. Curseen

kimberly curseen, MDBoard certified in Internal Medicine, Geriatrics, and Palliative Care, Kimberly A. Curseen, MD, is the Director of Supportive and Palliative Care Outpatient Services for Emory Healthcare. She is the director and the primary provider for the Supportive Oncology Clinic. The clinic provides physical, emotional, and spiritual care for patients with cancer at any point in their disease process. The clinic also assists patients with complex decision making.

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Working During Cancer Treatment

Working with CancerTo work, or not to work, during cancer treatment is often a very real decision that patients must make. Some patients need to continue working during treatment for financial support, or to keep their insurance coverage, or just an overall desire to continue working. Working during treatment can be difficult depending on the type of treatment a patient receives, but also on the type of work a patient does. For example, a patient who can work from home may be able to continuing working whereas a patient with a job that requires more physical demands may be unable to continue working. Here are a few things to remember when working during cancer treatment:

  • Discuss your job situation with your medical team. It is important for your medical team to be aware of your desire or need to work during treatment. This may help in determining a treatment schedule that works best for you in order to continue working. Also, discussing the type of work you do with your medical team will allow them to provide you with appropriate information about how your treatment may affect your ability to perform the duties of your job.
  • Depending on your level of comfort, talk with your employer or human resource department about your diagnosis and treatment schedule. This will allow you to discuss any accommodations you may need in order to complete your job tasks. This is also an opportunity to discuss the possibility of working from home.
  • Consider utilizing the Family Medical Leave Act, if you are eligible. This important legislation was put in place in order to protect patients when they must leave work in order to receive medical care. Consult your human resources department for additional guidance in determining if you are covered through this.
  • Consult your human resource department regarding possible short-term or long-term disability benefits you may have available. There may be times in which patients are unable to work due to lengthy hospitalizations or because their medical team advises against it. In instances such as these, you may consider utilizing your short-term and long-term disability benefits in order to continue receiving some income.
  • If you are comfortable, talk with your coworkers about your diagnosis and treatment. Coworkers can be a strong source of support and encouragement during these difficult times. This may also help in developing a work schedule that works for you during treatment.
  • Talk with the social worker at your oncology office. Social workers may be able to help problem solve any concerns or issues you may be having with your employer.

Although working during cancer treatment may be challenging, it does not have to be impossible. Just talking with others about this may help you get the assistance you need.

About Joy McCall, LCSW

Joy McCallJoy McCallJoy McCall is a Winship social worker with bone marrow transplant, hematology and gynecologic teams and their patients. She started her professional career at Winship as an intern, working with breast, gynecologic, brain and melanoma cancer patients. She graduated with a Bachelor of Science in Psychology from Kennesaw State University and a Master of Social Work from the University of Georgia. As part of her education she completed an internship with the Marcus Institute working on the pediatric feeding unit, and an internship counseling individuals and couples at Families First, supporting families and children facing challenges to build strong family bonds and stability for their future. She had previously worked with individuals with developmental disabilities for over 4 years, providing support to families and caregivers.

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7 Steps for Better Sleep During Cancer Treatment

Better Sleep with Cancer(This blog was originally posted on January 15, 2015 on the WebMD website)

One of the most common complaints I hear working with people who have cancer is that they can’t sleep. We all know the misery of not being able to fall or stay asleep, and the misery that awaits the next day, including fatigue, irritability and foggy headedness. And being awake at night, especially when you have cancer, is lonely, scary and frustrating. All the worries about your diagnosis, treatment and future are at their most intense when you don’t have daytime light, noise and people to distract you. Call it the 3am Misery. Understandably many cancer patients ask their doctor for a sleeping pill like Ambien or Xanax. While this may be an easy solution, it might not be the right solution. So before you assume that sleeping pills are the answer, pause. Have you and your doctor talked about what is really causing your sleep problem?

For people with cancer, sleep problems generally fall into three categories: daytime escape, after-dark fear, and body aches. Knowing your category is the first step in dealing with the sleep problem.

Daytime Escape

“Wake me up when it is over!” Who would not want to escape from cancer? Escaping into your bed during the daytime and letting sleep take you away from the cancer reality seems pretty appealing. Unfortunately, the bed escape can backfire. The more time you spend in your bed during the day, the less time you sleep at night. If you are in the daytime escape category, the remedy for sleeplessness is not a sleeping pill, but a plan that helps you stay out of bed during the day, so you may rest well at night.

After-Dark Fear

“When I turn out the lights, I worry I am going to die.” Intense fear about your cancer prognosis, heavy grief about changes in your life because of cancer, racing thoughts and catastrophic thinking (“there are absolutely no good days ahead for me”) are symptoms of anxiety and depression. Fortunately, anxiety and depression can be treated, but not with a sleeping pill. In fact, sleep medicines may make some depressive symptoms worse. Strategies to manage after-dark fear include helpful thoughts (“I will deal with this in the morning”), limit setting (no cancer internet searches before bed) and relaxation (an evening bath). These strategies need to be practiced everyday to be most useful.

Body Aches

Body aches, otherwise known as treatment side effects, are major contributors to 3 a.m. misery. Pain, either aching muscles or sharp, shooting nerve pain, keeps you from falling or staying asleep. There may also be cottonmouth, urges to pee and nausea. Getting rid of body aches requires a bit of work, but worthwhile if you are able to turn down the volume on your symptoms and avoid 3am Misery. Keep track of your body aches in a written calendar and talk to your oncologist about your symptoms. If you have “as needed” medicines (prochlorperazine, hydrocodone, oxycodone), definitely don’t take them without keeping track of how they work for you. Write down the date, your symptom on a scale of 1-10 and then try one medicine at a time. Be sure to only continue with the pill if the medicine allows you to be more awake and active during the day. Some people develop body aches from too little movement as muscles and joints get deconditioned during cancer treatment. Talk to your oncologist about a physical therapy referral. Safe daytime movement will certainly improve your sleep at night.

Below is a 7 Point Program that may be your best shot at minimizing 3 a.m. misery. Different parts of the program target escape, night fear and body aches.

The 7 Point Program

  1. Absolutely no cancer talk or internet searches after dinner; repeat “I will manage that in the morning.”
  2. Pick a bedtime and a wake time with 8 hours in between. Write and post the times around your home. Be a stickler.
  3. Caffeine is off limits after noon. No smoking either (nicotine is another stimulant that kills your sleep).
  4. Pick a helpful thought. “This shall pass.“ Repeat slowly & calmly, while you breathe slowly & deeply, three times before bed and if you waken in the night.
  5.  One nap a day max, 45 minutes or less, before 4 p.m.
  6. Motion is lotion. Walk the dog, or with a friend, daily (if your oncologist says ok).
  7. Chill for one hour before bedtime (stretch, read, listen to music or journal).

Of course, everyone’s medical status is unique. For example, people with very advanced disease or a heavy treatment burden may need extra daytime rest. So adjust the plan to fit your specific condition, then challenge yourself to stick it – all 7 points for 2 weeks. If you’re still having trouble sleeping, talk to your doctor.

In certain situations sleep medicines and pain pills may be necessary, but you should know the source of your sleep problem before you start a sleep medication. And the goal of any medication or sleep program should be to feel more energetic, happy and clear-headed over time, so that you can well not just tonight, but in the weeks and months to come.

About Dr. Baer

Wendy Baer, MDWendy Baer, MD, is medical director of psychiatric oncology at the Winship Cancer Institute of Emory University, with appointments in the Department of Psychiatry & Behavioral Sciences in the Emory School of Medicine, and the Department of Hematology and Medical Oncology at Winship.
In her work at the Winship Cancer Institute, Dr. Baer helps patients and their families deal with the stress of receiving a cancer diagnosis and subsequent treatment. As a psychiatrist, she has expertise in treating clinical depression and anxiety both with medications and with psychotherapy to help people manage emotions, behaviors, and relationships. The fundamental goal of Dr. Baer’s practice is to promote wellness and maximize patients’ quality of life as much as possible. She believes strongly in the team approach to patient care and collaborates regularly with the doctors, nurses, and social workers that make up a patient’s care team.
Dr. Baer attended medical school at the University of North Carolina at Chapel Hill, where she graduated with honors. From UNC she went to the University of Pennsylvania, where she completed her residency in psychiatry and served as the chief resident in her senior year. Prior to moving to Atlanta, Dr. Baer worked with patients dealing with cancer at the Swedish Cancer Institute in Seattle, WA.

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How Will I Cope With Cancer?

Why Winship?

Winship Cancer Institute of Emory University“For every question that we answer or seek to answer, new questions arise.”

Winship’s executive director, Wally Curran , MD, said that in answer to an interview question about Winship, and I think it provides insight on the incremental way that progress is made against cancer.

It also helps describe the dedication of cancer doctors and researchers who are willing to keep pursuing answers to this vastly complex puzzle.

The communications team at Winship has been asking another type of question lately: “Why Winship?” The answers we got are now the basis of a website, social media and poster campaign highlighting stories that show how our doctors, researchers and healthcare staff make discoveries and translate the latest breakthroughs in cancer research into better treatments for patients.

The stories are told through the words and thoughts of people who have been treated at Winship, and through the Winship staff who work toward finding ever-better ways to defeat cancer.

Our first round of “Why Winship?” videos, now on our website, features a group of Winship physicians who represent the comprehensive spectrum of patient care we are able to offer, from the latest drug and radiation therapies, to innovative surgical techniques. Here is a sampling of their thoughts on what makes Winship a unique place for them.

WALTER J. CURRAN, JR., MD
WINSHIP EXECUTIVE DIRECTOR
“Winship is about depth and breadth. It’s the depth and breadth of our team that approaches a cancer problem. For example, in lung cancer, we have depth and breadth in the surgical, pulmonary, oncology, scientific, and epidemiologic teams which confront the leading cancer killer. Without the depth and breadth, we could not make the progress for a given patient and we also could not make the progress for a given problem as complex as lung cancer.”

FADLO R. KHURI, MD
WINSHIP DEPUTY DIRECTOR
“I think there is a spirit of humility and genuine discovery that suffuses the place. People want to know not just why, but why didn’t a treatment work, why didn’t a patient benefit, and go back to understand from every specific patient encounter how we can do better and more importantly how we can help them to do better.”

KAREN GODETTE, MD
WINSHIP RADIATION ONCOLOGIST
“With that team effort, [you’re] getting the best technology, multi-modality therapy with what we call translational research and the up-to-date protocols and everything in one place. Rather than having to hunt around to get the best in each thing you have it right here. An example is our sarcoma conference. There’s a thoracic surgeon, a radiation oncologist, a medical oncologist, everyone is right there at the same time talking about the patient…. you have the best of everything right there.”

PETER ROSSI, MD
Winship Radiation Oncologist
“I know that I am going to be supported to go in the direction I think is most cutting edge that is the best for my patients… You have to have an administration that has a long-term vision of that. You don’t see that commonly and we have that at Winship Cancer Institute.”

VIRAJ MASTER, MD, PhD
Winship Urologist
“What gets me really excited about working at Winship is I have the ability to have incredible collaborative efforts that take place every day, and I particularly point out my colleagues in surgery, be it thoracic surgery, vascular surgery, surgical oncology. We work well together because we truly believe that the sum is greater than the individual. It allows us to do operations that I only dreamed of doing when I was in training, and we do it better here at Winship than anywhere else.”

About Catherine Williams

catherine-williams-2014As Senior Communications Manager for Winship Cancer Institute of Emory University, Catherine Williams creates print, video and electronic communications materials and serves as a media relations contact for consumer health, news and science media.

Catherine came to Winship after 30 years as a television producer in New York, Washington and Atlanta, producing news, magazine and documentary programming. She has won awards for special reports covering health/science, public affairs and entertainment. She says news was exciting but nothing compares to the satisfaction of working with the dedicated and inspiring staff of Winship.

A Look Back at Winship Cancer Institute’s Extraordinary 2014

Since 1937, Winship Cancer Institute of Emory University has provided cancer patients throughout Georgia, the Southeast and beyond, with outstanding patient care and research, and 2014 was no exception. From several national recognitions to record-setting fundraising goals, Winship at Emory continues to be among the leaders in the state of Georgia and the nation in finding ways to defeat cancer. While we enter 2015 with excitement and expectancy, the administrators, physicians and researchers of Winship at Emory have taken time to celebrate the remarkable last year. Click on the “Year in Review” video below to see some of Winship’s highlights from 2014, including:

Key 2014 milestones:

  • U.S. News & World Report ranked cancer care at Emory University Hospital through Winship among the 25 best in the country.
  • Nurses at Emory University Hospital and Emory Saint Joseph’s Hospital were honored with the prestigious Magnet award for excellence in patient care.
  • Winship was the only cancer center in Georgia named as one of 30 U.S. cancer centers for the new National Cancer Institute’s National Clinical Trials Network.
  • Winship exceeded its fundraising goal for the Win the Fight 5K in September, bringing in more than $600,000 for cancer research.

Winship 2014

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Key Steps for Coping with Cancer-Related Fatigue

cancer fatigueFatigue is one of the most common side effects reported by cancer patients, and symptoms of cancer- related fatigue differ significantly from the fatigue patients experienced before cancer diagnosis.

Cancer-related fatigue is not only caused by the disease itself, but cancer treatment as well as the emotional and psychological effects of fighting cancer can also contribute. Described by patients as more pronounced during treatment, cancer-related fatigue can leave patients feeling wiped out by simple and small activities. It can also last years after treatment.

According to the American Cancer Society, characteristics of cancer-related fatigue include:

  • Extreme tiredness that may vary in severity from day to day
  • Weakness, weariness or lethargy even after sleep
  • Feeling worn out after simple tasks like standing up from a chair or getting out of bed
  • Heaviness in arms and legs
  • Trouble with concentration and memory

Kay Halbert, Director of Outpatient Services at Emory Johns Creek Hospital, works with cancer patients undergoing cancer treatment on energy conservation. “Energy conservation is coming up with ways to decrease the amount of energy patients use to complete a task while still achieving similar end results so they continue to function in their day-to-day lives.” One energy-conserving technique is using a rolling cart to move heavy dishes rather than carrying them. Another example is prior to getting up from a chair, scoot to the edge, lean forward and push off with the arms and then straighten the legs.

“It’s important for patients and survivors to understand their bodies aren’t the same after cancer treatment,” Halbert explains. “It’s okay for them to modify how they accomplish daily tasks and learn to let go of some things completely.”

Some specific energy-conserving tips are:

  • Keep items within easy reach to limit how often you have to get up.
  • Avoid reaching for items overhead and/or below your knees; keep needed items and work surfaces at a comfortable height.
  • Decide which tasks are absolutely necessary. Let the rest go.
  • Share your workload with family and friends. Remember to delegate.
  • Complete tasks that require the most energy during times throughout the day when you have the most energy. Journaling can help you keep track of these high-energy vs. low-energy periods of time.
  • Alternate between easy and difficult tasks and rest 10 to 15 minutes every hour.
  • Stop before you feel worn out.

“Think about your energy levels as if it were a gas tank. Be economical about the how much energy you use, and make sure you refuel before you’re completely out of gas,” adds Halbert.

It’s very important to note that not all patients experience the same after affects of cancer, such as fatigue, but knowing about ways to help you cope may limit the severity of these after effects with early intervention and modification.

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Prepare for Life after a Diagnosis of Cancer

Enjoy Holiday Food without Regret

Eating Thanksgiving with CancerEating healthy during the holidays can be a challenge for most of us, but for many cancer patients it’s a struggle just to eat. If you’re currently going through cancer treatment, eating might not be the first thing on your mind. However, staying nourished during treatment is extremely important. Your body needs more nutrients than normal to repair the effects of treatment.

We are all well aware that holiday foods tend to be fatty and sugary with many strong flavors. If you are having symptoms such as nausea, low appetite, taste changes or pain with swallowing, many of the traditional holiday foods will be unsettling. Avoid heavy cream sauces or gravies if you have a sensitive stomach. Also, stay out of the room where food is being cooked because cooking smells can make you nauseous. Turkey breast, cranberry sauce, potatoes, and basic vegetable dishes should be well tolerated. Whole grains like brown rice, barley and quinoa make excellent side dishes. Eat lots of fruits or veggies without buttery sauces or other fats. Let friends and family know how you feel and what dishes you can tolerate. Eat small portions and see how you handle the food, then go back for larger portions. Don’t overdo it.

If you are in cancer treatment, you may have a weakened immune system and you will need to be extra careful about foodborne illness and food safety. The primary cause of foodborne illness is eating perishable foods that have been held longer than two hours at room temperature. Keep hot foods at 140F or higher and cold foods at 40F or lower, out of the “danger zone.” Discard any turkey, stuffing, gravy or other items left out longer than two hours. Do not wait to refrigerate leftover foods; place immediately in a shallow container and pop them in the fridge. Keep turkey and dressing no longer than three days in the refrigerator, or freeze them. If you have any doubt about whether raw vegetables have been washed, skip them or your bring your own.

During this season of parties and social gatherings, many struggle to balance holiday indulgences with a healthy lifestyle. Weeks of eating foods high in sugar and fat, and limited amounts of fruits and vegetables, can start the New Year off with unwanted extra pounds. For rich seasonal treats, focus on small portions: a bite size piece of chocolate, a small handful of party nuts, slivers of pumpkin pie. Studies show that the first few bites of a food taste the best.

Limit high calorie, sugary beverages and get creative with plain water by making your own infused water. My favorite combination is mint with cucumber slices, refrigerated for at least 4 hours. But you can mix any fruit and herb variety. Include some of these healthy foods into your holiday diet: green and orange fruits and vegetables, cruciferous vegetables, berries, wild legumes, almonds and brazil nuts, and ginger.

The holidays are a special time, but for those in cancer treatment, there’s also anxiety. With careful planning and preparation, you can create an enjoyable holiday season.

About Tiffany Barrett

Tifffany BarrettTiffany Barrett, MS, RD, CSO, Clinical Dietitian Specialist, provides personalized nutritional advice to Winship at Emory patients who are undergoing cancer treatment. Ms. Barrett also consults with patients who have completed treatment and wish to continue to build a strong and healthy diet. She earned her Bachelor of Science at Florida State University and a Master of Science at University of North Florida. Tiffany is a Certified Specialist in Oncology Nutrition and completed a Certificate of Training in Adult Weight Management.

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Coping After Cancer Treatment is Finished

Cancer TherapyA cancer diagnosis can be overwhelming. In fact, many patients have told me that cancer can easily define your life with on-going treatment lasting months and even years. Many patients stop working, limit their social interactions and even change roles within their household as a way to focus on completing treatment. You might think that once chemotherapy, radiation and surgery are over a patient would celebrate and move on, but that’s not always the case. Many patients feel lost and can find themselves asking what now? The intense focus on treatment often overshadows the future.

Here are five tips to help you cope after your treatment is finished:

  1. Consider attending a local support group. They are a great way to connect with others who have a similar diagnosis and have completed treatment. Support groups are a safe place to discuss the feelings that go along with being done with treatment and handling post treatment life.
  2. Reach out to a social worker or counselor. They are often available to provide individual counseling. This is helpful in allowing you an opportunity to identify your strengths and appropriate ways to move forward now that you’re better.
  3. Think of what helped you cope before treatment. Make a list of things that made you feel better when you were having a difficult time before you were diagnosed or treated. Some of those same healthy techniques such as exercise, yoga, or talking to a friend could be useful post treatment.
  4. Don’t rush yourself. Be realistic about your expectations of how you should feel after treatment. Be sure to ask your medical team how you should feel both physically and emotionally post treatment. Remember, you have been through a lot, and it will take time for you to fully recover. Putting additional stress and pressure on yourself to “feel better” because you are finished with treatment can only make this more difficult.
  5. Remind yourself you are a survivor! You have survived your diagnosis and treatment. Positive self-talk is beneficial in reducing stress and decreasing depressive symptoms.

More than 14 million Americans are cancer survivors. No matter what the type or stage of the disease, reaching out for additional support and assistance is just as important after treatment as it is during treatment.

About Joy McCall, LCSW

Joy McCallJoy McCall is a Winship social worker with bone marrow transplant, hematology and gynecologic teams and their patients. She started her professional career at Winship as an intern, working with breast, gynecologic, brain and melanoma cancer patients. She graduated with a Bachelor of Science in Psychology from Kennesaw State University and a Master of Social Work from the University of Georgia. As part of her education she completed an internship with the Marcus Institute working on the pediatric feeding unit, and an internship counseling individuals and couples at Families First, supporting families and children facing challenges to build strong family bonds and stability for their future. She had previously worked with individuals with developmental disabilities for over 4 years, providing support to families and caregivers.

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Living with Cancer

How Will I Cope with Cancer?

Wendy Baer, MDGetting diagnosed with cancer is a unique experience for every person. It can mean many different things depending on the type of cancer, the stage, the treatment options and the overall health of the person. Regardless of the type of cancer, most people experience a whirlwind of emotions during the time of diagnosis. Uncertainty and loss of control are two common feelings. Uncertainty is especially intense in the work-up phase when you are not sure what kind of cancer you have, what your options are for treatment or who is going to take care of you during treatment. Loss of control may be an issue when you feel your body is broken, tumors may be growing, cells may be multiplying, and you wonder about dying. You may feel loss of control over your energy since you are not able to do activities or work you enjoy. The time needed for appointments may make you may feel as if the medical system has taken control of your entire schedule.

If you are asking yourself the question, “How will I cope?” you are actually in a good starting place. Actively thinking about how to manage emotions such as uncertainty and loss of control is a sign that you will be able to get through your cancer experience.

There are two key questions to ponder as you work through the issue of how to cope during cancer. How have I coped before? And, what do I like?

How have I coped before? When faced with difficult situations in the past, everything from a new school or a new home to a relationship breakup or a job loss, what have I done to get by? What thoughts or behaviors helped me manage my emotions? There are definitely many unhelpful coping strategies during stressful life events, such as becoming isolated, sleeping too much or using more alcohol. Unhelpful coping strategies should be noted and avoided. More helpful coping strategies include being with people who really care about your wellbeing, spending time outdoors, listening to music, breathing deeply and slowly, making lists and schedules and allowing other people to help you with chores.

What do I like? Not just what flavor of ice cream or what kind of movie, but what makes you feel joyful? What do you care about, what do you want to be good at? Who in your life matters to you? Who do you like to be around? Cancer can make your own mortality prominent in your mind on a day-to-day basis. The question, “what do I like?” is essential to consider when you recognize time is limited. Thinking about what matters to you, even writing those things down, encourages you to then take steps to include them in your life. Make a list with specifics. There may be simple pleasures you can enjoy during cancer treatment, and others that will have to wait until after treatment, but plan them, talk about them, work towards getting there. Having both short and long term goals can help you cope with cancer.

Some people are not able to answer these two questions because clinical depression gets in the way of seeing anything pleasant or joyful, or severe anxiety short-circuits the ability to think logically. Drugs and alcohol interfere with the ability to experience pleasure in a meaningful way. Emotional and behavior disturbances can be treated, both with medication and with talk therapy. A comprehensive cancer center offers psychiatrists, psychologists and social workers willing and interested in helping you get your mind in a healthy place to answer the two important questions. Taking care of your brain is critical for overall health.

You can cope. Answering the first question shows that you’ve coped with hard things before. Answering the second question gives you motivation to get through treatment for cancer. There may be challenges, really tough ones, but you can absolutely conquer these challenges. How do I know? I witness people surviving and thriving everyday at Winship.

Wishing you well,

Dr. Baer

About Dr. Baer

Wendy Baer, MD is the Medical Director of Psychiatric Oncology at Winship Cancer Institute of Emory University. In her work at Winship, Dr. Baer helps patients and their families deal with the stress of receiving a cancer diagnosis and subsequent treatment. As a psychiatrist, she has expertise in treating clinical depression and anxiety both with medications and psychotherapy to help people manage emotions, behaviors and relationships. The fundamental goal of Dr. Baer’s practice is to promote wellness and maximize patients’ quality of life as much as possible. She believes strongly in the team approach to patient care and collaborates regularly with patients’ doctors, nurses and social workers.

What You Need to Know About Personalized Cancer Care

personal cancer careThe most promising advances in cancer treatment today center around personalized or precision medicine, but what exactly does that mean? We asked Dr. Fadlo Khuri, deputy director of the Winship Cancer Institute of Emory University, to explain the terms and help us understand who is benefitting from these types of treatment.

Q: What is personalized or precision medicine in cancer treatment?

Khuri: The best individualized care plan for every patient is one that delivers the most precise, informed and effective treatment possible. One of the new tools we use today in order to add to the patient’s medical history, social history, and pathologic diagnosis, is modern molecular testing.

Q: What is molecular testing?

Khuri: Molecular testing in cancer is performed on tissue taken during a tumor biopsy. Several tests can be done to reveal the genetic makeup of the mutation present in the cells of a particular cancer, such as non-small cell lung cancer. This genetic mapping, or DNA sequencing, is called genomics.

Q: People are familiar with genetic testing for the BRCA gene mutations that cause ovarian and breast cancers. But how are genomics or genetic targeting used in cancer treatment?

Khuri: Genomics uses modern DNA sequencing methods, recombinant DNA and informatics to study the complete genetic makeup of individual cells, patients, populations and their diseases. We learn how certain gene mutations, such as EGFR or ALK mutations in lung cancer, determine a tumor’s behavior and survival. We use these driver mutations to design treatments that specifically target the protein product of the mutated (or altered) genes. This leads to more targeted treatments based on an individual patient’s cancer.

Q: What is immunotherapy and how is it being used at Winship?

Khuri: Immunotherapy is a type of treatment that stimulates a patient’s own immune system to either work harder overall, or to attack cancer cells specifically. We are exploring immunotherapy at Winship through research and clinical trials. We have a series of clinical trials designed to activate or drive the immune system to recognize the individual’s cancer as foreign to their body, such as vaccines or immune checkpoint inhibitors, to attack the tumor.

Q: Which type of patients benefit from immunotherapy?

Khuri: Patients with leukemia, lymphomas, myeloma, lung cancer, kidney cancer and especially melanoma seem to benefit from immunotherapy. Other diseases are also being studied. Immunotherapies are demonstrating durable (long lasting) responses in a number of the above tumor types, and this has added a powerful new option to the toolbox of targeted therapies of cancer.

Q: What are the advantages and challenges?

Khuri: The advantages include the durability of the responses seen, but the people with cancer who benefit are in the minority so far. Efforts at developing efficient and precise ways to deliver immunotherapy are ongoing.

Q: What is the latest research at Winship that is related to precision medicine?

Khuri: Winship has clinical trials in myeloma, lung cancer, leukemia, lymphoma, breast cancer, colon cancer, thyroid cancer and melanoma which target specific driver mutations and are excellent examples of precision medicine.

Q: How have these approaches changed the way doctors now treat cancer patients?

Khuri: Many centers, like Winship, do reflex testing, which automatically sends a patient’s sample for a molecular screening panel that looks for tumor mutations. Certain gene mutations are known to drive cancer growth, cause drug resistance or susceptibility, or are currently under investigation as therapeutic targets in clinical trials, so the results of those tests can determine the type of treatment a patient receives.

About Dr. Khuri

Fadlo Khuri, MDFadlo R. Khuri, MD, deputy director of the Winship Cancer Institute of Emory University and Professor and Chairman of the Department of Hematology & Medical Oncology, Emory University School of Medicine, is a leading researcher and physician in the treatment of lung and head and neck cancers. He is Editor-in-Chief of the American Cancer Society’s peer-reviewed journal, Cancer.
Dr. Khuri’s contributions have been recognized by a number of national awards, including the prestigious 2013 Richard and Hinda Rosenthal Memorial Award, given to an outstanding cancer researcher by the American Association for Cancer Research.

An accomplished molecular oncologist and translational thought leader, Dr. Khuri has conducted seminal research on oncolytic viral therapy, developed molecular-targeted therapeutic approaches for lung and head and neck tumors combining signal transduction inhibitors with chemotherapy, and has led major chemoprevention efforts in lung and head and neck cancers. Dr. Khuri’s clinical interests include thoracic and head and neck oncology. His research interests include development of molecular, prognostic, therapeutic, and chemopreventive approaches to improve the standard of care for patients with tobacco related cancers. His laboratory is investigating the mechanism of action of signal transduction inhibitors in lung and aerodigestive track cancers.

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