Benefits of psychosocial oncology care: Improved quality of life and medical cost offset . In the year 2. 00. Additionally, over six million people died from the disease in that year alone . Although most psychosocial oncology research stems from developed countries, there is clearly a need to consider the impact of psychosocial care on patients in less developed countries, as the argument will be forwarded in this paper that psychosocial care not only improves quality of life, but can decrease the overall burden of cost to the health care system. This is clearly an important goal in health care management in both developed and developing countries. We will first consider the psychosocial impact of a cancer diagnosis and subsequent treatment, followed by consideration of what appropriate treatment of this level of patient burden might mean in terms of professional staffing needs. This will be followed by a review of the literature detailing the efficacy of psychosocial treatments for cancer patients, and a summary of the literature on medical cost offset, supporting the notion that psychosocial interventions are not only effective, but also economical. Distress levels. Many studies have looked at distress levels and Quality of Life (QL) in cancer patients. Quality of life encompasses a broad spectrum of issues in cancer care, including physical, social, cognitive, spiritual, emotional and role functioning as well as psychological symptomatology, pain and other common physical symptoms. Emotional distress refers to problems such as anxiety, depression and fears around the cancer experience. It is well documented that emotional distress is very common in cancer patients. Research has repeatedly revealed a high prevalence of psychiatric illness in a variety of populations of cancer patients, which has been reviewed in several publications . In one of the earliest and most widely- cited studies by Derogatis and colleagues, the point prevalence of DSM- III diagnoses were assessed, and over one third of a randomly selected sample of cancer patients from three cancer programs met diagnostic criteria for Adjustment Disorder with Depressed or Anxious Mood, and an additional 7% were diagnosed with a current Major Depressive Disorder . Overall, 4. 7% of the patients were diagnosed with a DSM- III Axis I disorder . Reported rates of depression in patients with cancer ranged widely from 1% to 5. Reviews conclude that he most commonly reported point prevalence rates of major depression are in the 2. Adjustment disorder is also very common . A recent large- scale study targeting all patients visiting a large Canadian tertiary cancer centre assessed over 3,0. Brief Symptom Inventory . A study of 3. 86 patients from 1. American cancer centers found that the prevalence of psychological distress did not vary significantly across the disease continuum, with the exception of the terminal phase, which was characterized by more QL problems . Overall, significant levels of distress were identified in 3. Another study of 5. Turkish cancer patients found no association between QL and disease duration, but did find that those diagnosed at a later disease stage had lower QL than those with earlier stage diagnoses . A large study of 4. Hodgkin's disease, pancreas, lymphoma, liver, head and neck, breast, leukemia, melanoma, colon, prostate and finally gynecological (2. These results suggested a pattern of higher distress in diseases with a poorer prognosis and greater patient burden. This was confirmed in a study of newly diagnosed head and neck patients which found more advanced stages were related to higher distress levels . In another study, younger women with breast cancer (those who were pre- menopausal) reported lower QL than older women following cancer treatment . These studies have identified groups of patients at higher risk for distress, namely, those with later stage disease, poorer prognosis, greater disease burden, and perhaps, younger age. The question often follows as to how the preceding numbers might translate into staffing needs for psychosocial oncology programs. What is Psychosocial Oncology? For example, research in the area of mental health. Ottawa Hospital Psychosocial Oncology Program. Cellie Cancer Coping Kit Research. After conducting two studies from July 2010 to July 2011, researchers found that the Cellie Cancer Coping Kit has the potential to. Psycho-oncology is a field of interdisciplinary study and practice at the intersection of lifestyle, psychology and oncology. It is concerned with aspects of cancer. Psychosocial Oncology Program: Hope & Cope: New Referrals. Psychosocial Research: Hope & Cope Research Program: Research Partnerships: Peter Brojde Lung Cancer. In general, psychiatrists will play a role in the treatment of major depression, which responds well to medication, while psychologists are well trained to treat adjustment disorders. General distress can be treated by any of the professional groups often involved in psychosocial care, namely social workers, advanced oncology nurses, psychologists and psychiatrists, depending on the specific nature of the distress. Some problems are specific to treatment from social workers, including financial/insurance, disability, employment and other practical concerns. American studies have documented significant out of pocket expenses in patients undergoing therapy: one study reported a range of expenses associated with chemotherapy, up to $3,1. Another reported the average out of pocket expenses associated with breast cancer at $3. Over 6. 0% patients with health insurance reported paying for some aspect of their medical care . An additional 1. 5% will need the services of a psychologist for treating distress, and some 2. Several large psycho- oncology programs have responded to the growing awareness of high distress levels in many cancer patients by establishing routine psychosocial screening programs. One of the best known distress screening programs that has worked to integrate screening and psychosocial clinical practice has been undertaken at Johns Hopkins, by Zabora and colleagues . Carlson, PhD, R.Psych., Enbridge Research Chair in Psychosocial Oncology, Professor, Department of Oncology, Cumming School of Medicine, Adjunct. In this model, all new patients are targeted around the time of initial diagnosis and treatment and screened for distress and common problems upon entry to the system. The purpose is to identify those patients who experience significant distress early in the treatment trajectory in order to treat them proactively, and hopefully avoid future psychosocial problems. Enbridge Research Chair in Psychosocial Oncology. Chair in Psychosocial Oncology. The goal of this research program is to provide evidence.The information is acted upon by personally contacting patients over certain cut- off levels of distress, and those who indicate certain social problems. The information is also quickly charted so that other health professionals are aware of the patients' distress levels. Groups at Memorial Sloan Kettering Cancer Centre . Outcomes generally assessed include: psychological functioning, primarily anxiety and depression, and overall quality of life. These interventions have been thoroughly reviewed several times over the past decade, and the curious reader would best be directed to one or more of these reviews for details . Although most reviews have concluded that psychosocial interventions are often efficacious in decreasing distress and improving QL, a more recent and thorough review using rigorous methodological criteria concluded that no strong recommendations and relatively few tentative recommendations could be made about the effectiveness of psychosocial interventions for cancer patients . The authours went on to make several concrete methodological suggestions for how future psychosocial oncology trials could be improved. Interventions themselves usually assume one of four common forms: psychoeducation, cognitive- behavioral training (group or individual), group supportive therapy, and individual supportive therapy. As well, they are usually targeted to one of three points on the illness trajectory: diagnosis/pre- treatment, immediately post- treatment or during extended treatment (such as radiotherapy or chemotherapy), and disseminated disease or death . Certain modalities of treatment have been shown to be more efficacious at one or more of these time periods. For example, psychoeducation may be most effective during the diagnosis/pre- treatment time period, when patient information needs are high. However, for later stage adjustment with more advanced disease, group support may be more effective . In fact, relaxation and imagery have been shown to be useful in controlling nausea and vomiting associated with chemotherapy treatment in several early studies, particularly by Burish and colleagues . Cunningham has identified a hierarchy of different types of therapy, based on increasingly active participation by the recipient. These five types are: providing information, emotional support, behavioral training in coping skills, psychotherapy, and finally spiritual/existential therapy . All of these five levels of therapy are supported by research demonstrating their efficacy, although the bulk of the research is in the area of supportive and cognitive- behavioral interventions. Breast cancer patients have historically been the most common patient group studied (e. Some authours have repeatedly suggested that the evidence of the efficacy of psychosocial therapy is strong enough that it should be considered on the same footing as adjunctive medical therapies such as chemotherapy . Cunningham suggests a model wherein every cancer patient receives at least minimal group adjunctive therapy as a routine part of cancer treatment. Some have suggested that the evidence is so compelling that there is no need to further test this proposition . In their meta- analysis of 4. Meyer and Mark (1. In percentage terms, the differential success rates for participants in intervention versus control conditions were 5. These effects are considered to be clinically significant for patients. Many reviews have focussed on the efficacy of group interventions, . Group therapies have repeatedly been shown to be as effective, if not more effective, than individual treatment. Given the reduced cost of group therapies, and the greater number of patients who can be treated using this modality, it is not surprising that many researchers identify group therapy as the preferred route for treating distress in cancer patients. Several specific group therapy interventions have been standardized and proven efficacious using randomized controlled trials, for example, supportive expressive therapy for metastatic . Psychosocial Oncology . The PSO program works collaboratively with other health care members in the oncology clinics including; oncologistsradio- oncologistsnursessocial workers and others.
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