When to Ask for Help

Talking about symptoms is first step in treating them

Larry Stone joined a clinical trial in fall 2009 to test a medication that offered the possibility of prolonging the effectiveness of the hormone therapy he was taking to stave off prostate cancer.

When he started to experience mild numbness in his hands and feet later that spring, he didn't think too much about it. But by June, pain and swelling sent him to the hospital overnight.

His hospital stay relieved his pain somewhat, but it prompted him to ask his oncology team a question: "Is there a specialist I can see?"

That simple question triggered a referral to the University of Michigan Rogel Cancer Center's Symptom Management and Supportive Care Clinic. Stone met with Susan Urba, M.D., and Suzette Walker, F.N.P.-A.O.C.N.P. -- the clinic's leaders -- as well as pharmacist Emily Mackler, Pharm.D. Together, the team mapped out a program to reduce Stone's discomfort.

"That was the start of a great relationship," Stone said.

All too often, people who live with cancer suffer with symptoms that could be eased with aggressive management, Urba said. The reasons for this vary.

Some people are naturally inclined to downplay how sick they are feeling, particularly in front of family members whom they're trying to protect emotionally, Urba said. Other times, patients downplay new symptoms because they are afraid it means the cancer has returned or is growing. Some patients may fear that reporting symptoms will delay treatment.

And in some cases, the reason may be even plainer: People don't realize there are options to ease their symptoms.

"The only way to know what's normal and what's not is to speak up and let the doctor or nurse help you sort that out," Urba said. "A recent study showed that people didn't tell their doctors that they were experiencing fatigue. They thought there wasn't much that could be done about it, so why bring it up? But, in fact, there are options for treating fatigue."

For some symptoms, many interventions exist, but it may take time to figure out which one works best for the individual. For example, with fatigue, altering medications may be helpful in some situations, while working with a physical therapist or taking a gentle yoga class may work for others. Clinicians who work with the Symptom Management and Supportive Care Program specialize in helping patients find the right solutions for them.

Patients should always discuss all symptoms with their oncology team first. But it can often be difficult to address numerous symptoms during a routine visit to the oncologist, since there's already a lot to discuss regarding the cancer and its treatment. One of the benefits of visiting the Symptom Management and Supportive Care Clinic is having dedicated time to sort through the often complex issues surrounding symptoms, Walker said.

"Many physicians are glad to collaborate with us in managing patients' symptoms, particularly if the symptom is resistant to initial interventions," Walker said. "Sometimes, they may not realize how badly a patient is feeling."

In addition, the clinic partners with other subspecialties that can help manage symptoms, such as the Pain Clinic and Physical Therapy. This means the team can cut through red tape to get a consultation scheduled immediately.

For Stone, visiting the Symptom Management and Supportive Care Clinic has helped him regain the use of his hands. He's back to his longtime passion -- playing the guitar.

"Dr. Urba and Suzette and Emily are very attentive to detail as well as conscientious and caring," Stone said. "I'm so glad I got that referral."

Read the Fall, 2011 issue of Thrive.

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