Caring for the whole cancer patient

“You have cancer.” About 14 million people around the world get this frightening diagnosis every year, according to the Centers for Disease Control and Prevention (CDC).

In addition to the physical toll, the disease and its treatments can also cause anxiety, stress and depression, not only for patients but for their caregivers and other loved ones. Psychosocial factors can impair a patient’s ability to respond to treatment.

In 2012, the American College of Surgeons’ Committee on Cancer established standards, to be implemented by 2015, for cancer programs to screen patients for distress and provide access to professional behavioral support.

The National Cancer Institute has funded the Screening for Psychosocial Distress Program, a joint project of Yale University School of Nursing and the American Psychosocial Oncology Society (APOS). Eighteen programs were chosen to participate, including the University of Cincinnati Cancer Institute (UC).

“We can give people the best chemotherapy (and other treatments) in the world,” Georgia Anderson, manager of palliative care and outpatient social work at the UC institute, told The Cincinnati Enquirer. “But if we’re not checking in to see how they’re doing as people, we may not get the best outcomes.”

“There is clear evidence that the psychosocial aspect in the care of patients is just as important as the actual treatments being delivered – it’s important to look at the whole person for better outcomes,” Anderson said in a UC news release.

Anderson is partnering with Clair Bifro, malignant hematology and bone marrow transplant social worker at UC, in the study, which has among its goals developing ways to identify specific stressors and measure the effectiveness of support services.

“We want to be able to decide the point in care for when we need to retest for distress and show how interventions work,” Anderson said. “We want to meet these people sooner, when they’re not in crisis mode, and eliminate barriers to treatment so that they can get well and feel emotionally supported.

“This will make psychosocial distress testing and care a standard practice for every patient and highlight that people with cancer do benefit from this type of assessment,” Anderson said.

The Institute of Medicine of the National Academies has identified causes of psychosocial stress, including:

• Fears and worries that accompany having a life threatening-illness.

• The physical pain and exhaustion of disease and treatment.

• Lack of care-givers or transportation to health services.

• Financial problems that may result from soaring medical bills or job interruption during illness.

“When a woman has breast cancer, that cancer is inside a wonderful normal person who has all of life’s stressors and then must face a cancer diagnosis,” says Dr. James Ruffer, a radiation oncologist at Advocate Good Shepherd Hospital in Barrington, Ill.

“I take care of a person who has a disease, I’m not taking care of a disease,” Dr. Ruffer says. “For people to get well, we need to take care of them as people.”

Dr. Ruffer says that in pediatrics, it’s always been known that the disease affects not just the child but the whole family dramatically.

“That’s true of adult patients as well,” he says.

Cancer care navigators “shepherd patients through not just the physical treatment process but the life process, because cancer is a life-changing event for so many people,” he says. “We’re supporting people as people and not just addressing their disease.”