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EBMT 2020 | Optimizing a patient’s CAR T-cell therapy journey

Surabhi Chaturvedi, MBACP, of King’s College Hospital NHS Foundation Trust, London, UK, discusses how to optimize a patient’s CAR T-cell therapy journey. This interview was recorded via an online conference call with The Video Journal of Hematological Oncology (VJHemOnc).

Transcript (edited for clarity)

At our center for patients receiving CAR-T therapy, they are referred to the psychology service for an initial assessment as a routine part of the care we provide to them. That’s at King’s College Hospital. So we have an opportunity to meet every patient who’s coming to us for CAR-T therapy because of many of them are referred from treatment centers all over the country. It might be the first time they’re meeting somebody at King’s, somebody who’s not a consultant I mean...

At our center for patients receiving CAR-T therapy, they are referred to the psychology service for an initial assessment as a routine part of the care we provide to them. That’s at King’s College Hospital. So we have an opportunity to meet every patient who’s coming to us for CAR-T therapy because of many of them are referred from treatment centers all over the country. It might be the first time they’re meeting somebody at King’s, somebody who’s not a consultant I mean.

So we start off by conducting a thorough holistic psychosocial assessment, where we get a sense for how they feel about the treatment, whether they have any anxieties or particular worries about it, whether they’re experiencing other emotional distress like low mood or depression, whether they have a history of mental health problems for which they’ve needed support in the past, which might mean they need support again now, as they approach this crucial juncture in their treatment. From that point onwards, they are able to access psychological therapy services if they want to, if there’s something they want to process with a psychotherapist or a counselor, they have that option. As well as their families have that option after we’ve met them.

I think our approach is to keep offering patients the support or keep reminding patients that the specialist psychological support is there, but it’s not necessary or mandatory and it shouldn’t be for any patient to take it up because people have their own ways of coping with situations. So the way we see it is to optimize the patient’s journey is psychological input should be offered and it should be offered at repeated time points. So when the patient gets approved for the treatment or when the patient is waiting for treatment because that can be quite a long wait for some people and people can feel quite anxious during that time, when they start treatment there may be anxieties about side effects. So at these particular time points, it’s important to keep checking in with the patient, asking them how they’re coping, how’s your mood been, would you like to speak to somebody from the psychological side of things? So that the patient has the option of accessing the support if it is available.

Finally optimizing the patient’s journey is also about remembering that psychosocial support needs or psychological distress can also arise once treatment has come to an end because it’s only when treatment comes to an end that some patients might start to process what they went through, might start to think about the meaning of some of the difficult challenges they faced and might need support at that time.

Secondly, because I think the fear of relapse is a very common phenomenon in cancer. So once treatment ends patients might have worries even if they’re in remission and the treatment has worked for them, they might have worries about the disease coming back. Psychological input can be helpful to help people manage those fears while also living as well as they can.

 

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