The Mass General Cancer Center tackles the dual challenge of treating cancer patients who also have substance use disorders with an innovative approach.

To meet the challenges of treating cancer patients who also have drug addictions, the Massachusetts General Hospital Cancer Center has launched a new Substance Use Disorder Tumor Board to provide patients with the best possible care.

The new board brings doctors, nurse practitioners, social workers, and other clinicians together to build a strategy for treating patients who struggle with cancer and drug addiction simultaneously.

The new board brings doctors, nurse practitioners, social workers and other clinicians together to build a strategy for treating patients who struggle with cancer and drug addiction simultaneously.

The nationwide opiate epidemic has increased the number of cancer patients with substance use disorders entering treatment at the Mass General Cancer Center, says radiation oncologist Helen Shih, MD.

Such patients often struggle to meet the demands of cancer treatment which may involve chemotherapy, surgery, radiation therapy and follow-up visits. Patients frequently fail to show up for appointments, and their mental health issues can cause stress and disruption while they are in the Cancer Center.

“We may have a patient who comes in for surgery or radiation therapy and is in withdrawal,” Dr. Shih explains. “They are in pain from withdrawal, but they don’t tell us. Instead, they may become uncooperative or disruptive to everyone around them.” Clinicians also deal with uncertainty about when and whether to prescribe pain relief medicine for patients who have substance use problems.

“By establishing the Substance Use Disorder Tumor Board, Dr. Shih and colleagues are helping the Cancer Center meet an important need with compassion and insight,” says David Ryan, MD, chief of Hematology and Oncology. “This innovative program is designed to serve our patients with a full understanding of the challenges they face.”

One Man’s Struggle

David Fontaine had lived drug free for 18 years until he was diagnosed in 2013 with melanoma, a deadly form of skin cancer. At age 58, the diagnosis hit the former property manager hard. “When somebody says cancer, it’s like a death sentence,” Mr. Fontaine says. “I cried for two weeks and I went right back to heroin.”

David Fontaine

At Mass General, he often missed appointments for cancer treatment. “I figured I would get high before going to my appointment. Then I would miss my appointment,” he says. “My use became more important than taking care of my health.”

In 2015, following a car accident, a scan found the cancer had spread to his brain. He was treated with chemotherapy, brain surgery and radiation therapy delivered by Dr. Shih.

Following the surgery, he struggled to stay off drugs but did not succeed. He overdosed on heroin, survived, and headed back into a rehabilitation facility. This time it worked. He has now been substance free for 19 months and his cancer scans are clear so far.

Substance Use Disorder Tumor Board

Mr. Fontaine is a good example of the kind of patient the new Substance Use Disorder Tumor Board is designed to help, Dr. Shih says. Earlier this year, she and a group of Cancer Center colleagues in collaboration with the MGH Substance Use Disorder Initiative established the board as a place where clinicians discuss individual cases and help determine the best approach for each patient who is struggling with the burden of addiction.

At the same time, the hospital-wide Substance Use Disorders Initiative, launched in 2014, has expanded its work into the Cancer Center.

The idea for the board began a few years ago when Dr. Shih began to observe the challenges of treating cancer patients with addictions. She learned all she could about addiction and became active in Narcotics Anonymous and Alcoholics Anonymous.

As a radiation oncologist who treats brain cancer, she saw parallels between the mental health problems of addiction and the mental changes that can accompany brain cancer. She took her new knowledge back to the Cancer Center and worked to create the board.

Around the same time, Carlos Fernandez-Robles, MD, a specialist in Psychiatric Oncology observed some of the same problems and joined the hunt for a solution.

“We were at a crossroad with our patients in cancer treatment who also have substance use disorders,” Dr. Fernandez-Robles says. Expecting patients who cope with stress by using narcotics not to abuse narcotics during the difficult experience of cancer treatment is unrealistic, he says. “We needed to offer additional support during the most stressful moment of their lives.”

Cancer and substance use disorder
Helen Shih, MD

The board now includes clinicians from Medical Oncology, Radiation Oncology, Palliative Care, Pain Medicine, Psychiatric Oncology, Social Work and the hospital’s Substance Use Disorders Initiative. At monthly meetings, they talk about how to handle drug-seeking behavior, disruptive behavior and noncompliance with treatment.

Mass General Initiative Expands

At the same time, the hospital-wide Substance Use Disorders Initiative, launched in 2014, has expanded its work into the Cancer Center. That means a Cancer Center patient with a substance use disorder can be seen by the Addiction Consult Team which evaluates the patient and recommends related treatments and community services to help them recover from drug addiction.

For David, the progress has been remarkable, Dr. Shih says, including both his recovery from addiction and his cancer treatment. Although complete remission remains in the future, his regular scans remain clear.

Sitting in a hospital café recently, Mr. Fontaine lifted a stylish Kangol cap from his head to reveal the faint surgical scar from his surgery. He is happy to be drug free and, thus far, clear of cancer. “The oncology team here has been incredible,” he says, “I can’t say enough about the care I received here at the Mass General Cancer Center.”

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