Photograph by John Gaucher
Catriona Leckie, a nurse practitioner in neuro-oncology at the Tom Baker Cancer Centre, has seen hundreds of people dealing with brain cancer and knows all too well how draining the experience can be. “When you get radiation and chemo together, that’s the hardest part of the treatment,” she says. “It can be a debilitating fatigue.” Her experience with the difficulties of living with cancer isn’t just limited to her work, as she helped take care of her father when he developed prostate cancer 20 years ago. That experience increased her interest in quality of life for cancer patients, and how to improve their mental state in particular. “I had a lot of questions regarding anxiety in a cancer diagnosis, what information patients need to reduce anxieties and how do you move on knowing you have cancer,” she says. “[I wanted] to reduce anxiety associated with a cancer diagnosis, which could be part of me trying to figure out my father’s experience.”
In an effort to reduce the anxiety and depression that often accompany cancer care, Leckie is conducting a study on the benefits of early palliative care conversations on patient well-being. Palliative care discussions, the process of talking to patients about what resources and options they have in terms of quality of life and end-of-life care, typically occur once all avenues of treatment have been exhausted and aim to help patients cope with terminal illness. Leckie’s new approach introduces patients to care workers in community resources, rehabilitation and home care early on so they feel less like strangers should patients eventually opt for their services. These early conversations also help patients identify goals and values they want to pursue, including everything from when they wouldn’t want to be resuscitated to the effects of surgeries and treatments.
Leckie believes having these conversations early and throughout a person’s cancer treatment will help alleviate a number of problems, for patients and caregivers. Patients would benefit from greater knowledge of their options, as well as peace of mind, and medical staff will have an easier time broaching what can be difficult subject matter. “This whole process has actually improved the conversations we have as health-care providers. Ongoing conversations are much easier now,” says Leckie. “Before we started, the main complaint was that these conversations remove hope. [Early palliative conversations] don’t remove hope, they actually instill hope, because patients have a little more control of their decision-making.” Leckie believes having the tough conversations at the start of treatment will lower levels of anxiety and depression, as reported on the Edmonton Symptom Assessment Score (ESAS), a ratings system by which patients indicate on a 10-point scale how they feel in 10 different areas, including depression, anxiety, pain, tiredness and nausea.
“Hopefully, the benefit will be that their anxiety scores and depression scores will be lower, and they will have goals set for end of life, where they want to be and that we’re meeting some of these goals that they potentially have discussed. I’m hoping that will be a benefit to the system as well.”
At a Glance
Leckie’s study follows 140 glioblastoma patients, 70 from 2011, before her initiative started, and 70 from 2015, after the implementation of the early palliative care conversations. By reviewing their experiences for 30 months from the start of their respective treatments, she is hoping to see improvements in self-reported levels of anxiety and depression in the 2015 patients who participated in her earlier palliative conversation clinic.