The Comfort Corner #3: Dialogue with Prof. Stein Kaasa, hosted by Martin Harutyunyan

In this episode of ‘The Comfort Corner’ OncoDaily, Professor Stein Kaasa, a pioneer in palliative medicine, is interviewed by Martin Harutyunyan, a medical oncologist and palliative care specialist. Prof. Kaasa shares his journey from oncology to palliative care, discusses the importance of patient-centered approaches, and highlights key challenges in pain management, cancer cachexia, and the future of palliative care. Tune in for insightful stories and advice on improving quality of life for cancer patients through holistic care.

Stein Kaasa, MD, specializes in medical oncology, radiotherapy, and palliative medicine. He is the Head of the Department of Oncology at Oslo University Hospital and a Professor of Oncology and Palliative Medicine at the University of Oslo, Norway. He previously served as the National Cancer Director in Norway and as President of the European Association for Palliative Care (EAPC). He currently coordinates the MyPath Project and has led the EAPC Research Network.

Dr. Martin Harutyunyan is a medical oncologist and palliative care specialist who currently serves as the Head of the Palliative Medicine Service at Yeolyan Hematology and Oncology Center in Yerevan, Armenia. He has been working as a medical oncologist at the same center since October 2021.

Dr. Harutyunyan has made significant contributions to research and patient care throughout his career. He has worked as a clinical researcher at the “City of Smile” Charitable Foundation and as a medical coordinator at the Union of Armenian Doctors.

Dr. Harutyunyan’s played a key role in the launch of a Palliative Medicine Service at Yeolyan Hematology and Oncology Center.

Martin Harutyunyan: Greetings and a warm welcome to the Comfort Corner, a palliative care series on OncoDaily. We aim to raise awareness about the critical need for palliative and supportive care among cancer patients with the goal of improving their quality of life. Our motto, navigating life’s twist with compassion, encapsulates our mission.

My name is Martin Harutyunyan and I’m a medical oncologist and palliative care specialist from Yerlan Hematology and Oncology Center in Yerevan, Armenia. It is my honor to introduce Professor Stein Kaasa, distinguished medical oncologist, radiotherapy specialist, and expert in palliative care. With a remarkable career spanning decades, he was appointed the first professor of palliative medicine in Scandinavia back in 1993.

As a founder of the palliative care unit in Trondheim, Norway, Professor Kaasa has been instrumental in advancing palliative care research, both nationally and internationally. His extensive contributions include serving as the national cancer director in Norway, a president of the European Association for Palliative Care, and a leader of the EAPC research network. Currently, he heads the Department of Oncology at the Oslo University Hospital and holds a professorship in oncology and palliative medicine at the University of Oslo.

With an impressive publication record of more than 546 articles and book chapters, Professor Kaza’s impact on the field is significant. Hello, Professor Kaasa. We are delighted to have you with us today.
Thank you. Thanks a lot.

Stein Kaasa: Very nice to be here.

Martin Harutyunyan: What inspired you to specialize in palliative medicine?

Stein Kaasa: I think palliative care and palliative medicine is an integrated part of cancer care. I started as an oncologist. And in my first years, I worked with lung cancer patients.

And at that time, we didn’t have immunotherapy and we didn’t have all the new molecules. So, basically, we could offer life prolongation if the tumor was inoperable. And that was either radiation therapy to the tumor and the mediastinum or cisplatin-based chemotherapy.

And at that time, now we are back to the 1980s. There were very little information about quality of life and how patients were coping with this to chemotherapy and radiation therapy. So, I was actually encouraged by one of my tutors at that time to also look into the patient’s quality of life.

And I think that’s, at least for me, some of the backbone when I started also to specialize later, also in palliative medicine, that the patient-centered approach, palliative and supportive care need to be an integrated part of all type of cancer care. So, I think it’s very encouraging to work with the patients and the families, not only with anti-cancer therapy, but combining it with the patient-centered approach, both physical, psychological and social.

Martin Harutyunyan: Thank you. Could you share a memorable patient story that highlight the impact of palliative care?

Stein Kaasa: Well, there are lots of patient histories I have been through the last decades. I think one history is related to a patient I had many years ago. She had lung cancer and she was living at that time.

Patients need to travel to the oncology center. But she was living, I think it was approximately 350 kilometers away from the hospital. She came here at that time to receive chemotherapy, as I mentioned, a combination of cisplatin and metoposite.
And I think she was very eager to receive the anti-cancer therapy. But at the same time, she had children at home. And she was actually suffering from major side effects due to the cisplatin-based chemotherapy.

And at that time, we didn’t have the 5-HT3 antagonists. So, we only used the more traditional antiemetic therapies. So, she actually complained and said, well, I want to have the anti-cancer therapy, but I feel sick for another 10-15 days after I go home.
And then I recover for three to four days. And then I’m back at the Radium Hospital to receive another course of chemotherapy. And it needs to be regionalized, not only centralized.

And then it also showed me that it’s more to the patients than the anti-cancer therapy. It’s the family, it’s the children, it’s the travel, and it’s the importance of being at home. And I believe that’s one of the central parts of palliative care.
We need to help patients to live as long as possible, but also as normal as possible. So, I think to combine this approach is important. And I believe that we see that all the time.

If you open up and ask the patients what’s important for you, most patients then tell me, as this woman did, well, I want to have the anti-cancer therapy, but at the same time, I want to balance it. It’s important for me to be with my family, and it’s important for me to be at home.

Martin Harutyunyan: Thank you. As a leader in palliative care research, what gaps or challenges do you see in current practices?

Stein Kaasa: Oh, I think there are several gaps. But before I talk about the gaps, I think we have learned quite a lot the last decades. I think we have learned quite a lot about how we can treat pain in a better way, which is one of the symptoms that patients fear the most.
When we combine, for example, anti-cancer therapy, radiation therapy with opioids, we can treat the pain in a very effective way.

However, if you look into the clinic, and we will go into more the data from epidemiological studies about pain control, we still see that quite a few patients we are talking about, it depends upon which cohort you’re looking at, but 30 to 50% of patients with pain are not treating properly. So, we need to work on how we can implement the knowledge about how to treat the patient with pain into clinical practice.

So, I think that’s a major gap to apply the knowledge we have about the effects of palliative care into daily clinical practice. Then another condition which I’ve been working with quite a lot, that’s nutrition and cancer cachexia. That’s a big problem for very many cancer patients.
And we need more research to understand the basic mechanisms behind cancer cachexia. We see that insight might help us to treat the condition more directly, but still, the standard treatment of cachexia is not very, very effective. So, that’s an area I think is really important.

And I think a third area we are working on right now, which I think is a gap related to more health services research, because we will see in the next decades, in Europe, in Japan, in US, in Canada, that we won’t have enough staff to work in healthcare, because it’s very staff demanding. And I think at this one area we are working very actively in right now is how can we use modern information technology to make it more effective, but also better palliative. Can we change working behaviour?

How can we be more effective? And how can we use modern information technology? I think that’s an extremely important area.
And if we can develop, which we are doing right now through the MyPath project funded by EU, where we are making and programming specific tools for use for palliative care, and get that implemented into cancer care, I think we can improve, as I said, the effectiveness, but also the quality. So, I’m very much now in my last part of my career, to see how I can and my group can change clinical behaviour and improve palliative care for large amounts of patients across Europe.

Martin Harutyunyan: Okay, thank you. And what role does interdisciplinary collaboration play in providing holistic care?

Stein Kaasa: Well, interdisciplinary care is essential. And I think both in palliative care, but also in cancer care in general, we have a lot of disciplines working together. The key professions are nurses and doctors.

But we also have nutritionists, psychologists, chaplains, sociologists, etc. And we have had at least a tendency to work in parallel. So, what I’m talking about, and I think your question fits very well with the thinking about how can we use modern information technology to communicate between different professions, and also decide who is doing what to the patients at what time.

So, we are at least in our research group and in our institution, focusing quite a lot about how we work interdisciplinary, but also how the different disciplines take individual responsibilities for parts of the patient’s journey and what the patient needs.

Martin Harutyunyan: And what advice would you give to aspiring palliative care practitioners?

Stein Kaasa: Oh, that’s a hard one. It depends where you are and where you are working. If I should use a little bit from my own experience, I think if you’re working in an academic institution or in a hospital, we need more physicians and more healthcare providers, psychologists, nurses, etc, who will go into clinical research.

So, I think to search for combined positions, where you can do both research and clinic is extremely important because palliative care needs to be more academic. On the other side, I think as a palliative care specialist, as a palliative medicine specialist, I think it’s extremely important as you raised the question about interdisciplinary work. So, as a palliative medicine specialist, I think you need to take the responsibility to coordinate the team, but you also need to be reflective around what you can do as a doctor and what a social worker and what a psychologist and what a nutritionist can do.

So, to understand and have interest in other disciplines, I think it’s extremely important. And then, I would think that it’s also very important to reflect upon your position in a society because when we hear that anti-cancer therapy is improving, it might, it’s less need for palliative care. I think it’s the opposite.

So, we need to be active and to inform the society about the needs for palliative care, because I think there’s going to be even more needs for palliative care when patients are living longer with active disease. So, I would strongly encourage younger doctors also to be active in the public debate about the need for palliative care around the world.

Martin Harutyunyan: And how do you stay resilient and maintain empathy while dealing with emotionally challenging situations?

Stein Kaasa: First of all, I think you need to, personally, I think you need to reflect upon what’s your position as a doctor. You cannot solve all type of problems. On the other hand, as a doctor, you are very important to the patients.
But the most important people for the patients is the family and relatives. So, you shouldn’t overestimate your role. On the other hand, to be empathic and to be professional.

But at the same time, to understand the patient is extremely important. And so, to combine the cognitive dimension and the emotional dimension, which is empathy actually, is extremely important. And that’s something I believe that you need to discuss with colleagues.

You need to practice it. And I think you also need to reflect upon it yourself. And I think in order to stay empathic and resilient with daily life, working with serious ill patients, it’s very good to discuss the patients and specific cases with colleagues.
To me, that’s the best support I can get is to discuss it. Because when you discuss it and get feedback, at least for me, it’s more easy to go home and think that today was a good day.

Martin Harutyunyan: Thank you, Professor Kaasa for your insights today. And thanks to our listeners for joining us. Keep exploring palliative care and join us next time for more discussions at the Comfort Corner.
Take care.