Supportive Oncology: Understanding the Basics of Holistic Care

Tools like the NCCN Distress Thermometer can help assess patients' symptoms.

Supportive oncology interventions provide a comprehensive approach to oncology, addressing patients’ needs holistically, which start with understanding a patient’s baseline needs, according to Heather Jackson, PhD, APRN, FNP-BC, NEA-BC, FAA-NP. Jackson shared insights on supportive oncology in a presentation at the 9th Annual School of Nursing Oncology, hosted by Physicians’ Education Resource®, LLC.¹

Jackson, the administrative director of advanced practice at the Vanderbilt-Ingram Cancer Centers in Franklin and Nashville, Tennessee, provided an overview of how to provide supportive care using tools that help nurses and advanced practice providers (APPs) get to know a patient and their concerns better, including the NCCN Distress Thermometer and Problem List and the “5 As” of pain management.

Defining Supportive Oncology

As Jackson explained in her presentation, the goal of supportive oncology is to connect patients with resources to improved quality of life (QOL) “as early as possible” through treating patients’ physical, psychological, spiritual, and social needs.

These needs may come from the disease itself or from adverse effects (AEs) of the treatments for the patient’s cancer. Supportive oncology also encompasses providing similar support for the patient’s loved ones.

In an interview with Oncology Nursing News, Jackson used a “whole pie” metaphor to explain why addressing each aspect of a patient’s wellbeing is imperative.

“It seems like so often we focus on 1 aspect, right? Maybe the physical component of patient care,” said Jackson. “The way I best describe it for patients is that I look at it like a piece of pie. If we’re giving comprehensive care, we don’t want to treat just 1 slice, right? … If you’re not treating the other aspects of the patient, then you’re not actually giving comprehensive care.”

Gauging Patient Issues: NCCN Distress Thermometer and Problem List

Jackson shared that the NCCN Distress Thermometer and Problem List provides a starting point to understand a patient’s baseline symptoms. She added that it can provide a “lens” through which to evaluate a patient’s distress at the start of care and compare going forward.

“It’s a great tool to use to see the impact of an intervention that you might be doing, especially in cancer care, so it’s a great tool to make sure we have this lens,” Jackson explained. “It’s a really quick tool you could put in your documentation system create quick dot phrases to make sure we’re capturing everything.”

The NCCN Distress Thermometer is an illustration of a thermometer with tick marks lining the side from 0 to 10, with 0 denoting “no distress” and 10 representing “extreme distress.”² Patients are prompted to rate their distress in the past week from 0 to 10 on the thermometer.

The resource also defines distress for patients as “an unpleasant experience of a mental, physical, social, or spiritual nature.” The definition explains that it may affect thoughts, feelings, or actions and make it coping with cancer, symptoms, and treatment more difficult.

The NCCN Problem List prompts patients to indicate specific issues they have had in the past week. It breaks those issues down into 9 physical concerns, 9 emotional concerns, 7 social concerns, 13 practical concerns, and 6 spiritual or religious concerns. The form also provides 3 lines for patients to write in any other concerns.

Jackson emphasized that using this tool can help open conversations with patients about their concerns and allow clinicians to understand the patient on a deeper level as an individual.¹

The “5 As” of Pain Management

In her presentation, Jackson, who was named America’s top nurse practitioner for pain management by the Point of Care Network in 2025, provided guidance on best practices for addressing patients’ pain through a comprehensive supportive care lens.

Pain management, she explained, should have the patient’s goals of care in mind and improve function. Interventions may include over-the-counter solutions like acetaminophen and NSAIDs, prescription drugs like opioids, and/or adjuvant analgesics like antidepressants or anticonvulsants.

Jackson emphasized that integrative interventions and strategies like acupuncture and injections can elevate care. Additionally, the multidisciplinary team should be considered when addressing patients’ symptoms. Jackson demonstrated in her presentation that biological, psychological, and social factors can not only contribute to pain, but can in turn escalate one another.

In order to perform a comprehensive assessment of patients’ pain symptoms, Jackson recommended using the “5 As” of pain management:

1. Analgesia: assess the physical pain regimen a patient is receiving and if it is improving patients’ symptoms
2. Activities: evaluate the level to which patients’ daily routine and function have been interrupted
3. Adverse effects: understand what AEs patients may have incurred since beginning treatment as a result of therapy
4. Aberrant behavior: evaluate a patient’s risks and if medication misuse or combination with other substances is a concern
5. Affect: assess if the patient’s typical mood, including how they interact with other, including their care team, their caregivers, or other patients

“This all starts with building a relationship, making sure that the patient understands that I’m not there to be judgmental,” Jackson shared. “Nothing’s off the table. We’re here to talk about anything and everything.”

References

1. Jackson HJ. Comprehensive Supportive Care for Oncology Patients. Presented at: 9th Annual School of Nursing Oncology; August 9, 2025; Nashville, TN.
2. NCCN. Clinical Practice Guidelines in Oncology. Distress management, version 1.2025. November 18, 2024. Accessed October 2, 2025. https://www.nccn.org/docs/default-source/patient-resources/nccn_distress_thermometer.pdf