#StrengthAndStyle: From the Physician’s Perspective
WE Can Make a Difference
If you have been keeping up with some of my recent posts, you probably know I am currently running as a candidate in the Leukemia & Lymphoma Society’s Woman of the Year Campaign! As part of my efforts to raise awareness with #StrengthAndStlye, I am dedicating this blog series to featuring cancer survivors, their families, and anyone else who has had an experience, directly or indirectly, with blood cancer. My goal is to cover this difficult topic from a wide variety of perspectives in order to educate, empower, and reach as many people as possible. The more conversations we can start, the more awareness we can raise, and the more lives we can save!
This particular post addresses blood cancer from the perspective of a physician. Meet Dr. Thomas LeBlanc, an oncologist, palliative care physician, and blood cancer specialist at Duke University Medical Center.
Dr. LeBlanc’s current research explores the experience of patients living with acute myeloid leukemia (AML) and how developing targeted interventions, such as the integration of specialist palliative care services into a patent’s comprehensive cancer care regime, may improve the quality of life for those living with blood cancer. He was kind enough to answer a few questions that I had on blood cancer, palliative care, and current research developments.
“Cancer changes people, and it does so in some very profound ways.”
AL: Can you tell me a little about yourself and your career as an oncologist specializing in blood cancer?
TL: Being a physician has been a life-long dream for me. I’ve always wanted to do something that allows me to use my skills to give something back to the community, and to those in need. Though I always imagined medicine would be rewarding, caring for patients with cancer has been an even more amazing experience than I ever expected. Cancer changes people, and it does so in some very profound ways. I couldn’t imagine a more special group of patients! They teach me so much about life, and about what’s truly important. Although I work very hard to help them, I sometimes feel like I get back even more in return. I couldn’t imagine a more rewarding line of work.
AL: Was there anything in particular that drove you to choose blood cancer as a specialty? TL: Some of my most enjoyable moments in medicine have involved caring for patients and families dealing with a blood cancer diagnosis. Blood cancers encompass an incredibly diverse array of diseases, and they impact patients of all ages. Some are readily curable, while others are not, but nearly all are treatable. In other words, even when I cannot cure the disease, there is always something I can do to help a patient. It’s an incredibly gratifying feeling to look at a patient’s blood or bone marrow and to instantly know what’s wrong with them, and then prescribe a treatment that helps them get better! I’m especially interested, however, in cases where we cannot cure, as this is an area where we have so much more to learn. This is the focus of my research.
“Even when I cannot cure the disease, there is always something I can do to help a patient.”
AL: What is palliative care, and why do you believe this approach is important for your blood cancer patients?
TL: Palliative care is a type of specialized medical care for patients with serious illness. It focuses on helping patients live well despite their diagnosis, by addressing bothersome symptoms, improving quality of life, and helping them navigate the complex health care system, to ensure that their treatments are matched well to their personal goals, values and preferences. Palliative care can be provided alongside cancer treatments, or other disease treatments, and at any stage of illness, and regardless of treatment goals. Experts in palliative care have special expertise in communication, symptom management, pain relief, and end-of-life care, among other things. Palliative care is a relatively new medical specialty, so many patients are not aware of it, and some physicians misunderstand it.
I did an additional year of training in palliative care, and am board-certified in this specialty, so I have seen its many benefits firsthand. When added to high-quality cancer care, evidence suggests that palliative care improves quality of life, helps patients cope with their illness, and perhaps even helps them live longer! I therefore strongly believe that all patients with cancer should have access to palliative care. Unfortunately, patients with blood cancers are less likely to access palliative care than patients with other cancer types.
AL: What is your current theory on why patients with blood cancers are less likely to access palliative care than patients with other cancer types?
SN: This is something I’m currently studying in a few ways. The short answer is that we really don’t know. Having talked with several blood cancer specialists around the country about this issue though, I can say that there are many misconceptions about what palliative care is, and this probably precludes many referrals. Many physicians still think of palliative care as just end-of-life care, or think it’s just another word for hospice. In 2014, nothing could be farther from the truth. There are also many fears about how patients will react to the mention of palliative care. Interestingly, public opinion polling suggests that most patients don’t actually even know the word, nor what it means, yet many physicians assume that mentioning the “p-word” will make it seem like they’re giving up on the patient. Educational efforts to get physicians more up to speed on palliative care are sorely needed, along with training and suggestions for physicians about how to introduce it to patients in a way that’s complementary to their cancer care.
AL: What is acute myeloid leukemia (AML) and how is it different from other forms of leukemia?
TL: The so-called “acute” leukemias are serious, fast-growing, life-threatening blood cancers that require rapid diagnosis and aggressive treatment. They are different from the “chronic leukemias,” which may be more slow-growing, may not always require treatment, and may not cause symptoms, at least not usually in early phases of the disease, which can go on for years. AML is the most common type of acute leukemia in older patients. Although it can sometimes be cured, our treatments are very aggressive and can be fatal in themselves, and some patients have very high risk disease that we remain poorly-equipped to treat despite our best efforts.
AL: Can you tell me about your research on understanding the experience of patients with AML and the goals of the project?
TL: My research seeks to better understand the experience of patients living with AML. Although we know a great deal about the biology of AML, we actually know very little about the patient experience of going through treatment, nor about how they work together with their physicians to make decisions about treatment. Important questions to answer include the following: What symptoms are most common for patients receiving aggressive chemotherapy in the hospital? What happens to patients’ quality of life over time, and what things make it better or worse? What causes the most distress for patients living with AML? My research seeks to answer these questions, and I hope it will lead towards more targeted interventions to better address the issues that bother patients the most. I also hope it will help us to better understand why patients with blood cancers are less likely to have access to palliative care, and to inform ways for us to work together to provide palliative care to this population alongside their cancer treatments.
AL: What is currently occurring in research and treatment for blood cancers in general?
TL: On one hand, this is a VERY exciting time in the history of blood cancer treatment. Several new, targeted treatments have become available in recent years. These new treatments are much more like “smart bombs,” more effectively targeting the cancer cells themselves, with fewer side effects compared to more traditional chemotherapy. Very exciting new treatments were just approved for chronic lymphocytic leukemia (CLL), a common type of leukemia in older patients. There are also many new treatments available for other blood cancers, including multiple myeloma, and many types of lymphomas. This has significantly improved our ability to help patients live longer and better with these diseases. On the other hand, we still have a long way to go. Many blood cancers remain incurable, and not much has changed in over 30 years in the management of acute myeloid leukemia (AML). In fact, today we still use the same main treatment regimen that was being used in 1974! There remains an enormous need for research in this area.
“So many of us have dedicated our lives to helping patients like you, and we’re there to help.”
AL: What advice would you give to anyone living with cancer?
TL: First, know that you’re not alone! So many of us have dedicated our lives to helping patients like you, and we’re there to help. Don’t be afraid to ask questions, and make sure you understand your options. Don’t be afraid to ask (politely) for a second opinion for peace of mind, and make sure you understand the goal of your treatment (is it cure, or comfort, or longevity, or some combination?). And make sure to ask about palliative care! You can receive palliative care even if you’re also receiving cancer treatment.
Also, no matter what the “stage” of your cancer may be, make sure to think about what you would do if things got worse. Just as importantly, talk with your family about your wishes, so that everyone is on the same page if something catastrophic happens (where you’re unable to make decisions for yourself). I’ve seen far too many patients end up in awful situations that they never would have wanted, just because they thought it was too difficult to talk about these possibilities with their family. In cases like this, a loving family member may push for aggressive care at the end of life because they’re afraid of losing you, or because they don’t know what you would have wanted. They also won’t want to bear the burden of feeling like they made a life or death decision on your behalf. The truly loving, yet difficult, thing to do is to talk openly and honestly about ALL possibilities when facing cancer, including not only the cure that we all hope for, but also what you would want if things don’t go as well as we all hope.[divider] [/divider]
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