Psychosocial Health Needs of Ca Pts Not  Met

Psychosocial Health Needs of Cancer Patients Not Being Met

Roxanne Nelson

Medscape Medical News 2007.

October 29, 2007 Attention to psychosocial health needs is the exception rather than the rule in oncology practice, according to a new government report.

Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, issued by the Institute of Medicine (IOM), found that many of the recommendations that have been made over the years calling for more attention to the psychosocial concerns of cancer patients and their families have not been acted upon.

There are more than 10.5 million people living in the United States with a current or past diagnosis of cancer, and 41% of all Americans can expect a cancer diagnosis at some point over the course of their lifetime.

Although advances in biomedical care have extended life expectancy and/or cured the disease, providing high-quality care for the psychological and social effects of cancer continues to fall short of recommendations.

To address this issue, the National Institutes of Health requested that the IOM create a committee that would study the delivery of the diverse psychosocial services needed by community-dwelling cancer patients and their families.

The committee found that both cancer survivors and their caregivers report that their providers failed to understand their psychosocial needs and to recognize and adequately address depression and other symptoms of stress.

Their providers also appeared to be unaware of available resources that could offer support or at least did not make any referrals, and providers generally did not consider psychosocial support to be an integral part of quality care for the oncologic patient.

Living with a diagnosis of cancer can create a great deal of emotional stress, according to the report. Treatment, the fear of a relapse, and generalized distress that results from living with the day-to-day physical problems often associated with a cancer diagnosis can create new or worsen existing psychological distress.

In addition, both physical and psychological impairments can lead to significant social problems.

A number of interventions have been identified and used, some of them drawn from theoretical or conceptual frameworks and others based on research and/or empirical testing. According to a model proposed by the committee, the most effective delivery of psychosocial health services should include the following components: identifying the population affected by psychosocial health issues who are most likely to be adversely affected by them; developing an appropriate plan for them; connecting and referring patients to appropriate psychosocial health services; giving them adequate support in managing their disease; coordinating psychosocial with biomedical healthcare; and ensuring appropriate follow-up so that the adequacy of interventions can be determined and changed if necessary.

Although psychosocial health issues have been identified, research has not yet established effective remedies for a number of them. For example, currently available data are unable to effectively guide the clinician in addressing continued tobacco use among cancer patients, cognitive impairment that might be the result of treatment, or problems encountered by pediatric patients as they reenter school.

Addressing the psychosocial health needs of the cancer patient should be an integral part of cancer care, and the committee has made recommendations to that end.

Their first recommendation is to establish a standard of care, and they believe that key participants and leaders in the cancer care community can play a major role in promoting and adhering to these standards.

According to the recommendations, all cancer care should ensure the provision of appropriate psychosocial health services by:

Facilitating effective communication between patients and care providers.

Identifying each patient's psychosocial health needs.

Designing and implementing a plan that:

▪ Links the patient with needed psychosocial services.

▪ Coordinates biomedical and psychosocial care.

▪ Engages and supports patients in managing their illness and health.

Systematically following-up on, reevaluating, and adjusting plans.

The second recommendation of the committee builds on the first, in that all providers should ensure that every cancer patient receives care that meets the standard for psychosocial healthcare.

Providers should be assisted in implementing these standards of care by the National Cancer Institute, which can maintain a directory of psychosocial services available free of charge to patients and their families.

Another recommendation is for quality oversight. The committee suggests that the National Cancer Institute, the Centers for Medicare & Medicaid Services, and the Agency for Healthcare Research and Quality fund research that focuses on developing performance measures for psychosocial cancer care.

The organizations responsible for setting standards, such as the National Comprehensive Cancer Network and American Society of Clinical Oncology, should create the mechanisms that can measure and report on the quality of ambulatory oncology care, including the psychosocial health component.

The committee also points out that cancer care that addresses psychosocial needs largely depends on the attitudes, knowledge, and skills of the workforce; professional education and training is a factor that should not be ignored, because it can influence practitioners' practices.

Although cancer patients might receive care from a variety of healthcare practitioners, the committee believes that all clinicians should address psychosocial health needs as part of their practice.

Oncologists can and should lead the way in addressing these needs.

"Although it is clear that psychosocial problems influence health, evidence is still emerging on just how they do so," the authors write. "Moreover, some problems (such as poverty) obviously cannot be resolved by the healthcare system. Nevertheless, evidence clearly supports the need for attention to psychosocial problems as an integral part of good-quality healthcare."

This study was supported by Contract No. N01-OD-4-2139 between the National Academy of Sciences and the National Institutes of Health.

Institute of Medicine. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: The National Academies Press; 2007

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