IPOS Sutherland Memorial Lecture: psycho-oncology and health care research

Psychosocial oncology care resources in Europe: a study under the European Partnership for Action Against Cancer (EPAAC)

BACKGROUND

Cancer is a complex health problem requiring multidisciplinary care. There are clinical guidelines available in order to improve the process and outcomes of cancer care within Europe. However, strategic action is still needed in many European Union (EU) Member States to develop or improve national cancer control plans (NCCPs), which play a key role in cancer control and care. The current study clarifies the extent of implementation of psychosocial oncology care (PSOC) in the EU.

METHOD

A survey methodology was used to cover four dimensions: (1) inclusion of PSOC in NCCPs; (2) structure and resources of PSOC delivery; (3) use of NCCP clinical guidelines; and (4) education and training resources available along with determination of training needs in PSOC.

RESULTS

Twenty-seven (90%) countries returned questionnaires of which 21 (78%) include PSOC in their NCCP. However, only 10 (37%) reported having specific budgets for PSOC, 8 (30%) having nationally recommended PSOC clinical guidelines, and 6 countries (22%) reported having an official certification for PSOC education.

CONCLUSION

Although many countries seem to have integrated PSOC into their NCCP, there is still much to do in terms of allocating resources and delivering psychosocial care equitably. Also, there is a need for improving training and certification in PSOC. The findings indicate the need to develop national policies concerning PSOC with clear targets for deliverables in an appropriate timetable in order that psychosocial services and existing clinical guidelines are implemented and fully integrated into EU NCCPs. Copyright © 2015 John Wiley & Sons, Ltd.

Four-Week Prevalence of Mental Disorders in Patients With Cancer Across Major Tumor Entities

Purpose

To provide the 4-week prevalence estimates of mental disorders in cancer populations.

Patients and Methods

We enrolled adult patients with cancer from in- and outpatient care facilities, using a proportional stratified random sample based on the nationwide cancer incidence in Germany. Patients who scored 9 or above on the Patient Health Questionnaire (PHQ-9) were administered to the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for cancer patients (CIDI-O). A random sample of those with a PHQ-9 score that was less than 9 were selected for a CIDI-O.

Results

A total of 5,889 patients were identified, which led to 4,020 participants (a 68.3% response rate); of those, 2,141 patients were interviewed. The 4-week total prevalence for any mental disorder was 31.8% (95% CI, 29.8% to 33.8%); this included any anxiety disorder (11.5%; 95% CI, 10.2% to 12.9%), any adjustment disorder (11.1%; 95% CI, 9.7% to 12.4%), any mood disorder (6.5%; 95% CI, 5.5% to 7.5%), any somatoform/conversion disorder (5.3%; 95% CI, 4.3% to 6.2%), nicotine dependence (4.5%; 95% CI, 3.6% to 5.4%), alcohol abuse/dependence (0.3%; 95% CI, 0.1% to 0.6%), any mental disorder resulting from general medical condition (2.3%; 95% CI, 1.7% to 2.9%), and any eating disorder (0%). The highest prevalence for any mental disorder was found in patients with breast cancer (41.6%; 95% CI, 36.8% to 46.4%), followed by patients with head and neck cancer (40.8%; 95% CI, 28.5% to 53.0%). The lowest prevalence was found in patients with pancreatic cancer (20.3%; 95% CI, 8.9% to 31.6%) and stomach/esophagus cancers (21.2%; 95% CI, 12.8% to 29.6%).

Conclusion

Our findings provide evidence for the strong need for psycho-oncological interventions.

Critical incidents reveal how patients with head and neck cancer construct their "secure base" as a "helping system"

Most studies of the psychosocial needs of patients with head and neck cancers (HNC) use predefined categories and explicitly ask for specified needs. These studies are important but should be complemented with inductive studies based on patients' own descriptions of experiences. This qualitative study is such a contribution. In repeated interviews positive and negative incidents were collected from 137 patients with HNC, and these experiences were categorized in dimensions expressing needs. A core category--"being included--neglected by a helping system"--emerged from the narrated incidents and was based on the dimensions engagement, competence, and information. The findings are easily related to attachment theory by stressing the significance of establishing trustful relationships with the health care staff, as attachment figures, who respond flexibly and sensitively to the patient's needs. In the constitution of health care as a helping system, all encounters between the patient and health care staff matters. Further research should preferably focus on the creation of guidelines for the constitution of health care as a helping system, that is, how the found factors of a helping system can be operationalized in clinical practice.

A critical exploration of the International Classification of Functioning, Disability, and Health (ICF) framework from the perspective of oncology: recommendations for revision

BACKGROUND

In 2001, the World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) framework in an effort to attend to the multidimensional health-related concerns of individuals. Historically, although the ICF has frequently been used in a rehabilitation-based context, the World Health Organization has positioned it as a universal framework of health and its related states. Consequently, the ICF has been utilized for a diverse array of purposes in the field of oncology, including: evaluating functioning in individuals with cancer, guiding assessment in oncology rehabilitation, assessing the comprehensiveness of outcome measures utilized in oncology research, assisting in health-related quality of life instrument selection, and comparing the primary concerns of health professionals with those of their patients.

DISCUSSION

Examination of the ICF through the lens of cancer care highlights the fact that this framework can be a valuable tool to facilitate comprehensive care in oncology, but it currently possesses some areas of limitation that require conceptual revision; to this end, several recommendations have been proposed. Specifically, these proposed recommendations center on the following three areas of the ICF framework: (1) the replacement of the term "health condition" with the more inclusive and dynamic term "health state;" (2) the continuing development and refinement of the personal factors component to ensure issues such as comorbidities can be accounted for appropriately; and (3) the inclusion of a mechanism to account for the subjective dimension of health and functioning (eg, quality of life).

SUMMARY

It is through the expansion of these conceptual parameters that the ICF may become more relevant and applicable to the field of oncology. With these important revisions, the ICF has the potential to provide a broader biopsychosocial perspective of care that captures the diverse range of concerns that arise throughout the continuum of care in oncology.

Prevalence of mental disorders, psychosocial distress and need for psychosocial support in cancer patients - study protocol of an epidemiological multi-center study

BACKGROUND

Empirical studies investigating the prevalence of mental disorders and psychological distress in cancer patients have gained increasing importance during recent years, particularly with the objective to develop and implement psychosocial interventions within the cancer care system. Primary purpose of this epidemiological cross-sectional multi-center study is to detect the 4-week-, 12-month-, and lifetime prevalence rates of comorbid mental disorders and to further assess psychological distress and psychosocial support needs in cancer patients across all major tumor entities within the in- and outpatient oncological health care and rehabilitation settings in Germany.

METHODS/DESIGN

In this multicenter, epidemiological cross-sectional study, cancer patients across all major tumor entities will be enrolled from acute care hospitals, outpatient cancer care facilities, and rehabilitation centers in five major study centers in Germany: Freiburg, Hamburg, Heidelberg, Leipzig and Würzburg. A proportional stratified random sample based on the nationwide incidence of all cancer diagnoses in Germany is used. Patients are consecutively recruited in all centers. On the basis of a depression screener (PHQ-9) 50% of the participants that score below the cutoff point of 9 and all patients scoring above are assessed using the Composite International Diagnostic Interview for Oncology (CIDI-O). In addition, all patients complete validated questionnaires measuring emotional distress, information and psychosocial support needs as well as quality of life.

DISCUSSION

Epidemiological data on the prevalence of mental disorders and distress provide detailed and valid information for the estimation of the demands for the type and extent of psychosocial support interventions. The data will provide information about specific demographic, functional, cancer- and treatment-related risk factors for mental comorbidity and psychosocial distress, specific supportive care needs and use of psychosocial support offers.

Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients

The aim of this study is to identify anxiety, depression and post-traumatic stress disorder in prostate cancer patients and to investigate the association with social support and health-related quality of life. A total of 511 men who had undergone prostatectomy were surveyed during ambulatory follow-up care for an average of 27 months after surgery using standardised self-report measures (e.g. Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist--Civilian Version, Illness-Specific Social Support Scale, Short-Form Health Survey). Seventy-six per cent of patients evaluated their disease as 'not' or a 'little threatening'. The cancer diagnosis and uncertainty were most frequently reported as 'distressing', while medical treatment and doctor-patient interaction were most frequently evaluated as 'most helpful'. The number of patients reporting increased levels of psychological distress was 16%, with 6% demonstrating signs of having severe mental health problems'. No higher levels of anxiety and depression were observed in cancer patients compared with age-adjusted normative comparison groups. Lack of positive support, detrimental interactions and perceived threat of cancer were found to be predictors of psychological co-morbidity (P < 0.001). Lack of positive support, detrimental interactions, threat of cancer, disease stage and age significantly predicted mental health (P < 0.001), whereas the impact of social support on physical health was rather weak. Findings emphasise the need for routine psychosocial screening.

Identifying research priorities and research needs among health and research professionals in psycho-oncology

AIM

To identify and prioritize the key research questions in psycho-oncology in order to guide the development of large multicenter clinically relevant studies.

METHODS

All members of the Psycho-Oncology Co-operative Research Group (n = 295) were invited to participate in an online survey and 180 responded (response rate = 61%). Participants rated eight priority research areas identified from a previous focus group study on a five-point scale, and ranked their top four priority areas. Within the four ranked research areas, participants selected the three most important specific research questions.

RESULTS

The highest rated research priority areas were distress identification (23.3%), survivorship (22.7%), and distress management (15.3%), followed by issues relating to health services (9.7%) and carers (8.0%). Interventions were commonly nominated among the most important research questions within each priority area. The single most important research question identified by 44% of the sample was to "Determine the most acceptable, reliable and valid screening tool to be administered routinely at diagnosis and at other key transition points to identify distress and psychosocial needs".

CONCLUSION

This is the first Australian study to explore research priorities in psycho-oncology, and the first international study to explore these issues in depth. To ensure that the research effort is strategic, clinically relevant and cost-effective, clear priorities need to be established. The results of this survey will enable limited resources to focus on key research questions of direct clinical benefit.

'Admission into a helping plan': a watershed between positive and negative experiences in breast cancer

Cancer patients are in an exposed situation that raises certain psychosocial needs in contact with health care. Previous studies have mainly investigated these needs by assessments on pre-defined categories.

OBJECTIVE

The purpose of the present study is, from the patients' perspective, to identify breast cancer patients' psychosocial needs, and to synthesise them in a model reflecting the core of these needs.

METHODS

Seventy-one patients treated with radiation therapy were consecutively included and repeatedly interviewed about their experiences of health care. 'Critical incidents' where identified from the interviews and analysed due to the similarities-differences technique in grounded theory.

RESULTS

Four categories of needs where detected: 'access', 'information', 'treatment' and 'how approached'. These categories and their properties merged into a core category--'admission into a helping plan'. These findings are well understood in terms of attachment theory. In times of imminent danger and stress people strive to find a 'safe haven' to attach to. Cancer patients' 'safe haven' can be described as 'a helping plan'. It is not the result of a separate patient-caregiver relationship but is created by a pattern of individual experiences from all kind of contacts with the health-care system as a whole.

CONCLUSIONS

The presented model of patients needs as converging into 'admission into a helping plan' may serve as an easily comprehendible model for caregivers, guiding them to contribute to the patient's feeling of security and trust, and thus to the patient's own 'hope work'.

Views of psycho-oncology health professionals on priority psycho-oncology research questions

PURPOSE

There is a need for periodic review of research priorities in psycho-oncology. The purpose of this research was to conduct a qualitative study designed to canvass the views of health professionals working in psycho-oncology in Australia regarding current priority areas for research in psycho-oncology.

METHODS

This study was conducted in two phases. This article reports the results from the first phase, where focus groups were conducted with key researchers and clinicians active in psycho-oncology.

RESULTS

A total of 55 individuals took part in ten focus groups and two interviews. Participants identified 12 priority areas for research. These areas were grouped into four global themes given a significant overlap in the research issues identified. The four global themes are: distress-improving identification, detection, referral and management; specific populations requiring intervention research; the patient journey; and health services research. Key issues identified for each theme are documented along with participant quotes.

CONCLUSIONS

This research provides the first steps in identifying research priorities in psycho-oncology and will guide the development of pertinent research studies as well as inform collaborative research studies focusing on clinically relevant interventions. The outcomes of such studies should ultimately guide optimal patient care.