Janet Abrahm


Q&A with Janet Abrahm, MD

April 17th, 2020

Janet Abrahm is a nationally recognized expert in Palliative Medicine and author of A Physician's Guide to Pain and Symptom Management in Cancer Patients. She is Professor of Medicine at Harvard Medical School and the Former Chief of the Division of Adult Palliative Care in the Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute and Brigham and Women’s Hospital.

Why did you decide to work in palliative care?

I initially practiced as a hematologist-oncologist. I started doing what we now call palliative care because I wanted to improve the quality of life of my cancer patients. In some cases, I had to control their symptoms so that they could tolerate life-prolonging or even curative therapies. And when the therapies were not effective, I wanted my patients to be as comfortable as possible at the end of their lives. Later, as a Faculty Scholar of the Project on Death in America, which Drs. Kathy Foley and Susan Block led, and as a faculty member in Dr. Block’s Department, I sought training from her, Dr. Eric Cassell, and others to add to my symptom management skills with improved communication techniques and a better understanding of the psychosocial and spiritual components of distress.

Tell us about your research. 

I’m part of a research team that is trying to create electronic medical record (EHR) and clinical decision support (CDS) tools to enable oncology clinicians to practice “primary” palliative care symptom assessment and management. The CDS process integrates patient-reported symptoms (PROs) with lab data and the medications patients are already taking, and sends the data to servers programmed with algorithms based on national guidelines that analyze this information. The oncologist receives tailored recommendations for assessment and management of each moderate or severe patient symptom in the EHR during the patient’s visit. Our recommendations include exact specifications for nonpharmacologic therapies (e.g. amount of exercise) as well as which drugs and what doses should be used. As the oncologist clinician “clicks” to accept each suggestion, a note is automatically created and billing codes are provided. The goal is to enable oncology clinicians to provide guideline-based symptom management for pain, nausea, anxiety, depression, fatigue and shortness of breath.

In our previous study, we provided paper reports to thoracic oncology clinicians in the “study group”; they accepted about 60% of our suggestions. Patient anxiety, depression and fatigue all improved in the study group patients compared with the control group. So we are excited to study the effect of providing the assessment and management suggestions directly on the computer screen while oncology clincians are seeing their patients.

Are there any publications or projects that you’d like to highlight?

I am a co-author of a paper in the 2020 ASCO Educational Book about new strategies to integrate palliative care into standard oncology practice, Palliative Care Skills and New Resources for Oncology. This is an ASCO goal, but there aren’t enough palliative care clinicians to meet the need. This article explores other ways to deliver palliative care to more patients with cancer. Anthony Back discusses communication techniques for oncologists, Tara Friedman discusses palliative home care options and telehealth palliative care, and I discuss how to use the electronic health record to integrate basic palliative care symptom assessment and management for oncology patients.

I recently co-authored a paper with Elizabeth Rickerson that was published in the Journal of Palliative Medicine. The article discusses the use of Dexmedetomidine for patients with severe symptoms in order to avoid or delay the use of palliative sedation and keep them comfortable towards the end of their life.

I am also working with a team including palliative care physicians BR Daubman and Molly Collins to create a fourth edition of my book, A Physician's Guide to Pain and Symptom Management in Cancer Patients, which will feature guests authors social workers Amanda Moment and Arden O’Donnell, psycho-oncologist Dr. Hermioni Amanoo, and Reverend Katie Rimer.

Tell us about your background.

I’m a native San Franciscan as were my parents. I grew up in the City, went to public high school, did my undergraduate at UC Berkley, went to UCSF for medical school, and received wonderful training at all of those institutions. I was in medical school during the Vietnam War, an experience which taught me an enormous amount. As I was finishing, my mentors urged me to leave UCSF to train at an institution I had not already worked in, so I went to Mass General as a medical intern. It was the first time there were four women in the intern class, and it was a time that women in medicine were still a novelty.  As my career has progressed, I have always been concerned about advancing women in the workplace and giving them opportunities to succeed. I am particularly proud, therefore, of receiving the Edward Benz Award in 2019 for the Mentorship of Women in Medicine.

What is the most helpful advice that you have received?

“Be careful what you wish for, because you’re likely to get it.” What that means to me is that if I put my energy towards achieving the things that really matter to me, I’m likely to succeed.

Learn more about Dr. Abrahm