Podcast "Let's Talk Cancer" – Beyond treatment: making supportive care part of every cancer journey under the World Cancer Declaration

The World Cancer Declaration 2025-2035 calls for a future where cancer care is more equitable, people-centred and focused on quality of life as well as treatment outcomes. Achieving that vision requires more than access to diagnosis and treatment. It also means ensuring that people affected by cancer receive the support they need throughout their cancer journey.
In this episode of Let's Talk Cancer, Professor Alexandre Chan, President of the Multinational Association of Supportive Care in Cancer (MASCC), discusses why supportive care is an essential component of comprehensive cancer care. From managing side effects and symptoms to supporting mental health, nutrition, rehabilitation and survivorship, supportive care helps people maintain the best possible quality of life during and after treatment.
Drawing on his experience as a clinician, researcher and leader of a global network of supportive care professionals, Professor Chan reflects on the challenges of integrating supportive care into routine cancer services and explains why it should be considered a priority in every health system, regardless of resources. 

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Podcast transcript

Cary Adams: Hello and welcome to Let's Talk Cancer, the podcast where we explore the issues shaping cancer prevention, treatment, care and survivorship around the world. Nearly a year ago, the global cancer community came together around the World Cancer Declaration, a shared vision for reducing the global cancer burden and improving the lives of everyone affected by cancer. Central to that vision is the recognition that cancer care is about more than diagnosis and treatment alone. It is also about the quality of life, equity, people-centred care and ensuring that patients receive the support they need throughout their cancer journey. Today's episode focuses on one of the most important, yet sometimes overlooked aspects of cancer care: supportive care. Supportive care encompasses everything from managing treatment, side effects and symptoms to nutrition, mental health, rehabilitation, survivorship and helping patients maintain the best possible quality of life during and after treatment. To discuss why supportive care is increasingly recognised as an essential component of comprehensive cancer care, I'm delighted to be joined by Professor Alexander Chan, President of the Multinational Association of Supportive Care in Cancer, known as MASCC and a UICC member. Professor Chan is internationally recognised for his work in supportive oncology and people-centred care. Through his leadership at MASCC, he has worked with healthcare professionals, researchers and advocates around the world to advance evidence-based supportive care and improve the experience of people living with cancer. Alex, thank you very much for joining us today. Perhaps we can start off by talking about cancer treatment and care over the decades, which has largely been about therapy, with success measured in terms of survival, basically. So, at what point did people really begin to recognise that treating the disease alone was not enough?

Prof Alexandre Chan: Thanks for inviting me to chat. I think we are talking about something very important and I think, for all of us clinicians who are caring for patients, we want to make sure that supportive care is an important piece when it comes to the patient journey. So, to answer your question in terms of the measure of success, I don't think there's one single moment, but rather, it's a slow accumulation of evidence and things that we've been doing over the years that we really kind of ignored. To give you some background, I'm the President of MASCC, which is the Multinational Association of Supportive Care in Cancer. We were founded in the 1990s, and that was the time when supportive care was seen as something that you did after the real treatment of cancer. So, basically, you treat your patients with chemo and then they have side effects and there you go, you manage the aftermath. And that's really not the best approach. So, our founders' argument was the opposite. So, you cannot deliver curative therapy if patients cannot tolerate the treatment. So, one of the very first success stories that I can talk about is the use of nausea and vomiting medications, or what we call antiemetics. And that's an important concept because if we are not able to control chemotherapy-induced nausea and vomiting, then what happens is that your patients are not able to complete treatment. But with some of the new antiemetic drugs at that time that were being developed and approved for treatment in clinical practice, we saw many more patients complete treatment. And completion rates, of course, drive survival. So as a result, you're seeing how this very important supportive therapy can really transform how we ensure that our patients survive longer? And then of course, over the last decade, what we have been looking at is, how do we implement certain supportive, oncology modalities that really would improve survival. So I would argue it's not one single time point, but really like over the years, we see an accumulation of this evidence that really have changed the way we practice.

Cary Adams: Alex, is cancer supportive care a unique skill set, which an individual may have within the oncology department among their responsibilities or is this something that you wish to see integrated and should be integrated within the broader healthcare workforce that is actually dealing with patients?

Prof Alexandre Chan: I think that all institutions that offer cancer care should have both supportive care specialists, but also having supportive care integrated throughout in terms of all professionals should be understanding and also practice part of it as the way how they deliver cancer care. Because I think one of the biggest challenges is that we always see supportive care as something that we use to manage the aftermath, right? But if we have people who are thinking ahead of time, coming up with, institutional guidelines, making sure that a lot of this wisdom is already woven into our routine care. Hopefully we're able to prevent toxicities rather than just waiting for patients to crash and burn and then we go and rescue them. That's really not the way the way we want to deliver quality cancer care.

Cary Adams: I don't want to undermine the credibility of the oncology profession at all, Alex, but do you find that there's pushback from oncologists on this, or are they willing to accept the fact that they're dealing with a person as well as the disease?

Prof Alexandre Chan: Yeah. So this is a huge myth. And we want to debunk that one. So, in fact, we just published a paper from MASCC addressing the myths and misconceptions that prevent the provision of cancer supportive care? And I think it's so important because a lot of clinicians or oncologists think that, well, this is a nice-to-have element in the institution. And I think that's the most damaging misconception that people have, and that could be an issue even on the policy level. Because we understand it's important to make sure that patients can get access to all the anti-cancer drugs and certainly to appropriate diagnostics and screening, etc. But I would argue that without the supportive care, you can have the best treatment but if these drugs cause a lot of toxicities and side effects, it will also be very difficult for our patients to finish their treatment and achieve the optimal outcome. So, I think they all go hand in hand. One of the biggest misconceptions is also that supportive care is only needed at the end of life but I would argue that, a lot of the cancers that we're seeing now are really turning into a chronic disease. So, we do have chronic cancer survivorship issues that we're seeing in a lot of our patients who are continually getting treatment for much longer periods of their lives. So, MASCC partnered with ASCO and produced guidelines on survivorship and patients with advanced cancer. Because I think it's important to have that advocacy so people to understand the importance that, when it comes to cancer supportive care, it's not just the end of life for people. The other thing, of course, is a lot of the clinicians also feel that, well, they're already doing it. However, it's very inconsistent in terms of how it is implemented on the ground. So, are you making sure that all the treatment protocols have all the supportive care elements that patients should be receiving? There are also a lot of other sort of concerns that are not routinely being addressed, like fertility issues. A lot of patients experience fatigue. How do you ensure that patients are getting the same type of modality to manage some of these symptoms?

Cary Adams: I noticed that you've worked in Asia and also North America. There must be, as there are in so many aspects of cancer control, inequities in the availability of supportive care. What has your experience been?

Prof Alexandre Chan: Yeah. So I'm very fortunate that I have the opportunity to work in so many places in the world. Of course, I have seen differences in healthcare policies and systems, as well as availability. Certainly I'm seeing a lot of disparity. Of course, a lot of it comes down to access to drugs, but also access to modalities of care, even supportive care. For instance, when we are talking about accessing a lot of the integrative oncology sort of modalities to manage symptoms, such as pain or even some very basic symptoms. It's very different around the world. And of course, because a lot of these modalities would require payment. Patients who experience financial hardship may not be able to access those treatments as well. So that's one. And of course, some of the very basic sort of medications that we're talking about for supportive care. Some of them may not be readily available. So olanzapine is a classic one that I want to talk about. This is a drug that we know that is now routinely being given for highly emetogenic chemotherapy. So with drugs that can cause nausea and vomiting at a very high rate, such as 90%, patients will experience nausea and vomiting. They should pre-emptively receive, olanzapine. Now, interestingly, this is a drug when it was first developed was an antipsychotic. So in some places of the world, very interestingly, the drug can only be prescribed by psychologists, not even by an oncologist. But access is a huge issue. And that's something that we have identified. But also, when it comes to supportive care, there's also a lot of cultural as well as, in my opinion, lifestyle-related differences as well. And that's what I see a lot like compared to my practice in the US versus in Singapore. So I think that there are some differences as well when it comes to decision-making, even for, how do you support your patients through their therapies?

Cary Adams: Alex, it's pretty clear that in high-income countries, there's a lot being done in this space because obviously there are resources and financing and probably the health systems can actually accommodate it. But how do you lift and drop, that great work into low- and middle-income countries where the resources are really stretched and even the basic medicines and treatments aren't available? What are the challenges you face and how do you overcome that?

Prof Alexandre Chan: It's an important question, especially in the world of supportive care. So in fact, this is something that we just published through MASCC. We actually came up with some guidance on how to resource-stratify supportive care modalities. So what we're doing is that, we are basically looking at four levels of resources. So ranging from what we call basic to core, enhanced and even maximal sort of resources when it comes to supportive care modalities. Now, you might be asking, how is that helpful? Well, essentially, I think, at the basic level, we are thinking about fundamental supportive care that must be available in every part of the world. What do you really need to provide to ensure that your patients are well? But then, we also know that there are options, right? That, again, different countries may have different availability. So we want to make sure that, people understand what some of these basic resources that you must provide in that setting? Whether you are in Rwanda or India or you are in the United States or any country in Europe, these modalities are still available. Again, that is still helpful for managing our patients' symptoms. And that I would say is very essential to ensure that there's, equitable management of these symptoms around the world.

Cary Adams: And of course, within countries. When we broadly refer to low- and middle-income countries, we know even within a country, within the major conurbations, there could be an excellent cancer treatment centre, which presumably will be adopting some of the higher-level guidance that you provide, but elsewhere, maybe not. So it's variable, I guess, within a country.

Prof Alexandre Chan: Yeah. And I think this is where, when I said earlier, it's important for supportive care to be embedded and integrated into your national cancer control plan, ensuring that no matter which centre you are at, you will still get this sort of basic support to ensure that, supportive care is being thought about and is not just an afterthought.

Cary Adams: The issue of palliative care comes up quite a lot around the world, the unavailability of morphine and opioids. Presumably you have the same concerns about that, particularly in low- and middle-income countries where the presentation of cancer tends to be quite late and therefore there isn't a lot with regard to helping that patient survive their cancer. Do you find that is also a challenge within the context of supportive care, the availability of the basic medicines for pain relief?

Prof Alexandre Chan: It is a huge challenge, and again, the availability of a lot of these medicines also differs across the world. Of course, it also ties in with a lot of stigma that patients and families associate with these medications. A lot of families and patients want to avoid using morphine or even any of the derivatives because they perceive morphine and these medications as being associated with end of life. I guess that's something that they have seen in, movies and in a lot of the media, right? I've talked to tons of patients who refuse to receive morphine or even any of the derivatives, even low-potency types of opioids just because of that reason. So, again, as a supportive care advocate, I always make sure that, when we talk to patients about managing their symptoms, if we use morphine or some of these opioids, it is important to address why we are using these medications. And that is something that I do believe that, patients have to work very closely with their healthcare professionals to ensure that they are getting these medications earlier.

Cary Adams: It sounds like it's very much a dialogue with the patient all the way through in supportive care, understanding where they are and listening to them and understanding what they want to do. Do you have to be a psychologist to do this sort of thing?

Prof Alexandre Chan: No, and this is a very interesting question. A lot of us are understanding some of the problems that our patients are having, right? it's not simply just, again, psych-related issues. Like, for instance, a lot of our patients are having cognitive changes and the people on the receiving end are us: pharmacists, nurses, oncologists, and we may not have any sort of psych background or even cognitive training to understand what these issues are. And I would argue that we want to build some of the self-management skills of our patients, because we also don't want our patients to rely on our healthcare professionals forever to manage their supportive care issues. So one of the things I also advocate is for people who have very low levels of distress. If we're able to provide some sort of routine management that can build patients' skills to practise on their own, like, for instance, to manage their symptoms on their own, then they would not need to routinely be managed by certain specialists. And we can preserve the time for these specialists, for, patients with more severe symptoms, for patients with a lot more distress or with issues that are more challenging to manage.

Cary Adams: Does supportive care, in your opinion, include the families as well?

Prof Alexandre Chan: Well, so it depends on which sort of phase of treatment that we're talking about. Certainly for people who are actively undergoing treatment, I think the amount of family support, as well as making sure that you can continue your routine daily life is so important. And the support that you need from family is tremendous. In a high-income country, where a lot of people are working and have their daily jobs, and of course there are tons of bills to pay. Your family support is so important, right? How do you even bring food to the table? And, after treatment is also something that we have to think about because some of our survivors have trouble going back to work. So how do you ensure that you can sustain that, right? But I would argue even end of life is something that we really need to consider because, some of the decisions about end of life have to be, again, not just for yourself, but also having family sort of support and making sure that everyone is comfortable with some of these decisions. And I think, when it comes to supportive care, we don't just think about supportive care for the patient, it needs to be something for caregivers, and caregivers can be family or non-family members. So making sure that the access issues that we talked about, also have to be addressed for caregivers as well.

Cary Adams: So what is currently on the table that you're looking at that excites you with regard to helping patients deal with their cancer treatment?

Prof Alexandre Chan: So I recently took on a directorship in cancer survivorship and wellness at our national cancer centre here in Singapore. And one of the things I envision is to build this house where we're able to house different programmes, in integrative oncology, in rehabilitation and survivorship so that, we're able to better channel our patients towards support for the different types of symptoms they have. And one of the things is, how can we better navigate our patients into these different supportive care modalities and different programmes? And I would argue that it needs to be a tiered approach. So with MASCC, we are now coming up with quality standards and trying to figure out how to better implement patient navigation so that patients with very little distress are still getting some type of navigation from community navigators. But then, we would also have a middle layer where people who have some symptoms, but are not so complicated, can be seen by supportive care nurses and receive some of that personalised sort of management. Then, people who have a lot of symptoms will certainly need to be seen by multidisciplinary care teams, including some of the specialists that we're talking about, and will require much closer monitoring. But, this is sort of a very large endeavour that we need to do and it cannot work in silos.

Cary Adams: Alex, you may be aware that the UICC obviously is a large membership organisation and we've got, I think, at least 500 patient groups around the world. Now, this clearly should be important to them. There's no doubt that having an army of patient groups supporting this sort of initiative would be very powerful. Have you engaged with patient groups around the world, and how does that work?

Prof Alexandre Chan: We have, and even with MASCC, we actively engage our patient partners and we learn so much from our patient partners, particularly at our annual meetings. Having patient partners involved in all our sessions and panels makes a huge difference because we get to hear some of the issues that they're going through. Patient partners can also help us to think about how to redesign the way we manage our patients as well. Early on, I was talking about navigation. So in fact, one of our main partners here in Singapore, the Singapore Cancer Society, I'm working very closely with them to think about how our community partners, many of whom may be caregivers or survivors, can come back and help with some of these supportive services, because they know exactly what the issues are that patients are facing. So I think, whether it is on an international level talking about MASCC or even on the local level, I think it's so important that we actively engage these patient partners. And, because they will be able to provide us the first-hand feedback on any new programmes that we're implementing.

Cary Adams: Last year, we launched the World Cancer Declaration in Melbourne, Australia, at the World Cancer Leaders Summit and it was very interesting because a significant difference between the previous declaration, which was many years before, was the integration of people-centred care, a drive for greater equity, a stronger focus on quality of life and well-being alongside treatment outcomes. Presumably you're 100% behind that and you believe it's absolutely critical that we take that ambition forward?

Prof Alexandre Chan: Absolutely. I actually dug out the World Cancer Declaration and read it to see how well that aligns with the mission that we're looking at, as a supportive care organisation as well. And certainly a lot of it really resonates with how we want to move forward. Like, for instance, one of the statements talks about how we reduce cancer mortality by at least a quarter, right? And I think that really highly depends on whether or not people can complete effective treatment, as we talked about earlier on. Your earlier point about countries committing to integrate essential cancer services, including palliative care and universal health coverage, I think that's also very important. So, I would argue that for many countries considering their cancer plans, they really should ensure that supportive care and survivorship are embedded and make sure that they're addressed in the cancer plan their national cancer plan.

Cary Adams: Well, I've got to say that it's delightful to talk to you and also to work with colleagues at MASCC. So thank you very much indeed for what you do.

Prof Alexandre Chan: Thank you so much. Thanks for having me today.

Cary Adams: Thank you for listening to this episode of Let's Talk Cancer. If you like this podcast, please give us a rating and subscribe for more content every month. And if you want to know more about UICC's work, visit uicc.org or follow us on social media.