Title: The 6th Vital Sign in Cancer Care WHY SCREENING FOR DISTRESS IS CHANGING PRACTICE S U P P O RTIVE CARE S U P P O RTIVE CARE
Abstract: While the discipline of psychosocial oncology is relatively new in the field of cancer care, many if not most health care providers, would say that it is a vital component of clinical care and its application is necessary to improve the patient experience along the cancer care continuum from diagnosis, treatment, recurrent disease, palliative care and survivorship. Historically, this acknowledgement has been the politically corre c t response. Unfortunately, however, institutional funding for psychosocial care has been quite limited and services across Canada vary with less than two per cent of cancer programs’ operating dollars directed to the emotional care of the cancer patient. 1 As a society, when we talk about cancer, despite all the biomedical success and advances, we are all fully aware of the life-threatening issues associated with this illness. Susan Sontag, after being diagnosed with breast cancer, wrote Illness as a Metaphor and articulated her distress with cancer by saying she saw cancer as being synonymous with death, pain and suffering. 2 Traditionally, cancer care has focused on the tumor and the biomedical aspect of treatments with survival being the sole endpoint. This is quite understandable given the focus on acute and inpatient care. However, care of the cancer patient has been changing. Today, cancer is being treated as a chronic disease with the focus much more outpatient oriented. In 1992, at the first National Forum on Breast Cancer, a panel of experts was asked where they thought the most significant changes in cancer care had taken place. David Beatty, then President of the National Cancer Institute of Canada, stated that he believed the greatest changes were occurring with the inclusion of formalized emotional care programs for the cancer patient. 3 That was over 15 years ago. What was driving this change? I believe it came from two sources: i) the patient advocacy networks, and ii) ethical issues surrounding “informed consent”—the patient’s right to know the full extent and impact of cancer and the complex side effects of treatment. No longer was it possible for health care providers to assume they would know best what the patient needed without a full discussion. While directed at the effect at biomedical treatments, the issue of informed consent opened a Pandora’s Box of new issues, the patient’s experience of living with cancer and its associated distress. In the past few years, there have been a number of studies conducted internationally that have addressed the prevalence of distress. Except for inpatients where distress is seen as being higher, virtually all studies have reported patient’s distress in the 35‐45 per cent range. 4,5 Compounding these high rates is an overworked medical staff with limited expertise or training in psychosocial care and limited interest in spending the required time to help the patient adjust and cope with the emotional side of cancer. 6
Publication Year: 2008
Publication Date: 2008-01-01
Language: en
Type: article
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