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Enhancing Palliative Care for Patients with Cancer and Heart Failure

A new palliative care service at UVA CARE Track is helping patients with heart failure and advanced cancer better manage their pain and symptoms.

Learn more from Dr. Leslie Blackhall, a UVA expert in palliative care.
Enhancing Palliative Care for Patients with Cancer and Heart Failure
Featured Speaker:
Leslie Blackhall, MD
Dr. Leslie Blackhall is a board-certified specialist in palliative medicine, helping patients manage pain and symptoms caused by serious conditions or intensive treatments.


Transcription:

Melanie Cole (Host):  A new palliative care service at UVA, CARE Track, is helping patients with heart failure and advanced cancer, better manage their pain and symptoms. My guest today is Dr. Leslie Blackhall. She is a board certified specialist in palliative medicine, helping patients manage pain and symptoms caused by serious conditions or intensive treatments. Welcome to the show, Dr. Blackhall. I'd like to start by having you explain the difference between palliative care and hospice care. People hear palliative and they think end of life care.

Dr. Leslie Blackhall (Guest):  Thanks so much for having me on. I am delighted to be able to talk to you about that. I have been working at UVA with palliative care since 2001 and since that time, we have been there in the Cancer Center--now the Emily Couric Clinical Cancer Center--and our job there is to help people with cancer in that setting at any stage of their illness, including people who are cured of cancer but still have problems. Sometimes even after you finish your treatment, you’ll have on-going symptoms like pain or nerve damage in your feet, fatigue or mood problems that are related to the cancer or treatment of the cancer. So, for palliative care, our job is to help people with those kinds of symptoms, whether they are caused by a cancer that is now cured or cancer undergoing curative therapy or a cancer undergoing treatment, the purpose of which is to prolong life that is unlikely to completely cure the cancer. Really the difference is that hospice care is done for people who are terminally ill, expected to not live for six months and they have their symptoms taken care of. In palliative care, folks like me felt like that type of care, why should only be reserved for patients who are likely to die of their cancer? Why can't all of us who have those kinds of serious illnesses get that kind of treatment, really directed at improving quality of life, and by that I mean function—the ability to lead a normal life while you are undergoing these treatments.

Melanie:  Do you still see your regular internist or oncologist or cardiologist while you are involved in palliative care?

Dr. Blackhall:  Absolutely. One of the things I really loved about working in the Cancer Center, and now, with the cardiologists, is the ability to work as a part of the team. If you are undergoing chemotherapy, if you are getting treated for a serious heart condition, you want your oncologist or your cardiologist to be focused on treating that underlying illness but there is need to also be somebody who focuses on treating things that are either side effects of treatment such as chemotherapy related nausea or fatigue or other side effects of treatment and so you need both of those. It’s really a team effort within an illness as serious as this. This is something I think we have known about for oncology for a long time but, it’s really a breakthrough if we think about cardiology in the same way. I think as we have treatments that may not completely cure an illness but prolong peoples’ lives for a long time, we have to be really aware of how much we want that life to be one that’s as normal as possible, so people can continue to live in a normal way and enjoy every moment.

Melanie:  I understand that UVA now offers a program called CARE Track. How does it work? Tell us a little bit about it.

Dr. Blackhall:  Sure. I think many years ago--maybe twenty year ago--I was at something called Cancer Care Initiative that was a nationwide effort to improve the care of people with cancer and to improve their pain control specifically, which can be very difficult. I remember commenting to one of the people at this meeting that we would probably paying more attention to pain if we have like a blood test, that told people what your pain level was because that is the sort of documentation that the doctors tend to pay attention to. The CARE Track Program actually came as the idea that sort of idea that if you look in someone's medical chart, what you see is what their blood counts are, what their kidney function is, a lot of numbers related to their care. But until the CARE Track Program, we didn't really have a good way to keep track in the same visible way of how the patient is feeling, their ability to get up and around, their ability to function due to pain, their fatigue, their shortness of breath. So, in 2012, Dr. Paul Read and myself along with our colleagues, Jim Harrison and George Stukenborg, got a large national grant to develop a program that would track patient symptoms using a specific type of questionnaire that’s built into medical record so that every time patient comes, they answer these sets of questions and there is a trigger that goes off in the electronic medical record for people who are starting to struggle. Are getting fatigued that they’re having trouble with getting up and out of bed? Are they having so much pain that they find it difficult to interact? Are they incredibly anxious? And when that trigger goes off, it alerts a whole group of supportive care specialists, physicians, social workers and dieticians and folks like that to help come and deal with those symptoms in the same emergent way you would have if somebody’s white blood cell count went way down or their kidney function became threatened. So, CARE Track Program stands for “Comprehensive Assessment with Rapid Evaluation and treatment. So meaning, we don't wait until someone is so ill that they end up in hospital. We try to get to them as quickly as we can prior to that point and support those types of symptoms because what we do know is that those things tend to make people end up in the emergency room. Our program has shown a lot of success at the Cancer Center in keeping people out of the hospital and in getting them to feel better. So, we have now expanded that into another group of patients which is people with advanced heart failure.

Melanie:  So, that was going to be my next question. Which patient is CARE Track designed to help?

Dr. Blackhall:  It started off for people with very advanced cancers and that’s from 2012 until this July. Those are the folks that we reached. Then starting in July, we got another award called the “Buchanan Award” at University of Virginia because of the success of this program to extend it into cardiology. So, there an advanced heart failure clinic at University of Virginia with Drs. James Burgin and Jamie Kennedy and they’ve expressed interest in having this type of program to help support the seriously ill people in their unit, who also suffered from pain, problems with functioning, getting up and about and the fatigue, and shortness of breath often. So, we are developing for the heart failure clinic, a similar group of palliative and supportive care specialists, who will be there to help support those patients and have their symptoms taken seriously as we work side by side with our cardiology colleagues as well.

Melanie:  What a wonderful program. I certainly applaud your work. In just the last few minutes, Dr. Blackhall, please give the listeners your best advice, what you want them to know about pain management, palliative care and the care track program that you've developed and why patients should come to UVA for the palliative care.

Dr. Blackhall:  I think it’s important that people know that palliative care is about taking good care of people. Studies have shown the patients with cancer who have followed in a coordinated way by palliative care specialists and oncologists not only feel better, they actually live longer because part of taking extra care of patients is taking care of the whole patient, not just the tumour but all of them. Similarly, I think people with serious illnesses like heart failure need that same type of team based coordinated care. There not that many places that have dedicated so many resources to helping our patients in this way and I just want to say I feel incredibly grateful to be working at an institution which had the foresight to allow us to develop this sort of coordinated care program where there is a team-based approach to help all patients feel their best, no matter how seriously ill they are.

Melanie:  Thank you so much for such great information. You are listening to UVA Health Systems Radio and for more information you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole and thanks so much for listening.