Elevating Supportive Cancer Care Research : Cancer Care Research Online

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Elevating Supportive Cancer Care Research

Kagan, Sarah H. PhD, RN

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Cancer Care Research Online 1(2):p e0005, April 2021. | DOI: 10.1097/CR9.0000000000000005
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In an era of unprecedented advances in cancer treatment, supportive cancer care gets lost. Excited calls for a flash mob or similar 21st century event to herald promising supportive care science, as for translational therapeutic science, are hard to imagine. Attention to supportive care pales in comparison to enthusiasm for cancer treatment.

Cancer care, broadly speaking, is composed of 2 main types of care. Biomedical diagnosis and treatment is what the public think about when they hear “cancer care.” Supportive cancer care is everything beyond screening, diagnosis, and treatment. Increasingly, it also includes efforts to ensure equity, ameliorating disparities in care. The scope of supportive care remains often unseen and generally unacknowledged. While our social contract, as scientists and clinicians, to provide supportive care science and practice is clear, our success in fulfilling that contract it is less evident.

Globally, cancer is socioculturally constructed as a lethal diagnosis and not as the often curable and frequently controllable disease it is today. Cancer, seen as a lethal diagnosis, then constitutes supportive care as optional. Supportive care is thus welcome but not requisite if the question of impending death dominates. Nevertheless, knowing cancer as a death sentence to be survived with luck and arduous treatment is increasingly historical artifact. Realities of cure and long-term control transform ever more lives.

Therapeutic progress portends potential to extend survival and realize life beyond cancer. Survival alone, however, is insufficient. People living with and after cancer must live real, complete lives. Full, meaningful lives—where desire and purpose do not fade in the shadow of impairments incurred during the course of treating cancer—fulfill the promises behind exciting treatment innovations.

Every step forward in treating cancer creates a cascade of supportive care needs. That cascade begins with physiological and functional symptoms and side effects. It reaches into all aspects of social function with a range as broad as people are individual. It commonly stretches on to the spiritual where impacts of a disease as storied as any human beings face are keenly felt. Yet, supportive care science lags, typically failing to meet most expressed needs. We fall further behind in our social contract with each step forward in cancer therapeutics that fails to generate matched supportive care science.

Gaps in supportive care science are easily illustrated. Take fatigue where the science remains stuck in the 20th century and, with it, our evidence-based practice. Nonetheless, when compared with other aspects of supportive care, symptom and side effect management with phenomena like fatigue constitute a relative strength. Here, at least, we wield some evidence and possess some clinical standards.

Other elements of supportive care flag far more severely, whether a result of complexity, inattention, or a sense of “solvability” with the scientific tools at hand. For example, financial toxicity—though a recognized concern—remains poorly defined and studied. Evidence-based standards for counseling are, of course, necessary to address financial toxicity. However, such standards must account for varied health systems and policies for healthcare and employment internationally. Consequently, science in financial toxicity and counseling often seems an intricate maze where complexity and variability outpace scientific capacity. Making comprehensive financial counseling a routine part of supportive care remains a dream and not a vision easily realized in most societies. Other strands in supportive care are similarly stunted, awaiting our concerted scientific efforts.

Meeting this challenge of advancing supportive cancer care and upholding our social contract is within our grasp. Emerging topics in scientific paradigms and research methods stand ready for integration into scientific training and program development. Imagine possibilities in data science or in user engagement, as examples. Scientific possibilities marry well with critical ethical and social mandates. Mandates, including redressing disadvantage like poverty and health illiteracy and dismantling discrimination including the racism, ageism, and healthism that threaten daily life and wellbeing for people affected by cancer, necessarily improve science and practice. Thus, we possess good scientific tools, poised for deployment in strong studies, and cultivate just mindsets, aimed achieving equity and undoing bias in science and practice with those tools.

Advancing supportive care and fulfilling our social contract, however, requires more than science alone. We must shine a light on the cause, playing our part to transform sociocultural constructions of cancer. Elevating supportive cancer care research requires actively reshaping what it means to living with and after cancer. Doing so helps us to bring supportive cancer care research into the 21st century, matching success in cancer therapeutics and improving daily life for those affected by cancer.

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Cancer Care Research Online. All rights reserved.