Cancer care today is markedly different than what it was before the COVID pandemic. Some changes in cancer care, from lower numbers of screening tests like mammograms through alterations in how treatments including surgery, chemotherapy, and radiation are done, garner a good deal of attention in news and social media. Changes to supportive care, a mainstay of cancer care, are less talked about. That gap in attention is probably because the concept of supportive care is less well known and less understood.
Cancer care, broadly speaking, is composed of two main types of care. Cancer diagnosis and treatment – the biomedical part – is what comes to mind when most of us think ‘cancer care’. We are thinking about the biomedical care needed to cure or control cancer. Critically, however, the biomedical aspect of cancer care cannot occur without supportive care.
Supportive cancer care influences the lives of millions of people in the United States and many more around the world, often living decades with and after cancer. Simply said, supportive care in cancer is everything in cancer care beyond screening, diagnosis, and treatment. It includes all the people on the cancer care team who make it possible for the physicians, surgeons, nurses, and technicians who do the screening, diagnosis, and treatment to do what they do. Supportive care also encompasses all of the education, counseling, therapies, and other measures to help people living with and after cancer, and the people who love, support, and care for them including their caregivers, in their daily lives. Social workers, nurses, dietitians, psychologists, physical therapists, and chaplains are among the more familiar professionals who provide supportive cancer care. Many more professionals, like financial counselors and speech-language pathologists, make up the interdisciplinary supportive care team in most cancer centers.
Supportive care helps individuals and families manage during cancer treatment and then continues to help address what matters to them after cancer treatment ends. Aims of supportive care direct efforts of the interdisciplinary team to help people live as long and as well as possible during treatment and after their cancers are cured or controlled. Supportive care also helps people live as comfortably and as well as they can when end of life care becomes necessary. Palliative care – those measures aimed at improving physical, emotional, and spiritual comfort for people living with serious illnesses like cancer – is often placed under the umbrella of supportive care. Palliative care provides vital relief and guidance to people along with their family and friends throughout the cancer experience from diagnosis through long-term survival and at the end of life.
Supportive cancer care, like all healthcare, turned on a dime as COVID swept through much of the world in the middle of March. Cancer care professionals’ and administrators’ herculean efforts resulted in a rapid transformation over a very short period of time. Before the pandemic, patients, their loved ones, and cancer care professionals typically met face-to-face. Now, appointments for supportive care are more often virtual, using video conference platforms like BlueJeans, Telehealth applications like DoxyMe, or just the good old telephone. Many of the changes COVID generated in supportive cancer care are surprising people living with cancer and the professionals who provide their care with unexpected benefits. However, expected as well as unanticipated challenges mean others are contending with disadvantages. Now the pressure is on to maximize benefits and resolve challenges to ensure everyone involved shares this potential silver lining in the COVID pandemic.
In post-COVID cancer care, where and when supportive care happens is a mix of what is needed and where it can safely occur. Now, more often people living with and after cancer and their family caregivers are able to capitalize on the option of Telehealth appointments. It turns out, too, that this virtual way of delivering supportive care may be more illuminating for cancer care professionals. Ensuring optimal cancer care, overall, requires exploring just how providing and receiving supportive care, virtually and face-to-face, affects perceptions, experiences, and effects of that care.
For example, before COVID, nurses provided education about chemotherapy and advice on how to manage side effects in face-to-face appointments, typically while they administered the treatment. Now, those same nurses may offer that education in the same way that they did before COVID. They also have an option, often welcomed by people receiving that treatment as well their caregivers, to offer both preparatory and follow up guidance in Telehealth visits.
Similarly, cancer dietitians – who would have met patients and family members in person – are now often using videoconference platforms. Telehealth means they are meeting people in their own kitchens which may help them talk about specific ways to make diet changes diets and prepare nutritionist meals.