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Fall 2007 Vol. 7 No. 3

Table of Contents

Treating Body and Mind

Cancer Care for the Whole Patient

 Linda Bleck/

Ask cancer patients about the worst parts of their treatment and they probably will cite physical effects such as nausea and pain, but they also may mention anxiety or depression, strains on their relationships, loss of motivation or the ability to keep up on the job, the financial hit to their savings, and any number of other mental, emotional, and social impacts.









C linicians and patients would agree that the psychological and social tolls of cancer and its treatments can undermine the gains made in ridding the body of the disease, and that someone should address these effects. Trained to focus on the body, many cancer care providers have assumed that this responsibility rests elsewhere. But a new report from the Institute of Medicine puts the job squarely on the cancer care provider's examining room doorstep.

The report proposes a new standard of care under which all oncology care providers would systematically screen patients for debilitating stress and other problems; connect patients with health care or service providers who have resources to address these issues and coordinate care with these professionals; and periodically re-evaluate patients to determine if any changes in care are needed. It's a standard that would apply equally well to the management of other chronic diseases.

 Brooke Fasani/Corbis"Eradicating tumors is important, but it's not enough," said Nancy E. Adler, chair of the committee that wrote the report. "This report provides an action plan for ensuring that every patient's oncology team identifies and coordinates the additional psychosocial health services that a patient requires to be as healthy and whole as possible during and after cancer treatment."

Psychosocial health care addresses the emotional challenges that can accompany a serious illness as well as the life challenges that can get in the way of good health care. Cancer care providers do not typically have the knowledge and skills to treat depression, teach anger management, or otherwise handle every psychosocial health need. But elsewhere a wealth of resources already exists, many at low or no cost; cancer care providers could easily make connecting patients to these resources a routine part of care, the report says.

Several leading cancer care providers have taken this more comprehensive tack. Some providers with more resources integrate psychosocial health services with the patient's cancer care in one setting. Psychologists, social workers, and other service providers on staff work with the oncology team to screen patients for problems and ensure that their needs are managed. This "on-site" approach requires substantial resources that not all cancer care practices have. But smaller practices can also provide comprehensive care by tapping psychosocial service providers throughout their communities via referral agreements and partnerships.

Some communities, particularly in rural settings, may have even fewer providers of psychosocial health services in the immediate vicinity. Small or remote oncology practices still can connect patients with a wide range of services through national foundations, nonprofit organizations, online support communities, educational telephone workshops, and many other resources.

Managing patients' psychological and social well-being will require some oncology providers to change how they supply care, but the good news is that many health insurance plans already reimburse much of this care. Health insurance purchasers and health plans should examine the adequacy of their reimbursement rates for the delivery of psychosocial health care, the report urges.

Of course, cancer care providers can only partially resolve some problems such as limited finances or lack of health coverage among patients, and currently there are not enough resources to meet the needs of all patients. But these realities should not preclude oncology practices from attempting to remedy as many psychosocial problems as possible, the committee stated.   -- Christine Stencel

Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Committee on Psychosocial Services to Cancer Patients and Families in a Community Setting, Board on Health Care Services, Institute of Medicine (2007, approx. 460 pp.; ISBN 0-309-11107-2; available from the National Academies Press, tel. 1-800-624-6242; $46.95 plus $4.50 shipping for single copies).

The committee was chaired by Nancy E. Adler, vice chair, department of psychiatry, and director, Center for Health and Community, University of California, San Francisco. The study was funded by the National Institutes of Health.

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Copyright 2007 by the National Academy of Sciences