Living With and Beyond Cancer

Physician and hospital administrator Robert Sidlow recently joined Memorial Sloan Kettering as Head of our newly created Division of Survivorship and Supportive Care within the Department of Medicine.

Robert Sidlow, Head of the Division of Survivorship and Supportive Care, is focused on improving quality of life for cancer patients.
Robert Sidlow, Head of the Division of Survivorship and Supportive Care, is focused on improving quality of life for cancer patients.

The division — which brings together internal medicine, hospital medicine, geriatrics, integrative medicine, employee health and wellness, urgent care, and palliative care under one umbrella — aims to improve patient access to supportive care, better integrate these services throughout the course of patients’ care, and stimulate new research and standards of care.

We spoke with Dr. Sidlow about his background and his plans for the new division.

Tell us about the Division of Survivorship and Supportive Care.

While MSK has long had services to address survivorship and supportive care for our patients, they have grown organically in importance, scope, and size over the years — yet they have largely remained separate from one another. Since supportive care and survivorship all are now recognized as core standards of care for people with cancer and are vital for supporting the patient throughout the entire course of treatment and beyond, it made sense to bring these practitioners under one umbrella and focus our clinical and research efforts together.

As cancer becomes more of a chronic disease, with doctors often able to offer patients multiple types of treatment if the cancer comes back, patients’ needs for supportive care may change over the long term. Because of scientific advances that identify the molecular causes of disease, many patients now have access to new therapies, and many of these treatments have side effects.

We are living in an extraordinary time with regard to the way we’re treating cancer, and MSK is pushing the envelope of what is possible. We have to be there to support the patient through his or her entire journey, whatever the outcome. It is only by understanding the whole person in a larger context that we can truly support our patients and ease their burden in the fundamental ways — physically, psychologically, and spiritually — that they need us to. This new division is uniquely poised to lead the way.

What kind of work is the division undertaking?

The chiefs of the different services within the division are meeting regularly with each other, and we are establishing forums to stimulate conversations among the different groups and across all of MSK. A monthly research “Works in Progress” seminar enables team members to share their findings and promotes investigative collaboration across the organization.

Regarding research, issues around quality of life and patient experience — as seen from the patient perspective — are becoming increasingly important. There’s been a lot of study of the prevalence of different symptoms in patients undergoing cancer treatment — not only physical symptoms but also psychological and existential symptoms.

One study that recently came out looking at patients with breast cancer found that worry and difficulty sleeping are two of the most prevalent symptoms. In addition, fatigue, pain, change in food taste, lack of ability to concentrate, and sexual problems are all common.

All of these types of symptoms permeate the experiences that people have while being treated for cancer and are very important to address. The focus of cancer research has expanded beyond questions such as “did the tumor grow or shrink?” and “how much longer did the patient live?” We are now trying to understand if, and how, our cancer treatments are affecting the quality of life of our patients. This is a fundamental change. 

How do you measure quality of life?

Obviously this is not as simple as using a thermometer to measure someone’s temperature. However, there is a body of research that addresses the challenge of measuring the personal experience of being a cancer patient, usually using standardized surveys that ask patients what they’re thinking and feeling. Important outcomes such as pain, fatigue, how well the patient is able to function in daily life, and emotional and spiritual distress are called “patient-reported outcomes” and are becoming increasingly important elements of research into new drugs.

Why has looking at cancer care from a quality-of-life perspective become more important?

Over the past few decades, we have developed many good therapies to keep patients alive longer, but those therapies come with their own toxicities. Some of the side effects from cancer treatment can last years after treatment is completed and can greatly diminish a patient’s quality of life.

In addition, because of other improvements in healthcare, people are living longer lives. As a result, the population of cancer patients over age 80 is expected to swell over the next few decades. As MSK continues to push the envelope on the treatment of geriatric patients with cancer, we have to figure out how to balance the risks and benefits of various treatments in this vulnerable population. 

How did you get interested in this field?

I’m a general internist by training, have chaired a department of medicine, and have run a palliative medicine service. This broad experience gives me the advantage of perspective when it comes to caring for patients — something I call using the “macroscope.” I can get into the nitty-gritty details of patient care, but I can also come up and ask the bigger questions about the whole patient. In addition, my experience as a hospital administrator helps me know what it takes to provide quality and safe care both to patients and to the overall healthcare system writ large.

What do you hope to accomplish now that you’re here?

I’m so grateful that MSK leadership has brought me here to head this new division. The patient-centered culture of MSK is unique, and it allows us to pursue research and hard-core science while taking care of our patients in a compassionate manner. My vision is to integrate the core elements of the division’s care as a standard part of cancer therapy for all MSK patients, and eventually at all locations. Scaling this effort across the institution will be challenging, but we’ll also be setting the standard for what it means to be a comprehensive cancer center. What MSK does really matters.