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What Are Palliative Care, General Oncology and Integrative Medicine, Anyway?

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fisch_signingFor some reason, I have a track record for working in areas of cancer medicine that are fundamentally patient-centered, difficult to understand based on their labels and challenging to briefly explain. Three examples: palliative care, general oncology and integrative medicine. What do these topic areas mean to you? 

I arrived at M. D. Anderson in November 1999. I had been trained in internal medicine and hematology/oncology, and had spent the first two years of my career as an academic oncologist focusing on the care of genitourinary malignancies. But I had decided to pursue my interests in issues related to symptom management and quality of life, so my job position here was in the Department of Palliative Care and Rehabilitation.

The department was new, and I would be asked by faculty and staff on a frequent basis, "what is palliative care, anyway?" I would babble something about quality of life and helping people live better, but I couldn't explain it coherently before the questioning colleague got off the elevator or veered in a different direction. So I decided to find a succinct definition that I liked, and rehearse and memorize a version of it. Here's what I memorized:

"Palliative care is comprehensive, interdisciplinary care for patients with life-limiting illness, where the focus of care is enhancing quality of life and reducing suffering for the patient and family."

OK, so what's general oncology? It's the ultimate paradox at our institution, which is well known for incredible subspecialty expertise in so many areas. Why would M. D. Anderson want "general oncology?"

On our main campus, general oncologists have a role in the initial evaluation of complex international patients as they're evaluated and cared for in preparation for the appropriate subspecialty, multidisciplinary team. Moreover, they're often called upon to help navigate complex care when multiple specialty teams are involved. General oncologists provide care in our Integrative Medicine Clinic as well.

Our Department of General Oncology leads the medical oncology care at Lyndon B. Johnson General Hospital and at our community-based clinical care centers. Also, general oncologists often lead and participate in patient-oriented research projects and clinical trials that address issues cutting across different diseases, and collaborate on other projects and clinical trials that are led by subspecialists.

Finally, if general oncologists evaluate patients in the Integrative Medicine Clinic, what exactly is integrative medicine? According to the Consortium of Academic Centers in Integrative Medicine, it's "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals and disciplines to achieve optimal health and healing."

To me, that sounds exactly like good medical care -- just the kind of patient-centered care that people expect. The thrust of the care in integrative medicine is tailoring to each individual patient a program that improves his or her health and well-being, above and beyond the disease-focused expert care provided by other care teams.

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