Thread by @RThienprayoon

Next up: TH109B- Together is better: a combined #hapc and #psychiatry substance use disorder clinic for patients with advanced #cancer
@AmericanCancer take note of this model
#hapc23

@lauramakaroff thinking of special populations and your work!

Rates of concomitant SUD and #Cancer -
EtOH rates higher than opioids (similar to society)

Challenges in SUD+Cancer
- adherence & transportation issues
- stigma from med teams
- poor coping and PTSD
- mistrust of med system
- poor health literacy
#hapc23 #hapc #cancer

Stigma worsens mistrust of medical system which challenges health literacy.
This is so real.
Patients with SUD are stigmatized in society and by us.
The intersection of pt #safety and #SUD is fraught, esp when adults are cared for in peds hospitals.
So challenging. #hapc23

Combined clinic model for SUD+Cancer:
The appt is always the same.
Same day of the week.
Same time of day.
Same location.
Patient knows where to be and when, even if there is little communication in between.
#hapc23

SUD+Cancer Clinic set up to decrease power differential.
Not an exam room- round table. No white coats.
Strengths-based approach:
Start with what's going well!
Preview week ahead.
Affirm coping.
Validate growth.
Approach relapse and recovery.
#hapc23

Adding #PallOnc to this thread for those of you who follow that #- sorry to miss early on.

Approach to challenges:
- Built rapport and trust
- Use destigmatized language (avoid "addict", "user")
- Realistic, nonjudgmental approach to relapse
- Consistency w team members
- High touch approach
- "Warm, welcoming place rather than a place of fear and anxiety"
#hapc23

Practical stuff for SUD+Ca #pallonc
They prescribe a lot.
Frequently one-week script filled on site.
Buprenorphine, methadone, benzodiazepines.
Multimodal approach to sx management.
Plan for what to do if they don't come- lesser script or taper.
#hapc23

Critical point: these patients can be draining for clinicians. Pts are "tough", "challenging".
The team-based approach helps find "genuine goodness and humanity in pts with devastating lives". #compassion for patients
#compassion for selves
#compassion for team
#hapc23

"Cancer can be a life-saving diagnosis" for patients with SUD.
Wow.
Compassionate, holistic, team-based treatment for SUD and cancer can drive life change in these patients.
#hapc23 @lauramakaroff @AmericanCancer

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