Psychosocial Considerations in Cancer Care
Cancer treatment addresses a patient's physical health but the mental state of the patient is something that might need more than an oncologist's expertise.
Wayne A. Bardwell, PhD, MBA
Oncologists are focused on treating a patient’s cancer. They want to eliminate tumors, minimize the side effects of chemotherapy and radiation therapy, prevent the disease from spreading, and focus on patient survival. While this treatment addresses a patient’s physical health, the mental state of the patient is something that might need more than an oncologist’s expertise.
“We have wonderful medical technicians and clinicians who will treat the cancer itself,” said Wayne A. Bardwell, PhD, MBA, director, Patient and Family Support Service and the Doris A. Howell Palliative Care Service at the University of California, San Diego Moores Cancer Center. “But we need to be aware of the individual and the family support system that’s affected by the cancer as well.”
Bardwell spoke at NCONN 2011 about psychosocial considerations in cancer patients, noting that gathering concrete data in this population can be quite difficult. The data that are available reveal that the most common mood disorder among cancer patients is depression, which can be triggered by everything from the initial diagnosis, to treatment, to changes in physiology. In breast cancer, Bardwell said it is estimated that as many as 55% of patients deal with depressive disorders, with 17% to 30% of patients experiencing depression well into survivorship.
Factors associated with depressive symptoms in patients with early-stage breast cancer.
[Bardwell et al. J Clin Oncol. 2006;24(16):2420-2427]
Bardwell discussed a study he published in the Journal of Clinical Oncology in 2006 that reported the unexpected finding that cancer-related variables such as treatment and diagnosis were not associated with breast cancer patients’ depressive symptoms (FIGURE). Rather, those depressive symptoms were more closely linked to psychosocial variables beyond cancer.
“The quality of the individual’s social support network, whether or not they had insomnia, whether or not they felt comfortable expressing their feelings, these were factors that we understand are important risk factors for depression in the general population, and they turned out also to be the important factors in this breast cancer population,” Bardwell said. “The surprise was that these very specific cancer variables such as cancer severity or type of treatment were unimportant in understanding who might get depressed.”
Lisa Allison, RN, BSN, OCN® Thoracic Oncology Nurse Navigator Memorial Health System Colorado Springs, Colorado
Cancer patients’ psychosocial needs have only recently begun to be addressed as part of comprehensive cancer care by nationally recognized organizations, such as the American College of Surgeons, ASCO, and NCCN. Wayne Bardwell, PhD, MBA, spoke to the NCONN attendees specifically about the complexity of these patients’ psychosocial needs.
Bardwell emphasized the importance of early and ongoing assessment. Though a cancer diagnosis is not predictive of depressive symptoms, early and ongoing intervention is important for quality of life. This can also have an impact on overall survival, though further studies are needed to determine the significance and relevance of this theory.
ASCO Standards for Psychosocial Care were implemented in 2008. While participating practices saw an increase in the assessment of newly diagnosed patients, rates for taking action did not change.
Bardwell reviewed active listening skills, which are helpful for developing a therapeutic relationship with cancer patients and their families. Having a healthy therapeutic relationship with patients is a crucial aspect of patient navigation, particularly when action is needed in a timely fashion. He also discussed common emotional needs that patients may have during the continuum from diagnosis to survivorship. He closed by remarking on healthy coping habits and skills, and left us with some inspirational quotes.
At the NCONN conference, Bardwell suggested a number of actions that nurses can take to minimize depressive episodes in cancer patients. Active listening, providing valuable feedback, and responding to the patient’s questions and concerns appropriately are among the ways nurses can ensure that patients’ mental health concerns are properly addressed.
Bardwell said that physicians often tell patients that they have nothing to fear after being given a cancer diagnosis, yet even though the practitioner might have the best of intentions, saying that might leave the patient feeling ashamed or misunderstood. Letting patients speak and offering them help might be a better approach to allaying patients’ concerns.
“We have a tendency to want to help people solve their problems,” Bardwell said, “but there’s a power in just listening to an individual describe what’s going on with them.”
The overall accessibility of psychosocial care for cancer patients will receive a tremendous boost next year from an update to the Cancer Program Standards of the American College of Surgeons Commission on Cancer (CoC). Starting in 2012, all cancer programs seeking accreditation from the CoC will be required to screen and evaluate patients to identify psychosocial issues impeding patient progress during treatment and survivorship. The new standard will additionally require that all CoC-accredited oncology programs either have psychosocial services onsite or be equipped to link patients to the proper resources.
Bardwell WA, Natarajan L, Dimsdale JE, et al. Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer. J Clin Oncol. 2006;24(16):2420-2427.