Treating the Whole Person
Meeting the Emotional and Social Needs of Cancer Patients and Their Families
All too often the emotional, social, and practical problems that accompany a diagnosis of cancer are not discussed or addressed during treatment, and this may prevent patients and their families from getting the care they need, according to a report by the Institute of Medicine (IOM).
Cancer Care for the Whole Patient - Meeting Psychosocial Health Needs calls for a new standard of cancer care in which physicians screen patients for psychological and social issues as early as at the time of diagnosis. Regular follow-up would be required to ensure that recommended care was received and that new needs are being identified and addressed.
Many studies have suggested that unmet psychosocial needs can affect treatment and put patients at risk of illness later in life. Yet the report found that these needs are often not acknowledged or addressed in cancer care.
We're so focused on biomedical aspects of care that a patient's psychosocial needs are not being met," says Dr. Julia Rowland, who directs NCI's Office of Cancer Survivorship. The good news is that many community resources as well as Internet and telephone support services are available to help patients with needs.
The report includes recommendations for how to implement the new standard of care. Interest in psychosocial issues is high because many individuals are experiencing cancer as a chronic disease, and decisions made at the time of treatment can have long-term consequences.
"This report touches a nerve for people who have experienced cancer in terms of the extent to which psychosocial factors are not attended to during treatment," says Dr. Nancy E. Adler of the University of California, San Francisco, who chaired the IOM committee.
She notes that the IOM recently received an e-mail that read simply: "Thank goodness this is finally acknowledged because it is so important."
The report describes three models for delivering psychosocial care, which vary depending on the size of a practice. For instance, comprehensive cancer centers may have the support services on site, while providers in rural areas could use remote services, such as CancerCare and NCI's Cancer Information Service.
Though it focuses on cancer, the IOM report could be adapted for delivering quality care to patients with any chronic disease. The basic strategy requires a foundation of good communication between health care providers and patients.
"This is absolutely critical," notes Dr. Adler. "A health care provider has to ask what the patient's psychosocial needs are in order to help, and the patient has to articulate those needs."
The elements of effective communication are the subject of a new monograph published by NCI, Patient-Centered Communication in Cancer Care. The report shows how better communication can improve clinical outcomes and psychosocial health and lays out the research agenda for the future. The focus is on teams because cancer patients communicate with a variety of health care providers.
"We need to look at the entire journey of cancer patients and their families to understand how the health care system is meeting their needs," says Dr. Neeraj Arora of NCI's Division of Cancer Control and Population Sciences, which produced the report.
—Edward R. Winstead