"Why Do Oncologists Need This New Journal"
A L E T T E R F R O M T H E E D I T O R Why do oncologists need this new journal? P erhaps the simplest and most straightforward answer is that most oncology journals are focused on curative therapies primarily, with relatively few pages available for discussion of the essential supportive care measures for best patient management. Our understanding of the pathophysiology of treatment- and cancer-related symptoms is expanding, and with this knowledge comes the potential to improve the quality of life for patients with cancer and the quality of care we can provide. Unfortunately, the cure/care dichotomy remains, and supportive therapies are not fully integrated into oncologic care. Despite major advances in cancer biology and therapeutics, can- cer and its treatment continue to cause devastating suffering, not only for the many patients who will die from their illness but also for those who are successfully treated. Patients with advanced cancer most often experience multiple physical and psychological symptoms concurrently. Symptom prevalence data from a number of studies identify pain, fatigue, anorexia, loss of physical functioning, reduced overall health, and quality of life and mood changes as major con- cerns for patients in palliative or end-of-life care settings. These find- ings are fairly consistent across multiple studies. While patients in an ambulatory setting may be expected to have fewer symptoms, routine screening identifies an average of 7 to 10 distressing physical and psychological symptoms per patient. Not surprisingly, the severity of the symptoms in ambulatory patients is not as great as those in end-of-life care settings, though certainly those patients receiving active treatment experience symptoms not only due to their illness but due to their treatment as well. These treatment- and cancer-related symptoms have been associated with functional impairments and reduced quality of life, and may lead to patient refusal of further—even potentially curative—therapy. The recommendations of the Institute of Medicine and the Na- tional Cancer Policy Board call for the integration of palliative care for relief of suffering into the continuum of care for all patients with cancer. While palliative care has traditionally been focused on the last days of life, there is increasing evidence that the application of palliative care practices earlier in the trajectory of illness results in improved long-term control of pain and other symptoms. Compre- hensive, cure-oriented cancer care must incorporate treatment in- terventions that effectively manage symptoms and improve quality of life. Optimal symptom control and supportive care are best VOLUME 1, NUMBER 1 ■ MAY/JUNE 2003 www.SupportiveOncology.net 7 A Letter from the Editor achieved when they are incorporated from the time of diagnosis and throughout the course of illness, whether or not the underlying can- cer is curable. On many levels, the everyday practice of oncology has integrated symptom management effectively. For example, who would prescribe platinum-based therapy without appropriate antiemetics? Prophy- laxis for infection and cytopenias are standard prescriptions for pa- tients undergoing high-dose chemotherapy. Bisphosphonates are routinely prescribed for women with metastatic breast cancer and osteolytic bone lesions to prevent fractures and decrease skeletal metastases-related pain. Some Encouraging Signs and Some Shortcomings It is encouraging that research and knowledge, particularly in the area of treatment-related symptoms, have received increasing atten- tion over recent years. Unfortunately, there continues to be a signif- icant proportion of patients who suffer with tumor-related symp- toms that are inadequately assessed and inadequately treated. Pain is perhaps the best-studied example. A significant proportion of patients with advanced cancer continue to suffer with severe pain in spite of the wide availability of the knowledge and methods to pre- vent pain in more than 90% of patients with cancer-related pain. Depression, anxiety, and fatigue also continue to be under-assessed and under-treated. We as a community of professionals are in a position to change this. We interact with patients and their families—from diagnosis through treatment and follow-up, through end-of-life care—and at each point we have the opportunity to ease the suffering, be it phys- ical, emotional, or spiritual, that our patients and their families experience. The Journal of Supportive Oncology will focus on symptom and side- effect management, communication issues, and end-of-life care for patients with cancer. Each issue will present peer-reviewed research articles on symptom management to advance the science, a scientif- ically based article to understand the pathophysiologic mechanism of symptoms, and reviews with peer commentary on supportive on- cology topics. I am excited about the development and future of this journal, and I look forward to your critical commentary and feedback. Jamie Von Roenn, MD Editor-in-Chief 8 www.SupportiveOncology.net THE JOURNAL OF SUPPORTIVE ONCOLOGY