From evidence to implementation: The global challenge for psychosocial oncology

Abstract

The human dimensions of medical care were highlighted by such pioneering figures as Cicely Saunders, Elizabeth Kubler-Ross, and Jimmie Holland and their tireless advocacy helped to build an evidence base for psychosocial and palliative interventions. In that spirit, we studied physical and psychological distress in advanced cancer and modeled pathways to distress in this population. We considered acute stress disorder as the prototype for psychological disturbances following the acute onset of life-threatening disorders, showing that it occurred in one-third of patients after the diagnosis of acute leukemia. To treat and prevent these symptoms, we developed Emotion and Symptom-focused Engagement (EASE), an integrated psychotherapeutic and early palliative intervention. We showed that EASE reduced both traumatic stress and physical suffering in these patients and a large multi-center trial is now underway. We also identified symptoms of depression and hopelessness n one quarter of patients with metastatic and advanced cancer, with worsening toward the end of life. To alleviate this distress, we developed a brief supportive-expressive therapy, referred to as Managing Cancer and Living Meaningfully (CALM). We showed in a large RCT that CALM improves depression, distress related to dying and death, and preparation for the end of life. We have now launched a global initiative involving 20 sites to date across North and South America, Europe, Australia, and Asia to have CALM implemented routinely in cancer care. Such initiatives are needed to move psychosocial care in cancer from evidence to implementation and to fulfill the dream of Jimmie Holland that cancer care be as humanistic as it is effective.

Exploring perceptions and practices of cancer care among caregivers and care recipients of breast cancer in India

“…The review by Thompson et al on psychosocial oncology stresses the effectiveness of psychosocial interventions during the course of illness . It was found that although reassurance was important in coping the illness, standard care seldom stressed the need for psychological care in the management and prevention of distress and promotion of well‐being . These findings are in keeping with those of the present study wherein the participants were hardly ever referred to a mental health professional for counselling despite the presence of the facility within the same hospital.…”

“…Care recipients experience internal, repetitive, and cumulative trauma throughout the cancer trajectory, which is analogous to that of trauma experienced by people living in war zones, natural disasters, or abusive homes . Additionally, diagnosis of cancer leads to identity disruption .…”

A systematic review of cancer caregiver interventions: Appraising the potential for implementation of evidence into practice

“…With recent calls for a need to focus on implementation of interventions, 17,60,61 this review aimed to explore the implementation potential of cancer caregiver intervention studies. Although the reviewed studies focused on efficacy, there is a need to design, conduct, and report research that can be implemented into practice.…”

New challenges in psycho‐oncology: Using drug development methodology to improve survivorship and supportive care intervention trials

“…As cancer survival improves and greater numbers of patients require evidence‐based psychosocial support, the need for good quality survivorship research will intensify. Survivorship studies are challenging to conduct for a number of well‐documented reasons, including cost limitations and lack of institutional interest or support . This creates a chicken‐and‐egg situation whereby there is an insufficient evidence‐base from which to implement standardised survivorship programmes in cancer centres.…”

“…Survivorship studies are challenging to conduct for a number of well-documented reasons, including cost limitations and lack of institutional interest or support. 12,25 This creates a chicken-and-egg situation whereby there is an insufficient evidence-base from which to implement standardised survivorship programmes in cancer centres. In the context of cancer distress, this can lead to long-term psychological morbidity in patients, resulting in failure to return to work and chronic demands on health care resources.…”