Models of supportive care in oncology

Abstract

Purpose of review: Supportive care services have evolved overtime to meet the growing supportive care need of patients with cancer and their families. In this review, we summarize existing definitions of supportive care, highlight empiric studies on supportive care delivery, and propose an integrated conceptual framework on supportive cancer care.

Recent findings: Supportive care aims at addressing the patients' physical, emotional, social, spiritual, and informational needs throughout the disease trajectory. Interdisciplinary teams are needed to deliver multidimensional care. Oncology teams have an important role providing supportive care in the front lines and referring patients to supportive care services such as palliative care, social work, rehabilitation, psycho-oncology, and integrative medicine. However, the current model of as needed referral and siloed departments can lead to heterogeneous access and fragmented care. To overcome these challenges, we propose a conceptual model in which supportive care services are organized under one department with a unified approach to patient care, program development, and research. Key features of this model include universal referral, systematic screening, tailored specialist involvement, streamlined care, collaborative teamwork, and enhanced outcomes.

Summary: Further research is needed to develop and test innovative supportive care models that can improve patient outcomes.

Figure 1.. Supportive Care Needs and Supportive Care Services throughout the cancer trajectory.

A vast majority of patients have multiple supportive care needs starting around the time of cancer diagnosis (blue horizontal shapes). These supportive care needs may vary along the disease trajectory and among patients. To address the supportive care needs of patients and their families, multiple specialized supportive care services have been developed. Examples of these services such as palliative care, cancer pain clinic, psycho-oncology teams and treatment support services are depicted here with colored cylinders. Of note, palliative care has evolved over the past decade from predominantly caring for patients at the end-of-life to earlier in the disease trajectory.

Figure 2.. Conceptual Model for Supportive Care.

(A) Siloed Supportive Care Model. Currently, patients are mostly dependent on the oncology team to make referrals to various supportive care departments/services on an as needed basis, resulting in heterogenous access to specialized supportive care and fragmented care. Note that only several examples of supportive care services are shown here and the list is not meant to be exclusive. The key concerns are shown in the bottom half leading to suboptimal outcomes. (B) Integrated Supportive Care Model. This unifying framework may overcome some of the issues in the Siloed Model. Longitudinal specialist supportive care is provided by an interdisciplinary supportive/palliative care team, with timely involvement of other teams (e.g. cancer pain service, rehabilitation) when the need arise. For patients who have completed curative treatments on surveillance, the survivorship team may be the main supportive care service instead of the supportive/palliative care team. Key features of this model include universal referral, systematic supportive care needs screening, tailored specialist involvement, streamlined care, collaborative teamwork and extended followup.