Curr Oncol, Vol. 21, pp. 161-162; doi: http://dx.doi.org/10.3747/co.21.2156
E
D
O
R
Biologic, psychological, and social health needs in cancer care: how far have we come? F. Sch u lte
In 2007, th e U .S. In stitu te o f M ed icin e d eliv ered a re p o rt titled C a n cer C are f o r the W hole P atient: M e etin g P sy c h o so c ia l H ea lth N e e d s 1, in w h ich gaps in th e p ro v isio n o f p sy ch o so cial care for ca n cer p a tien ts w ere identified. T he re p o rt h ig h lig h ted that, desp ite a b u rg e o n in g evid en ce b ase d em o n stratin g th e effectiv en ess o f a v a rie ty o f p sychosocial health in terv e n tio n s for p atien ts an d su rv iv o rs o f cancer, th e p sy ch o so cial health n eed s o f patients w ere not b ein g ad e q u a te ly m et. T h at re p o rt b ro u g h t to the fo refro n t th e n ec essity not sim ply to co n sid er the psychosocial needs o f cancer patients, but to carefully in teg ra te p sy ch o so cial asse ssm e n t an d su b sequent tre a tm e n t w ith m an ag em en t o f the physical needs o f each patien t. In essence, one set o f n ee d s cannot be co n ceiv ed w ith o u t the other. C an ce r care for the “w hole p a tie n t” m u st co n sid er biologic, psy ch o lo g i cal, an d social factors. T h e article titled “T he influence o f c h e m o th e ra p y -in d u ced n eu ro to x ic ity on psychological distress an d sleep d istu rb an ce in ca n cer p atien ts” by H ong an d c o lle a g u e s th a t a p p e a rs in th is issue o f C u r ren t O n co lo g y is a p rim e exam ple o f the in tricate re la tio n s h ip b e tw e e n p h y sic a l a n d p sy c h o so c ia l sy m p to m s in ca n cer care. T he article explores the re la tio n sh ip s o f c h e m o th e rap y -in d u c ed p e rip h e ra l n eu ro to x ic ity ( c i p n ) w ith p sychosocial d istress and re d u c e d sleep q u a lity in n ew ly d ia g n o se d ca n c e r p atients. S pecifically, the study sam pled 706 new ly d iag n o sed ca n c e r p atien ts b etw e en 18 and 70 years o f age u n d erg o in g ca n cer th era p y at four in stitu tio n s across C h in a. P atients com pleted m easu res designed to o p eratio n aliz e p erip h e ral neurotoxicity, an x iety and d ep ressio n , and sleep quality. R esults rev ealed that, a fte r co n tro llin g for age, sex, edu catio n level, social su p p o rts, fatig ue, d isease stage, and tu m o u r site, p a tie n t-re p o rte d n e u ro to x ic ity w as th e m o st sig n ifican t p re d ic to r o f d epression and an x iety ; c i p n also sign ifican tly p re d ic ted sleep quality. U nfo rtu n ately , this research w as not longitudinal in desig n , lim itin g the ab ility o f the authors to d e te rm in e cau satio n . Q u estio n s m ig h t therefore arise
P hD *
ab o u t w h e th e r p a tie n ts e x p e rie n c in g g re a te r p s y chosocial d istre ss— including d ep ressio n , anxiety , and p o o r sleep— are m ore likely to re p o rt g re ater self-perceived p erip h eral n eu ro to x ic ity o r w h eth er c i p n leads to an in cre ased freq u en c y o f psy ch o so cial difficulties. T he p o ten tial to u n d ersta n d causatio n is fu rth e r affected by the inclusion o f a self-rep o rt m easu re o f c i p n co m p risin g only tw o item s, w hich p re clu d es a b ro a d e r clin ic a l p ic tu re o f a d d itio n al chem otherapy side effects that m ight also be affecting psychosocial sym ptom s. N ev erth eless, th is research em phasizes a significant lin k betw een chem otherapyin d u ced n eu ro to x icity an d p sychosocial sym ptom s. M ost notable is the fin d in g th at the relatio n sh ip ex ten d s over and above th o se o f o th er v ariab les k n o w n to affect m ood and anxiety, including social supp o rts an d fatigue. Today, alm ost 7 years since the Institute o f M ed i cine rep o rt, research continues to overw helm in g ly support an association o f the p revalence o f p sycho so cial sym ptom s w ith the physical side effects o f cancer treatm ent. H as care for the cancer patient becom e bet ter integrated w ith resp ect to assessing, m onitoring, and treatin g the “w hole p atien t”— that is, including the biologic, psychological, and social needs? B ased on th e ir re se a rc h fin d in g s, H o n g e t al. co n c lu d e th at ongoing assessm ent o f peripheral neuropathies should be em phasized. A s health care practitioners and academ ics, w e have an ongoing responsibility to recognize, m onitor, docum ent, and treat psychosocial sym ptom s across the cancer continuum . S ince the early 2 0 0 0 s, a trem e n d o u s m ovem en t has b eg u n to screen for psychosocial d istress in all c a n c e r p atien ts. P sy ch o so cial d istre ss is now a c k n o w ledged in tern a tio n ally as “th e 6th v ital sign ”2. T he co st o f u n id e n tifie d p sy c h o so c ia l d istre ss in ca n c e r p atien ts, su rv iv o rs, an d fam ilies is severe. P atien ts ex p e rie n c in g m u ltip le stre sso rs ca n h ave m ore d ifficu lty m ak in g decisions and ad h e rin g to tre a tm e n t reco m m en d atio n s. T h ey ca n also strain the re so u rces o f o ncology team s by re q u irin g m ore h ealth care p erso n n el tim e to deal w ith non m ed ical
____________________________________________________________ C u r r e n t O n c o l o g y — V o l u m e
21 , N u m b e r 4 , A u g u s t 2014
Copyright © 2014 Multimed Inc. Following publication in Current Oncology, the full text of each article is available immediately and archived in PubMed Central (PMC).
161
SCHULTE
concerns3. Further, w hen psychosocial distress is not addressed, the ways that patients w ith cancer and their fam ilies cope w ith the disease is affected. Beyond the direct im pact on patient and family, the cost o f unidentified psychosocial distress is a public health concern. Patients and fam ilies who do not receive the help they need are at risk o f developing chronic m ental health issues that w ill ultim ately require tim e, resources, and financial expenditures from the health care system 4. Psychosocial care should not be considered a luxury— it is a necessity.
2008. [Available online at: http://books.nap.edu/openbook. php?record_id=11993; cited March 26, 2014] 2. Bultz BD, Carlson LE. Emotional distress: the sixth vital sign in cancer care. J Clin Oncol 2005;23:6440-1. 3. Kazak AE, Cant MC, Jensen MM, et al. Identifying psycho social risk indicative of subsequent resource use in families of newly diagnosed pediatric oncology patients. J Clin Oncol 2003;21:3220-5. 4. Chiles JA, Lambert MJ, Hatch AL. The impact of psycho logical interventions on medical cost offset: a meta-analytic review. Clin Psychol Sci Pract 1999;6:204-220.
T he a u th o r has no fin a n c ia l c o n flic t o f in te re st to declare.
C orrespondence to: Fiona Schulte, A lberta C hil dren’s Hospital, 2888 Shaganappi Trail NW, Calgary, A lberta T3B 6A8. E -m ail: fiona.schulte@ albertahealthservices.ca
REFERENCES
*
CONFLICT OF INTEREST DISCLOSURES
1. Adler NE, Page AEK. Institute o f Medicine: Cancer Care fo r the Whole Patient: M eeting Psychosocial Health Needs. Washington, DC: The National Academies Press;
D epartm ents o f O ncology and Paediatrics, Uni versity o f Calgary; A lberta C hildren’s Hospital Research Institute; and Haem atology, Oncology and T ransplant P rogram , A lb e rta C h ild re n ’s Hospital, Calgary, AB.
I C urrent O ncology— V olume 21, N umber 4, A ugust 2014 | Copyright © 2014 Multimed Inc. Following publication in Current Oncology, the full text of each article is available immediately and archived in PubMed Central (PMC).
Copyright of Current Oncology is the property of Multimed Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
E
D
O
R
Biologic, psychological, and social health needs in cancer care: how far have we come? F. Sch u lte
In 2007, th e U .S. In stitu te o f M ed icin e d eliv ered a re p o rt titled C a n cer C are f o r the W hole P atient: M e etin g P sy c h o so c ia l H ea lth N e e d s 1, in w h ich gaps in th e p ro v isio n o f p sy ch o so cial care for ca n cer p a tien ts w ere identified. T he re p o rt h ig h lig h ted that, desp ite a b u rg e o n in g evid en ce b ase d em o n stratin g th e effectiv en ess o f a v a rie ty o f p sychosocial health in terv e n tio n s for p atien ts an d su rv iv o rs o f cancer, th e p sy ch o so cial health n eed s o f patients w ere not b ein g ad e q u a te ly m et. T h at re p o rt b ro u g h t to the fo refro n t th e n ec essity not sim ply to co n sid er the psychosocial needs o f cancer patients, but to carefully in teg ra te p sy ch o so cial asse ssm e n t an d su b sequent tre a tm e n t w ith m an ag em en t o f the physical needs o f each patien t. In essence, one set o f n ee d s cannot be co n ceiv ed w ith o u t the other. C an ce r care for the “w hole p a tie n t” m u st co n sid er biologic, psy ch o lo g i cal, an d social factors. T h e article titled “T he influence o f c h e m o th e ra p y -in d u ced n eu ro to x ic ity on psychological distress an d sleep d istu rb an ce in ca n cer p atien ts” by H ong an d c o lle a g u e s th a t a p p e a rs in th is issue o f C u r ren t O n co lo g y is a p rim e exam ple o f the in tricate re la tio n s h ip b e tw e e n p h y sic a l a n d p sy c h o so c ia l sy m p to m s in ca n cer care. T he article explores the re la tio n sh ip s o f c h e m o th e rap y -in d u c ed p e rip h e ra l n eu ro to x ic ity ( c i p n ) w ith p sychosocial d istress and re d u c e d sleep q u a lity in n ew ly d ia g n o se d ca n c e r p atients. S pecifically, the study sam pled 706 new ly d iag n o sed ca n c e r p atien ts b etw e en 18 and 70 years o f age u n d erg o in g ca n cer th era p y at four in stitu tio n s across C h in a. P atients com pleted m easu res designed to o p eratio n aliz e p erip h e ral neurotoxicity, an x iety and d ep ressio n , and sleep quality. R esults rev ealed that, a fte r co n tro llin g for age, sex, edu catio n level, social su p p o rts, fatig ue, d isease stage, and tu m o u r site, p a tie n t-re p o rte d n e u ro to x ic ity w as th e m o st sig n ifican t p re d ic to r o f d epression and an x iety ; c i p n also sign ifican tly p re d ic ted sleep quality. U nfo rtu n ately , this research w as not longitudinal in desig n , lim itin g the ab ility o f the authors to d e te rm in e cau satio n . Q u estio n s m ig h t therefore arise
P hD *
ab o u t w h e th e r p a tie n ts e x p e rie n c in g g re a te r p s y chosocial d istre ss— including d ep ressio n , anxiety , and p o o r sleep— are m ore likely to re p o rt g re ater self-perceived p erip h eral n eu ro to x ic ity o r w h eth er c i p n leads to an in cre ased freq u en c y o f psy ch o so cial difficulties. T he p o ten tial to u n d ersta n d causatio n is fu rth e r affected by the inclusion o f a self-rep o rt m easu re o f c i p n co m p risin g only tw o item s, w hich p re clu d es a b ro a d e r clin ic a l p ic tu re o f a d d itio n al chem otherapy side effects that m ight also be affecting psychosocial sym ptom s. N ev erth eless, th is research em phasizes a significant lin k betw een chem otherapyin d u ced n eu ro to x icity an d p sychosocial sym ptom s. M ost notable is the fin d in g th at the relatio n sh ip ex ten d s over and above th o se o f o th er v ariab les k n o w n to affect m ood and anxiety, including social supp o rts an d fatigue. Today, alm ost 7 years since the Institute o f M ed i cine rep o rt, research continues to overw helm in g ly support an association o f the p revalence o f p sycho so cial sym ptom s w ith the physical side effects o f cancer treatm ent. H as care for the cancer patient becom e bet ter integrated w ith resp ect to assessing, m onitoring, and treatin g the “w hole p atien t”— that is, including the biologic, psychological, and social needs? B ased on th e ir re se a rc h fin d in g s, H o n g e t al. co n c lu d e th at ongoing assessm ent o f peripheral neuropathies should be em phasized. A s health care practitioners and academ ics, w e have an ongoing responsibility to recognize, m onitor, docum ent, and treat psychosocial sym ptom s across the cancer continuum . S ince the early 2 0 0 0 s, a trem e n d o u s m ovem en t has b eg u n to screen for psychosocial d istress in all c a n c e r p atien ts. P sy ch o so cial d istre ss is now a c k n o w ledged in tern a tio n ally as “th e 6th v ital sign ”2. T he co st o f u n id e n tifie d p sy c h o so c ia l d istre ss in ca n c e r p atien ts, su rv iv o rs, an d fam ilies is severe. P atien ts ex p e rie n c in g m u ltip le stre sso rs ca n h ave m ore d ifficu lty m ak in g decisions and ad h e rin g to tre a tm e n t reco m m en d atio n s. T h ey ca n also strain the re so u rces o f o ncology team s by re q u irin g m ore h ealth care p erso n n el tim e to deal w ith non m ed ical
____________________________________________________________ C u r r e n t O n c o l o g y — V o l u m e
21 , N u m b e r 4 , A u g u s t 2014
Copyright © 2014 Multimed Inc. Following publication in Current Oncology, the full text of each article is available immediately and archived in PubMed Central (PMC).
161
SCHULTE
concerns3. Further, w hen psychosocial distress is not addressed, the ways that patients w ith cancer and their fam ilies cope w ith the disease is affected. Beyond the direct im pact on patient and family, the cost o f unidentified psychosocial distress is a public health concern. Patients and fam ilies who do not receive the help they need are at risk o f developing chronic m ental health issues that w ill ultim ately require tim e, resources, and financial expenditures from the health care system 4. Psychosocial care should not be considered a luxury— it is a necessity.
2008. [Available online at: http://books.nap.edu/openbook. php?record_id=11993; cited March 26, 2014] 2. Bultz BD, Carlson LE. Emotional distress: the sixth vital sign in cancer care. J Clin Oncol 2005;23:6440-1. 3. Kazak AE, Cant MC, Jensen MM, et al. Identifying psycho social risk indicative of subsequent resource use in families of newly diagnosed pediatric oncology patients. J Clin Oncol 2003;21:3220-5. 4. Chiles JA, Lambert MJ, Hatch AL. The impact of psycho logical interventions on medical cost offset: a meta-analytic review. Clin Psychol Sci Pract 1999;6:204-220.
T he a u th o r has no fin a n c ia l c o n flic t o f in te re st to declare.
C orrespondence to: Fiona Schulte, A lberta C hil dren’s Hospital, 2888 Shaganappi Trail NW, Calgary, A lberta T3B 6A8. E -m ail: fiona.schulte@ albertahealthservices.ca
REFERENCES
*
CONFLICT OF INTEREST DISCLOSURES
1. Adler NE, Page AEK. Institute o f Medicine: Cancer Care fo r the Whole Patient: M eeting Psychosocial Health Needs. Washington, DC: The National Academies Press;
D epartm ents o f O ncology and Paediatrics, Uni versity o f Calgary; A lberta C hildren’s Hospital Research Institute; and Haem atology, Oncology and T ransplant P rogram , A lb e rta C h ild re n ’s Hospital, Calgary, AB.
I C urrent O ncology— V olume 21, N umber 4, A ugust 2014 | Copyright © 2014 Multimed Inc. Following publication in Current Oncology, the full text of each article is available immediately and archived in PubMed Central (PMC).
Copyright of Current Oncology is the property of Multimed Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
