Psychosocial oncology: Supportive care for the cancer patient

doi:10.1053/j.seminoncol.2004.11.011

Seminars in Oncology

Volume 32, Issue 2, April 2005, Pages 211-218

https://doi.org/10.1053/j.seminoncol.2004.11.011 Get rights and content

Increasing attention is being paid to the emotional and psychosocial needs of cancer patients. As a result of huge advances in early detection and in treatment modalities, there now are millions of cancer survivors in the United States. There has been a realization that cancer survivors have distinct psychosocial needs. As cancer survivors live longer, reduction of psychological distress has been recognized as being an important part of having an improved quality of life. There have been numerous changes in the field of psychosocial oncology since it first began 25 years ago. Guidelines now exist for the definition of distress and decision trees are available for making the appropriate referrals. Advances in pharmacologic treatment for depression and anxiety have made it possible to decrease distress and increase coping in cancer patients undergoing treatment as well as in cancer survivors. Numerous individual and group therapies have demonstrated effectiveness in improving mood and quality of life in cancer patients and those at high risk for developing cancer. Due to the forthright efforts of cancer patients, there are now many organizations and list serves (e-mailing lists) that cancer survivors can turn to for help before, during, and after cancer treatment. Finally, with the rapid expansion of the internet not only are there websites available as resources, but also the creation of interactive online support is becoming a reality. One of the most important issues in providing supportive care to cancer patients in the future is to meet the individual needs of patients and provide the type of psychological therapy that will work best for them.

Section snippets

Historical perspective

As recently as 50 years ago, surgical oncologists treated patients physically and only minimally addressed the emotional or psychological needs of cancer patients. There was a stigma attached to the diagnosis of cancer such that no one wanted to use the word cancer and it was frequently referred to as the big “C.” There also was a stigma attached to seeking psychiatric/psychological care for one’s emotional problems. Patients who had cancer usually were not told their diagnosis; to tell a

What is psychosocial oncology?

In the early 1950s it was primarily psychologists and psychiatrists who asked patients how they felt about their surgical treatment for cancer. Even then the surgeons did not fully understand the relevance of psychosocial care. The surgeons only agreed to let the mental health professionals talk to patients once they were assured they would do no harm to their patients. The physician told the patient what treatment was needed. Patients who were anxious, fearful, depressed, or who questioned

Anxiety and depression

Forty years ago many cancer patients suffered silently with anxiety and depression. Initial reports in the literature indicated that as many as 50% of cancer patients reported depression and up to 30% reported high levels of anxiety.⁵ In the 1950s and 1960s most of the work done by psychologists and psychiatrists focused on describing how patients handled their emotional reactions to surgery, primarily mastectomy for female breast cancer patients.⁶

Twenty years ago, the focus shifted to

Psychotherapeutic treatment of distress

Over the years there have been numerous types of interventions developed to help patients cope with a cancer diagnosis and treatment. Research studies have shown that social support can help reduce the negative consequences of a cancer diagnosis. Cohen and Syme³¹ found that patients using social support to cope with cancer were less distressed. The results of studies conducted almost 30 years ago hold true even today. A recent study showed that breast cancer patients who had more social support

New areas of treatment and research

There are many new, emerging areas of psychosocial interventions in patients with cancer. Most notably is the explosion of research and clinical work being done in genetic testing for cancer susceptibility, the impact of religious and spiritual beliefs on coping with cancer, the use of complementary medicine by cancer patients undergoing treatment, and cancer pain management. The last three topics are covered elsewhere in this volume so we will focus on the work being done in the area of

Traditional organizations

There are several organizations that provide invaluable services to cancer patients and have been in existence for a very long time. Most notably are the American Cancer Society (ACS; www.cancer.org) and the National Cancer Institute (NCI; www.cancer.gov). These organizations provide not only written material for cancer patients but also have help-lines for patients to call. They have offices across the United States and make available information on all types of cancer and methods of

Summary

Caring for cancer patients who demonstrate emotional distress has come a long way in the past 25 years. Treatment strategies have greatly improved, resulting in millions of cancer survivors who recognize their levels of distress and want to improve their mood and quality of life. Many medical and surgical oncologists today recognize the importance of their patients’ quality of life, as their patients are asking them for ways to manage their symptoms and enjoy the rest of their lives.

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The study aimed to identify the effectiveness of using art therapy (drawing) in alleviating feelings of anxiety and depression among a sample of Princess Noura University students, females (the study sample consisted of eighteen students in the third year (basic education) at the College of Designs and Arts. Their median age was 18 years old and suffering from high feelings of anxiety and depression. With art therapy, the results showed a statistically significant difference between the educational study achievement grades of the sample members before and after the therapy. Moreover, there is an improvement in the scale of “feeling anxious and depressed” with the using of art therapy (drawing). In conclusion, it is recommended in clinical and hospital settings, painting art therapy with psychiatric patients of anxiety and depression could produce a good benefit in improving non-verbal communication between patients and the on-side medical team, helping with their treatment and enhancing the moods therefore decrease the needs for medications.
Perceptions of radiation therapists about providing psychosocial and supportive care to patients at peel regional cancer center
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Citation Excerpt :
These facts underscore the prevalence and severity of needs in patients with cancer and the urgency for some kind of response. It is recognized that PSOSC may be delivered by many different health care practitioners including doctors, nurses, dietitians, therapists, social workers, psychologists, and spiritual care providers [3]. Throughout a patient's radiation treatment trajectory, from consent to the last day of treatment (between 1 day and 12 weeks), there are PSOSC needs.
Many patients with cancer undergoing radiation treatment have unmet psychosocial and supportive care (PSOSC) needs. Radiation therapists (RTs) have a unique opportunity to provide PSOSC, but the published literature is limited regarding their perceptions and beliefs about delivering such care. A survey was designed to evaluate these aspects.
A one-time, cross-sectional survey was distributed to 52 RTs at the Peel Regional Cancer Centre, Mississauga, Ontario, Canada. This survey contained six baseline questions and 34 item statements. The 34 statements spanned three themes: (1) convictions and motivations, (2) preparedness and execution, and (3) resources and facilitators. Participants were asked to rank statements on an eight-point scale, from “strongly disagree” to “strongly agree.”
Eighty-three percent of the RTs responded. Respondents reported they were engaged for 6.2 hours per week in supporting patients with PSOSC. This was despite a technical focus of organizing and delivering a course of radiotherapy for each patient, a relatively fixed schedule, and short-duration time slots booked per patient. Overall, respondents reported a moderately strong level of convictions and motivations for including PSOSC in practice. They perceived that they were not using all of their existing PSOSC skills and knowledge on the job and that supporting professional (eg, training and scheduling) and environmental (eg, screening tools, physical environment, and policies) infrastructures for PSOSC were not optimized.
A majority of the respondents believed PSOSC to be an integral part of providing quality care to radiation oncology patients. Findings showed that staff members were highly motivated to provide this care and perceived that, with additional support, their capacity to provide such care in a way that is meaningful to patients would increase.
De nombreux patients atteints du cancer et qui suivent des traitements de radiation éprouvent des besoins psychosociaux qui ne sont pas comblés. Les thérapeutes en radiation (TR) ont certainement une occasion unique de répondre à ces besoins particuliers, mais il existe peu de documentation sur leurs perceptions et leurs croyances en matière de prestation de ce type de soins. Nous avons conçu un sondage pour évaluer la question.
Un sondage transversal a été distribué à 52 TR du Peel Regional Cancer Centre. Le sondage comportait 6 questions de base et 34 affirmations. Les affirmations couvraient trois thèmes : (1) convictions et motivations; (2) préparation et exécution; (3) ressources et facilitateurs. On a demandé aux participants de classer les affirmations selon une échelle de 8 points allant de « fortement en désaccord » à « fortement d’accord ».
Quatre-vingt-trois pour cent des TR ont répondu au sondage. Ils ont indiqué consacrer 6,2 heures par semaine à répondre aux besoins psychosociaux des patients, et ce, en plus de se consacrer principalement à l’organisation et à la prestation des soins de radiothérapie des patients. Les TR ont des horaires relativement rigoureux et peu de temps à consacrer à chaque patient. Dans l’ensemble, les répondants ont indiqué un degré de modéré à fort en ce qui a trait aux convictions et aux motivations les portant à inclure la réponse aux besoins psychosociaux dans leur pratique. Ils estiment qu’ils n’utilisent pas toutes leurs compétences et connaissances sur ce point dans le cadre de leur travail et que les ressources professionnelles (formation, temps, etc.,) et environnementales (outils de dépistage, milieu physique, politiques, etc.) en ce qui a trait aux besoins psychosociaux ne sont probablement pas optimisées.
La majorité des TR sondés estiment que répondre aux besoins psychosociaux fait partie intégrante des soins de qualité à fournir aux patients en oncologie. Les résultats ont démontré que le personnel est fortement motivé à fournir ces soins et qu’avec plus de soutien, leur capacité à le faire d’une façon signifiante augmenterait.
Current depression among adult cancer survivors: Findings from the 2010 Behavioral Risk Factor Surveillance System
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A cancer diagnosis and subsequent treatments constitute a significantly increased psychological burden among cancer patients. This study examined the prevalence of current depression and the risk factors associated with a high burden of depression among cancer survivors in the US.
We analyzed data from 3550 cancer survivors (aged ≥18 years) and 26,917 adults without cancer who participated in the 2010 Behavioral Risk Factor Surveillance System. Depressive symptoms were assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Participants with a total depression severity score of ≥10 were defined as having current depression. Prevalence and prevalence ratios were estimated by conducting log-linear regression analysis while controlling for potential confounders.
Overall, 13.7% of cancer survivors (vs. 8.9% of adults without cancer, P < 0.001) reported having current depression; the prevalence varied significantly by cancer category. Among cancer survivors, after multivariate adjustment for covariates, cancer diagnosis within a year, being in ‘other’ racial/ethnic group, divorced, separated, widowed, or never married, current or former smoker, or having histories of diabetes, disability, or depression were associated with significantly higher prevalence ratios for current depression; whereas being at an advanced age (≥60 years old), attaining educational levels of >high school graduate, or engaging in leisure-time physical activity were associated with significantly lower prevalence ratios for current depression.
Our results indicate that cancer survivors are at increased risk of current depression. Targeting cancer survivors at high risk of depressive issues may be especially important for clinical support and interventions aimed at improving mental well-being.
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Citation Excerpt :
Thirty percent of cancer patients experience disabling “distress” resulting in the need for psychosocial treatment.33 The term “distress” was used by the National Comprehensive Cancer Network (NCCN) task force to develop standards for distress and a simple tool, The Distress Thermometer, for assessing distress among cancer patients.34,35 The movement to label the psychosocial sequelae as “distress” rather than depression or anxiety made the term less stigmatizing and more acceptable for patients.35
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Psychosocial oncology: Supportive care for the cancer patient

Section snippets

Historical perspective

What is psychosocial oncology?

Anxiety and depression

Psychotherapeutic treatment of distress

New areas of treatment and research

Traditional organizations

Summary

Hematol Oncol Clin North Am

Psychosomatics

J Pain Symptom Manage

J Pain Symptom Manag

Gen Hosp Psychiatry

Lancet

Cancer Facts and Figures—2004

A brief spiritual beliefs inventory for use in quality of life research in life-threatening illness

Psychooncology

A three-year study of chaplains’ professional activities at Memorial Sloan-Kettering Cancer Center in New York City

Psychooncology

Psychiatric symptomatology among hospitalized cancer patients

Am J Psychiatry

The psychological impact of cancer and its treatmentIV adaptation to radical mastectomy

Cancer

The prevalence of psychiatric disorders among cancer patients

JAMA

Psychological distress among oncology outpatientsPrevalence and severity as measured with the Brief Symptom Inventory

Psychosomatics

Major depression in outpatients attending a regional cancer centreScreening and unmet treatment needs

Br J Cancer

NCCN Task Force: Practice Guidelines in Oncology—v. 1. 2003

Assessing psychological distress in cancer patientsValidation of a self-administered questionnaire

Oncology

Validating automated screening for psychological distress by means of computer touchscreens for use in routine oncology practice

Br J Cancer

Health-related quality of life and tamoxifen in breast cancer preventionA report from the National Surgical Adjuvant Breast and Bowel Project P-1 study

J Clin Oncol

Tamoxifen for the prevention of breast cancerPsychosocial impact on women participating in two randomized controlled trials

J Clin Oncol

Efficacy and safety of mianserin in the treatment of depression of women with cancer

Acta Psychiatr Scand

A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer

Psychooncology

Treatment of depression in patients with breast cancerA comparison between paroxetine and amitriptyline

Breast Cancer Res Treat