Supportive care: Edited by Jean Klastersky
The concept of supportive care was formalized nearly 20 years ago, when the MASCC (Multinational Association for Supportive Care in Cancer) was founded and held its first official meeting in Bruges (Belgium) in 1992. At that time, the idea was to bring together multidisciplinary expertise into a variety of problems met by cancer patients in addition to the direct burden caused by the neoplastic disease itself.
Many aspects of supportive care have received, since then, a satisfactory response, although areas of uncertainty remain in most and justify further research efforts. Among the most successful achievements of supportive care in cancer patients, one can list, among others, the control of infections and emesis, the introduction of biphosphonates, and a rational approach to pain management. These progresses have led to major improvements in the quality of life of countless patients.
Other areas such as cancer-associated anaemia and fatigue, chemotherapy-induced mucositis and cardiotoxicity, nutritional support, to cite only a few examples, have been less successful, although progress has taken place and improved the well-being of many patients.
There are two main areas in which we need a dedicated research effort today.
The first pertains to the multiple aspects of the psychological approach to cancer patients. Although psychological support has become a standard in many centres caring for patients with neoplastic diseases, many fields remain to be explored including the reactions of the patient and his/her family to the evidence of cancer progression after an apparently successful therapy.
Equally important for the optimal psychological work-up and care is to pay attention to the multicultural aspects of many of our societies. In the developed world, we face, more often than earlier, populations with language, religion and life style differences for which specific approaches are needed. This multicultural dimension poses a major challenge for ensuring an optimal feeling of well-being during cancer therapy and follow-up.
Another important area for further innovative research is the so-called new ‘biological’ and ‘targeted’ therapies. It is obvious that these approaches will become widely used for cancer treatment and will become standard therapy in many cases.
These new therapeutic possibilities are linked with a variety of adverse effects, often completely unknown until recently by oncologists. Many of these side effects are not benign and are threatening the quality of life and the autonomy of numerous patients. Some, such as hypertension, haemorrhage or diffuse pneumonitis, are potentially life-threatening.
Supportive care, as many other areas in medicine, is in a constant stage of evolution and requires continuous and dedicated research to maximize the comfort and well-being of patients.