From the Fourth Annual Chicago Supportive Oncology Conference, Chicago, Ill.:
I’ve been covering oncology for a few years now, and usually go to the big, high-powered meetings like ASH and ASCO. This time, I’m covering supportive oncology. Unlike the “three ring circuses” I’m used to, this meeting is being held in one, albeit large, room. The audience is predominantly female, for the most part RNs. Roughly 30% of the attendees are physicians.
Everyone is here to learn the best ways of caring for people with cancer. The focus is not so much on treating the disease, but on treating the side effects of treatment: What to do about mucositis, constipation, fatigue, dyspnea, nausea and vomiting. How to reduce or prevent the cardiotoxicity from breast cancer therapy, or preserve bone health during androgen deprivation therapy for prostate cancer. How best to sustain patients mentally and spiritually. How to help patients and their families cope with grieving and loss.
What nobody talks about, at least formally, is the cost of providing such care. Right now, there are 47 million Americans with no medical insurance. And an even greater number with no dental insurance. Yet, good oral health is essential for cancer patients.
I spoke with an RN who cares for patients in an inner-city hospital in Milwaukee. He said that most of his patients are indigent. They present when their cancer is at an advanced stage because they can’t afford to go to the doctor. Routine dental care for these individuals, many of whom are on Medicaid, consists of pulling their teeth out. When the teeth are all out, they get ill-fitting dentures, which cause another host of problems.
He said he likes to come to this meeting because he wants to know what’s out there for his patients, but he admits he is frustrated because so little of what he learns can actually be applied where he works. Very little state-of-the-art cancer care actually trickles down to his patients because they can’t pay for it.
What he is able to provide is an ear for listening. Listening may be one of the most important supportive oncology care strategies. It has no side effects. And it’s free.
This is what he told me: “I’m there for them in the middle of the night, when they can’t sleep. This is when they open up to me. They talk about their worries, their anxieties. They want to know what will happen to them as they start on their final descent to death. Will their pain be well managed? Will they be treated with respect? Will they be able to die with dignity? Even though I can’t wave a magic wand and make their illness go away, or give them money to pay for the latest drugs to relieve their nausea and vomiting or get appropriate dental care, I can listen. It’s a small thing really, but I know it helps my patients.”
The reality is, if you get cancer in the U.S., you better be close to a center that can provide good and compassionate care and be rich enough to afford it.
And lucky enough to have a nurse who will listen to you in the middle of the night.