Dr. Declan Walsh, chair of the Department of Supportive Oncology at Atrium Health Levine Cancer, has been named a 2025 Fellow of the Multinational Association for Supportive Care in Cancer (MASCC), recognizing his sustained contributions to cancer supportive care practice and research. The award comes as Walsh continues to advocate for systematic integration of supportive oncology services within comprehensive cancer centers.
Restructuring Supportive Care Delivery
Walsh's department, established in 2017, represents a novel approach to organizing supportive care services. Rather than operating as disparate programs, the model consolidates counseling, support groups, nutrition, and palliative care services under a formal departmental structure similar to radiation oncology or surgical oncology departments.
"Many cancer centers already have a lot of supportive services being provided," Walsh explained. "They're not organized in a [proper] manner, and they're not necessarily readily accessible to patients. The insight that we had here was that we could restructure, reorganize, and coordinate these services and programs much more effectively within a formal department of supportive oncology."
The approach has proven transferable and scalable to other cancer centers nationally and internationally, with Walsh expressing hope that this model will become standard of care within the next decade.
Multidisciplinary Integration Strategy
Central to Walsh's vision is the integration of supportive oncology specialists into tumor boards alongside radiation and medical oncologists. This comprehensive approach ensures that supportive care considerations are incorporated from the beginning of treatment planning rather than as an afterthought.
"Those of us who are interested in providing supportive oncology services should be very willing to engage in the sharp end of cancer care so that we are accessible, we respond quickly, and we are part of the comprehensive clinical care team," Walsh stated.
The cultural shift among oncology colleagues has been notable, with increased appreciation and understanding of supportive care services. Walsh emphasizes the importance of early recognition of patient needs by clinical colleagues to enable supportive oncology services to intervene at the beginning of the illness trajectory for maximum impact.
Critical Unmet Need: Nutrition Management
Walsh identifies nutrition and malnutrition as the most neglected area requiring immediate attention in supportive oncology. The scope of the problem is substantial: the majority of cancer patients diagnosed annually in the United States are either overweight or obese, while weight loss and severe weight loss remain common complications of cancer and its treatment.
"A huge proportion of patients with cancer in the US who are diagnosed this year will be either overweight or obese," Walsh noted. "That is a major issue in terms of, first, why somebody gets cancer. It also complicates the management of the disease if they, for example, have diabetes because of obesity, and it affects other outcomes in many ways."
The clinical significance extends beyond symptom management, as these nutritional issues significantly alter disease trajectory and outcomes. Despite the prevalence and impact of nutritional complications, Walsh acknowledges that the field lacks adequate evidence-based answers to patients' common question: "What should I eat?"
Evidence Base Expansion
Recent developments have strengthened the evidence base for supportive oncology interventions. Walsh highlighted findings presented at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting demonstrating that exercise therapy in cancer rehabilitation produces significant effects on the natural history of illness, moving beyond symptom improvement to actual disease trajectory modification.
"This is not an insignificant effect," Walsh emphasized. "All the exercise therapy in cancer rehabilitation is moving the needle in the natural history of the illness, and this needs a lot more attention, investigation, and education."
Future Directions
The field has experienced significant cultural transformation among cancer clinicians, with the vast majority now recognizing and valuing supportive care services. This shift reflects growing evidence that supportive interventions can substantially impact patient outcomes and the recognition that cancer's complexity requires comprehensive team-based care.
Walsh's institution operates under the "loved one standard" advocated by cancer center president Dr. Ruben Mesa, approaching care delivery with the question: "If you had a family member who was [affected by] cancer, how would you want them to be looked after?"
The comprehensive approach addresses common cancer problems including financial toxicity, nutrition issues, and symptom control—areas that affect most cancer patients and require expert clinical attention. Walsh advocates for enhanced education and research across all supportive oncology aspects, emphasizing that improved patient support, symptom control, and family strengthening will ultimately enhance cancer outcomes overall.
