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Early supportive care and palliative care interventions are associated with better outcomes for patients with disease that is otherwise terminal, notes moderator Robert A. Figlin, MD. The type of interventions offered will vary based on an individual patient's disease characteristics, remarks Daniel Heng MD, MPH. Some patients experience less symptomatic disease, and their renal cell carcinoma (RCC) may be managed more as a chronic disease, whereas other patients have very active, progressive disease.
In the case of patients with progressive, symptomatic disease, Heng involves the supportive care and pain/symptom management group early, to help manage pain and other symptoms such as nausea. Brian I. Rini, MD, adds that in his practice, he also involves the palliative care department early, for appropriate patients. For example, patients with RCC who experience disease progression while on their first tyrosine kinase inhibitor tend to have a worse prognosis; these patients may be candidates for referral for palliative care.
Charles A. Henderson, MD, notes that it can be challenging to get patients into palliative care early, as patients may interpret being referred for palliative care as the end of their therapy. Figlin comments that patients may need to be assured that supportive care/palliative care differs from hospice care. Janice P. Dutcher, MD, adds that many palliative care groups do not provide care to patients undergoing active treatment.
Figlin presents a hypothetical patient case of a 65 year-old male with a history of metastatic kidney cancer who presents nine years later with lung nodules. Heng remarks that when an individual with a history of RCC presents with lung nodules, it can be difficult to determine the specific pathology without obtaining a biopsy. It is likely to be kidney cancer if the individual’s lung nodules occurred 3 months after their original diagnosis of RCC, and Heng would likely not biopsy such patients. However, for individuals who develop lung nodules after a longer disease-free interval, Heng recommends biopsy to rule out other pathology (eg, lung cancer). If the nodule is a solitary lesion that can be surgically removed, Heng considers surgery, as this may offer a chance at long-term remission