What is Psycho-Oncology?
Psycho-oncology is a multi-disciplinary speciality focusing on the psychological and mental health care of people affected by cancer, their carers and families. Cancer and its treatments have the potential to significantly impact on mental health, physical health and socio-economic status in multiple ways. Most people will use a variety of resources to cope including their own emotional resources, often accessing the advice of healthcare professionals and other support systems such as family, friends, and community cancer support centres.
Psycho-Oncology addresses the psychological, behavioural, medical and social factors that may influence the disease process and the patients’ experience of their care. It recognises that cancer has a significant psychological impact on patients and families and that this can occur at any time from the time of diagnosis onwards. It has been reported that between 20-52% of patients show a significant level of psychosocial distress with between 10% and 15% of that group experiencing significant levels of distress (NCCN, 2019).
For this specific group of patients, where there may be additional social and psychological adversity, additional resources are needed in the form of specialist Psycho-Oncology teams that can offer timely and appropriate intervention so that patients can adapt to their diagnosis and what it means in their lives. Additionally, psychological obstacles if not addressed, can impact on adherence to treatment protocols, engaging in self-management and rehabilitation programmes and ultimately impact on clinical outcomes.
People working in the field are concerned with the individuals' experience of cancer, across the cancer experience, including at diagnosis, during treatment, transitioning to and throughout survivorship, and approaching the end-of-life. In other words, Psycho-Oncology has a valuable role to play at all times during the cancer experience and is concerned with the impact on the patient and the whole family.
Within the field of Psycho-Oncology, there is also recognition of the psychosocial needs of children diagnosed with cancer as well as the impact of a diagnosis of cancer on the children of adults diagnosed with cancer. This is referred to as Paediatric Psycho-Oncology and this discipline is concerned with providing services to children and their families who are affected by cancer.
The integration of Psycho-Oncology into routine care for cancer patients and their families represents a major step forward in terms of care for the whole patient. Cancer is not just a medical illness but can also have significant psychological and social consequences for both the family and patient. Quality cancer care today must integrate the psychosocial domain into routine cancer treatment.
Psycho-Oncology in Ireland
According to the most recent data from the National Cancer Registry, Ireland, 23,890 cases of cancer were diagnosed in 2017. Based on international studies, this indicates that approximately 12,000 cancer patients were psychologically impacted by their diagnosis and that of these, between 1,200 and 1,800 had significant coping difficulties. The National Cancer Strategy 2017–2026 makes clear recommendations in relation to the development of Psycho-Oncology service in Ireland, recognising that Psycho-Oncology services within cancer centres has not developed as envisaged. The specific recommendations are:
The HSE will develop closer links, on a hub and spoke model, between the National Centre for Child and Adolescent Cancer and the other designated cancer centres to provide appropriate and flexible transition arrangements for adolescents/young adults. This will include the joint appointment of adolescent/ young adult oncologists and haemato-oncologists and the provision of age-appropriate psycho-social support for these patients.
The NCCP will appoint a National Clinical Lead for Psycho-oncology to drive the delivery of networked services.
Each designated cancer centre will establish a dedicated service to address the psychosocial needs of patients with cancer and their families. This will operate through a hub and spoke model, utilising the MDT approach, to provide equitable patient access.
Designated cancer centres will have a sufficient complement of specialist palliative care professionals, including psycho-oncologists, to meet the needs of patients and families (such services will be developed on a phased basis to be available over seven days a week).
What is the aim of the NCCP Psycho-Oncology Programme?
The aim of the programme is to deliver a Psycho-Oncology service to cancer patients and their families across the cancer trajectory firstly through meeting the recommendations in the most recent National cancer Strategy. This means developing integrated psychosocial professional support services across the acute, primary, voluntary and charity sectors so that the needs of cancer patients and their families can be addressed in a comprehensive, fair and equitable way. It has a role to play in:
• Health behaviours that prevent or minimise the risk of developing cancer
• How behaviour can influence how people cope with cancer
• How social factors affect how people adapt to being diagnosed with cancer
• Providing psychological and counselling support to cancer patients and their families at all points in the cancer experience
• Designing good quality research in Psycho-Oncology so that the evidence base for interventions expands.
Meeting the Psychological Needs of Cancer Patients and their families within the Health Service
The necessity of offering appropriate and timely psychological support to cancer patients and their families has been recognised internationally for some time. Canada, Australia, the US and some European countries have well developed psychosocial support services for cancer patients. The kinds of difficulties that cancer patients report include:
• Adjustment difficulties
• Anxiety and phobias
• Decision-making difficulties: indecision related to cancer treatment choices
• Fear of recurrence
• Problems with personal relationships
• Concerns about children managing cancer
• Psychosexual and body image difficulties
• Cognitive impairment
• Organic brain syndromes (e.g delirium)
• Bereavement support for family members and carers.
Through the National Cancer Strategy, Ireland now has the opportunity to both enhance existing services and also expand these services across hospital and community settings. It also addresses the psychological, behavioural, medical and social factors that may influence the disease process and the patients’ experience of their care.
What can Psycho-Oncology offer to patients and their families?
• Influence education programmes to prevent the occurrence of cancer by looking at the psychological factors that affect health behaviours
• Develop a clearly defined referral pathway for psychosocial difficulties in coping with cancer from acute care to community and vice versa
• Improved quality of life
• Improve access to psychotherapy and counselling services at all points in the cancer experience so that patients can manage their mental health
• Helping patients to self-manage their illness and its consequences particularly in the survivorship phase
• Provide support for the families of cancer patients
• Provide support to doctors, nurses and Allied Health professionals working in cancer through education and training so that they are better equipped to manage psychological distress in cancer patients and their families.
Dr Helen Greally, Chartered Psychologist is the National Clinical Programme Lead in Psycho-Oncology.