Cancer Treatment: Support Crucial

Oct. 23, 2007 -- Psychological and social support is a crucial part of treatment for every cancer patient, says the Institute of Medicine.

Psychological treatment and social support are central to cancer care, argues Cancer Care for the Whole Patient, a new report from the IOM Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting.

There is now abundant evidence that psychosocial factors underlie a person's susceptibility to and recovery from illness, argues committee chairwoman Nancy E. Adler, PhD, professor of medical psychology and vice-chairwoman of psychiatry at the University of California, San Francisco.

"To ignore these factors while we pour billions of dollars into new technologies is like spending all one's money on the latest model car and then not have the money left to buy the gas needed to make it run," Adler argues in the preface to the report.

The good news: According to the report, many of the needed resources already exist. What does that mean?

"All patients with cancer and their families should expect and receive cancer care that ensures the provision of appropriate psychosocial health services," the report states.

Cancer care remains incomplete for many Americans. According to the report:

• 28% of families affected by cancer say their doctors paid no attention to factors beyond direct medical care.
• A third of oncologists say they do not screen patients for psychological distress -- and those who do often use unreliable methods.
• Only three of the world's 20 leading cancer centers routinely screen all patients for psychological and social distress.

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The Scope of the Problem

It's not somebody else's problem: 41% of Americans will get cancer at some point in their lives.

Cancer treatment is getting more effective. Over the last 20 years, the five-year survival rate for the most common cancers has increased from 43% to 64% for men, and from 57% to 64% for women.

Yet treatment takes its toll. More than one in 10 cancer survivors are unable to perform at least one daily living activity (such as using the bathroom), and 58% of cancer survivors report other disabilities (such as being unable to carry groceries). Depression and anxiety are common in cancer patients.

Cancer patients -- and patients with other chronic diseases -- have a wide range of psychosocial needs:

• Understandable and practical information on illness, treatments, heath, and services
• Help coping with the emotions that accompany illness and treatment
• Help managing illness
• Help with the behavior changes needed to minimize disease impact
• Material and logistical assistance, such as transportation
• Help managing life disruptions
• Financial advice and financial assistance

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The IOM Plan

Here's the IOM's 10-point plan:

1. Standard cancer care should include a plan to link patients with psychosocial services, coordinate medical and psychosocial care, support patients in managing their illness, and follow-up on patients to ensure that the plan is working.
2. Cancer doctors should make sure every one of their patients receives psychosocial care.
3. Patient education and advocacy groups should educate patients and families about the kinds of psychosocial care they should expect.
4. The National Cancer Institute (NCI), the Centers for Medicare and Medicaid Services (CMS), and the Agency for Health Research and Quality (AHRQ) should conduct large-scale demonstrations and evaluations of model psychosocial care programs.
5. Insurers -- including Medicare/Medicaid -- should "fully support" psychosocial health services.
6. The NCI, CMS, and AHRQ should fund research on how best to evaluate psychosocial cancer care.
7. Medical groups, including licensing and accreditation boards, should require providers to be competent in delivering psychosocial health care.
8. The National Institutes of Health (NIH) should develop a standard language for describing psychosocial interventions in order to promote research and quality measurement.
9. Organizations funding cancer research should promote studies of how to improve psychosocial health care.
10. The NCI should make regular reports on progress in delivering psychosocial care to cancer patients.

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