Psycho-oncology

DEFINITION: Originally, psycho-oncology was a subspecialty of oncology that investigated, assessed, and treated the social and psychological aspects of having cancer. Psycho-oncology evolved to include the study and amelioration of pain stemming from cancer and its treatments, subjective emotional responses to receiving and carrying the diagnosis (anxiety, depression, degree of hope/hopelessness, delirium), application of patients’ effective coping, functional status and quality of patients’ lives, the role of spiritual and philosophical beliefs, management of stress on caregivers and professional staffs, and the interactions between psychological and emotional factors on immune systems.

Subspecialties: Behavioral medicine, health psychology, medical-liaison psychiatry/psychology, pain management, psycho-immunology, psychoneuroimmunology, psychosomatic medicine, psychosocial medicine, psycho-spirituality

Cancers treated: All

Training and certification: Because psycho-oncology is a clinical and research application of professional training, there is no universally accepted academic credential, although training programs exist at most major cancer treatment centers. Professional organizations promoting psycho-oncology work include the American Psychosocial Oncology Society, the British Psychosocial Oncology Society, and the International Psycho-oncology Society. Their membership consists of oncologists, psychiatrists, and allied health professionals.

Those practicing or researching psycho-oncology come from several professional disciplines that apply their training to the psychological and psychosocial treatment of cancer patients and their families: residency-trained physician oncologists, residency-trained physician psychiatrists, clinical health psychologists, nurse practitioners, medical social workers, and pastoral counselors. (Pastoral counselors are not routinely required to possess a state license.) Professionals follow the individual requirements of their disciplines regarding obtaining licenses to practice their specialty independently, privileges to treat patients from the institutions where they practice, applicable specialty board certification, and maintaining or renewing board certification.

Specific training in psycho-oncology usually occurs as an elective track or certificate program at the major cancer treatment centers for professionals in training there. Psycho-oncology is not typically a requirement of curricula in oncology, psychiatry, health psychology, or social work. Therefore, people who engage in its practice generally have actively sought out training, reflecting a high degree of interest and commitment.

The National Comprehensive Cancer Network (NCCN) represents most major comprehensive cancer care centers in North America. It has produced standards for psychosocial cancer care and clinical practice guidelines for those providing psycho-oncology services, including nonlicensed professionals like pastoral counselors. Institutional regulatory and oversight bodies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American Osteopathic Association (AOA), and governmental departments of health do not fully incorporate these guidelines or psycho-oncological care itself as standard criteria for providing treatment to cancer patients.

Psycho-oncology interventions generate meager reimbursements and revenue relative to other cancer treatment modalities such as surgery, radiation oncology, and chemotherapy. When institutions reassess fiscal priorities, psycho-oncology services and programs are often among the first to be discontinued.

Services and procedures performed: Historically, receiving a cancer diagnosis was equivalent to receiving a terminal diagnosis. In a humanely motivated effort to protect patients from losing hope and entering a state of despair, a cancer diagnosis routinely was not revealed to patients, though families were generally told. In the mid-1970s, people began understanding it was more harmful to patients to keep their diagnosis a secret—an idea supported by research concerning patients’ psychological reactions to cancer treatment conducted at Memorial Sloan-Kettering Cancer Center in New York and the Massachusetts General Hospital in Boston. Early services in psycho-oncology promoted telling patients the truth, encouraging patients with similar diagnoses to meet for emotional support, disseminating treatment information, and educating professionals about quality-of-life considerations and the values of comfort care over curative intervention among grave prognostic cases. These growing changes in the environment of cancer treatment were concurrent with improvements in actual cancer treatments and increasing survival rates. In the twenty-first century, psycho-oncology professionals provide multiple services under the umbrella of engaging the psychological and psychosocial aspects of having cancer.

Psycho-oncology researchers have developed many instruments that assess a wide range of patients’ reactions to cancer—pain, anxiety, depression, and delirium. These instruments assist with evaluating the efficacy of interventions and provide quantitative parameters through which ongoing research in psycho-oncological methods can be tracked and understood. Preexisting psychological assessments were not normed on populations that were this medically ill and routinely overreported patients’ experiences. Researchers have developed scales derived from patient responses to sets of cancer-specific questions.

Psycho-oncology’s contribution to outcomes research (whether a new treatment, drug, or procedure is effective, worth the costs and risks, and so on) has moved beyond whether the intervention increases survival to include consideration of whether the survival is worth having it asks the question whether sustaining this life allows the patient to enjoy a high enough quality of life. In the twenty-first century, oncological treatments must reduce tumor growth and promote sufficient functional status to be productive and beneficial. “Quality-adjusted life years” is a widely cited statistic combining survivability (how much time the treatment adds to patients’ lives) with measures of patients’ quality of life. Mortality rate statistics are inadequate by themselves.

Psycho-oncology practitioners who perform consultation-liaison services commonly treat adjustment disorders that arise in cancer patients. In effect, they treat not the disease but the disturbed emotions that understandably occur in the face of coping with cancer. They do not treat cancer, but patients’ reactions to having cancer.

Health psychologists’ study of how patients cope with illness and comply with treatment plans has become a standard component of what psycho-oncologists work to facilitate in their patients: adaptive patterns of feeling, thinking, and behaving in facing cancer and its treatments and informed compliance with treatment plan options. Psycho-oncology practitioners unite understanding of patients’ subjective experiences without judgment or reprimand, respect for patients’ rights to react in the way they do, and compassionate, positive regard for their emotional suffering with the focused treatment of the cancer itself.

Psycho-oncology practitioners also focus on preventive and behavioral health measures, helping patients make lifestyle changes to reduce the risk of developing or exacerbating cancer. Reducing sun exposure and high-fat, high-calorie food intake, eliminating tobacco use, and achieving and maintaining healthy levels of exercise can reduce cancer risk.

Psycho-oncology’s contribution to cancer treatment includes the provision of comfort and palliative care so that patients who are terminally ill do not needlessly suffer because of aggressive or invasive treatments that prolong life but reduce functional ability. Helping patients and their loved ones face life-threatening diseases means that psycho-oncologically oriented treatments include the patient’s spiritual beliefs, religious practices, and search to find meaning when death is inevitable.

Finally, the high emotional demands of dealing with life and death, the uncertainty of treatments, and cancer-caused physical and emotional pain profoundly affect not only patients but also healthcare professionals and caregivers. Psycho-oncology interventions include protocols and strategies to avoid provider burnout and depression.

Bibliography

Ahmad, Tauseef, et al. "Global Research Mapping of Psycho-oncology Between 1980 and 2021: A Bibliometric Analysis." Frontiers in Psychology, vol. 13, 2022. doi.org/10.3389/fpsyg.2022.947669.

Barraclough, Jennifer. Cancer and Emotion: A Practical Guide to Psycho-Oncology. Wiley, 1999.

Bearison, David J., and Raymond K. Mulhern, eds. Pediatric Psychooncology: Psychological Perspectives on Children with Cancer. Oxford University Press, 1999.

Breitbart, William, et al., eds. Psycho-oncology. Oxford University Press, 2021.

Kusch, Michael, et al. "Integrated, Cross-sectoral Psycho-oncology (isPO): A New Form of Care for Newly Diagnosed Cancer Patients in Germany." BMC Health Services Research, vol. 22, no. 1, 2022, pp. 543. doi.org/10.1186/s12913-022-07782-0.

Lang-Rollin, Isabelle, and Götz Berberich. “Psycho-oncology.” Dialogues in Clinical Neuroscience, vol. 20, no. 1, 2018, pp. 13-22. doi:10.31887/DCNS.2018.20.1/ilangrollin.

Lewis, Clare E., Jennifer Barraclough, and Rosalind O’Brien. The Psychoimmunology of Cancer. 2nd ed. Oxford University Press, 2023.

"What Is Psychosocial Oncology?" American Psychosocial Oncology Society, 2024, apos-society.org/professionals/what-is-psychosocial-oncology. Accessed 20 July 2024.