The way patients and their physicians work together when battling cancer is instrumental for patient treatment. Helping patients to navigate their cancer, and treatment-related symptoms, is the focus of research conducted by Alla Sikorskii’s, Ph.D., M.S., faculty in Psychiatry at Michigan State University College of Osteopathic Medicine (MSUCOM).
As part of a National Institutes of Health (NIH) Award, Sikorskii serves as a Multiple Principal Investigator with colleague Terry Badger at the University of Arizona, evaluating “the efficacy of an automated telephone symptom management (ATSM) intervention, supplemented with a telephone-based interpersonal counseling (TIPC) intervention, to reduce distress and immune-related adverse events in cancer survivors receiving immune checkpoint inhibitors (ICIs).”
Sikorskii said ICIs by themselves or in combination with other therapies have great success when treating different types of cancer. However, patients experience many symptoms during treatment. Some can be self-managed, but symptoms that may be sentinel to immune-related adverse events need to be brought to the attention of a health care provider. Often physicians may prescribe medications that would allow the patient to continue with their immunotherapy. “It’s important to ensure treatment is going as well as planned and not interrupted,” Sikorskii explained.
Working with cancer survivors – people from cancer diagnosis to the end of life – Sikorskii’s research is focused on how to help patients recognize symptom early and talk and work with their doctor or nurse. “Many times, patients are concerned that if they bring the information to their doctor, the physician will stop treatment, and patients don’t want their cancer treatment to be compromised. During immunotherapy treatment, it is integral that patients are sharing information about their symptoms with their physicians,” Sikorskii said.
“This project tests a highly scalable automated intervention for managing symptoms during immunotherapy, adding a counseling intervention for survivors in need with high psychological distress,” Sikorskii’s project narrative describes. Determining what supportive intervention patients need early in their cancer treatment, and when and how to provide additional support throughout the treatment, ensures they’re receiving the planned cancer treatment, Sikorskii said.
The research is not limited to one specific type of cancer and takes into consideration various medications and treatments for cancer. Multiple symptoms – pain, fatigue, nausea and many more – can be triggered by cancer or its treatments, including chemotherapy and radiation, or other diseases that a person has in addition to cancer.
To bring this into perspective, consider a cancer survivor going through treatment who could also have another disease, such as arthritis. Joint pain that cancer survivor is experiencing may be due to arthritis or cancer treatment. Determining the cause of symptoms is impossible, but the doctor and patient can work together to find the best avenue to manage pain, Sikorskii explained.
Fatigue is another problem that is often debilitating for cancer patients, along with sleep disturbance. Physicians can help patients manage some of these issues, but often self-management by patients is key. Some self-management treatments are simple and common, such as drink fluid to stay hydrated, manage diarrhea and constipation. Other self-management approaches may not be something people think about. Telling patients not to eat their favorite foods on the day of treatment is one such approach, because the body may learn to associate that food with nausea. Patients can develop a dislike for that food and for patients who may already have little appetite, that is a great loss.
Mild to moderate exercise is another symptom self-management approach. It can help with fatigue and sleep problems. Other common problems during cancer treatment include depression or anxiety. Some people may have been diagnosed with these disorders in the past, and for some, these problems arise during cancer diagnosis and treatment. Managing these multiple symptoms can help these patients maintain quality of life, which is especially important because cancer treatment could last for years.
It's a lot to work through while treating cancer, Sikorskii admits, and it’s the reason why she is doing this research. Immunotherapy treatment for cancer is designed to drive the immune system to attack the tumor, but other problems could appear or become exacerbated since the body’s immune system is “all in” attacking the cancer. It is difficult to predict which other organs in the body would be affected by immunotherapy, and it is important that patients keep track of their symptoms, self-manage them when possible, and communicate with the health care provider to avoid interruptions in treatment due to immune-related adverse events, she said.
“We need to find the best way to implement this,” Sikorskii says. “How we move this to the real world is our next step.”