[Psycho-oncology and supportive care: psychiatrist's practice.]

From a psychiatric point of view, supportive care does not only involve coordinating care among caregivers, even though the inadequacy between patients' needs and patients' access to psychological support is a sufficient incentive for promoting these supportive services. In patients with comorbidities, only cooperative efforts between medical and psychological teams can ensure efficient patient management. Supportive care is essentially based on a more systematic assessment of symptoms and of their impact on patient quality of life. Symptoms are not so much a clinical manifestation required to establish the diagnosis of the disease, but they represent the disease itself. They are the guiding principle of patient management, which is based more on "dimensional" than on "categorical" measures, and which requires active participation of the patients through auto-evaluation. Patients try to fit clinical events into a "narrative picture of their disease", which can actually add temporality to the fleeting transiency of symptoms. Exchanges between the different caregivers involved in coordinated supportive care and comparisons between the different versions of the patients' narrative make it possible for the caregivers to elaborate their own understanding of the disease which, somehow, becomes the "validated version". This version will be more or less directly fed back to the patients during the next period of care delivery and will likely interfere with facts, or disorders reported by the patients, thus inducing a distortion in the reported picture. This explicit confrontation between the two "narrative lines" is a potent incentive for the patients to rethink their attitude toward their disease, and to accept the changes sustained by the strong determination of caregivers to improve, even only marginally, their clinical status. The patients are challenged to rethink the events, which, in their narrative, were viewed as omens. There is evidently a psychotherapeutic effect involved.