In 1998, the American Cancer Society (ACS) Board of Directors voted to officially add measurably improving quality of life as an objective to our goals of reducing cancer incidence and mortality rates, which were established in previous years. Significantly improving the quality of life of everyone who is touched by cancer, including patients, families, caregivers, and cancer survivors will require a multifaceted approach that includes research, advocacy, community-based programs and services, and public, patient, and professional education.
With this goal in mind, this issue of CA—A Cancer Journal for Clinicians includes two articles on important quality of life topics—management of treatment-related nausea and vomiting and the importance of the clinician, family caregiver, and patient relationship, especially for patients with advanced disease.
Both topics share common threads:
• The impact of these issues on quality of life is often underestimated.
• Some patients and healthcare professionals are unaware of the availability and benefit of appropriate interventions.
• Optimal evaluation and intervention depends on ongoing communication between well-informed clinicians and well-informed patients and their families.
In Nausea, Vomiting, and Retching: Complex Problems in Palliative Care, authors Rhodes and McDaniel note that nausea and vomiting “are the most frequently reported adverse effects of antineoplastic chemotherapy and significantly affect patients' daily functioning, quality of life, and compliance with therapy.”1 The prevalence of nausea and vomiting among patients receiving chemotherapy is about 80%, and is closer to 90% for some highly emetogenic chemotherapy regimens and among patients receiving abdominal radiotherapy.2 This article discusses the pathophysiology, assessment, and management (pharmacological and nonpharmacological) of nausea and vomiting.
For clinicians interested in additional information, we recommend practice guidelines developed by organizations such as the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology. We also suggest that physicians provide Nausea and Vomiting Treatment Guidelines for Patients with Cancer, the “lay-language” version of the NCCN guidelines for their patients. This document was jointly developed by the ACS and the NCCN and is available online at www.nccn.org. Printed copies may also be ordered by calling NCCN (1-888-909-NCCN) or ACS (1-800-ACS-2345).
In Family Support in Advanced Cancer, authors Given, Given, and Kozachik discuss the increasingly critical contributions of the family caregiver in “disease and treatment monitoring, symptom management, medication administration, emotional support, assistance with personal care, and assistance with instrument care,”3 as well as the challenges they face, and the toll this responsibility has taken on patients and their families. The authors point out the need for further research in this area and the importance of information, instruction, and guidance from clinicians.
Clinicians and family caregivers should also realize that organizations such as the ACS can provide additional information, and services, both directly and through referrals to local organizations. They can contact the ACS electronically (www.cancer.org) or by phone (1-800-ACS-2345), or visit their local ACS unit for access to programs and services, such as a visit with a breast cancer survivor from the Reach to Recovery program, the opportunity to meet with other men who have prostate cancer in a Man-To-Man support and information group, and help in finding a drug assistance program.
The ACS also offers information for caregivers with books such as the recently published Caregiving: A Step-by-Step Resource for Caring for the Patient with Cancer at Home—a comprehensive resource for people with cancer and their caregivers that offers concrete suggestions for people with cancer and their family and friends. Specifically, the book contains information about recognizing serious complications and side effects of treatment, about managing cancer-related problems at home, and advice on when to contact the physician. The book takes a step-by-step approach to problem solving, outlining ways to work more effectively with health care professionals and providing an exhaustive list of available resources. Caregiving is available in bookstores and by contacting the ACS at 1-800-ACS-2345 or www.cancer.org.