Treating the Person, Not Just the Patient

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Treating people with cancer is about more than just fighting the disease itself. At the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, a team of psychologists, psychiatrists, social workers, dieticians, and patient navigators work together to address the many other needs that come with a cancer diagnosis.

Clinical psychologist Timothy Pearman, PhD, serves as director of the Lurie Cancer Center’s Supportive Oncology Program. He’ll be a panelist at the center’s upcoming Lynn Sage Breast Cancer Town Hall Meeting on Sunday October 2nd, which will cover the latest in breast cancer research, treatment and support. Science in Society spoke with Pearman about the importance of supportive oncology, and what to expect from the upcoming event.

Timothy Pearman, PhDTimothy Pearman, PhDThere are many other challenges that come with cancer beyond the disease itself. What are some of these, and how does your group help patients through them?
A lot of these issues, which may be either disease related or treatment related, tend to revolve around emotional support. We know that anywhere from thirty to fifty percent of our patients will be clinically depressed or experience clinical anxiety at some point during their treatment. So a lot of our supportive oncology services focus on that.

[There are also] a lot of instrumental needs that can affect treatment, things like basic financial needs—people losing their jobs, losing insurance coverage, [and] needing to go on disability—childcare, transportation, and [so on]. We have patient navigators that work within our program to help people overcome those things.

Some of the treatment sides of the illness can impact nutritional intake, so we have dieticians on staff as well. There is also a fertility preservation piece within the program.

When facing a new cancer diagnosis, things like psychological support and fertility preservation aren’t always at the forefront of a person’s mind. How do you make sure that new patients are aware of the services you offer, and their importance?
We try to do this in a few ways. Once a month we have a meeting called Cancer Connections. Patients and family members are invited, and we also include community partners, places like Gilda’s Club and the American Cancer Society. We talk about all of the support services that are available, both here at Northwestern and in the community, for our patients.

We also have a New Patient Orientation Program, which actually just started a few months back. We have them twice a month—one at Northwestern’s Prentice [Women’s Hospital] and one at Galter [Pavilion]. A big part of these programs is orienting people to the full range of services that are available here. That includes not only the Lurie Cancer Center’s services, but also services like the Cancer Rehabilitation Program (in cooperation with the Rehabilitation Institute of Chicago) and Northwestern Integrative Medicine, which offers complementary medicine services like acupuncture and massage.

Finally, the members of a patient’s healthcare team are often the first to recognize that a patient needs help, and they can help make the connection.

Is the Supportive Oncology Program unique to Northwestern, or are there other programs like this around the country?
They’re becoming more popular. The one that we have at the Lurie Cancer Center is really unique in terms of how broad and comprehensive it is. It’s really hard to find supportive oncology programs outside of academic health centers.

Why is this?
It’s partly because the field of oncopsychology is only about twenty years old. Prior to the mid 1980s, there was no research to suggest that there was a need for these programs—we just didn’t know. [When] the hospice movement started in the late 1960s/early 1970s, that was the first time people saw clinically that there was a real benefit to providing for emotional needs as well as just physical needs.

Then, in the 1970s and 1980s, the survival statistics finally started to turn around in cancer. Before, cancer really had been viewed as a kind of death sentence. When that finally started to turn around, and we had a good proportion of survivors—[patients] who had survived for five years or longer—then people started realizing that there were all of these lingering aftereffects. That’s when the research really popped up [on] what we can actually do to help, and what actually works and what doesn’t work.

I think that’s why these programs have remained in academic centers. But still to this day, if you look at the [supportive oncology] programs [in most academic centers], what you’ll end up finding is a couple of social workers, maybe a psychologist and maybe a psychiatrist. That will be the sum total of the whole program. So we’re [very] lucky here. Northwestern is just a great environment for this, and the Lurie Cancer Center really buys into the idea that you need to care for the whole person, not just the cancer patient.

In addition to being director of the program, you are also a clinical psychologist. What are some of issues that you address most often with patients who are fighting cancer?
A lot of people living in major metropolitan areas come from underserved communities. They tend to experience a really immediate financial impact from their cancer diagnosis. The trickle down of that, when you can’t work and you’re having trouble paying your bills, [is that] there can be some real emotional issues, and then family function starts to be a problem. People lose self-esteem [and] they start to have problems with depression, anxiety, sleep, and appetite—those kinds of things. So I think it’s a linear process for a lot of people: what starts out as a strictly medical problem can turn very rapidly into a functional problem, a support-system problem, with a lot of psychological and psychiatric problems as well.

Have insurance providers caught up to these supportive oncology needs?
It depends very much on the specialty. Psychology and psychiatry—yes. As long as people have adequate medical insurance, generally some degree of behavioral health coverage will be afforded. But dieticians—no. It’s impossible to get reimbursed unless you have diabetes. That’s the really nice thing about being in a place like Northwestern. Despite the fact that insurance may not cover [dietetic services], Northwestern has bought into the idea that patients just need it as a core service, so we can often provide it to patients for free. Social services are somewhere in between—some of the things that social workers do are covered, but a lot of [them], again, [are] provided free of charge.

You’ll be a panelist at the Lynn Sage Breast Cancer Town Hall Meeting on Sunday October 2nd. What can people expect to learn from the event?
The biggest questions people come with are treatment related—[they want to know about] the latest innovations. I think the panel members will be great for answering [those questions], because every one of them truly specializes in breast cancer—both treatment and research.

There are so many clinical trials that are only available at an academic medical center like Northwestern, some of which are open to people even if they get treated elsewhere. I think people will get a good sense of what the state of the science is in terms of breast cancer research—that’s the second biggest thing. They can also learn about cancer genetics, fertility preservation, visit exhibits, and learn about local and national support services that are available to people with breast cancer.

The Lynn Sage Breast Cancer Town Hall Meeting will take place on Sunday October 2nd from 1:00 PM to 4:00 PM. Exhibits and walk-in registration open at noon. The interactive discussion is free and open to the public. Visit the Lurie Cancer Center website for more information.

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