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Simone's OncOpinion: Supportive Care for Cancer Patients

Simone, Joseph V. MD

doi: 10.1097/01.COT.0000430988.76668.49


Any day that I learn something new and meaningful is a joy for me. As a consultant and advisor, I sometimes accept assignments just because I believe there is something interesting and/or worthwhile to learn from the experience. In the last few months, I have added a great deal to my understanding of supportive care for cancer patients receiving cancer therapy (but applicable to survivors who have completed cancer therapy). I owe these revelations to a good friend of mine, Matt Loscalzo. He initially developed his skills under the tutelage of Drs. Kathleen Foley and Jimmie Holland at Memorial Sloan-Kettering Cancer Center (Jimmie is a unique treasure in the oncology world, but more about her later). Matt has developed programs at several institutions and is currently the head of the supportive care program at the City of Hope.

First, about terminology: Supportive care, palliative care, end-of-life care, social work, psychosocial care, pain control, and many other related areas together describe services for cancer patients that usually are not provided by medical, radiation, or surgical oncologists. These services are aimed at the difficult, depressing, and often neglected problems that cancer patients face as they move through the stages of treatment. Dante could have recognized their suffering in his Purgatorio or Inferno, except that the patients do not deserve to be in either. So we will use “supportive care' to describe this collections of services.



In February I gave a lecture at the annual meeting of the American Psycho-oncology Society ( If you have never heard of it, you are not alone. Neither did I until I got a call from Matt asking me to give a talk at the meeting. I responded that I didn't know anything worthwhile to say about the field. He responded that I knew about institutions, leadership, and other important factors that influence one's ability to develop a program that, while most of us would consider it essential, is often not highly regarded by the administrators of hospitals and universities, partly because these activities do not make money for the institution.

Matt is an effective salesman, and I agreed to speak.

I was very impressed by the activities members described in workshops and committee meetings. There were signs of creativity, successes, and struggles. The atmosphere was one of helping each other overcome barriers to providing supportive care in their institutions. Some members had grants to study new models of supportive care and they described their findings.

The atmosphere was friendly and collegial as well as seriously focused on the welfare of cancer patients. APOS membership is open to the complete array of specialists who work to ease the disruption of life and security that the cancer patient faces from both the difficult therapy and the lurking Grim Reaper.

I must point out that Jimmie Holland founded APOS. If you don't know her, you have a serious gap in understanding the modern care for cancer patients. Jimmie is a psychiatrist who started the field of psychosocial support for cancer patients. She and Dr. Kathleen Foley, a pioneer in managing cancer pain, made Memorial Sloan-Kettering a hotbed of clinical innovation and research in supportive care. Jimmie and Kathy are among my favorite people in the entire oncology world for developing services for cancer patients that too often are poorly supported or ignored.

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R25E Grant

My second opportunity to work with Matt Loscalzo arose when he asked me if I would be willing to join him and others as a consultant in submitting an R25E grant request to the NIH titled, “Building, Implementing, and Evaluating Cancer Supportive Care Programs.”

Here is a brief description of the proposal: An ad campaign would invite institutions to compete for 40 personal slots. Several people from each institution would attend a three-day session that includes some lectures, but mostly guided workshop exercises in solving common problems; another benefit would be meeting and networking with others also facing problems in moving forward. The institution must be able to bear the cost of travel, hotels, and dinners.

The grant is for five years with two sessions held each year, alternating sites being the City of Hope and Mt. Sinai Medical Center in New York. The 10 sessions would each consist of new groups so that approximately 150 institutions in all would participate. A website is prepared to list all the discussions, questions, solutions, and commentary from the three-day sessions so all participants will be able to follow the ideas and outcomes of the other nine sessions.

Since I have provided an outline of the grant, needless to say, Matt and his colleagues were awarded the grant. The first meeting occurred recently at City of Hope. I gave a couple of lectures and guided some discussions along with Matt, Dr. Susan Block from Harvard and Dr. Donald Rosenstein from the University of North Carolina. Both are psychiatrists deeply engaged in supportive care.

It was a wonderful experience for me. I learned a lot, I met nurses, physicians, social workers, psychologists, and others deeply dedicated to bettering the lives of cancer patients. Most were seasoned veterans who have been involved in one way or another with these patients. They were smart, committed, and open to new ideas and approaches.

The breakout workshops reported back to the group as a whole with some truly innovative ideas for getting financial, administrative, and oncologists' support by demonstrating how their programs could save time for physicians and money for the institution.

The attendees were fun to be with. We had some laughs and enjoyed each other's company. I am looking forward to the next meeting in New York in October. I expect to learn something new and meaningful just as I did at the City of Hope and having another joyful day.

(To apply for participation, email

© 2013 Lippincott Williams & Wilkins, Inc.
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