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The Push to Palliate Cancer Symptoms

By: LARRY MCCLAIN for Nashville Medical News

Jim Meadows, MD, Leads the Charge for Tennessee Oncology

PHYSICIAN SPOTLIGHT: The Push to Palliate Cancer Symptoms | Jim Meadows MD, Tennessee Oncology, Palliative Care, Symptom Management, Pain Management, CancerWhile studying medicine in southern California, Jim Meadows, MD, balanced the demands of education with activities such as rock climbing and motorcycle trips through the high desert – things that might surprise many of his patients. And while some of his cancer patients might not share those same interests, they know better than anyone the need to have quality in their lives. It’s that goal that brings Meadows, a board-certified palliative care physician with Tennessee Oncology, into their care plan.

Palliative medicine is a rapidly growing specialty that focuses on treating medical symptoms – such as pain, depression and insomnia – in patients with serious health issues. Tennessee Oncology’s palliative care team, primarily consisting of Meadows and two full-time nurse practitioners, is based at TriStar Centennial Medical Center, with a new location opening this month at Saint Thomas West. The team also draws on the talents of two staff psychologists, as well as Tennessee Oncology patient advocates. Palliative care appointments typically coincide with oncology visits, which is an added convenience patients appreciate.

Local and national momentum for palliative care continues to grow for many reasons, including unmet patient needs, unnecessary ER visits for issues such as pain, and research that continues to highlight the benefits of palliative involvement. In fact, a recent New England Journal of Medicine study found that when lung cancer patients received concurrent oncology and palliative care therapy, patients experienced greater symptom control and better survival versus oncology treatment alone.

Meadows explained, “We don’t receive adequate symptom management education in medical school. And despite study after study demonstrating that patients suffer with unnecessary symptoms, we continue to undertreat. There are many reasons for this.”

He continued, “Fortunately, cancer therapy is rapidly improving, but patients still have significant needs. We attempt to treat all symptoms in our program. The most common are fatigue, pain, and psychological burdens such as anxiety and depression. Some patients also experience insomnia, bowel issues, nausea, and poor appetite. We tell our patients, ‘No symptom is off-limits.’ It’s not uncommon for me to hand a patient prescriptions for both pain and erectile dysfunction medication. If it’s a quality of life issue that is affected by their disease, it’s pertinent.”

Meadows emphasized that palliative care across the U.S. is often misunderstood and underused.

“Patients don’t know much about palliative care so most don’t ask for it,” he said. “Some clinicians are unfamiliar with its full scope and perceive that a patient must be terminal or have debilitating issues before getting a palliative care team involved, but research consistently shows that palliative medicine is most effective when utilized early,” he noted.

Meadows added palliative care and hospice care are often linked in clinicians’ minds, partly because board certification is the same for both disciplines. “They share primary goals – to improve quality of life – but hospice care must be tied to prognosis, while palliative care does not,” he said. “There are many patients in complete cancer remission that still see us because of lingering symptoms.”

Meadows said he is grateful Tennessee Oncology’s leadership has enthusiastically continued to support and expand the palliative care program since its launch three years ago. “It’s rare to see a practice invest the way Tennessee Oncology has to build a palliative care department. It reflects our group’s primary focus – to surpass the needs and expectations of our patients.”

Besides the national lack of palliative clinicians, the greatest obstacle facing palliative care growth is poor reimbursement for their services. “Providing good palliative care takes time … lots of time,” said Meadows. “An hour-long visit is not uncommon in my clinic. Historically, the healthcare system doesn’t compensate adequately for invested time, but I’m optimistic this will improve because of value-based care and quality metrics. Palliative care can greatly reduce costs, in part because so many ER visits are caused by poorly controlled symptoms.”

Meadows, who grew up in Sumner and Robertson counties before attending Lipscomb University for undergrad and Loma Linda for medical school, returned to Tennessee in 2005 after a decade in California. “Yeah, the weather was nice and there were lots of outdoor activities,” Meadows jokingly said, “but I love Nashville. It’s my home.”

These days, Meadows admits to enjoying less intense activities such as woodworking and photography. “I actually recommend creative hobbies to my patients, as well. It’s an invaluable therapy.” He’s quick to say, though, that the greatest quality in his life comes from being with his 3-year-old daughter and 10-year-old son.