Integrating Wellness Into Cancer Care

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A presentation by:

Ida Ackerman, MD
Associate Professor,
Dept. of Radiation Oncology
University of Toronto
Odette Cancer Centre

Published in: Health & Medicine
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  • Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
  • Integrating Wellness Into Cancer Care

    1. 1. Integrating Wellness Into Cancer Care Things I Have Learned Ida Ackerman, MD Associate Professor, Dept of Radiation Oncology University of Toronto. Odette Cancer Centre Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    2. 2. Integrating Wellness At the Start <ul><li>The Consultation:The Physician’s Role </li></ul><ul><li>Emphasize possibility or probability of cure </li></ul><ul><li>Emphasize what will NOT happen </li></ul><ul><li>Discuss their life—their job, their hobbies, their personal history, their family </li></ul><ul><li>Use plain language to explain issues </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    3. 3. Integrating Wellness At the Start <ul><li>The Consultation:The Physician’s Role </li></ul><ul><li>None-verbal communication: LISTEN </li></ul><ul><li>Sit, Smile, Sympathize/empathize </li></ul><ul><li>Sometimes-touch </li></ul><ul><li>All these strategies make the patient feel human and “normal” and allays some anxiety </li></ul>
    4. 4. Integrating Wellness At the Start <ul><li>The Consultation:The Physician’s Role </li></ul><ul><li>Should I work, Doctor? </li></ul><ul><li>Maintenance of normality important but not always feasible. For some it is paramount and strategies to make it feasible should be initiated </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    5. 5. Integrating Wellness At the Start <ul><li>“ As cancer patients, we also search for ways to remain healthy, relaxed, alert, productive, and engaged in normal activities of daily living at home, at work, and in our communities. Quality of life focuses on being and feeling like a &quot;normal&quot; person, the kind of person we would choose to be, given that choice. ” </li></ul><ul><li>Gail Broder </li></ul><ul><li>Founder and President Emeritus, Cancer Survivorship Alliance of South Florida, Bethesda, Md. </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    6. 6. Integrating Wellness At the Start <ul><li>The Physician’s Role: </li></ul><ul><li>Guide, Advise and Inform </li></ul><ul><li>Seek referrals to deal with identified patient issues not within sphere of expertise </li></ul><ul><li>The challenge: to identify those issues! </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    7. 7. Integrating Wellness At the Start <ul><li>Other Strategies </li></ul><ul><li>Exercise </li></ul><ul><li>Support Groups </li></ul><ul><li>Hobbies—discovering a talent </li></ul><ul><li>Nutrition </li></ul><ul><li>Psychosocial </li></ul><ul><li>Financial Aide </li></ul><ul><li>Look-good, feel better </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    8. 8. Integrating Wellness At the Start <ul><li>Question #1 </li></ul><ul><li>How to coordinate this? </li></ul><ul><li>Multidisciplinary care may resulted in fragmented care </li></ul><ul><li>Who is in charge? </li></ul><ul><li>Who is the person the patient can contact for guidance? </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    9. 9. Integrating Wellness At the Start <ul><li>How to coordinate this? </li></ul><ul><li>OR </li></ul><ul><li>How should these multidisciplinary health professionals communicate with each other for patient’s benefit? </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    10. 10. Integrating Wellness In Cancer Care Later <ul><li>An Example: </li></ul><ul><li>Sexuality Clinic at Odette Cancer Centre </li></ul><ul><li>January 2007 </li></ul>
    11. 11. Integrating Wellness into Cancer Care Later <ul><li>Sexuality Clinic </li></ul><ul><li>sexuality is an important problem in gyne cancer survivors </li></ul><ul><li>a pilot clinic to run at OCC to address issues related to sexuality in gyne cancer survivors </li></ul><ul><li>Potential to provide new research and training opportunities </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    12. 12. Integrating Wellness into Cancer Care Later <ul><li>Data: Quality of Life & Sexuality in Cancer Survivors (Frumovitz, M, JCO 2005, 23(30): 7428-7436) </li></ul><ul><li>Cervix cancer survivors (>5yrs post diagnosis) interviewed </li></ul><ul><li>Had surgery or RT but not both </li></ul><ul><li>Age, race matched controls </li></ul><ul><li>QoL and sexual function in surgical patients was comparable to the controls </li></ul><ul><li>Radiated patients had worse sexual function compared to surgical patients </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    13. 13. Integrating Wellness into Cancer Care Later <ul><li>Objectives of Sexuality Clinic </li></ul><ul><li>To develop a comprehensive set of resources that address issues of sexuality in gyne-cancer patients </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    14. 14. Integrating Wellness into Cancer Care Later <ul><li>Staffing and Operations </li></ul><ul><li>One clinic/month </li></ul><ul><li>Gynecologist: fellowship in reproductive endocrinology, with clinical and research expertise in menopause </li></ul><ul><li>Psychologist: certified in Psycho-oncology and Sexuality in Oncology </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    15. 15. Integrating Wellness into Cancer Care Later <ul><li>Who and How </li></ul><ul><li>completed treatment for any gynecologic malignancy and are disease free </li></ul><ul><li>recruited from the gyne clinic </li></ul><ul><li>introductory pamphlet distributed in clinic </li></ul><ul><li>standard intake questionnaire administered at first visit </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    16. 16. Integrating Wellness into Cancer Care Later <ul><li>Operations </li></ul><ul><li>Most problems will be managed satisfactorily by either gynecologist or psychologist over a short number of visits (<3) </li></ul><ul><li>Patients with issues beyond the scope of their expertise or requiring a larger number of visits will be referred to consultants </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    17. 17. Integrating Wellness into Cancer Care Later <ul><li>Consultants </li></ul><ul><li>psychiatrist </li></ul><ul><li>couples counselor </li></ul><ul><li>sexologist </li></ul><ul><li>social worker </li></ul><ul><li>urologist </li></ul><ul><li>..add others </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    18. 18. Integrating Wellness into Cancer Care Later <ul><li>The Future </li></ul><ul><ul><li>Broaden scope to all pelvic cancers; men and women; all cancers </li></ul></ul><ul><ul><li>Build a broader program addressing survivorship </li></ul></ul><ul><ul><li>Address reproductive issues such as fertility preservation </li></ul></ul><ul><ul><li>Strengthening relationships between hospital and community </li></ul></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    19. 19. Integrating Wellness into Cancer Care Later <ul><li>Research Opportunities </li></ul><ul><ul><li>Improve vaginal stenosis </li></ul></ul><ul><ul><li>Establish natural history/ severity of premature menopause </li></ul></ul><ul><ul><li>Improve menopause in young women unwilling to take HRT </li></ul></ul><ul><ul><li>Investigate web based education/support tools </li></ul></ul><ul><ul><li>Improve QoL in survivors </li></ul></ul><ul><ul><li>Investigate effects on partner relationships </li></ul></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    20. 20. Integrating Wellness into Cancer Care Later <ul><li>Educational/Training Opportunities </li></ul><ul><li>For a gyne or a radiation oncology fellow </li></ul><ul><li>For students from medicine, nursing and social work </li></ul><ul><li>For unique educational partnership with University of Guelph with a sexology program </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    21. 21. Integrating Wellness into Cancer Care Later <ul><li>Web-based Support Groups </li></ul><ul><li>(Winzelberg A. et al: Stanford University School of Medicine, Stanford California. Cancer 2003: 97: 1164-73) </li></ul><ul><li>72 breast cancer patients randomized to participate in a 12 week web-based social support group or not. </li></ul><ul><li>38 to 54 % relative reduction in depression or cancer related trauma and perceived stress. </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc
    22. 22. Integrating Wellness into Cancer Care Later <ul><li>Question #2 </li></ul><ul><li>Where do some of these responsibilities for wellness lie? </li></ul><ul><li>How much is the responsibility of the health care system and how much is the responsibility of patient, family, friends and community? </li></ul>Published by Current Oncology and the Cancer Knowledge Network © 2011 Multimed Inc

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