Integrating cancer care – holistic support for patients

Each year, more than 10 million people worldwide are diagnosed with cancer, but with early detection and treatment, more patients can be expected to live longer than five years after initial diagnosis.¹

Cancer care is multifaceted and involves many treatment modalities, including – several different specialists, surgery, chemotherapy, radiation therapy and support services such as rehabilitation for physical strength, psychotherapy for the management of the often-complex emotional issues that may arise, and spiritual wellbeing, all aiming to improve patient’s quality-of-life.

Wellness is a crucial part of a cancer patient’s journey. Integrated care needs to be patient-centred with good communication which includes family and carers and applies across the cancer experience from diagnosis, treatment, survivorship to end-of-life care.

Exercise, as a means for primary prevention of cancer is becoming more widely accepted as more evidence for its protective effect is published. It is an attractive cancer preventive strategy because it has many health benefits in addition to reducing the risk of certain cancers.^1,2 It is also associated with significant reductions in the recurrence and mortality rates of several cancers.^1,2

Exercise may also alleviate symptoms that interfere with daily life of cancer patients and survivors such as lack of appetite, diarrhoea, tingling, constipation, physical and mental fatigue, treatment related fatigue, muscle pain, joint stiffness and other pain, depression, anxiety, and insomnia.^1,2

During cancer treatment, toxicities can affect eating patterns and can lead to malnutrition resulting in loss of lean body mass and excessive weight loss.^3,4

Following treatment and throughout survivorship, patients are at risk of not meeting national nutrition guidelines for cancer survivors, which can affect recurrence and survival. Poor nutritional intake may also impact efficacy of treatment and clinical outcomes.^3,4

At the other end of the spectrum, obesity, which is highly prevalent in cancer patients and survivors, can affect clinical outcomes during treatment by masking malnutrition and, is also a risk factor for cancer recurrence and poorer survival in some cancers. Appropriate and effective nutritional education and guidance by trained clinicians are needed throughout the cancer care journey and beyond.^3,4

Facing cancer puts huge stress on the patient and their families and friends, as they all face challenging issues and choices. Accepting diagnosis, undergoing treatments, understanding prognosis, handling possible side effects, managing a possible relapse, facing an uncertain future, financial stressors, are all stages of a process that can cause psychological affects including depression, anxiety, and other mood disorders.^5,6

Many cancer patients experience multiple psychological symptoms during their cancer journey, often running concurrently, such as distress, anxiety, depression, cognitive impairment, and body image/sexual dysfunction.^5,6

Psychotherapeutic and supportive approaches have proven effective for cancer patients and their care groups, including cognitive behavioural therapy, support groups – both clinical and peer, mindfulness practices, and coaching.^5,6

Other modalities and support, depending on cancer type, may include, but are not limited to:

• Massage inc. lymphatic drainage to support lymphoedema
• Reflexology
• Acupuncture
• Occupational therapy
• Speech therapy

It is widely accepted that early integration of supportive care can lead to improved outcomes for cancer patients. Active patient involvement is crucial for good integrated care, and an integrated system must deliver customised services to patients, with the object of having them at the centre of care.⁷

1. Rajarajeswaran P & Vishnupriya Indian J Med Paediatr Oncol.2009; 30(2):61–70.
2. Schwartz A, et al. Oncology. 2017; 31(10):711-717.
3. Greenlee H, et al. Cancer J. 2019; 25(5):320-328.
4. Schmid A, et al. Nutr Cancer. 2021; 5;1-12.
5. Hulbert-Williams NJ, et al. Curr Opin Sup Pallia Care. 2018; 12(3):276-292.
6. Grassi L, et al. F1000Res. 2017; 6:2083.
7. Hughes G, et al. Milbank Quarterly 2020; 98(2):446-492.et al. American Society of Clinical Oncology Educational Book. 2019; 39:332-340.