Patient-centric care: Recognising the value of non-clinical intervention

Continued from page 1 neuroendocrine tumours and used them to illustrate why survivorship matters—many live with their cancer “for years or decades” and thus “miss out on a lot of resources” by virtue of not fitting the “standard model” of a survivorship cancer patient.

Laffan explained that those who work within the programme look at patients’ individual needs, which are affected by “age, gender, stage of life, treatment, diagnosis, and goals for treatment”. Key for consideration, the presenter continued, are whether a patient prioritises quality over quantity of life, or vice versa, as well as the financial and caregiver burden that their illness is having. “This conference is looking at increasing quantity of life, but there are things we can do as healthcare providers to increase quality”.

Echoing Keller on acknowledging with patients the multiplicity of lifestyle factors that can impact their healing, Laffan cited an American College of Sports Medicine consensus paper from 2019, which recommended exercise as a means of improving cancer patients’ “quality of life, mental health, sleep”, among other factors. “Despite this, the majority of patients say healthcare providers are not routinely telling them not to exercise […] we should refer patients to exercise counselling if it is available”.

Laffan then expressed her certainty that “you all know the huge mental toll” on patients, who will often be living “from scan to scan” and footing “exorbitantly expensive” bills. Meditation can be a means of assuaging this psychological burden, and also improving symptom profile and pain levels, the presenter supplemented, recommending that physicians working with cancer patients should also offer this form of therapy where possible.

Beyond the patients themselves, Laffan then turned her focus to caregivers—a 2016 National Alliance of Caregivers study found that this group is 60% women, and 50% reported high levels of emotional stress. Half were also working in paid employment alongside their caregiving. “So, what do caregivers need from healthcare providers?” Laffan posed as a rhetorical question. “Recognition, detailed education and support with their role […] the vast majority of the time, they are not doctors or nurses,” Laffan stated, underlining that they are still “asked to perform medical tasks.”

In summary, there needs to be an “individualised approach for patients living with cancer as chronic illness,” Laffan advocated. “It is important we check in with patients and caregivers, particularly at times of transition […] Often they smile and say they are fine but that might not be their reality.” Reiterating, Laffan’s parting note was that “extending life does not necessarily equate to living well” and therefore, the focus should also be on quality of life, intervening early with a multidisciplinary approach. An example of the success of this is Laffan’s neuroendocrine wellness clinic, where patients are referred proactively, “rather than reactively, which is what we often do”.

Patient point of view: treatment as a “miraculous” tapestry

Lynn Lazzaro (a financial advisor based in Sparks, USA) gave her patient perspective on the care that saved her life mirrored much of what Laffan’s presentation covered. Diagnosed with a 13.5cm mass on her liver in January 2016, Lazzaro told delegates how her interventional oncology (IO) team gave her a year to live, “maybe two with treatment”. Living from scan to scan as Laffan had described was Lazzaro’s reality, the presenter acknowledged. “Looking back on the journal I kept […it] almost seems to reel as if it happened to someone else”. But Lazzaro recognised her experience in the previous presenters advocating for conversations—about treatment plans, goals and how to achieve them. “My treatment team asks me these questions often,” Lazzaro affirmed, referencing Atul Gawande’s book ‘Being Mortal’, which outlines how the “ultimate goal is not a good death but living a good life all the way to the end”.

Lazzaro described her life during treatment like a “beautiful tapestry—maybe if you pulled one string the whole thing would fall apart”. However, IO, she avowed, “was the miracle that began by adding years to my life, which ultimately gave me the chance at a cure—transplant after downstaging.” Her relationship with her multidisciplinary team, as mentioned by Laffan, was instrumental in reducing hers and her family’s stress—“treating me as a whole person gave me the resilience to get up and do it all again. They kept me informed always of my prognosis—an easier conversation for some than others—but factual honesty was key for family.” n INTERVIEW: SPECIALIST CLINIC BRINGS IVC FILTER INNOVATION INTO FOCUS: n SIO ANNOUNCES FIRST SITE APPROVED FOR ENROLMENT IN ACCLAIM CLINICAL TRIAL:

“If treatment was an art or tapestry then the outcome is really the result of the art form of your profession—your judgement, your risks, your compassion saved my life,” was Lazzaro’s thanks for the work that the IO community, drawing attention to how the clinical and non-clinical aspects of a patient’s care play complementary roles.

William T Kuo (Stanford University, Stanford, USA), spoke to Interventional News about his work in the field of advanced inferior vena cava (IVC) filter retrieval. Recounting how he came to set up a clinic dedicated to removing these filters, he also gives aspiring physician-innovators some words of wisdom.

For more on this story go to page 7.

The Society of Interventional Oncology (SIO) has declared Mayo Clinic (Rochester, USA) the first site approved for enrolment on the society’s primary clinical trial ‘Ablation with Confirmation of Colorectal Liver Metastases (ACCLAIM) Prospective Trial for Microwave Ablation as a Local Cure.’ Constantinos T Sofocleous (Memorial Sloan Kettering Cancer Center, New York, USA) presented background to the trial, as well as its design, to delegates at the recent SIO 2023 annual scientific meeting (19–23 January, Washington DC, USA).

For more on this story go to page 13.

BSIR BUSTS MYTHS AROUND BEING A GIRL IN THE IR “GANG”:

Paula Novelli (University of Pittsburgh Medical Center, Pittsburgh, USA) brought the perspective of ‘the only girl in the gang’—the gang being her interventional radiology (IR) team at Pittsburgh—to the British Society of Interventional Radiology (BSIR) 2022 annual scientific meeting (2–4 November, Glasgow, UK) and its dedicated myth-busting session. “On all levels”, according to Novelli, women are not overinvesting in education, despite the fact that, in the USA, “women practise fewer total hours than men due to significant household responsibilities.”

For more on this story go to page 15.

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