Cancer doesn't attack just the cells of the people who have it. While research has shown that the toll cancer takes on the mental health of patients can lessen chances of recovery and outcomes, medicine has been slow to react to this knowledge.
The University of Cincinnati Cancer Institute is part of a broad study that may bring change by finding better measures of the mental health of cancer patients. The goal is to bring social and mental health professionals to patients' aid before they reach a crisis, as well as identify key moments when such help is likely to be needed.
We can give people the best chemotherapy (and other treatments) in the world, said Georgia Anderson, manager of palliative care and outpatient social work at the UC institute. But if we're not checking in to see how they're doing as people, we may not get the best outcomes.
The institute is one of 18 locations in the U.S. and Australia participating in the two-year Screening for Psychosocial Distress Program.
The program, funded by a grant from the National Cancer Institute, is a joint project of the Yale University School of Nursing and the American Psychosocial Oncology Society.
Anderson will work with Clair Bifro, malignant hematology and bone marrow transplant social worker at the institute, to lead the study locally.
Under the study, newly referred patients facing bone marrow transplant and malignant hematology, breast, lung and gastrointestinal cancers initially will receive new screenings after their first visit with their cancer specialist.
We can give people the best chemotherapy (and other treatments) in the world. But if we re not checking in to see how they re doing as people, we may not get the best outcomes.
Georgia Anderson, University of Cincinnati Cancer Institute
The program may be widened later to other cancer specialties.
The UC institute has been using the National Comprehensive Cancer Network-approved distress thermometer, which measures a patient's mental state in a similar way to pain on a scale of zero to 10, with 10 being the worst score.
The scale is designed to make it easier for people to talk to their physicians about the emotional effects caused by the diagnosis, symptoms and treatment of cancer. Yet its roll-out has been a bit rocky, Anderson said.
That's partly because different types of cancer patients have different needs and concerns.
One patient may worry about being cured to return to work, while another may only be worrying if she'll live to see a loved one's graduation or wedding.
They want to know if they'll be able to do those things, Anderson said. But a newly diagnosed patient may be so flummoxed that he doesn't ask those kinds of questions, triggering stress.
Under the study, Anderson and Bifro and their colleagues will work to identify specific stresses as a way to trigger better interventions; measure the effectiveness of psychosocial oncology services being provided, including testing, retesting and score tracking; and expand the program by demonstrating the need for services,including adding staff and incorporating practices into treatment plans.
Cancer and mental health
Depression and social isolation worsen the conditions of cancer patients, research shows. For example:
The impaired thinking and loss of memory due to depression can reduce a patient's adherence to treatment, weaken their motivation and promotes other problems such as unhealthy eating or misusing medications.
Imbalances in neuro-endocrine and immune system functions triggered by mental distress affect cell growth and replication boosting the metabolism of tumors and suppressing the body's defenses.
Withdrawn and socially isolated women with breast cancer had a 66 percent higher risk of dying within six years, a 2006 study showed.
The stress associated with cancer can cause the onset or progression of other illness, especially heart disease.
Finally, the stress on patients can affect their whole family. Eight percent of families with a loved one with cancer delay or do not obtain medical care because of cost and worries about money.
Source: Institute of Medicine of the National Academies
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