A hot topic in my coffee klatch is com­pre­hensive cancer care. Mark, our ring­leader and the healthiest of the bunch, constantly brings our con­versa­tion round to that con­cept.

(For the record, there are four of us in the klatch, three of whom have cancer, and the fourth of whom has some mysterious debili­tating chronic illness, or com­bi­nation of illnesses, that has stumped several major medical insti­tu­tions.)

Mark’s passion is connecting the dots between oncology and com­pre­hensive care. So he often poses a series of questions when we meet.

Which of us, when we were diagnosed, were given nutritional informa­tion or directed to a nutritionist by our oncologist?

Which of us, when we were diagnosed, were given an exercise regi­men or directed to a physical therapist or trainer, by our oncologist?

Which of us were directed to a counselor or other psychosocial services by our oncologist? Were any of us connected to a mentor or guide with the same kind of cancer?

If any of us were treated in the past, or are treated in the present, at a certified comprehensive cancer center, Mark allows us to substitute “treatment center” for “oncologist.”

Our responses are all some variation of “not I.”

The Commission on Cancer (CoC), a program of the American College of Surgeons, certifies facilities that provide “comprehensive, high-quality, and multidisciplinary patient centered care.” The certification process requires, among other things, “improving survival and quality of life for cancer patients through ... com­pre­hen­sive quality care.” If you were to look at the CoC’s 2016 standards for certification, you will see benchmarks for nutrition, rehabilitation, and psycho­social services, among others.

The takeaway from what our small number (certainly not a valid statistical set) has experienced so far is that, while a cancer facility must establish such a wraparound program to be certified, the program itself need not be very accessible to the patient – or, for that matter, even viable in terms of patients served and the strength of the program.

Mark and another member of our klatch are treated at a large cancer center in our area, and both agree that while the comprehensive program exists on paper, it has not in seven years ever really gotten off the ground in reality. (Mark is involved in establishing a stand-alone comprehensive survivorship program, and so has plumbed the depths of the aforementioned institution as part of his work, in addition to being treated there for the last three years. So he’s not just speculating as to the quality and viability of the program.)

We talked a long time at our most recent klatch about who or what should have the responsibility – moral or ethical – to steer a cancer patient right out of the gate towards comprehensive care. The oncologist? The cancer facility or hospital? Someone or something else?

I suggested the entity that stood to gain the most and should demand comprehensive care is the insurance industry. Studies show that patients who eat well, exercise, and have psycho­social services (defined broadly) have better quality of life and sometimes better outcomes than those who don’t. If I am an insurance company that has just shelled out a lot of money on cancer treatment, I have a vested financial interest in demanding not only that the insured take all possible steps to achieve a more healthful state, but also that the medical providers I am reim­bursing make readily available a wide range of real (not promised) services from the diagnosis forward.

As a group, our klatch was pretty negative on what we see as the silo approach to cancer treatment. You know: the oncologist is in his or her silo, the nutritionist is in his or her silo, the psycho­social services are way over there in that silo, and who asked the physical therapists to the silo?

We all agreed that regardless of which group spearheaded any move to change this, a commitment to true comprehensive care would change the face of cancer treatment in this country. (I specify the United States because it's my understanding that many European nations have already made this leap. I cannot speak for Canada, but I bet some of the readers can.) We would all be the better for at least having the opportunity of getting wraparound services and support to improve our quality of life. Whether we the patients follow through is a topic for another column.

My experience?

My personal physician talked to me about nutrition way back when, my oncologist has for 12 years occa­sion­ally asked me about exercise, and no one has suggested any psycho­social services of any kind. (As to that last category, apparently I am just amazing and therefore immune to depression or other mood swings.) What survivorship anything I have garnered over the years has been the result of my own research or from reading columnists and readers’ contributions to The Myeloma Beacon.

I don’t know if reading The Beacon qualifies as psychosocial services, but, hey, it works for me.