Palliative and Psycho-Oncology Care: Dr. Ramy Sedhom on Patient Distress Signs

In oncology nursing, integrating comprehensive supportive care into routine cancer treatment is essential for addressing patient distress and improving overall quality of life. Ramy Sedhom, MD, a dual-trained medical oncologist and palliative care physician at Penn Medicine Princeton Health, serves as Clinical Director of Medical Oncology. Sedhom specializes in treating breast and gynecologic malignancies, focusing on expanding palliative and psychosocial oncology services across community practices.

In this Q&A with Oncology Nursing News, Sedhom discusses strategies for bridging historical silos between palliative care and psycho-oncology, debunks persistent misconceptions surrounding supportive interventions in curative settings, and identifies clinical red flags for unseen distress. He also provides guidance for nursing leaders advocating for embedded psychosocial services and outlines a practical communication framework of listening, repeating, normalizing, and defaulting that oncology nurses can implement during challenging conversations to support patients and family caregivers.

What unique distress signals for symptom burdens do you see in community oncology settings compared to major academic hubs?

Historically, one major challenge has been how to have the appropriate support staff or appropriate referral sources for patients who are undergoing distress from their cancer. If you were to look nationally at surveys from the early 2000s, for example, it was pretty rare for a community oncology practice to have a palliative care physician or to have a psychosocial oncology team or a geriatrician, all specialties that are common referrals to help patients and their families in need.

Palliative care and psycho-oncology are often treated as distinct silos. How does blending these specialties change day-to-day management of existential distress and physical symptoms work for late-stage cancer?

That is one of my passions, to blend what historically have been very siloed services. Historically, palliative care has been its own discipline. It's its own fellowship and there are many ways that one can get palliative care training. Psycho-oncology has historically come out of the department of psychiatry. Members of a psycho-oncology team are just as interdisciplinary as palliative care. Within psycho-oncology, you may sometimes have physicians who are psychiatrists, you may have PhD psychologists and oftentimes you can have social workers who are trained in the mental health profession.

I think what is most important is to avoid what is often the easy aspect of treating these as separate. I would say what's overlapping between the two is addressing a patient need and I would say in a perfectly run system the health system or the individual oncology practice would do a screening assessment of what is your distress and what is the source of it. If it's historically physical symptoms or if it is concerns about decision making around death or dying, historically these would be best served by a palliative care team.

However, palliative care, just like psycho-social oncology, does have a supply/demand problem. There are so many patients who would benefit from seeing these services and unfortunately not enough clinicians. So, I think the marriage of these two disciplines to meet the individual need with the right team is something that can help overcome these supply/demand problems.

What do you see as some of the persistent misconceptions regarding palliative care that you would like to see addressed?

One phrase I would love to never hear again would be “the family is not ready for palliative care yet.” Sometimes anchoring that this is a team that's a bridge to hospice, which is not true. I love the definition of palliative care, which is that palliative care is specialty care to improve the quality of life of patients and families with any serious illness.

Palliative care is distinct from hospice. It can be given concurrently with cancer therapy and we have so much data that it's helpful even in the curative setting. Think about a patient who's undergoing a stem cell transplant. There are just so many symptoms and that is a curative intent therapy, and those symptoms are not just physical — they can often be emotional, psychological, there can be caregiver burdens. Healthcare is a tough landscape to navigate, especially in cancer.

I think a common misconception is that palliative care is only for people who are dying or who are in their last year of life or not doing well with therapy. I sometimes have our palliative care physician see patients with me even in the curative setting or even with quote-unquote well-tolerated therapies because oftentimes there's an unmet need that collaboratively we can better address.

For oncology nurses who are on the frontline, what key clinical red flags indicate that a patient needs immediate psycho-oncology support?

One major challenge — and this is where our nursing colleagues can really help advocate for our patients and for our physicians — is oftentimes there can be unseen distress. Oncologists unfortunately have limited time with their patients and sometimes these clinical visits are very focused on a specific agenda. For example, for a patient who's undergoing chemotherapy, a lot of it may be the dose, the labs, the imaging, reflecting on is this going according to plan, and sometimes those more emotional needs just don't have time, unfortunately, to come up in the clinic, or they may be an afterthought to all of these similarly important issues.

Whereas our nursing colleagues oftentimes have these opportunities to have these quote-unquote softer conversations with the patient and the family, whether it's an infusion or it's accessing their port or it's a triage phone call. And what I'd love is this psychological safety where they feel empowered to be curious about what's going on, feel empowered to offer intervention to the patient and family. I love that our nurses in our practice will ask, "Have you thought about meeting with our palliative care team?” or “Have you thought about meeting with our psychologist? I know they can help you with anxiety or depression or distress." And I think it's really nice to have systems that objectively elicit these findings at scale.

There's a big push to move away from just initial single question or single-timepoint screening questionnaires which are to meet, for example, Commission on Cancer demands, and it's so much better if these questions could be longitudinally assessed over time. So, we do depression and anxiety and distress screenings every 3 months and it's another opportunity to meet a patient when there's an unmet need.

Transcript has been edited for clarity and conciseness.