Multimodal cancer care research.

well, may produce a crescendo of suffering and accelerate disease. An intertwining of approaches, perhaps regarded by many as separate entities, should therefore be seen as a common front. It is unsurprising that many aspects of quality of life improve for patients working with multimodal teams, as documented by Gagnon et al.8 and Chasen et al.9 in this issue of Current Oncology. Improvement of this kind has consistently been demonstrated in palliative care programs, and the multimodal teams being spoken of are, in reality, based on palliative care principles. But is there a biologic rationale for their potential success in controlling symptoms and possibly improving the results of drug therapy and patient survival alike? I think that there is. Tumour immune response is undoubtedly a twoedged sword. As advanced cancer progresses and metastasizes, the immune reaction engendered turns traitorous. The tapestry of cytokine and chemokine production stimulates tumour growth, angiogenesis, tissue invasion, and metastasis10–12. This aberrant chronic inf lammatory state increases symptom frequency and severity, most notably the anorexia– cachexia syndrome13,14, and clearly connotes a grim prognosis for survival15. Exercise, some dietary components, and psychosocial intervention have anti-inflammatory effects16–21. It can be hypothesized that adding sophisticated dietary counselling, follow-up exercise and self-help routines, and psychosocial interventions might not just increase appetite and help patients “feel good,” but might also ameliorate the chronic inflammatory state and thus decrease cancer symptoms and inhibit tumour progress. Sound social and biologic rationales therefore underpin the idea of combining conventional anticancer therapies with multimodal team care from first diagnosis. Only baby steps toward proving these hypotheses have been taken. The two papers in this issue—and the few other studies from teams dealing with cachectic cancer patients—have, in total, enlisted fewer Research models must more closely take into account the interdependence of social, behavioral, psychological, organ system and cellular molecular mechanisms of disease. — Norman Anderson1