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Cancer Care 2020: Challenges & Opportunities for Behavioral Medicine
Janine E. Gauthier, PhD, Cancer SIG Outlook liaison
There are more than 12 million people living with a current or prior cancer diagnosis. In many cases, cancer is viewed as a "chronic condition" that individuals will receive treatment for and live with for the remainder of their lives. The importance of the psychological toll of cancer has long been recognized, but is only now being mandated as a core aspect of cancer care. In 1954, Sydney Farber, MD, recognized the emotional distress cancer patients experienced physically, psychologically, and spiritually (Mukhergee, 2010). In 2008, the Institute of Medicine's report "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs" identified the importance of addressing the longstanding psychological distress of being diagnosed and undergoing treatment for cancer and not just addressing the medical aspects of cancer treatment (IOM, 2008). Beginning in 2012, the Commission on Cancer has mandated emotional distress screening for all patients presenting to a cancer program or cancer center.
The focus of oncology in the future will likely be aggressive patient care and satisfaction not only with quantity but also quality of life (Thomas & Bultz, 2008). Instead of continuing to work in silos of "biomedical" models and "psychosocial" models of care, cancer care professionals will need to develop collaborative working relationships that bridge both domains. Screening for emotional distress and scientifically pursuing the bio-psychosocial role in treatment planning and research will be at the center of cancer care and will become the central comprehensive repository for informed patient management.
Cancer care in 2020 is predicted to include three key elements (Thomas & Bultz, 2008): (1) The future patient - Patients are better informed, more savvy, and more assertive in their health care. They use global social networks and, at times, bypass the traditional referral pathways in order to obtain the best medical care in the face of cancer. (2) Treatment of the disease - Cancer survival is on the rise with the development of newer therapies which are targeted and more research is devoted to understanding the cellular impact of treatments. Cancer is seen as a highly prevalent but manageable chronic illness. (3) The healthcare system - With spiraling health care costs, shortages of physicians in oncology will result in a need to reconfigure patient care.
Thomas and Bultz (2008) describe a bio-psychosocial oncology unit model in which psychosocial oncology professionals are critical players in this changing culture of proactive health management. Biomedical and psychosocial oncology professionals work collaboratively to meet the complex needs of cancer patients along with members of the healthcare team such as nutrition professionals and pain care specialists in a "one stop shop" approach.
This kind of bio-psychosocial oncology research is being conducted in the psychoneuroimmunology laboratory of Susan Lutgendorf, PhD, at the University of Iowa. Dr. Lutgendorf's lab is investigating the effects of psychological stress on neuroendocrine and immune system functioning in oncology patients. Her research examines the relationship between stress and immune response, angiogenesis and other mechanisms of tumor growth. Additionally, Dr. Lutgendorf's research has documented a distinctive gene expression "fingerprint" in ovarian tumors in individuals with low social support and high depressive symptoms. This line of research is in line with current standards mandating our awareness of the emotional distress and its impact on cancer patients. This research may lead to developing innovative behavioral and pharmacological interventions with the goal of increasing survival in ovarian cancer patients.
As advances in medical treatments for cancer lead to targeted treatments and improved cancer survival rates, it will be imperative for behavioral medicine and psychosocial oncology to bring scientific evidence to the forefront of medicine to facilitate continued collaborations. As noted by Sir William Osler, it is more important to know the person with the illness rather than just knowing the illness affecting the patient.
Thomas BC, Bultz BD. The Future in Psychosocial Oncology: Screening for Emotional Distress - the Sixth Vital Sign. Future Oncol. 2008 Dec;4(6):779-84.
Institute of Medicine (IOM). 2008. Cancer care for the whole patient: Meeting psychosocial health needs. Nancy E. Adler and Ann E. K. Page, eds. Washington, DC: The National Academies Press.
Mukherjee, S. (2010). The Emperor of All Maladies: A Biography of Cancer. New York: Scribner.