Yale Cancer Answers_Palliative Care_DK_March 2022

Transcript

• 00:00Funding for Yale Cancer Answers is
• 00:02provided by Smilow Cancer Hospital.
• 00:06Welcome to Yale Cancer answers with
• 00:08your host, Doctor Anish Chappar.
• 00:10Yale Cancer answers features
• 00:12the latest information on cancer
• 00:14care by welcoming oncologists and
• 00:16specialists who are on the forefront
• 00:18of the battle to fight cancer.
• 00:20This week it's a conversation
• 00:22about palliative care with
• 00:23Doctor Dimitri Kochetkov.
• 00:25Dr Kashefi Nikov is an assistant
• 00:26professor at the Yale School of Medicine,
• 00:29where Doctor Chappar is a
• 00:31professor of surgical oncology.
• 00:34So, Dimitri, maybe we can start off
• 00:36by you telling us a little bit more
• 00:38about yourself and what exactly you do.
• 00:40I'm an internist by training in a
• 00:43palliative care physician, and what this
• 00:44means is that after medical school,
• 00:46I chose to specialize in internal medicine,
• 00:49giving me the training to treat a
• 00:52variety of diseases that affect adults.
• 00:54After graduation.
• 00:55Internists can either pursue work in general,
• 00:58medicine in the hospital or
• 01:00primary care practices,
• 01:02or they can continue their
• 01:03training by pursuing a fellowship.
• 01:05And specialties.
• 01:06Some specialties like cardiology,
• 01:08infectious disease and many others.
• 01:11And I was fascinated by the idea of
• 01:14specialty palliative care training,
• 01:15knowing that it would provide me
• 01:17with a unique skill set to help
• 01:19me provide patient centered,
• 01:20compassionate care to patients
• 01:22with serious illness.
• 01:24Palliative care is a type of
• 01:26specialized medical care for people
• 01:27living with a serious illness,
• 01:29and this type of care is focused
• 01:31on providing relief from the
• 01:32symptoms of the illness and also the
• 01:34stresses that come along with it.
• 01:36And the goal really is to
• 01:38help people live better.
• 01:39It's provided by a specially
• 01:41trained team of doctors,
• 01:43nurses and many other specialists
• 01:44who work together with the
• 01:46patient's other doctors to provide
• 01:47an extra layer of support.
• 01:49So, you know, palliative care is one of
• 01:53these things that is a little bit fuzzy,
• 01:56I think, to many people.
• 01:58Some people think of palliative care
• 02:02as Hospice. Some people think of
• 02:06palliative care as pain management.
• 02:08Some people think of palliative
• 02:11care as death panels.
• 02:15And yet palliative care,
• 02:18the way that you've described it just
• 02:22seems more like part of medical practice.
• 02:26So can you help kind of differentiate
• 02:30it from those other things?
• 02:34Absolutely. And I always emphasize
• 02:36that palliative care is really based
• 02:38on the needs of the patient and
• 02:40not the prognosis of the disease.
• 02:43It's appropriate at any age,
• 02:44in any stage of an illness and can be
• 02:47provided alongside curative treatments.
• 02:49Hospice is very different and
• 02:51there's a lot of overlap between
• 02:52palliative care and Hospice,
• 02:54but Hospice is really the benefit
• 02:56of that is additional support for
• 02:58patients who are living with a
• 03:01terminal illness and a prognosis
• 03:03many times of less than six months.
• 03:05So many of our patients in palliative care,
• 03:08especially in our clinic,
• 03:09are undergoing treatment for their
• 03:11cancer for different lengths of time,
• 03:13sometimes many years.
• 03:16And while we see our patients in our clinic,
• 03:18valuative care can also be delivered in
• 03:21multiple other settings like hospitals,
• 03:22nursing homes or even patients homes.
• 03:26And so, so it it seems to
• 03:29be different than Hospice.
• 03:31How is palliative care
• 03:33different from pain management?
• 03:36Yeah, pain management is certainly one
• 03:38of the aspects and domains of medical
• 03:40care that we cover in palliative care.
• 03:43There's so much to be said about
• 03:48physical symptoms that patients undergo
• 03:51and experience with their cancer,
• 03:54but also non physical symptoms like anxiety,
• 03:57depression, insomnia,
• 03:58these are all other things that we
• 04:01screen for when patients come to see us.
• 04:04Pain management is something that.
• 04:06There's a strong focus on in the
• 04:08training and we're really proud
• 04:10of how well we can treat pain,
• 04:12especially given what's going
• 04:14on in the media with opioids.
• 04:17And we know how to do this safely
• 04:19and we put in place many measures
• 04:21to to make sure that patients are
• 04:23getting access to pain treatment
• 04:25for their cancer in a safe way.
• 04:28But it seems like palliative care
• 04:30is more than pain management and
• 04:32it's kind of that extra layer
• 04:35of support that you mentioned.
• 04:37And and working with a team of doctors
• 04:40and nurses and you know often chaplains
• 04:45and pharmacists and social workers
• 04:48and all kinds of people to really.
• 04:51To assess and and help with the needs of
• 04:53the patients in many different domains.
• 04:56Is that right?
• 04:57That's totally right and he's
• 04:59palliative care is way more than just
• 05:01the pain management aspect of it.
• 05:03We we really do a lot for patients
• 05:06from the beginning and starting with
• 05:09basically getting to know who they are
• 05:11as people outside of their medical
• 05:12history and their medical records.
• 05:14So what things like,
• 05:15what is important to them,
• 05:17who is important to them,
• 05:19what are their goals,
• 05:20what are they looking forward to?
• 05:22Because we know that it's only
• 05:24once we learn about these vital
• 05:26aspects of people's lives that we
• 05:28can deliver the best care to them.
• 05:30We also know that multidisciplinary care
• 05:33has been shown to be more effective
• 05:35than when we provide care in silos.
• 05:38So when we work together in a team of
• 05:41people that have different expertise,
• 05:44as we do,
• 05:45and and many other fields have
• 05:47borrowed this as well,
• 05:48we find that we can uncover areas
• 05:51of distress that we may not have
• 05:53found if we just looked at it
• 05:55from one narrow point of view.
• 05:58You know, Dimitri,
• 06:00some may push back and say, you know,
• 06:03you talk about palliative care is
• 06:05providing the best quality of care
• 06:07for patients in a multidisciplinary
• 06:09approach and getting to know the patient
• 06:12beyond their medical diagnosis to kind
• 06:14of take care of the whole patient.
• 06:16But some may push back and say, well,
• 06:17I thought that's what doctors do.
• 06:19I I thought that doctors, you know,
• 06:22are supposed to get to know me as a
• 06:24patient and and treat the whole patient.
• 06:26Why do I need palliative care?
• 06:29Why can't my doctor, uh,
• 06:32who's managing my illness,
• 06:34whatever that illness may be,
• 06:36cancer or anything else,
• 06:37do all of the things that you do?
• 06:41I'm glad you brought that up in ease.
• 06:43And one of the big challenges that we
• 06:44face is that there simply aren't enough
• 06:47palliative care specialists to care for
• 06:49all the patients with serious illness.
• 06:51One study in 2017 highlighted something
• 06:54pretty startling that there's estimated
• 06:571 oncologist for every 140 newly
• 06:59diagnosed cancer patients in the US,
• 07:02but there's only about 1 palliative
• 07:04care physician for every 1200
• 07:06patients with serious illness.
• 07:07So this projected growth
• 07:10also looking forward.
• 07:11It's only about 1% for of palliative
• 07:14care specialists over the next 20 years.
• 07:16So one of the main things and one
• 07:18of the focuses that we have in
• 07:20our work is to teach these skills
• 07:23to our colleagues in other areas
• 07:25of medicine like primary care,
• 07:27critical care,
• 07:28oncology and and other specialties.
• 07:30So they can help us address all
• 07:32of these needs that we as a nation
• 07:34faced with serious illness and the
• 07:36palliative care specialists like us
• 07:38can be called in to help in situations
• 07:41which would benefit from a higher.
• 07:43Level of expertise.
• 07:44So like you said,
• 07:46you know I I encourage everyone to ask
• 07:48whether palliative care is available to you,
• 07:50and if it is,
• 07:51please take advantage of it.
• 07:53If if you aren't sure if it's available,
• 07:54then ask your medical team.
• 07:57And so how do you know if you're a patient?
• 08:00I mean because the way that
• 08:02you describe palliative care,
• 08:03it seems like everybody should want
• 08:05palliative care even if they're,
• 08:06you know, especially not at the
• 08:09end of a terminal illness, right.
• 08:12You mentioned that palliative care
• 08:14is something that can be used in
• 08:16addition to curative approaches,
• 08:18that it kind of takes care
• 08:19of the whole patient,
• 08:20that it looks at what your
• 08:22needs are in various domains.
• 08:23It seems like that should
• 08:25be something that everybody.
• 08:27Should want as part of standard medical care.
• 08:31So how do you know when palliative care
• 08:34is something that you particularly need?
• 08:37Or this higher end palliative care where
• 08:40you need a palliative care specialist?
• 08:44I think that palliative care can
• 08:46be introduced to a patient at
• 08:47any stage of a serious illness,
• 08:49you know, starting at diagnosis.
• 08:51But one of the challenges is trying
• 08:53to figure out when palliative
• 08:56care support is most helpful.
• 08:58And I think the studies that are
• 09:00being done now and and in the
• 09:02future are really kind of trying
• 09:04to figure out the optimal timing
• 09:06of referral to palliative care.
• 09:09So what I would say is that anyone
• 09:11is eligible for palliative care
• 09:13services with a serious illness.
• 09:14From diagnosis throughout any point.
• 09:18But what makes most sense,
• 09:20especially because it's an extra
• 09:21visit and it's an extra team.
• 09:23What makes the most sense is really when
• 09:25patients have symptoms that are burdensome,
• 09:28that aren't being,
• 09:30that aren't being managed or have
• 09:33opportunities to manage better,
• 09:35and these symptoms are interfering
• 09:38with their day-to-day function
• 09:40and what they want to actually
• 09:43achieve with their goals.
• 09:45And so, so talk a little bit more
• 09:47about the kinds of patients that you
• 09:49see and the kinds of symptoms that
• 09:51you treat because I can imagine that
• 09:53many people are listening to this
• 09:55kind of saying to themselves, well,
• 09:57you know, it sounds really great,
• 10:00but I really don't know still
• 10:02what what it entails.
• 10:04I mean when you say symptoms,
• 10:06do you mean things like, you know,
• 10:09why underwent chemotherapy and my
• 10:11hair fell out and that was really
• 10:14problematic for me or do you mean?
• 10:16Psychosocial distress where, you know,
• 10:19I was going through a cancer journey and
• 10:23found that some of the relationships
• 10:26that I thought I had were not as
• 10:29strong as they might have been.
• 10:31Or maybe it's financial distress is the
• 10:34thing that is most problematic to me.
• 10:38You talked a little bit about pain control.
• 10:41Tell us a little bit more about
• 10:43what exactly it is that you do.
• 10:47Yeah. So palliative care teams screen
• 10:50for common symptoms that are seen
• 10:52within the populations that they treat.
• 10:55So for example, at Smilow Cancer
• 10:57Hospital and our palliative care team,
• 10:59we assess patients for common
• 11:01symptoms like in addition to pain,
• 11:04nausea, fatigue, insomnia,
• 11:06mood issues like anxiety and
• 11:09depression and existential distress.
• 11:13And all of these could either be
• 11:15coming from the cancer itself.
• 11:17Or from the treatment that is
• 11:19being given for the cancer, so.
• 11:23You know, when we run into things like
• 11:25spiritual distress and actually screen
• 11:27for them proactively and financial
• 11:29distress like you mentioned, we are,
• 11:31if we find that the earlier that we
• 11:33uncover these sources of distress
• 11:35the better we can provide support to
• 11:38address them and also make it much
• 11:40easier for patients to get through their
• 11:42treatments which is our optimal goal.
• 11:45So you know I can imagine that.
• 11:48Well let me ask you this.
• 11:50In in in cancer centers it seems
• 11:53to me that not all cancer patients
• 11:57would be offered palliative care
• 11:59is particularly given the paucity
• 12:03of of availability of palliative
• 12:06care specialists as you mentioned.
• 12:09So it is that something that.
• 12:13Should be routine that every
• 12:15cancer patient should at least be
• 12:17introduced to palliative care?
• 12:18Or is it something where?
• 12:23You you would recommend that only
• 12:26when a primary care team or medical
• 12:30team cannot manage particular issues,
• 12:33palliative care is called in.
• 12:36Ideal World, I really wish that every
• 12:38cancer patient could be introduced to
• 12:41palliative care team and that would
• 12:42be really wonderful model of care and
• 12:45that's something maybe we can strive
• 12:47towards at least screening for the
• 12:50patients that would be highest would
• 12:52benefit the most from palliative care.
• 12:55What we find is that we just end up
• 12:58working together with the patient's
• 13:00primary medical team to figure out what
• 13:03issues are well sort of fall within.
• 13:07The primary palliative care skill center
• 13:09or skills that everyone in medicine
• 13:11should have and which ones require a
• 13:14little bit more expertise and and those
• 13:16are the patients that we really love to
• 13:18to be involved with because you know,
• 13:20you know we were so proud of the
• 13:22training that we have and also the
• 13:24interdisciplinary team that we have
• 13:25to address much of these things.
• 13:27You know what as you talk about palliative
• 13:30care and all of the things that you do.
• 13:33I think about people who may be
• 13:35getting care out in the community
• 13:38where there are not these resources.
• 13:40And after we come back from taking
• 13:43a brief break for a medical minute,
• 13:45I want to talk about how those
• 13:48people can get kind of palliative
• 13:50care where they live as well.
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• 15:05More information is available at
• 15:08yalecancercenter.org you're listening to.
• 15:10Connecticut public radio.
• 15:12Welcome back to Yale Cancer answers.
• 15:14This is doctor Anish Chappar,
• 15:16and I'm joined tonight by my guest,
• 15:18Doctor Dimitri Kochenkov.
• 15:19We are learning about the field of
• 15:22palliative care in the outpatient setting.
• 15:25And right before the break,
• 15:27Dimitri, you know,
• 15:28you were talking a lot about palliative
• 15:32care and the fact that there is a
• 15:35nationwide capacity of palliative care
• 15:38specialists that really palliative
• 15:40care in the ideal world would be
• 15:43introduced to every patient who had.
• 15:45A critical illness and that this really
• 15:48is much more than simply Hospice
• 15:51or pain control in this country.
• 15:54We have people being diagnosed every
• 15:57day in every center in America,
• 16:00and some of those are blessed
• 16:03to be large academic centers,
• 16:05but there are people who are being
• 16:08diagnosed in smaller centers and yet
• 16:10they may have some of the same symptoms,
• 16:13issues and other crises.
• 16:15Of other cancer patients in
• 16:18some of these smaller centers,
• 16:19they will try to piece together
• 16:22a palliative care team that's not
• 16:25really called palliative care.
• 16:27They might bring in a pain management
• 16:31specialist from anesthesia to deal with pain.
• 16:34They might have a social worker
• 16:36to deal with financial issues
• 16:39and psychosocial distress.
• 16:41They may have a chaplain to deal
• 16:44with existential crises and.
• 16:46In this.
• 16:48Issue of of spirituality that
• 16:51some cancer patients face.
• 16:54What are your thoughts on on that?
• 16:56It is that helpful for patients.
• 16:58You know palliative care has been
• 17:00one of the fastest growing fields
• 17:02in medicine as so many patients,
• 17:04clinicians, payers and policymakers
• 17:06have really recognized its potential
• 17:08to improve quality of care for
• 17:11patients with serious illness.
• 17:12Unfortunately, we're still in a place
• 17:14where there are areas in the country
• 17:16that don't have access to palliative
• 17:18care and I think that's where
• 17:19advocacy comes in within our field,
• 17:22especially with recent legislation.
• 17:24That is being worked on to attack
• 17:27this issue from multiple angles #1.
• 17:29Increase the funding for education
• 17:32of palliative care specialists,
• 17:34also not only positive care specialists
• 17:37but also general primary care palliative
• 17:40skills that any clinician should have.
• 17:43And #2.
• 17:45Increase ways that we can,
• 17:48you know,
• 17:49really promote a healthcare system that
• 17:51rewards us for the quality of care.
• 17:55That we can give to our patients
• 17:57rather than rewarding us for the
• 17:59number of patients that we see.
• 18:01And so you know despite this growth,
• 18:04you know unfortunately there are still
• 18:06barriers to accessing palliative
• 18:08care for millions of patients and
• 18:10this really varies by hospital
• 18:12size and geography and staffing.
• 18:14But what I would say is that the
• 18:16interdisciplinary approach that
• 18:18you mentioned even if there isn't
• 18:19a official palliative care team
• 18:21that's been well developed yet,
• 18:23that's a start and I think that that's
• 18:25a really. Step in the right direction.
• 18:27When do you think patients who may
• 18:30be at a smaller center and may be
• 18:33getting kind of this piece meal
• 18:36palliative care ought to ask for
• 18:40referral to a larger Center for a
• 18:44particular palliative care consultation?
• 18:46Is that something that people
• 18:48should be thinking about or is that
• 18:51not really something that is done
• 18:53well, I can't speak for.
• 18:56All of the programs across the country.
• 18:58But what I can say is that it's
• 19:00quite challenging for a program to
• 19:02take on patients from outside the
• 19:05system unless the patient is already
• 19:07getting care within that system.
• 19:09So I think it comes down to
• 19:12a continuity of care issue.
• 19:14It's so helpful for us to work so closely
• 19:16with our colleagues here in oncology
• 19:18and the outpatient setting and then
• 19:20all of the other specialties in the
• 19:23hospital because we all just communicate.
• 19:26Very smoothly.
• 19:27We all know the patient and it really
• 19:30promotes this patient centered care.
• 19:31I think the best way to approach that
• 19:35issue is really to for physicians,
• 19:38nurses,
• 19:39nurse practitioners and others within
• 19:42each system's healthcare system,
• 19:44local system to really advocate for
• 19:47this kind of support for their patients
• 19:50and that that might really make the
• 19:53difference over the long term and leadership.
• 19:56Putting resources towards dedicated
• 19:58palliative care teams that can,
• 20:01you know,
• 20:02add an extra layer of support
• 20:03and and you know to that end.
• 20:07All of the healthcare administrators who
• 20:10are are listening to us are thinking yes,
• 20:12that's yet another expense in an
• 20:17already very tight healthcare system.
• 20:21So talk to us a little bit more
• 20:24about evidence based outcomes of
• 20:27palliative care services and whether
• 20:30there is in fact data that supports
• 20:34palliative care services as improving.
• 20:37Quality of care, perhaps longevity
• 20:42doesn't and and and even further,
• 20:46is there any evidence for
• 20:48its cost effectiveness?
• 20:50Yeah, we have some fascinating
• 20:52evidence to support the early
• 20:54involvement of palliative care
• 20:55particularly in oncology patients,
• 20:57but in other diseases as well.
• 21:00And one of the pivotal studies in
• 21:02our field was published in the New
• 21:04England Journal of Medicine in 2010
• 21:06and this was led by our colleagues.
• 21:07At mass general,
• 21:08Doctor Temel and her team and the
• 21:11researchers recruited a group of patients
• 21:13with lung cancer who volunteered to be
• 21:16randomized to two different groups.
• 21:18One group receives standard
• 21:19oncology care and the other group,
• 21:21that comparison group,
• 21:23receives standard oncology care
• 21:25plus early palliative care.
• 21:27And what they found was sort of incredible.
• 21:29The patients in the early palliative
• 21:31care group had better symptom control.
• 21:34They had better mood,
• 21:35better quality of life scores.
• 21:38And they had less intensive care
• 21:39at the end of life and they also
• 21:42lived on average two months longer
• 21:44than the patients who did not have
• 21:47any exposure to palliative care.
• 21:49And this was really a huge aha moment
• 21:52for our field when we really could
• 21:55demonstrate the specific benefits
• 21:57of palliative care involvement when
• 21:58it comes to things that really
• 22:00matter to patients.
• 22:01And so with that less intense use of
• 22:04resources at the end of life did that study.
• 22:08There any other study demonstrate
• 22:10cost effectiveness of palliative care.
• 22:12In other words, was there an offset in
• 22:16terms of the cost of hiring palliative
• 22:20care specialists versus the cost
• 22:22of treatments at the end of life,
• 22:26which may not have been helpful.
• 22:28Yeah, there's some really strong
• 22:31data to support the the support,
• 22:34the resources of having a palliative
• 22:36care team in the hospital which has
• 22:38shown in multiple different studies.
• 22:40To minimize healthcare
• 22:41utilization at the end of life,
• 22:44which saves the system money.
• 22:47But that's not really what we
• 22:48focus on and that that's not the
• 22:50most important part of this.
• 22:51The, the real important part
• 22:53of this is that we align,
• 22:55we align what's important to the patients
• 22:58with what the care that they receive is.
• 23:00So for example,
• 23:01patients who want to spend whatever
• 23:04time they have at home and not be
• 23:07in the hospital back and forth,
• 23:09you know,
• 23:09which obviously is a burden to a lot of.
• 23:11People,
• 23:12those patients receive care that is
• 23:15aligned with that and that's that's
• 23:18really our our motivation and our daily
• 23:20focus and we're rewarding nature of this,
• 23:23of this field.
• 23:24Yeah, no, I get that completely Dimitri.
• 23:26But the healthcare administrators
• 23:28who are looking at hiring palliative
• 23:31care specialists and are thinking
• 23:33about the additional cost of doing
• 23:36so are often also thinking about its
• 23:39cost effectiveness. So it's nice.
• 23:41When you can provide evidence
• 23:43that not only does palliative care
• 23:46align with patients interests,
• 23:48but it also aligns with the healthcare
• 23:53systems interests in terms of
• 23:55reducing healthcare costs while at
• 23:58the same time improving quality.
• 24:00So the next question I have is this.
• 24:03You know you did a fellowship in
• 24:07palliative care in order for a
• 24:10healthcare system to provide.
• 24:12Tell you to care services,
• 24:14do they need fellowship trained
• 24:16palliative care specialists like
• 24:19you or is it possible for them to
• 24:22train up their existing workforce,
• 24:24whether it's nurses or physicians to
• 24:28provide them some palliative care
• 24:31training that so that they may be able
• 24:35to provide these kinds of resources
• 24:39to their patients without going through?
• 24:42A fellowship,
• 24:43training,
• 24:44or hiring somebody who who has
• 24:46fellowship training in palliative care.
• 24:49Yeah, the the standard of care
• 24:52really is to have board certified
• 24:55palliative care physicians on the team.
• 24:58But that being said,
• 25:00there are many ways that healthcare
• 25:03systems can invest in their current staff
• 25:06by providing training for for example,
• 25:09the nurses in the hospital taking
• 25:11care of patients on different in
• 25:13different settings and whether
• 25:15it's in the middle of critical
• 25:17care unit or on the normal regular.
• 25:19Floor investing in them to provide
• 25:22training on the primary palliative
• 25:25care skills that could really help
• 25:28them provide aligned care and then
• 25:31really patient centered care at all
• 25:33levels and all stages of disease.
• 25:35And so obviously we would all love
• 25:39to have you know board certified
• 25:41physicians on staff and but you
• 25:43know that's really been a challenge
• 25:45and I think it's going to be
• 25:47a challenge looking forward.
• 25:49I think we can address that.
• 25:50Through investing in other ways
• 25:52and so you know you,
• 25:55you mentioned that palliative care can
• 25:56be offered in a variety of settings,
• 25:59so certainly in the critical care units
• 26:01on the oncology units in the hospital,
• 26:04but your main area is,
• 26:07is in the outpatient clinic.
• 26:09Is that right and can you tell
• 26:11us a little bit more about how
• 26:14palliative care differs from
• 26:16inpatient services to outpatient?
• 26:20So I'm, I'm, I'm lucky enough to
• 26:23actually have a few weeks a year where
• 26:25I'm working in the hospital with our
• 26:28inpatient palliative care team as well.
• 26:29So I'm able to see patients both
• 26:31in the clinic setting and then
• 26:33also help them when they're in
• 26:35the hospital with an acute issue.
• 26:38And that there is a lot of overlap between
• 26:41the work that we do in the clinic and
• 26:43the work that we do in the hospital.
• 26:46One of the beautiful things is that
• 26:48when one of our patients, you know,
• 26:50we know and and they know us has an issue
• 26:53and they're admitted to the hospital,
• 26:55they have a team that already knows them
• 26:57and has developed a relationship with
• 26:59them to come and and check in on them,
• 27:02see what's going on,
• 27:04see if there are unaddressed symptoms
• 27:06or other aspects of their palliative
• 27:08care needs that we could add on to.
• 27:11So what the primary medical team is doing,
• 27:14the main difference is really between
• 27:16the two settings is that obviously
• 27:18in the outpatient setting we're able
• 27:21to develop relationships over longer
• 27:23periods of time and and that really is,
• 27:26is very rewarding to me.
• 27:28And presumably the other issue is
• 27:30that going back to something that
• 27:32you mentioned before the break,
• 27:35you know not all of these patients that
• 27:37you see particularly in the outpatient
• 27:40setting are quote at the end of life.
• 27:43And so some of these may be you know
• 27:46dealing with symptoms that they may have
• 27:49developed undergoing active treatment
• 27:51for curative intent and you're you're
• 27:54kind of seeing them through that
• 27:56process where they're able to come to.
• 27:59An outpatient clinic and avail themselves
• 28:02of your services, is that right?
• 28:04Yeah. So many of our patients are
• 28:06with us for years and years and they
• 28:08are living with serious illness.
• 28:10For example, cancers like breast cancer
• 28:13with which have which have amazing
• 28:15treatments that are coming out over the
• 28:18last few years really impacting patients
• 28:20lives and allowing them to live longer.
• 28:22And other hematologic cancers for example
• 28:24are are more like chronic illnesses
• 28:26that people live with for a long time.
• 28:29So we've really found our niche in
• 28:32helping those patients live better.
• 28:33Doctor Dmitri Kashefi Nikov
• 28:35is an assistant professor at
• 28:37the Yale School of Medicine.
• 28:39If you have questions,
• 28:41the address is canceranswers@yale.edu,
• 28:43and past editions of the program
• 28:45are available in audio and written
• 28:48form at yalecancercenter.org.
• 28:49We hope you'll join us next week to
• 28:51learn more about the fight against
• 28:53cancer here on Connecticut Public Radio.
• 28:55Funding for Yale Cancer Answers is
• 28:58provided by Smilow Cancer Hospital.