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 WORKING AT CAROLINA


Palliative care team brings expertise, relief directly to cancer patients

    From the left are physicians Laura Hanson and Stephen Bernard and nursing     coordinator Chip Baker – all affiliated with the UNC Palliative Care Program.

Helping cancer patients find some relief from their pain or depression requires commitment and compassion. For Stephen Bernard, co-director of the Palliative Care Center and professor in the School of Medicine’s division of hematology/oncology, these attributes seem to come naturally.

“As a cancer specialist, he is compassionate toward the pain and distress caused by this disease,” said Laura Hanson, co-director of the UNC Palliative Care Program. “He is tireless and singularly dedicated to the sickest group of cancer patients.”

Bernard’s path to palliative care, an approach that improves the quality of life for patients dealing with life-threatening illnesses, started four decades ago.

He earned his undergraduate degree in biology from the University of Pennsylvania in 1968 and went on to receive his medical degree from Carolina five years later.

Then, in 1998, he did a sabbatical at the University of Alberta with Eduardo Bruera, a Canadian expert in symptom management and palliative care, and brought his newfound expertise back to the Lineberger Comprehensive Cancer Center.

Palliative care differs from hospice care that aids dying patients who forgo treatment. Cancer patients are among the beneficiaries, but palliative care – which has been an important part of care in other countries – is not limited to people with cancer. In the last decade, palliative care has become increasingly recognized in the United States as active treatment for a patient’s condition.

Bernard helped start a committee to look at pain-management needs at UNC Hospitals and the medical school. During that process, he recognized that patients’ emotional symptoms and family needs were not being met with pain management alone.

After years of caring for patients with advancing cancer, Bernard and Hanson believed palliative services were needed at Carolina.

They helped initiate the UNC Palliative Care Program, developed about eight years ago through funding from the Duke Endowment. Additional funding was provided by the University Cancer Research Fund to focus on symptom management in outpatients with cancer through the Supportive Care Consult Service and Clinic.

Supportive care is only for adult outpatients with cancer. Bernard, along with John Valgus, a pharmacist who is trained in oncology and certified to write prescriptions, and nurse consultant Sandi Jarr visit patients who are being seen at the N.C. Cancer Hospital and the surgical, medical, radiation and gynecologic oncology clinics.

After the meeting, the team develops an action plan, runs the recommendation by the patient’s primary oncologist and, if approved, implements the plan.

“The goal is to help patients manage their symptoms, whether they are due to the disease or its treatment,” Bernard said.

Bringing these services to the patients is key because more than half travel at least an hour to get to Chapel Hill.

The supportive care program sees between 10 and 15 new patients each month and has been following 200 to 300 patients since the service began. This is in addition to seeing 400 patients a year in the hospital.

Because some patients with complex care issues require a longer visit, the team also developed a half-day clinic. Soon, Bernard said, the supportive care program will need additional resources and personnel.

Both patients and their families feel that the combination of medical, nursing and pharmacy expertise makes a difference in symptom management, he said. The biggest obstacle has been gaining acceptance by the oncology community.

“We have made presentations to most of these groups, and we’ve had a fairly positive reception,” he added.

Bernard, who has clinical interests in gastrointestinal cancer and palliative/supportive care, also coordinates the palliative care elective rotation for fourth-year medical students.

For more information about the Supportive Care Consult Service and Clinic, refer to www.med.unc.edu/pcare/clinical-1/supportive-care-consultation-service-and-clinic. For information about the Palliative Care Program, refer to www.med.unc.edu/pcare.

Editor’s Note: This article was written by Chala Jones, a junior who is double majoring in journalism and mass communication and Romance languages.

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February 9, 2011

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