Improving Life for People with Serious Illnesses
In 2013, Janet Early received a cord blood transplant to treat a rare blood cancer called mantle cell lymphoma. Unfortunately, she developed graft-versus-host disease, in which the transplanted cells began attacking her body as if it were a foreign invader.
Early is fighting this complication with the same intensity she used in her 20-year career as an intensive care unit nurse. She has the help of not only the Duke bone marrow transplant team, but also Arif Kamal, MD, a palliative care specialist and medical oncologist who is helping Early manage her symptoms and regain her quality of life.
When Early first began seeing Kamal, about six months ago, she was hospitalized with severe pain and vomiting caused by the graft-versus-host disease. Together, they have gotten the pain mostly under control.
Now back home in Cary, North Carolina, Early visits Duke’s bone marrow transplant clinic weekly, often receiving blood transfusions. She sees Kamal monthly. Between visits, Kamal gets regular updates about her from the bone marrow transplant team.
“Dr. Kamal is great. He listens,” Early says. “When he comes in to see me, he has already thought about what we could do and how he might help.”
Kamal treats Early as part of the five-days-a-week palliative care clinic offered to Duke patients with cancer and other serious illnesses. Patients can see a team of palliative care specialists—Kamal, who is an oncologist, or others trained in internal medicine, geriatrics, or psychiatry.
While many may associate palliative care with hospice care, it is much broader than that. “The modern definition of palliative care is a focus on quality of life by providing an extra layer of support, independent of prognosis, for all patients with serious illness,” Kamal says. “We’ve embedded palliative care physicians inside the cancer center so that a patient can see a lung cancer oncologist and a surgeon and then come see the palliative care team as well.”
A hallmark of a palliative care visit is time spent listening to the patient. On an initial visit, Kamal may spend as long as 60 minutes talking about the patient’s understanding of his or her illness and prognosis, goals and worries for the future, and any troublesome symptoms.
Kamal, who is also Director of Quality and Outcomes for Duke Cancer Institute, at one time planned to practice as a breast oncologist and lead breast cancer clinical trials, inspired by his mom’s breast cancer diagnosis.
But during his residency at the Mayo Clinic, his mother’s condition worsened. Helping his mom through her treatment and subsequent death, including hospice care, led Kamal to decide to pursue a fellowship in palliative care. “My mom received good care, but I couldn’t help but look at the whole thing and think, ‘I would be a better physician if I understood how to counsel others about this process.’ There weren’t a lot of people around me who could say, ‘This is what high- quality palliative care looks like,” he says.
So Kamal refashioned himself into an oncologist who helps cancer patients in need of support and who studies how to improve palliative care. “I can’t imagine doing anything else,” he says.
Early is not giving up. Her next immediate goal is to reduce the nausea that plagues her daily, so that she can feel like eating, instead of relying on IV nutrition. “You want so badly to get well and be able to progress,” Early says. During a September 2014 visit, Kamal switched her to a different regimen of pain control to try to ease the nausea.
“We’ve got the pain down pretty good, now we just have to get rid of the nausea,” Early says. “And we will. I can’t thank Dr. Kamal enough.”
This story originally appeared in the fall issue of Duke Cancer Institute Notes.