IPOS Sutherland Memorial Lecture: An international perspective on the development of psychosocial oncology: overcoming cultural and attitudinal barriers to improve psychosocial care

Psychometric properties and cross-cultural adaptation of the Indonesian version of the Brief COPE in a sample of advanced cancer patients

The Brief COPE Inventory has been proven as acceptable psychometric properties to examine coping strategies among cancer patients. However, most psychometric testing studies have been carried out in Western countries, raising concerns about the properties' relevance and applicability in other cultural contexts. This study aimed to present psychometric properties of the Brief COPE in a sample of patients with advanced cancer in Indonesia. Specifically, we intended to examine the factorial structure and the measure's validity and reliability. This study included 440 patients from the original study who completed the Indonesian version of Brief COPE. We used exploratory factor analysis and confirmatory factor analysis to assess factor structure and evaluate the structural model fit, respectively. Reliability was demonstrated by internal consistency represented by Cronbach's alpha coefficient. The factor analysis identified a 21-items scale with 5-factors (avoidance, religion and acceptance, social support coping, problem solving and distraction). Confirmatory factor analysis demonstrated a good model fit. For the whole scale and its subscales Cronbach's alpha coefficients were acceptable signifying good reliability. Convergent, divergent validity and contrast group comparison were evidenced by significant correlations among subscales and the other instruments used. This study shows that the Indonesian version of Brief COPE is a reliable and valid instrument to measure coping in advanced cancer patients and is ready for use amongst this population in the Indonesian cultural context.

Insomnia, Anxiety, and Depression in Patients First Diagnosed With Female Cancer

OBJECTIVE

This study evaluated whether insomnia, anxiety, and depression differ by type of gynecological or breast cancer.

METHODS

From September 7, 2011, to July 14, 2015, this study included 232 patients who were diagnosed with gynecological or breast cancer for the first time. The severity of insomnia, anxiety, and depression was measured with the National Cancer Center Psychological Symptom inventory (NCC-PSI), a self-reported scale, at the first outpatient visit after surgery. Multivariate logistic regression analyses were used to identify which diagnosis was associated with significant symptom levels.

RESULTS

Patients with ovarian cancer and breast cancer reported more severe insomnia and problems with daily life compared with cervical cancer patients. Anxiety symptoms were more distressing among breast cancer patients than cervical cancer patients, and the degree of interference in daily life was severe. Finally, compared to those with cervical cancer, ovarian cancer and breast cancer patients reported more severe depression, and their daily life was disrupted more often than reported by cervical cancer patients.

CONCLUSION

Many female cancer patients are suffering distress but are not looking for specialized care. Psychiatric approach in the early stages of cancer diagnosis is needed and will require overcoming the stigmas of mental illness and cancer.

Enhancing palliative care patient access to psychological counseling through outreach telehealth services

CONTEXT

Palliative care encompasses an interdisciplinary team, including mental health care professionals, to address psychological distress of cancer patients.

OBJECTIVES

To present the implementation of an outreach counseling program via videoconferencing or telephone to patients receiving care in an outpatient palliative care clinic and to compare patients using this service to those who only received psychological counseling in our outpatient clinic.

METHODS

We conducted a retrospective chart review of cancer patients seen for psychology counseling services in an outpatient supportive care center between June 2015 and March 2017.

RESULTS

We reviewed 2072 unique patients (52% of the total patients seen at the outpatient Supportive Care Center), who had 4567 total counseling encounters across outreach and outpatient settings. A total of 452 (22%) patients participated in a combination of outpatient and outreach counseling services. Patients who participated in outreach services had significantly more encounters (311 [69%] had two to five sessions) compared with those who had outpatient services only (1137 [70%] had one session only) (P < .001). Outreach patients also had shorter times between the initial and follow-up encounters (median 14 days) compared with those who had outpatient services only (median 30 days) (P < .0001).

CONCLUSIONS

Outreach telehealth counseling services was found to enhance palliative care patient access to psychological counseling. These services represent an additional modality for providing continuous psychological care.

The characteristics and risk factors for common psychiatric disorders in patients with cancer seeking help for mental health

BACKGROUND

Although the adverse effects of cancer diagnoses and treatments on mental health are known, about less than 10% of patients are estimated to be referred to seek help. The primary purpose of this study was to obtain the baseline information on patients with cancer seeking help for mental health who presented for the first time to the psycho-oncology outpatient clinic, and to identify risk factors that may provide clues healthcare practitioners in recognizing those needing psychological help in oncology practice.

METHODS

We reviewed the charts of 566 patients with cancer who were referred to the psycho-oncology outpatient clinic over a two-year period. The study includes the socio-demographic data, illness characteristics, psychiatric characteristics, psychiatric diagnoses, and treatment recommendations for these patients.

RESULTS

The incidence of diagnoses of psychiatric disorders was 97.5%. The distributions of psychiatric diagnoses were as follows: any kind of adjustment disorders, mood disorders, anxiety disorders, organic brain syndrome, personality disorders, delusional disorder, and insomnia. Recurrence of cancer, other chronic medical illnesses, a history of psychiatric disorders, poor social support, and low income comprised the common significant risk factors for adjustment disorders, mood disorders, and anxiety disorders. These risk factors were also seen to be significant in the regression analysis in terms of sex.

CONCLUSION

This study identifies the distribution of psychiatric disorders, the risk factors for specific psychiatric disorders, and draws attention to the fact that there are serious delays in patients seeking psychiatric help and in the referrals of oncologists for psychological assessment. Identifying risk factors and raising oncologists' awareness toward risk factors could help more patients gain access to mental health care much earlier.

Introducing psychology services to advanced cancer patients: A randomized double-blind trial

CONTEXT

Psychology services utilization in cancer patients remains low due to barriers such as patient/caregiver acceptance of counseling.

OBJECTIVE

We aimed to determine if the manner of introducing psychology services impacted patients' acceptance of services and to identify factors associated with acceptance and barriers to psychology utilization.

METHODS

In this double-blind randomized cross-over trial, cancer patients with no prior psychology services observed two video vignettes: (a) physician introducing counselor and psychology services to the patient (PI) and (b) counselor introducing psychology services alone (CI). A counterbalanced design was used to control for order effects. After viewing both videos, patients completed a survey regarding preference, attitudes, and barriers for psychology services. Patients and investigators were blinded to the purpose of the study and content and order of videos, respectively. We hypothesized that patients would prefer physician introduction of counselor.

RESULTS

One hundred patients participated: 40 (40%) expressed no difference, 34 (34%) preferred PI, and 26 (26%) preferred CI (P > .2). Younger patients (less than 40 years) either preferred PI (86%) or had no preference (14%, P = .01). Most reported awareness of available psychology services (N = 63), and half (N = 50) were offered psychology services by their physician. Only 40 (40%) and 43 (43%) patients felt psychology services would be helpful for them and their family/caregivers, respectively. Patients who perceived psychology as helpful for self or family had higher anxiety (P = .01 and P = .006, respectively).

CONCLUSIONS

No significant difference was found in patient preference of introducing psychology services except in patients less than 40 years old who preferred PI.

Relationship between physicians' perceived stigma toward depression and physician referral to psycho-oncology services on an oncology/hematology ward

OBJECTIVE

This study was performed to identify relationships between physicians' perceived stigma toward depression and psycho-oncology service utilization on an oncology/hematology ward.

METHODS

The study participants were 235 patients in an oncology/hematology ward and 14 physicians undergoing an internal medicine residency training program in Inha University Hospital (Incheon, South Korea). Patients completed the Patient Health Questionnaire-9 (PHQ-9), and residents completed the Perceived Devaluation-Discrimination scale that evaluates perceived stigma toward depression. A total PHQ-9 score of ≥5 was defined as clinically significant depression. Physicians decided on referral on the basis of their opinions and those of their patients. The correlates of physicians' recommendation for referral to psycho-oncology services and real referrals psycho-oncology services were examined.

RESULTS

Of the 235 patients, 143 had PHQ-9 determined depression, and of these 143 patients, 61 received psycho-oncology services. Physicians recommended that 87 patients consult psycho-oncology services. Multivariate analyses showed that lower physicians' perceived stigma regarding depression was significantly associated with physicians' recommendation for referral, and that real referral to psycho-oncology services was significantly associated with presence of a hematologic malignancy and lower physicians' perceived stigma toward depression.

CONCLUSION

Physicians' perceived stigma toward depression was found to be associated with real referral to psycho-oncology services and with physician recommendation for referral to psycho-oncology services. Further investigations will be needed to examine how to reduce physicians' perceived stigma toward depression.

EMDR Therapy in Psycho-Oncology: A Bridge Between Mind and Body

Of the many life-threatening illnesses, cancer can be one of the most traumatic and distressful. It impacts the individual’s sense of identity and interferes with essential features intrinsic to the person’s uniqueness and self-awareness. It attacks patients’ physical integrity, bringing death into the foreground and can directly threaten their sense of belonging to micro and macro social systems. This article stresses the importance of understanding that psychological pain and physical suffering are closely interconnected and, within the context of psycho-oncology, proposes a clinical perspective based on the eye movement desensitization and reprocessing (EMDR) approach, in which the cancer event is nested in the history of life of the patient. EMDR is a therapeutic approach guided by the adaptive information processing (AIP) model. The AIP model postulates that psychopathology results when unprocessed experiences are stored in their own neural network, incapable of connecting with other more adaptive networks. In this perspective, the core of the clinical suffering is hypothesized as embedded in these dysfunctionally suspended memories. In line with recent scientific literature presented in this article, it appears that previous and cancer-related traumas maintain a vicious cycle between psychological and physical health, and the aim of EMDR therapy is to break this cycle. Recent scientific research has hypothesized that EMDR therapy is effective at both the psychological and physical levels. However, because of the consistent heterogeneity of the research design, the findings reported in this article highlight the need for further controlled research for more comprehensive examination.

[Screening psychological distress in breast cancer patients on treatment]

OBJECTIVE

The aim of our study was to evaluate emotional distress among women with breast cancer treated by radiotherapy, using a Visual Analogue Scale (an adaptation of the "Distress Thermometer" French version) associated with a Needs Scale with several items, in order to identify patients requiring psychological care.

METHOD

Our sample is composed of 277 women treated for breast cancer with radiotherapy. Our psychological evaluation is made of a first enquiry using a visual analogue distress scale and complemented by a Needs Scale with several items. A grade above 3 on the visual analogue distress scale is a reliable indicator; a grade above 4 out of 20 leads us to propose the patient a consultation with a psychologist.

RESULTS

Two hundred and sixty-four female patients with a mean age of 61 years are the object of the study. Among them, 59.2% of patients display a disarray of low intensity (psychological suffering graded between 0 and 2) whereas 40% show a grade equal or superior to 3, considered as pathological on a psychological side: 30% of the patients have a grade between 3 et 5 and less than 2% of the patients display a grade reaching 9 or 10. Concerning the Needs Scale, more than 80% of the patients show a total score below 10 out of 20 and we observe a positive correlation between the total score of the Needs Scale with several items and the Visual Analogue Distress Scale score.

CONCLUSION

Our results highlight the difficulty for most of the patients to cope with emotional distress linked to their disease. We discuss the necessity to increase awareness among caregivers on this psychological distress, through the use of simple tools such as a Visual Analogue Scale associated with a Needs Scale, so as to provide a holistic care for women with breast cancer.

Psycho-oncology and primary prevention in cancer control plans: an absent voice?

BACKGROUND

One third of cancer deaths are attributable to modifiable lifestyle, behaviour and psychosocial risk factors. Psycho-oncology can contribute significantly to prevention initiatives such as those described in national cancer control plans (NCCPs), to reduce or eliminate these risk factors. However, the extent to which psycho-oncology expertise has informed prevention objectives in plans is unclear.

METHODS

Accordingly, 35 English language NCCPs were located via existing databases and were searched using Adobe text searches ('psycho', 'social', 'behav' and 'intervention') to identify (a) representations of psycho-oncology, its dimensions (psychological, social and behavioural) and roles (e.g. psychologist); and (b) behaviour/lifestyle change interventions.

RESULTS

A third of NCCPs included the term psycho- or psychosocial-oncology; approximately half referred to a psycho-oncology dimension regarding prevention and early detection and half included actions/objectives relating to health professionals and provision of psychosocial care. The majority of cancer plans included prevention outcomes and focussed primarily on smoking cessation and alcohol reduction. Interventions commonly proposed were education, regulation and service provision; however, many were aspirational statements of intent rather than specific interventions. Psycho-oncology was represented in NCCPs but was limited in reference to prevention with few behavioural interventions utilised.

CONCLUSIONS

Psycho-oncology input is needed to prescribe evidence-based interventions in cancer plans that not only educate, regulate and provide resources but also motivate, empower and create a supportive normative environment for behaviour change. In this manuscript, and throughout this Special Issue on Cancer Prevention, important principles, ideas and evidence within psycho-oncology are outlined which, if properly implemented, can help reduce the global cancer burden. Copyright © 2015 John Wiley & Sons, Ltd.

Correlates of oncologist-issued referrals for psycho-oncology services: what we learned from the electronic voluntary screening and referral system for depression (eVSRS-D)

OBJECTIVE

Depression in cancer patients is under-recognized and under-treated. To better identify depression, we designed a voluntary depression screening system. Based on its data, we examined trends in oncologist-issued referrals for the psycho-oncology service (POS).

METHODS

The Electronic Voluntary Screening and Referral System for Depression (eVSRS-D) comprises self-screening, automated reporting, and referral guidance. Using touch-screen kiosks at a tertiary hospital in Korea, participants with cancer completed the Patient Health Questionnaire-9 at their convenience, received the results, and reported their willingness to participate in POS. At oncology appointments, oncologists received the screening reports and issued referrals following pre-recommended guidelines. The correlates of actual referrals were examined across all participants and within the willing and non-willing groups.

RESULTS

Among the 838 participants, 56.3% reported severe depression symptoms, 30.5% wanted a referral, and 14.8% were actually referred. The correlates of participants' desire for referral were more severe depression symptoms, being unmarried, and being metastasis and recurrence free. Among all participants, the correlates of actual referrals were unemployment, less severe depression symptoms, poorer performance, treatment status, and wanting a referral. The sole correlate of actual referrals within the non-willing group was poorer performance, and no significant correlates existed within the willing group. The non-referrals were mostly (87.1%) because of postponed decisions.

CONCLUSIONS

The eVSRS-D cannot definitively diagnose major depression but may efficiently self-select a population with significant depression symptoms. The patients' willingness to engage the POS most strongly predicted the actual referrals. Oncologist reviews of screening reports may not result in further depression severity-specific referrals.

Contributing death factors in very low-birth-weight infants by path method analysis

Background:

Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. Therefore, efforts to achieve the UN Millennium Development Goal 4 of reducing childhood mortality by two-thirds by 2015 are focused on reducing neonatal deaths in high-mortality countries. The aim of present study was to determine death factors among very low-birth-weight infants by path method analysis.

Materials and Methods:

In this study, medical records of 2,135 infants admitted between years 2008 and 2010 in neonatal intense care unit of Alzahra Educational-Medical centre (Tabriz, Iran) were analysed by path method using statistical software SPSS 18.

Results:

Variables such as duration of hospitalisation, birth weight, gestational age have negative effect on infant mortality, and gestational blood pressure has positive direct effect on infant mortality that at whole represented 66.5% of infant mortality variance (F = 1018, P < 0.001). Gestational age termination in the positive form through birth weight, and also gestational blood pressure in negative form through hospitalisation period had indirect effect on infant mortality.

Conclusion:

The results of the study indicated that the duration of low-birth-weight infant's hospitalisation is also associated with infant's mortality (coefficient -0.7; P < 0.001). This study revealed that among the maternal factors only gestational blood pressure was in relationship with infants’ mortality.

The importance of psychosocial care

Introduction: Psychosocial support is very important for cancer patients, because it affects the quality of life of the patients and the course of the disease. It helps the family to deal with difficult situations and prepare for future challenges. Aim: The aim of this study was to analyse the psychosocial care in the Pécs-Baranyai Hospice Foundation and answer the following questions: what are the characteristics of psychosocial care and how many people receive this support. Method: It was a retrospective study. Results: During the 8 years examined, 36% of the patients (273 persons) asked or proposed by anyone psychosocial support for the family. However, meeting between the patient and expert evolved only in 49% of the 273 patients and, thus, only 18% of the patients received psychosocial support. Conclusions: In the Pécs-Baranya Hospice Foundation less patients received psychosocial support, than those who would need it. Psychosocial care is not yet an integral part of hospice care in practice. Orv. Hetil., 2014, 155(37), 1485–1492.

Aptitude-treatment interaction effects in psychooncological interventions

OBJECTIVE

To examine aptitude-treatment interaction (ATI) effects in cancer patients receiving psychooncological interventions (POIs).

METHOD

N=36 cancer patients were treated with POI. Hierarchical linear regression was used to test two interaction effects between patient baseline characteristics (aptitudes) and process analyses of therapy sessions (treatment) on change in mental health during POI.

RESULTS

Patients with high emotional distress did best when their therapy reduced arousal, and patients with lower emotional distress benefited most if therapists emphasized arousal induction. The interaction between the coping style of the patient (internalizing vs. externalizing) and the focus of the treatment (emotion vs. behavior) did not predict POI outcomes.

CONCLUSIONS

The ATI effect of patient's distress and therapist's arousal induction/reduction may help therapists to make differential treatment decisions in POI. Tailoring treatments to cancer patients based on their personal characteristics may enhance the effectiveness of POI.

[Psycho-oncological care for melanoma patients: conception and implementation]

Offering psycho-oncological care is an essential, guideline-based component of comprehensive care in skin cancer centers. This paper describes the development, implementation and utilization of a specific psycho-oncologic care concept for melanoma patients in the University Dermatology Clinic Freiburg. Based on the stepped-care principle, the concept is composed of interdisciplinary group sessions for patients and their relatives offered every 4-6 weeks addressing medical and psycho-oncological topics related to treatment of malignant melanoma and then individual psycho-oncological sessions modified for the patient's treatment needs. Between April 2010 and July 2012, 67 % of the melanoma patients treated in the Freiburg Skin Cancer Center were reached by the program. A stepped-care concept with a routinely initiated first contact and low-threshold patient education group sessions is a reliable approach to reach patients and inform them about further psycho-oncological care. The advantages justify the allocation of resources and the approach proved successful for routine clinical practice.

Naturalistic study on the effectiveness of psycho-oncological interventions in cancer patients and their partners

BACKGROUND

There is evidence for the efficacy of psycho-oncological interventions (POI) in randomized controlled trials for cancer patients. Our objective was to explore, under naturalistic conditions (using propensity score matching), whether POI are effective to decrease anxiety, depression, distress and overall psychopathological symptoms within cancer patients and their partners.

METHODS

This study was conducted in the Oncology and Hematology Center of a University clinic in Switzerland with a group of 186 patients and 117 partners. Outcome measures of mental health were the Hospital Anxiety and Depression Scale and the Symptom Checklist (SCL-9-K). Repeated-measures ANOVAs were used to analyze change over time and group effects between individuals with POI vs. without POI.

RESULTS

Highly distressed patients and their partners participating in POI reported better mental health over time. Among moderately distressed patients, a decrease over time emerged in depression and distress independent of POI. No effectiveness of POI could be demonstrated in moderately distressed patients and partners.

CONCLUSION

Most of the highly distressed patients receive additional POI and therefore conclusions about the efficacy of POI are difficult. For moderately distressed individuals, POI as implemented in Switzerland does not improve mental health in such patients and their partners, which may be caused by very time limited POI treatments. Studies with more intense POI treatments are needed.

On Being a Psycho-Oncologist

This special issue of TCP focuses on the psychological and psychosocial components of coping with cancer and its aftermath. Psycho-oncology, a subspecialty within professional psychology, is a multidisciplinary field emphasizing the psychological and social aspects of cancer. In this introductory article, I show the congruence between counseling psychology and psycho-oncology, indicate how counseling psychologists can expand their parameters of practice to include cancer patients and families, and explain what evidence-based resources are needed to acquire relevant background knowledge. Health care reform changes—in general and oncology-specific—are explained as they currently open new opportunities for counseling psychologists in psycho-oncology. Finally, the five articles that make up this special issue are previewed. Psycho-oncology is a challenging yet rewarding subspecialty within counseling psychology, congruent with its values and parameters of practice, and now is an opportune time to expand one’s practice to include psycho-oncology and help those coping with cancer and its aftermath.

Advancing the evidence base in cancer: psychosocial multicenter trials

BACKGROUND

The diagnosis and treatment of cancer is associated with significant distress and psychosocial morbidity. Although psychosocial interventions have been developed in an attempt to improve psychosocial outcomes in cancer patients and survivors, there is continued debate about whether there is adequate high-level evidence to establish the effectiveness of these interventions. The evidence base is limited as a result of numerous challenges faced by those attempting to conduct psychosocial intervention trials within the health system. Barriers include insufficient participant recruitment, difficulty generalizing from single-trial studies, difficulty in building and managing research teams with multidisciplinary expertise, lack of research design expertise and a lack of incentives for researchers conducting intervention research. To strengthen the evidence base, more intervention studies employing methodologically rigorous research designs are necessary.

METHODS

In order to advance the evidence base of interventions designed to improve psychosocial outcomes for cancer patients and survivors, we propose the formation of a collaborative trials group that conducts multicenter trials to test the effectiveness of such interventions.

RESULTS

Establishment of such a group would improve the quality of the evidence base in psychosocial research in cancer patients, by increasing support for conducting intervention research and providing intervention research training opportunities. A multidisciplinary collaborative group conducting multicenter trials would have the capacity to overcome many of the barriers that currently exist.

CONCLUSIONS

A stronger evidence base is necessary to identify effective psychosocial interventions for cancer patients. The proposed formation of a psycho-oncology collaborative trials group that conducts multicenter trials to test the effectiveness of psychosocial interventions would assist in achieving this outcome.

Projected referral to other healthcare services in an outpatient palliative radiotherapy clinic

AIMS

To investigate the projected referral to other healthcare services in an outpatient palliative radiotherapy clinic.

METHODS

Patients referred for palliative radiotherapy from 1999 to 2002 inclusive and 2007 to 2009 inclusive were evaluated. The Edmonton Symptom Assessment System, which assesses nine symptoms, was completed by 1439 patients prior to radiotherapy consultation. The numeric scale was converted into a categorical scale of none, mild, moderate and severe. Patients with moderate-to-severe symptoms were identified as potential referrals to other healthcare services.

RESULTS

Tiredness (66%), poor sense of wellbeing (64%), pain (57%) and poor appetite (52%) had the most patients scoring in the moderate-to-severe range. Moderate-to-severe anxiety and depression occurred in 39 and 30% of patients, respectively, reflecting the percentage of projected referrals for symptom and/or psychosocial management.

CONCLUSION

Cancer symptoms are complex, and a multidisciplinary and collaborative approach should be taken to provide timely management and maintain patients' quality of life.

Psychosocial services in the first 30 days after diagnosis: results of a web-based survey of Children's Oncology Group (COG) member institutions

BACKGROUND

This study examines what proportion of families of recently diagnosed pediatric cancer patients are offered recommended psychosocial services, and if that proportion is linked to size of institution or number of psychosocial staff.

PROCEDURES

A web-based survey was offered to all institutions belonging to the Children's Oncology Group (COG).

RESULTS

Respondents from 127/212 (=59.9%) COG institutions provided information about percentage of families offered specific services within the first 30 days after diagnosis, and barriers to providing such services, as well as information about other factors that might affect their ability to provide psychosocial care. All sites reported that ≥50% of families are offered 21 of the 27 services investigated in this study. Over half of respondents (n=290) indicated that inadequate funding for staff (72%) and families' time constraints (63%) were barriers to providing psychosocial care. There was a positive relationship between the total number of psychosocial staff and the number of new patients seen annually (Pearson correlation=0.3409, P-value < 0.0004), but not between the total number of psychosocial staff and specific services offered. Most sites do not use validated assessment tools or evidence-based psychosocial interventions.

CONCLUSIONS

While some version of most recommended psychosocial services are offered across COG institutions, evidence-based psychosocial services are offered at only 11% of sites. Advances in psychosocial outcomes in pediatric oncology could be accelerated by multi-site collaboration, use of standardized assessment tools, and evidence-based interventions.

Identifying research priorities and research needs among health and research professionals in psycho-oncology

AIM

To identify and prioritize the key research questions in psycho-oncology in order to guide the development of large multicenter clinically relevant studies.

METHODS

All members of the Psycho-Oncology Co-operative Research Group (n = 295) were invited to participate in an online survey and 180 responded (response rate = 61%). Participants rated eight priority research areas identified from a previous focus group study on a five-point scale, and ranked their top four priority areas. Within the four ranked research areas, participants selected the three most important specific research questions.

RESULTS

The highest rated research priority areas were distress identification (23.3%), survivorship (22.7%), and distress management (15.3%), followed by issues relating to health services (9.7%) and carers (8.0%). Interventions were commonly nominated among the most important research questions within each priority area. The single most important research question identified by 44% of the sample was to "Determine the most acceptable, reliable and valid screening tool to be administered routinely at diagnosis and at other key transition points to identify distress and psychosocial needs".

CONCLUSION

This is the first Australian study to explore research priorities in psycho-oncology, and the first international study to explore these issues in depth. To ensure that the research effort is strategic, clinically relevant and cost-effective, clear priorities need to be established. The results of this survey will enable limited resources to focus on key research questions of direct clinical benefit.

Historical threads in the development of oncology social work

As the Association of Oncology Social Work celebrates its 25th year, we pause to reflect on the many historical threads that contributed to its development and hear from each of the presidents who helped create the organization, as we know it today. Set within hospitals, medical social work was born in the early 20th century. In the 1940s medical social work became necessary for hospital accreditation. Two additional historical shifts, one in medical improvements in treating cancer, the other a shift to a consumer-oriented American Cancer Society, contributed to the push for a greater role for the federal government in funding cancer research. Oncology social work came to full blossom in the 1970s, a result of the physicians' need for a member of the health care team who understood cancer, its treatment, and the patient's need to address his or her psychosocial needs resulting from cancer. Today, oncology social work is a fully developed profession with a national organization providing education and support to oncology social workers' in their use of psychosocial interventions and research in behalf of cancer patients and their families.

Stigma in cancer patients whose behavior may have contributed to their disease

The purpose of the present review is to examine stigma and its consequences among people with cancer, with an emphasis on the situation in which one's behavior may have contributed to the disease. We examine whether voluntarily engaging in behavior that adds to cancer risk leads to increased stigma after cancer onset, as compared with when one's behavior is not considered (by the affected individual or by others) to have contributed to the onset of cancer. We conducted literature searches in PsychInfo and Medline and identified 38 published papers that empirically addressed cancer-related stigma. We found evidence of increased negative attitudes and more severe consequences of stigma among people that have engaged in a behavior that is perceived to have contributed to their cancer, compared with those who are not perceived to have contributed to their disease.

CBT for emotional distress of people with cancer: some personal observations

The detrimental effect of a helpless coping response on the quality of life of cancer patients is well documented. Helplessness is significantly related to emotional distress. There is also evidence that this coping response is an independent prognostic factor associated with a significantly increased risk of disease recurrence and death. These findings highlight the need to develop specific strategies to enable patients to overcome helplessness. Recent research in patients with advanced cancer indicates that emotional distress appears to be caused by low levels of positive effect. Consequently, attention should be paid to the much neglected study of positive psychological states such as fighting spirit and resilience. In the meantime, some suggestions-based on clinical experience-of inducing and fostering positive effect in our patients are outlined.

A partnership in like-minded thinking-generating hopefulness in persons with cancer

A conceptual model of a partnership in 'like-minded thinking' consists of the following components: a relationship, a shared goal with mutual agreement to work toward that goal, and reciprocal encouragement between two people. A like-minded alliance is a relationship that offers support while at the same time encourages hope and establishes a reciprocating emotional attitude of hopefulness. The discussion focuses on the principles of such a model that is designed primarily as a lay intervention for anyone who has a close friend with cancer and who wants to assist the friend in maintaining a hopeful attitude in the face of illness. While this model is not directed at healthcare professionals it may be transferable into psychosocial interventions to assist persons toward sustaining hopefulness in the context of the cancer trajectory. Much has been written in the literature about how hopelessness spawns despair for individuals who have cancer and in those near the end of life; it may even create a desire for hastened death (Breitbart W., Heller K.S.: 2003, 'Reframing Hope: Meaning-Centered Care for Patients Near the End of Life'. Journal of Palliative Medicine 6, 979-988; Jones J.M., Huggins M.A., Rydall A.C., Rodin G.M.: 2003, 'Symptomatic distress, hopelessness, and the desire for hastened death in hospitalized cancer patients', Journal of Psychosomatic Research 55, 411-418). Therefore, the aim of this paper is to explore how like-minded thinking for a person with cancer and his or her support person provides a framework for a personal shared worldview that is hope-based, meaningful and coherent.

Collaborative/active participation per se does not decrease anxiety in breast cancer

The information needs of breast cancer patients on their disease, its treatment, the prognosis, and their attitude to decision-making concerning treatment were assessed. One hundred and fifty early and 45 metastatic breast cancer patients were recruited into the study. The amount of information and role in the treatment decision-making process preferred by the patient were independently estimated by the patient and the oncologist, using questionnaires. Information was provided in accordance with the wishes of the patient as perceived by the physician. Test of anxiety was performed before, and one week after the consultation. Most of the patients claimed to anticipate the provision of extensive information and an active role in the decision-making, but real interest during the consultation was found less frequently. The post-consultation anxiety test revealed a significant decrease in situational anxiety; this was not related to the patient's information needs or her attitude to the decision-making concerning treatment. Our study demonstrates that a significant decrease in anxiety may be achieved via a consultation tailored to the needs of the patient. Loading the patient with information and involvement in the decision regarding therapy as much as the patient seems comfortable with lowers distress.

Telling children and adolescents about their cancer diagnosis: cross-cultural comparisons between pediatric oncologists in the US and Japan

PURPOSE

Over the last 50 years, direct communication about cancer with adults has shifted from an approach of not telling to one of telling. Less is known about communication practices with children. The purpose of this study is to (1) describe patterns of communication at diagnosis between pediatric oncologists and children with cancer and (2) compare cultural differences in these practices in the US and Japan.

METHODS

This 2003 survey, developed in English and translated into Japanese was mailed to members of the American Society of Pediatric Hematology/Oncology and the two Japanese Societies of Pediatric Hematology and Oncology; there were 350 US and 362 Japanese respondents. Descriptive statistics and logistic regressions were performed.

RESULTS

US physicians had a consistent pattern of telling children (65% always told the child; less than 1% rarely or never told). Japanese physicians had greater variability in their patterns of telling (with only 9.5% always telling, 34.5% rarely or never telling). Direct communication with the child was influenced by personal attitudes, patient factors, and work culture in both countries. Many more variables emerged as influencing Japanese physicians' communication practices than for US physicians. US physicians were influenced by their own sense of responsibility for telling, while Japanese physicians were more influenced by personal attitudes, patient factors, and work culture.

CONCLUSIONS

US and Japanese physicians differed when communicating directly with the child about his or her cancer. The impact of these practices on children and their parents should be explored and the parent and child's perspectives elicited. This information will help facilitate culturally sensitive patient and family centered communication.

Clinical practice guidelines for the psychosocial care of adults with cancer

Clinical practice guidelines are increasingly being developed in medical settings to provide evidence-based recommendations to guide the clinical care of patients. The development of Clinical practice guidelines for the psychosocial care of patients with medical illness is a newer initiative, and more complex as the target audience includes health care professionals from diverse backgrounds. In Australia, the National Breast Cancer Centre and National Cancer Control Initiative have collaborated to develop Clinical practice guidelines for the psychosocial care of adults with cancer, funded by the Australian Government Department of Health and Ageing. This paper outlines the development of these guidelines in the international context, gives an overview of their content, and describes strategies for their implementation and evaluation.

Psychosocial morbidity and its correlates in cancer patients of the Mediterranean area: findings from the Southern European Psycho-Oncology Study

BACKGROUND

A few and partial data are available on psychosocial morbidity among cancer patients in Mediterranean countries. As a part of a more general investigation (Southern European Psycho-Oncology Study-SEPOS), the rate of psychosocial morbidity and its correlation with clinical and cultural variables were examined in cancer patients in Italy, Portugal and Spain.

METHODS

A convenience sample of cancer outpatients with good performance status and no cognitive impairment were approached. The Hospital Anxiety-Depression scale (HAD-S), the Mini-Mental Adjustment to Cancer scale (Mini-MAC), and the Cancer Worries Inventory (CWI) were used to measure psychological morbidity, coping strategies and concerns about illness.

RESULTS

Of 277 patients, 34% had pathological scores ("borderline cases" plus "true cases") on HAD-S Anxiety and 24.9% on HAD-S Depression. Total psychiatric "caseness" was 28.5% and 16.6%, according to different HAD cut-offs (14 and 19, respectively). Significant relationships of HAD-S Anxiety, HAD-S Depression, HAD-S Total score, with Mini-MAC Hopeless and Anxious Preoccupation, and CWI score were found. No differences emerged between countries on psychosocial morbidity, while some differences emerged between the countries on coping mechanisms. Furthermore, Fatalism, Avoidance and marginally Hopeless were higher compared to studies carried out in English-speaking countries.

LIMITATIONS

The relatively small sample size and the good performance status prevent us to generalize data on patients with different cancer sites and advanced phase of illness.

CONCLUSIONS

One-third of the patients presented anxiety and depressive morbidity, with significant differences in characteristics of coping in Mediterranean countries in comparison with English-speaking countries.