Tag Archive for: Beth Sandy

Beth Sandy: Why Is It Important for You to Empower Patients?

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Beth Sandy: Why Is It Important for You to Empower Patients? from Patient Empowerment Network on Vimeo.

How can patients be empowered by cancer care providers? Expert Beth Sandy from Abramson Cancer Center shares her perspective and actions she takes to help activate patients in their care.

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 Dr. Isaac Powell: Why Is It Important for You to Empower Patients?

Dr. Isaac Powell: Why Is It Important for You to Empower Patients?

Transcript:

Beth Sandy:

I think the best way for me to empower my patients is to be optimistic and to give them hope and because I’ve seen a lot of good stories. I also think one of the best ways to empower patients is to get to know them and who they are as a person and what is important to them, because then we can tailor our treatments and our discussions to what is important to them. I think another way to empower patients is to give them time to ask questions and frequently I’ll say, “Do you have any other questions?” I always ask that before we leave the room. “Do you have any other questions for me? Do you understand everything that we’ve said?”

Another way is to make sure they know how to get in touch with me. So I personally really like the online portal. So patients can send us messages through the portal, but they can certainly call as well. But make sure they know how to get in touch with you, because that’s something that can be really scary when you’re at home and you’re worried about something, and you don’t know how to get in touch with your care team.

Overcoming Small Cell Lung Cancer Care Barriers

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Overcoming Small Cell Lung Cancer Care Barriers from Patient Empowerment Network on Vimeo.

How can small cell lung cancer care barriers be overcome? Expert Beth Sandy from Abramson Cancer Center discusses common barriers for patients in remote areas and underrepresented communities, advice for accessing resources and support, and tips to ensure lung cancer stigma doesn’t interfere with care.

[ACT]IVATION TIP

“…work very closely with the social worker in your practice who is very familiar with all of these different resources that are available…I’ll say up front is when providers like doctors or nurses ask you if you’ve ever smoked, that is by no means being something accusatory. It actually helps us understand the trajectory of your disease better… Another thing that we know about both non-small and small cell lung cancer is that patients who have smoked actually often respond better to immunotherapy. So that can help us understand just how your disease may act and what treatments may even work better.”

See More from [ACT]IVATED Small Cell Lung Cancer (SCLC)

Related Resources:

Extensive Stage Small Cell Lung Cancer _ Empowering Symptom Management

 When Can Small Cell Lung Cancer Patients Use Palliative Care

 Small Cell Lung Cancer Care | Optimizing Team Communication

Small Cell Lung Cancer Care | Optimizing Team Communication

Transcript:

Lisa Hatfield:

So if we can discuss some barriers to getting care for small cell lung cancer. I’ll break it down to three different areas or three different barriers. So if you could discuss or give advice for a person living with small cell lung cancer in a rural area who might not have access to state-of-the-art cancer care. Second area, if you have any advice or specific considerations or recommendations for small cell lung cancer, people dealing with small cell lung cancer from underrepresented communities. And then third, if you need me to remind you of these, I sure will. Third, kind of the elephant in the room, if you can address one of the barriers being the stigma that’s associated with not only small cell lung cancer but with any lung cancer, maybe address that as a barrier and any advice you have for a person dealing with that, we’d appreciate that.

Beth Sandy:

Yeah, so there are a lot of barriers. So let’s talk about the first one. If you’re living in a rural area and having access to state-of-the-art cancer care. I think the one thing that I’ll say here is that small cell lung cancer responds very well and very quickly to frontline treatment, which is chemotherapy and immunotherapy, and these are approved no matter where you live. This is not a clinical trial. You don’t have to go to a fancy hospital to get this.

As a matter of fact, the two chemotherapy drugs we’ve been using for 20 years, so you can get them anywhere. So now the point is about driving. So this is something you have to come back three days in a row for. So is there a place where you can stay close by? So at my institution, we have a charitable organization who turned an old hotel that’s about 30 minutes outside the city into a place for our patients to stay overnight for free. So that is kept up by charitable donations and so if patients live several hours away and they need a three-days-in-a-row treatment, a lot of times they will stay at that location.

So is there something like that that’s available if you’re driving from very far away? But I think the other thing that also concerns me is your blood counts can drop, and you can get sick from this chemotherapy. Most patients do pretty well, but if you’re getting sick, how far are you from the closest hospital? If you have a fever and your white blood cells are probably low, you need to go to the emergency room. So I think those are things to sort of start preparing for ahead of time and thinking, okay, do I maybe need to stay with family members who may be closer to a hospital? Just again, depending on how far away you are.

Where I live, it snows in the winter, so that’s always something that, especially the people in the more mountainous regions are like, what if we get like a foot or two feet of snow overnight and I can’t get out in the morning? How’s that going to affect me? So really thinking about those kinds of things. And are there, again, charitable organizations or money or grant support to help pay for rides or gas money even? Sometimes the American Cancer Society can help with things like that. 

Are there specific considerations or recommendations for small cell lung cancer for patients who are in underrepresented communities? So yeah, I think again, talking about getting back and forth to treatment, it can be really difficult, especially with small cell lung cancer. If you’re on radiation, radiation is daily and chemotherapy is three days in a row, like I’ve said. So it’s a lot of back and forth. Do you have to pay for parking? Do you have the rides?

Again, this is where a lot of times we’ll work with our social workers in both radiation oncology or medical oncology to help with transportation. There are transportation options, especially within many insurance plans. So that’s something to look into. The other thing is that at my institution, you have to pay to park, but we offer free parking for patients who are getting chemotherapy and radiation. So that’s not going to be something that you have to pay for on a daily basis, because that would be very expensive.

Other things like meals, so do you probably not feel like going to the store or cooking or aren’t even able to, especially when you’re receiving such intensive therapy. So there are definitely programs that are available to deliver meal services to patients and so that’s something, again, that we work really closely with social work to get these types of things set up. And again, some of this stuff is actually covered through your insurance, visiting nurses, home health aides to help.

The American Cancer Society, I go back to them because they have a lot of resources here. I work in the State of Pennsylvania, and in the State of Pennsylvania, if you are a caregiver to someone, there are actually financial resources that you can be reimbursed just for being their caregiver, especially if that takes you away from your work. So there are a lot of things that working with the social worker who understands the laws and the grants that are in your local communities can be really helpful.

So hopefully, I was going to say my activation tips for this really is to work very closely with the social worker in your practice who is very familiar with all of these different resources that are available. But then I forgot to address the last one, which is the stigma, and I do want to address this. This is something I could talk about for a long time. There is certainly a stigma associated with lung cancer and for patients who have smoked. And one thing I’ll say up front is when providers like doctors or nurses ask you if you’ve ever smoked, that is by no means being something accusatory. It actually helps us understand the trajectory of your disease better.

For example, if you were diagnosed with small cell lung cancer and you said, “Well, I smoked in my 20s and 30s, but now I’m 70,” we might question the diagnosis a little bit. We may do some further testing to make sure this is the right thing. Another thing that we know about both non-small and small cell lung cancer is that patients who have smoked actually often respond better to immunotherapy. So that can help us understand just how your disease may act and what treatments may even work better.

So when we ask you if you smoked, just be honest because that can change the way we think about your disease, but by no means is that something accusatory. The second concern with the stigma is that people are less likely to get screening for lung cancer or to be worked up early because they feel like, “Well, I did this to myself, so maybe it doesn’t matter.” But that’s not true. Obviously, I don’t want people to smoke. It’s bad for you for a million reasons, not just lung cancer, but cardiac disease and other types of cancers. There’s a lot of reasons that smoking is not good for you.

But that being said, lung cancer can still be a curative disease if we catch it early. So even if you’ve smoked or are currently smoking, you can get lung cancer screening and catch things early and get them taken care of. We are there to help you with whatever illness or addiction to cigarettes that you have, and we’re going to help you, number one, treat that, and help you quit smoking, but also treat your disease as we would treat anyone else’s. So getting that screening for lung cancer or that early workup as soon as you develop symptoms is going to be beneficial.

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Small Cell Lung Cancer Care | Optimizing Team Communication

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Small Cell Lung Cancer Care | Optimizing Team Communication from Patient Empowerment Network on Vimeo.

How can small cell lung cancer team communication be optimized? Expert Beth Sandy from Abramson Cancer Center shares advice for communication between care team members and for setting expectations about symptom management and treatment plans.

[ACT]IVATION TIP

“…don’t feel afraid or scared to ask the questions that you want the answers to. And if you do, it’s okay to change providers, to be honest with you, because you should have that level of trust and ability to be open with your provider.”

See More from [ACT]IVATED Small Cell Lung Cancer (SCLC)

Related Resources:

Extensive Stage Small Cell Lung Cancer _ Empowering Symptom Management

 How Can Small Cell Lung Cancer Patients Ask About Care Goals

How Can Small Cell Lung Cancer Patients Ask About Care Goals

 Overcoming Small Cell Lung Cancer Care Barriers

Overcoming Small Cell Lung Cancer Care Barriers

Transcript:

Lisa Hatfield:

So, Beth, how do you facilitate open and transparent communication between oncology nurses, patients, and their families and care partners to address concerns and set realistic expectations to ensure that everyone is on the same page regarding the symptom management and treatment plans?

Beth Sandy:

Yeah. So again, this is something that happens over time and I think it’s really important for patients to feel comfortable with their providers. If you don’t feel that you can ask your doctor or your nurse practitioner or your nurse, whoever you’re seeing, if you don’t feel comfortable that you can ask questions about your treatment and your disease, that’s a problem. You should have a good relationship with them. I feel like us in oncology as opposed to other fields like dermatology or whatever, I think we have a more personal relationship with them because this is a disease that often they’re dealing with for a long time and we want to make sure that we’re doing what’s best for them, what’s best for the patient.

So sometimes for me, again, I’ll say, how are you tolerating the treatment? Are you in bed a lot at home? Or are you feeling pretty good on the treatment? And then a lot of that too will partially be, well, the treatment is working very well. Are you willing to stay on it based on the side effects you’re having? But for me, it’s so much easier if the patient starts the conversation and says something along the lines of like, “I’m not tolerating this well, I’m not feeling well. Is there something more we can do? Or can we give less chemo?” Patients ask me that all the time.

And then we have a discussion about the pros and cons of that. So everything’s a discussion. Oncology is not black and white. There is gray area that we can work with you to improve your quality and be open about how much you want to know. Do you want to know exact numbers of your chances of survival? Do you want to know exact numbers of exactly how often this exact chemo works for other patients? We can give you those, but we don’t have to. So we really want to, for the most part, always instill hope, because I’ve seen lots and lots of miracles and great stories with patients who have done way better than I ever thought they would. So I would hate to say to someone, oh, this is the average when lots of my patients will do better than that. 

So I think my activation tip here is don’t feel afraid or scared to ask the questions that you want the answers to. And if you do, it’s okay to change providers, to be honest with you, because you should have that level of trust and ability to be open with your provider.

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How Can Small Cell Lung Cancer Patients Ask About Care Goals?

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How Can Small Cell Lung Cancer Patients Ask About Care Goals? from Patient Empowerment Network on Vimeo.

Small cell lung cancer patients can make care goals, but how can they ask about them? Expert Beth Sandy from Abramson Cancer Center shares her perspective about care goals, proactive questions, and advice for doctor-patient communication.

See More from [ACT]IVATED Small Cell Lung Cancer (SCLC)

Related Resources:

When Can Small Cell Lung Cancer Patients Use Palliative Care

 Coping With Small Cell Lung Cancer Rapid Treatment

 Overcoming Small Cell Lung Cancer Care Barriers

Overcoming Small Cell Lung Cancer Care Barriers

Transcript:

Lisa Hatfield:

As a person living with cancer myself, one of the things I know that is often focused on by my healthcare team is the standard of care, and then it’s more of a reactive approach to dealing with symptoms. Talking about goals of care seems more proactive. So for a patient going in and wanting to talk about goals of care, maybe it’s not brought up by their care team, would it be appropriate for that patient to say, “Hey, I’d like to talk about some goals for my care too?” And not just have it be a reactive approach, but more of a proactive approach. Would that be a weird thing to ask the care team or is that appropriate for a patient to ask that question? Can we have a conversation about the goals for my care?

Beth Sandy:

No, I would love if a patient said that to me, because these are conversations that we want to have with patients. We want to have an open communication so that everybody’s on the same page of understanding of what’s going on with their cancer, but patients are often reluctant, and I get it. To be honest, a lot of doctors are reluctant. Sometimes they feel awkward in the conversation. So it goes both ways, but if the patient is open and wants to have that line of communication, I think that’s great. When I say goals of care, I mean what are your goals out of the treatment I’m giving you?

And it’s something because you bring up a good point. In small cell lung cancer, goals of care are very important, because there are a lot of things we can do to you. Some patients do not want their whole brain radiated. There’s a risk there of loss of cognitive function, and especially in the extensive stage setting, we can offer it. There is actually a slight advantage in survival to doing preventative for whole brain radiation.

However, the trade-off is that you can have neurologic decline and physical decline from that. So it’s like do I want to take the risk of having that side effect to prevent the brain metastases? So these are goals of care discussions like, is this right for me? Is this something I want to do and risk feeling this way? And some of that may depend on your performance status which is something that we used to say like, do I have a lot of other conditions? I have bad COPD, and I’m in a wheelchair already, and if I get this whole brain radiation, will I never walk again? Something like that. Those are all things that are important to discuss with your treatment team.

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When Can Small Cell Lung Cancer Patients Use Palliative Care?

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When Can Small Cell Lung Cancer Patients Use Palliative Care? from Patient Empowerment Network on Vimeo.

When might small cell lung cancer patients want to use palliative care? Expert Beth Sandy from Abramson Cancer Center defines palliative care and shares examples of palliative care support.

[ACT]IVATION TIP

“…there’s even data to show in lung cancer that patients who see palliative care in addition to their primary oncologist actually live longer and have improved quality of life. So we will often pair up with the palliative care team to help our patients maximize their symptom support and their side effect support, and have a good understanding of what their goals of care are with the treatment so that everyone’s on the same page and everyone is having a good experience.”

See More from [ACT]IVATED Small Cell Lung Cancer (SCLC)

Related Resources:

How Can Small Cell Lung Cancer Patients Ask About Care Goals

How Can Small Cell Lung Cancer Patients Ask About Care Goals

 Overcoming Small Cell Lung Cancer Care Barriers

Overcoming Small Cell Lung Cancer Care Barriers

Transcript:

Lisa Hatfield:

Palliative care is important for quality of life during small cell lung cancer treatment. Can you, first of all, explain what palliative care is, and then also give some advice, any advice you have for patients and their families on including palliative care early on in their course?

Beth Sandy:

So first, let’s define what palliative care is. It seems to be a big word, and sometimes people get a little concerned or confused when they hear that and they think, “Oh, does this mean I’m at the end or something like that?” And it absolutely does not. So palliative care means helping with supportive care or treatment of your side effects or symptoms. So we have a whole different set of doctors and nurse practitioners at my institution who just focus on the palliative care needs.

So, for example, if I have a patient with lung cancer, that’s what I treat, or maybe small cell lung cancer, but if I have a patient with lung cancer who is having a lot of pain and in my visit, I know the basics of the opioids and other medications, but usually we’ll send those patients to palliative care because they will have some other ideas and they can really focus and spend a half-hour just talking about those symptoms, like the pain, the cough, the shortness of breath, the weight loss.

So some people call it palliative care service, other people call it a supportive care service. That’s another kind of term for it. What the palliative care teams often do is what’s called the goals of care discussion, and that can mean a lot of different things to patients. What are your goals with life in general? Not even related to your cancer. Learning about you. Like who do you live with? Who is dependent on you? Who are you dependent on? And then going from there, and what is your understanding of your cancer and what are your goals with the treatment?

Sometimes we use a term called trade-offs. We would say, if the cancer, we’re treating it and it’s worsening, and then we have another treatment for it, and those side effects may be a little bit harder, is that something you want to risk, is being in the hospital and maybe being sick over the holidays or something, or would you prefer not to do that?

So palliative care often helps us with these goals of care discussions, and that can even lead to discussions about do I want CPR and resuscitation and things like that? Some people from the very start of their cancer, even if it’s a curable cancer, say, “But I’m at the point in my life where I have all these other illnesses, and I don’t want to be resuscitated. I want a natural death.” So those are all things that palliative care oftentimes can help with, living wills and things like that. And it’s not to say that your oncologist can’t because these are things I can do as well. But if I’m in a visit with you and I wanted to focus really on the current chemotherapy you’re on and those side effects, it may be better to have a palliative care doctor come on who is trained more in having those discussions.

And I wanted to make one distinction. Is that palliative care is absolutely not hospice care. So hospice care is when we’ve decided we do not want to do any more treatment for the cancer, and we want to improve the quality of the time that we have left. That’s hospice care. Palliative care is not that. Palliative care is when you are still on treatment, and we just want to maximize the supportive care and talk about what your goals are of the treatment. So I think my activation tip here for palliative care is that we often use it in lung cancer.

There’s even a study, there’s even data to show in lung cancer that patients who see palliative care in addition to their primary oncologist actually live longer and have improved quality of life. So we will often pair up with the palliative care team to help our patients maximize their symptom support and their side effect support, and have a good understanding of what their goals of care are with the treatment so that everyone’s on the same page and everyone is having a good experience. 

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Extensive Stage Small Cell Lung Cancer | Empowering Symptom Management

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Extensive Stage Small Cell Lung Cancer | Empowering Symptom Management from Patient Empowerment Network on Vimeo.

How can extensive stage small cell lung cancer patients be empowered for symptom management? Expert Beth Sandy from Abramson Cancer Center discusses how she empowers patients and care partners, common treatment side effects, and advice for patients preparing for treatment.

[ACT]IVATION TIP

“…make sure before you leave the office or on the day you’re coming for chemotherapy that you have all your questions answered, that you feel pretty confident in what side effects you may experience. I am a proponent of writing down your questions.”

See More from [ACT]IVATED Small Cell Lung Cancer (SCLC)

Related Resources:

Coping With Small Cell Lung Cancer Rapid Treatment

 When Can Small Cell Lung Cancer Patients Use Palliative Care

 Small Cell Lung Cancer Care | Optimizing Team Communication

Small Cell Lung Cancer Care | Optimizing Team Communication

Transcript:

Lisa Hatfield:

Beth, extensive stage small cell lung cancer and its associated treatments often come with challenging symptoms. How do you prioritize the patient education to empower both your patients and their care partners in recognizing and managing these symptoms at home?

Beth Sandy:

Yeah. So the treatments that we have are predominantly chemotherapy. We also can use immunotherapy, and these have a whole host of different side effects. Some patients may be dealing with just symptoms of the disease like shortness of breath or cough, but then when you add in the chemotherapy, it’s going to add a whole host of other side effects. I think there are a few important things to note here. Number one, know the names of the drugs that you’re getting, and at my institution, we will print them out for you with an  education sheet. So we like to give printed materials, because it’s hard to remember everything we say and not everybody’s going to sit there and take notes and write it down, so we give printed materials. I think that’s important. And then understanding the schedule.

So typically the first-line treatment that we use for this is three days in a row. It’s given once every three weeks. So you’re not just coming in one day. You actually have to come in three days in a row, and most cancer centers aren’t open on the weekend, so you would often have to be preparing to start this regimen either on Monday, Tuesday, or Wednesday.

So just think about that. We rarely start these regimens on a Thursday or Friday, because we want that consecutive three days in a row. There are scheduling issues that come into play here. And then the side effects, so we can predict really well what the side effects actually are going to be. I often can’t predict a lot of things with cancer, but side effects of chemotherapy are fairly predictable, and truthfully, most patients are going to lose their hair with this treatment. It grows back. So don’t worry. It grows back, but in the beginning, hair loss is something that may happen, so we need to tell patients that. No one wants to be at home, and all of a sudden all your hair falls out and you didn’t know that.

And then there’s chemotherapy side effects, things like lowering of blood counts, nausea. What I do want to say as I’ve been doing this for 20 years, our supportive care medications for preventing and treating nausea are so much better now. So it’s nothing like it was 20 years ago, and 30 years ago. When I started as a nurse, we didn’t have good medications then. We’ve really good medications now. So nausea tends to not be as big of an issue as what you may have experienced with a family member in the past, so that usually we can prevent pretty well.

But talking about the lowering of blood count is a big issue that it can put you at risk for infection, you may need blood transfusions. These are things that you have to talk about. So just make sure you have a pretty good understanding of that. The other thing we can predict is fatigue. So most patients are going to get fatigue, and usually it will be in the first week of treatment, but it won’t last the entire three weeks between the treatments.

So my activation tip here for this would be to make sure before you leave the office or on the day you’re coming for chemotherapy that you have all your questions answered, that you feel pretty confident in what side effects you may experience. I am a proponent of writing down your questions and bringing them in and I like when patients do that because then I can answer them, because otherwise I feel sometimes like did I answer everything? Do I forget anything that’s important to you? What may be important to you may not be as important to another patient? So write down your questions and make sure you have all of them answered before you leave especially when it comes to chemotherapy side effects.

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Coping With Small Cell Lung Cancer Rapid Treatment

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Coping With Small Cell Lung Cancer Rapid Treatment from Patient Empowerment Network on Vimeo.

Small cell lung cancer treatment often must start quickly following diagnosis, so what should patients know? Expert Beth Sandy from Abramson Cancer Center explains the importance of rapid treatment and shares advice to help ensure optimal patient care.

[ACT]IVATION TIP

“…if you are short of breath or coughing, get to the doctor…If it’s more than a week and over-the-counter medications aren’t helping, go and get worked up because this is very much a curable illness if we can catch it early. So we want to catch this as early as we can, but you have to get to the doctor and get that workup going…if you are diagnosed with this, make sure that your doctor or when you’re calling in to get a new patient appointment, they know this is small cell, not non-small cell. This is small cell lung cancer. It’s a more aggressive type, and you should be seen immediately very quickly to get started on therapy.”

See More from [ACT]IVATED Small Cell Lung Cancer (SCLC)

Related Resources:

How Can Extensive Stage Small Cell Lung Cancer Symptoms Be Managed

 Extensive Stage Small Cell Lung Cancer _ Empowering Symptom Management

 How Can Small Cell Lung Cancer Patients Ask About Care Goals

How Can Small Cell Lung Cancer Patients Ask About Care Goals

Transcript:

Lisa Hatfield:

So, Beth, small cell lung cancer spreads quickly, so treatment often needs to start right away. How do you help your patients and their loved ones cope with the rapid changes in their health, both physically and emotionally, and the quick start of the intense treatment they’ll receive?

Beth Sandy:

I can’t stress this enough. As soon as someone is developing symptoms of shortness of breath or a cough, it’s really important to get to the doctor because this type of lung cancer can spread very quickly, but you may not even know you have this. So if you have a cough or shortness of breath, it’s important to get to the doctor. Getting a chest X-ray is really easy. It’s cheap, it’s easy, it’s fast, and it’s something that will show this. Almost nine times out of 10 is going to show if you have this type of lung cancer on just the chest X-ray. So it’s important to get your workup very quickly. That’s the first thing I’ll say.

Once you’re diagnosed with extensive stage small cell lung cancer, it’s very important that you are treated quickly. In my office, if you call and you have this diagnosis, we see you within seven days. This is not something…whereas other cancers, if there’s longer than a seven-day wait, they may get pushed the following week. This is a patient that we will see within the week, because it’s important to get them treated right away. A part of that is because they respond so well. Treatments for small cell lung cancer work very well, especially early on, so we need to get those treatments going very quickly because like you said, this is a very rapidly progressing disease. So I think my activation tip really here for this question is…

Well, two, I have two activations, but the first one is if you are short of breath or coughing, get to the doctor. Don’t just say, “Oh, it’s probably my allergies.” If it’s more than a week and over-the-counter medications aren’t helping, go and get worked up because this is very much a curable illness if we can catch it early. So we want to catch this as early as we can, but you have to get to the doctor and get that workup going. My second activation tip is, like I said, for sure if you are diagnosed with this, make sure that your doctor or when you’re calling in to get a new patient appointment, they know this is small cell, not non-small cell. This is small cell lung cancer. It’s a more aggressive type, and you should be seen immediately very quickly to get started on therapy.

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How Can Extensive Stage Small Cell Lung Cancer Symptoms Be Managed?

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How Can Extensive Stage Small Cell Lung Cancer Symptoms Be Managed? from Patient Empowerment Network on Vimeo.

When extensive stage small cell lung cancer patients experience symptoms, how can they be managed? Expert Beth Sandy from Abramson Cancer Center discusses collaborative symptom management for ES-SCLC patients for common symptoms including respiratory issues, appetite and digestion, and neurologic symptoms.

See More from [ACT]IVATED Small Cell Lung Cancer (SCLC)

Related Resources:

Coping With Small Cell Lung Cancer Rapid Treatment

 Extensive Stage Small Cell Lung Cancer _ Empowering Symptom Management

 Small Cell Lung Cancer Care | Optimizing Team Communication

Small Cell Lung Cancer Care | Optimizing Team Communication

Transcript:

Lisa Hatfield:

Beth, how do you approach collaborative symptom management for newly diagnosed patients with extensive stage small cell lung cancer?

Beth Sandy:

So when you’re newly diagnosed, it really depends. A lot of our patients will end up having symptoms such as shortness of breath or a cough or even coughing up of blood just because the natural biology of small cell lung cancer tends to be a very centralized cancer, the airways. So symptoms typically are respiratory, and we have a lot of really good treatments to help with things like shortness of breath and cough. To be honest with you, this type of lung cancer is so responsive to chemotherapy that sometimes the chemotherapy alone will help your symptoms because it responds so quickly.

If that’s not the case, we can do radiation also to help minimize the cancer where it may be causing shortness of breath, or certainly if you’re coughing up blood, a lot of times we’re going to go in and do something like radiation. There are other things that we can prescribe such as inhalers or medications that are prescriptions that can help with cough like certain syrups and other pills that can help reduce cough. Those typically are often the main respiratory symptoms. Other things that we may find are things like weight loss and decreased appetite. That can be harder, I will say.

There used to be medications that we used for appetite stimulation. The problem with some of those medications is they were increasing the risk of blood clot, which is already a risk when you have lung cancer, so we don’t have to use them as often. But there are some medications that we can work with, and we work with oncology nutrition a lot as well to help patients, especially when weight loss is an issue. There’s a whole other set of side effects the patient’s going to have once they start treatment, but they usually don’t typically present with things like nausea or vomiting, or constipation or diarrhea. Those things can be side effects of treatment.

Another thing that can be common in extensive stage small cell lung cancer is metastasis to the brain. So sometimes patients will have headaches or neurologic changes, but the good thing is that’s very responsive to steroids and radiation, so the sooner we get people on treatment, really those symptoms tend to improve very quickly. The activation tip for this really would be to make sure you let the nurses and doctors know exactly what sometimes you’re experiencing, because we really do have a lot of good supportive care medications, and truthfully the treatment for the cancer should really help improve your symptoms pretty quickly with this disease.

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