At the forefront of palliative care
The need for pain relief and comfort often begins the moment a patient learns he or she has cancer.
By Debra Ruder
Janet Abrahm, MD (right), of DFCI shared her warmth and expertise with Muriel Threlfall at Brigham and Women's Hospital before Threlfall's death in January.
What began as a nagging headache during the summer of 2001 had turned out to be a brain tumor, and by this past fall James Cummings-Saxton was facing death. Lying in bed at Brigham and Women's Hospital (BWH) surrounded by flowers and cards, he nodded to Janet Abrahm and John Halporn, both MDs. They bent over the 65-year-old environmental scientist and asked, ever so gently, about what hurt.
"We don't want you to be in pain," Halporn explained. "We're here to make you as comfortable as possible."
Cummings-Saxton's wife, Carolyn — herself a breast cancer survivor — rubbed her husband's feet and helped him communicate. Carolyn was exhausted from months of sadness and strain, and Abrahm wrapped an arm around her in a silent gesture of support.
Scenes like this, which took place in early November, often occur when members of Dana-Farber's palliative-care team are invited to lend their knowledge and touch.
As director of DFCI's Pain and Palliative Care Program, Abrahm works closely with Halporn (of BWH) and others to help improve the quality of life for adult patients with cancer. This cadre of specially trained physicians, nurses, and a pharmacist partners with social workers and chaplains to offer another dimension of expertise to patients, their families, and the oncology team giving treatment. The goal? To help relieve pain and address other physical, psychological, social, and spiritual concerns that may arise.
"Palliative care is an essential component of good cancer care," notes Abrahm. "People should never have to choose between potentially life-prolonging treatment and the best quality of life."
This goes for younger patients as well. A similar service, called the Pediatric Advanced Care Team, helps prevent and soothe symptoms among children with advanced illness at Dana-Farber and Children's Hospital Boston.
In addition to their direct-care roles, both of these growing programs conduct research on death and dying and provide training for caregivers, both within and outside the Harvard community, on this often-shunned but critical topic.
"Palliative care is an essential component of good cancer care. People should never have to choose between potentially life-prolonging treatment and the best quality of life."
— Janet Abrahm, MD
Dana-Farber is in the minority when it comes to delivering such services. According to a recent report by the national Last Acts coalition, only 23 percent of responding hospitals in Massachusetts, and 14 percent in the United States, have palliative-care programs. The Institute is considered a national leader in defining and building this new field, one that rests at the intersection of the art and science of medicine.
"We are seen as a center of excellence in this discipline," says Susan Block, MD, chief of Psychosocial Oncology and Palliative Care in the Department of Medical Oncology at DFCI. "Until recently, we were behind — but everyone was behind. Now we're making major strides. We've launched some innovative and important projects, many of them in collaboration with other Harvard affiliates, that will help raise the standard of care for patients here and nationally."
