As reported to Chris Pirschel by Janet Abrahm, MD

oncology nurses can Involve the Palliative Care Team Early to Minimize Symptom Impact
Janet Abrahm, MD, is a professor of medicine at Harvard Medical School and a member of the Division of Adult Palliative Care at Dana-Farber Cancer Institute in Boston, MA.

Patients with cancer experience many feelings: they’re frightened and they’re hopeful, but mostly they’re in a new world.

Symptoms associated with cancer and its treatment are taxing on patients’ physical, emotional, and spiritual well-being. In some cases, cancer-related symptoms and side effects are so debilitating that providers struggle to manage them just to get patients to a point where they can continue their treatment. Oncology nurses can lead the interprofessional care team to work together to proactively manage symptoms to ensure patients can endure treatment and come out as themselves on the other side. Proper symptom management doesn’t just promote quality of life but the best possible chance for patient survival.

Healthcare teams can work together in numerous ways by communicating openly during symptom assessment and management quickly and early on. A healthy respect for the roles of everyone on the care team can make working together easy. Having the conversations early about who is responsible for which assessments, when those assessments will take place, and how to follow through to relieve symptoms enables efficient and effective team-based symptom management. By identifying challenging problems early, the healthcare professionals can also involve palliative care early and often, from diagnosis on, to address symptoms and other concerns as they arise. 

Having a low threshold at which healthcare teams engage palliative clinicians can be beneficial to patients. Research has shown that integrating palliative care early for patients with advanced lung cancer and for stem cell transplant recipients resulted in better quality of life and less anxiety and depression than in those without palliative care interventions and the patients with lung cancer lived longer. By integrating palliative care early in the treatment plan, healthcare teams can give patients the best shot at survival while also maintaining the important focus on well-being and quality of life. 

Oncology nurses play an important role in highlighting to patients the importance of their quality of life to the treatment process. By encouraging them to report their symptoms—not just the dangerous ones like fevers, but their mental and physical states—nurses can help patients and their families understand that symptom reporting is never considered a burden. By asking and assessing patients often, nurses can work to normalize the symptom reporting process, and patients will likely feel less inclined to withhold symptoms that are affecting them.

Oncology nurses should continue to use their resources in symptom management practice. Consider consulting onsite palliative care specialists, engage patients in nonpharmacologic options like acupuncture and holistic treatments, and use organizations like ONS, the American Society of Clinical Oncology, the American Cancer Society, and the American Academy of Hospice and Palliative Medicine. With the palliative care team, call them early and often—their motto is “never worry alone.”