Current Opinion in Oncology:
SUPPORTIVE CARE: Edited by Jean A. Klastersky
Klastersky, Jean A.
Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Brussels, Belgium
Correspondence to Jean A. Klastersky, MD, PhD, Professor and Chief of Medicine (emeritus), Institut Jules Bordet, Rue Héger-Bordet, 1000 Brussels, Belgium. e-mail: firstname.lastname@example.org
Supportive care is a commonly accepted term in oncology; however, its definition remains unclear, and this results in a barrier to communication in clinical and research areas.
Hui et al. came up recently with a new definition of supportive care: ‘the provision of the necessary services for those living with or affected by cancer to meet their informational, emotional, spiritual, social and physical needs during their diagnostic, treatment, or follow-up phases encompassing issues of health promotion and prevention, survivorship, palliation and bereavement’.
This really expresses the comprehensive broad spectrum of supportive care, just as we felt it should be when we intuitively launched the concept many years ago. All the mentioned interventions do not need to be applied at the same time in a given patient; these aspects have also been well discussed and presented in Hui's study, which should serve as a paradigm for all of us involved in the implementation of the concept of supportive care.
Supportive care applies, in its broadest sense of the definition, to patients with incurable disease. But how precise and meaningful is ‘incurable’? Gaertner and colleagues tackle this difficult question and come with the recommendation that an unambiguous terminology is essential for making the right decisions. They emphasized the difference between curative and disease-modifying therapies in order to avoid sources of misunderstanding. The issues of prolonging life, alleviating suffering or both should be well understood at the time the patient is initially taken care of.
The discussion of ‘narrative ethics in the field of oncology’ by Lossignol et al. is a natural consequence of these necessary definitions. The advent of bioethics has made it inconceivable to go back to paternalistic practices and ignore the will of the patient. Narrative ethics promotes constructive communication between patients and caregivers, and thus helps in the decision about what the goals and expectations of therapy are and consequently to make optimal shared decisions.
At the end of life, intolerable suffering may be an almost unsolvable problem. Although it is essential to follow the patient's decisions, it can happen that the patient's autonomy is not adequate. The burden of the decision lies then on the physician's shoulders. Maltoni et al. discuss the difficult issue of palliative sedation for intolerable suffering and stress the restricted area for which it was conceived as well as the need for the expertise of an experienced palliative care team.
Clearly, supportive care has become a complex concept, because of the extreme complexity of the situation of the patients with advanced cancer and the multiplicity of the potential protagonists. Clear definitions of the situations, adjusted paradigms for therapy, respect of the patient's autonomy – as far as possible – and an open mind for possible changes and improvements are needed for progress in this important domain so closely related to the well being of the cancer patients.
Conflicts of interest
There is no conflict of interest.