Riba_edit.qxp 11/8/09 14:10 Page 58
Psycho-oncology
years than others their age.
23
The emotional distress of care-givers Bar-Sela found that art therapy improved depression and positively
can also directly affect patients. Studies of significant others of influenced fatigue levels in cancer patients on chemotherapy after just
women with breast cancer (including daughters and friends) find that four sessions.
29
Music therapy has been shown to help children with
the mental health of significant others correlates positively with the cancer cope better.
30
CBT has been studied and preliminarily shown to
anxiety, depression, fatigue and symptom distress of women with benefit patients who develop learned helplessness as a coping style and
breast cancer and that the effects are bidirectional.
24
Hence, psycho- to help persistent memory dysfunction secondary to chemotherapy.
31,32
oncological services should be available not only to cancer patients Additionally, various studies have been performed to determine the best
but also to their families and primary care-givers. standardised measures to use to assess spiritual well-being in cancer
patients.
33,34
As these various modalities of treatment show promise in
Mental Health Screening in Oncology Clinics helping cancer patients, thoughts should move towards delivery of
Another focus of psycho-oncology research involves finding reliable these services. Should patients be allowed to access more than one
and valid ways to screen and assess the psychosocial needs of cancer modality at a time? Are their overlapping effects synergistic or harmful?
patients. Oncologists themselves report frequent insufficiency in
attending to the psychosocial needs of their patients. In a national Conclusion
survey of members of the American Society of Clinical Oncology It is easy to see that the breadth and depth of current psycho-oncology
(ASCO), one-third of respondents reported that they did not routinely research is impressive. Psycho-oncology clinicians are constantly
screen patients for distress. Of the two-thirds who did, the methods challenged with the important task of bridging medical and
used were often untested or unreliable.
25
Several very quick methods psychosocial aspects of clinical patient care and finding new and
have been developed to screen for distress in cancer patients. The improved ways to do so. Where do we go from here in the field of
best-known tool is the distress thermometer, which is similar to psycho-oncology? A more accurate question is: where do we not go
the rating scale used to measure pain.
26
This method has been from here? Data unequivocally show that better communication with
validated by several studies. The needs assessment surveys patients and improved assessment and bio–psychosocial integration of
performed in ambulatory clinics using this screening tool show that patient care lead to improved outcomes. We need to continue not only
20–40% of patients have significant levels of distress.
27
The Functional to diversify the services that are provided in psycho-oncology, but also
Assessment of Cancer Therapy – General (FACT-G) quality of life scale to expand the people to whom they are available. The main challenges
and Brief Symptom Inventory (BSI) are two other methods used for ahead lie in the area of parity and the delivery of such broad psycho-
screening distress. Responses are immediately scanned and scored. oncology services. There is a need for creation and testing of
Patients are triaged; the patients with the highest scores are seen reimbursement arrangements that will promote psychosocial care and
immediately, and stressors are addressed. In the cancer world, reward its best performance.
35
■
emotional distress is quickly becoming the sixth vital sign to be
checked routinely, along with pulse, respiration, blood pressure,
Michelle B Riba is a Clinical Professor and Associate
temperature and pain.
28
Not only will standardised assessment of
Chair for Integrated Medical and Psychiatric Services in
emotional distress be more reliable and accurate, but also it will help the Department of Psychiatry, Associate Director of the
provide data to springboard further research into the types and
University of Michigan Comprehensive Depression
Center and Director of the PsychOncology Program at
aetiology of distressed experiences.
the University of Michigan Comprehensive Cancer
Center. As a psychosomatic medicine psychiatrist, her
Complementary/Creative Therapies
clinical and research interests include primary care
psychiatry, depression and cardiovascular disease,
The influence of cancer is far-reaching and multidimensional, therefore
psycho-oncology and the role of screening for distress in patients with medical
cancer care should be the same. The role of complementary therapies illness. Professor Riba has served on numerous Editorial Boards and is the author or
(including but not limited to art therapy, music therapy, guided imagery,
editor of over 100 scientific articles, books, chapters and scientific abstracts. She is
Past President of the American Psychiatric Association (APA), the Association for
relaxation, massage, acupuncture), pastoral care and manualised
Academic Psychiatry (AAP) and the American Association of Directors of Psychiatric
therapies (CBT, interpersonal therapy [IPT], dialectical behaviour therapy Residency Training (AADPRT), and zonal representative from the APA to the World
[DBT], family/couples therapy) is growing in the care of cancer patients
Psychiatric Association (WPA).
and their families.
1. World Health Organization, Cancer Fact Sheet, 2008. 1995;57(3):269–74. 2007;16(7):634–43.
Available at: www.who.int/mediacentre/factsheets/ 13. Hewitt M, Rowland JH, Yancik R, J Gerontology, 25. Institute of Medicine: Consequences of unmet psychosocial
fs297/en/index 2003;58(1):82–91. needs. In: Cancer care for the whole patient, Washington DC: The
2. Ness KK, et al., Ann Internal Med, 2005;143(9):639–47. 14. Spiegel D, Giese-Davis J, Biological Psychiatry, 2003;54(3):269–82. National Academies Press, 2008;53–61.
3. Ell K, et al., Gen Hospital Psychiatry, 2007;29:223–31. 15. Katon WJ, Biological Psychiatry, 2003;54(3):216–26. 26. National Comprehensive Cancer Network, NCCN clinical
4. Ciramella A, Poli P, Psychooncology, 2001;10:156–9. 16. Spitzer RL, Kroenke M, Linzer S, et al., J Am Medical practice guidelines in oncology: Distress Management,
5. Derogatis L, Morrow G, Fetting J, JAMA, 1983;249:751–7. Association, 1995;274(19):1511–17. 2007;15–19.
6. Onitilo AA, Nietert PJ, Egede LE, Gen Hospital Psychiatry, 17. Fujimori M, Psychooncology, 2007;16(6):573–81. 27. Zabora J, BrintzenhofeSzoc K, Curbow B, et al.,
2006;28:396–402. 18. Libert Y, Psychooncology, 2007;16(6):553–62. Psychooncology, 2001;10:19–28.
7. Gibson CA, Lichtenthal W, Berg A, et al., Anes Clin N Amer, 19. Epstein RM, Street RL, Patient-centered communication in 28. Bultz BD, Holland JC, Community Oncology, 2006;3(5):311–14.
2006;24:61–80. cancer care: Promoting healing and reducing suffering, NIH 29. Bar-Sela G, Psychooncology, 2007;16(11):980–84.
8. Ahmadzadeh GH, Farhat AR, Nalekian AZ, European Publication No. 07-6225, National Cancer Institute, 2007. 30. Robb SL, Psychooncology, 2008;17(7):699–708.
Psychiatry, 2008;23:S269. 20. Vogel BA, Psychooncology, 2008;17(2):182–9. 31. Greer S, Psychooncology, 2008;17(2):170–73.
9. Gaudreau JD, Gagnon P, Harel F, et al., J Clin Oncol, 21. Kasper J, Psychooncology, 2008;17(1):42–8. 32. Ferguson RJ, Psychooncology, 2007;16(8):772–7.
2005;23:6712–18. 22. Kotkamp-Mothes N, et al., Crit Rev Oncol Hematol, 33. Edmondson D, Psychooncology, 2008;17(2):161–9.
10. O’Connor MF, Psychooncology, 2007;16(5):499–501. 2005;55(3):213–29. 34. Cole BS, Psychooncology, 2008;17(2):112–21.
11. Kurtz ME, Kurtz JC, Given W, et al., Medical Science Monitor, 23. Schultz R, Beach SR, J Am Medical Association, 35. Institute of Medicine: Summary. In: Cancer care for the whole
2004;10(8):CR447–56. 1999;282(23):2215–19. patient, Washington DC: The National Academies Press,
12. Kiecolt-Glaser JK, Glaser R, Psychosomatic Med, 24. Segrin C, Badger T, Dorros M, et al., Psychooncology, 2008;1–23.
58 EUROPEAN PSYCHIATRIC REVIEW