PSYCHO ONCOLOGY- AN INTERDISCIPLINARY TREATMENT

MURTAZA.H.SHAKIR
M.Pharm

The cancer journey is an uncharted course which has the potential for having an
untoward psychological and emotional impact at any stage along the way….from
those very first words: “you or your loved one has cancer” to surviving the cancer
diagnosis in a disease free or treatment controlled or symptom managed state.
Distressing feelings and emotions, such as anxiety, fear, depression, low self esteem,
anger, shame, and guilt may result in disturbances which affect one’s overall sense of
well being and coping mechanisms with regard decision making, tolerating therapy,
sleep and eating habits, relationship intimacy, and work and school performance.

It is estimated that around 2.5 million people suffer from cancer at any given time in
India. 800,000 persons were given the diagnosis in 2000 and 550,000 died in the same
year due to cancer. Almost 80% of patients reach hospitals in advanced stages of the
disease. The majority needs palliative care, whereas only a minority of the needy receives
this input. The Government of India has included palliative care as part of the National
Cancer Control Program. It was suggested that palliative care be linked with cancer care
in the final stages of the disease as part of supportive measures.

THEORY

Psycho-Oncology is concerned with the psychological social behavioral and

ethical aspects of cancer. It deal mainly with the two psychological dimensions of
cancer: the emotional response of patients at all stages of disease, and those of their
families and their caretakers (psychosocial); and the psychological, behavioural and
social factors that may influence cancer morbidity and mortality (psychobiologica)

Potential survival mechanisms include greater adherence to anti-cancer treatments,

improved self-care, altered disease biology or enhanced host resistance.
PRACTICE

The contribution of psychiatrists and other mental health professionals can best be
integrated with that of general hospital staff in oncology and palliative care units, the
primary health care team and voluntary workers.

The psycho-oncology team may comprise a consultant liaison psychiatrist, psychiatric

trainees, psychologists, clinical nurse specialists (usually nurses with a background in
oncology and trained in counselling), social workers and counselors (either trust or
charity funded).

The liaison-consultation role of the psycho oncologist is broad but covers the following
areas.

 Assessment and pharmacotherapy: Acute referrals will be for patients suffering

adjustment disorder, anxiety and depression with or without suicidal ideation; less
commonly they will be for patients with dissociative disorders and confusional
states. Following these contacts, formal psychiatric assessment will be undertaken
and a treatment plan established, with the use of psychotropic medication and/or
psychological interventions where indicated.

 Education and training: The training of other health care professionals working
in cancer care (e.g. oncologists, junior doctors, nurses, social workers, clergy,
etc.) is central to the role of the psycho-oncologist. Intensive workshops have been
developed to teach physicians and nurses the interviewing, assessment and
counselling skills they need.

 Support groups far staff: Burn-out among oncology staff has been related to work
overload, low satisfaction in relationships with patients and feeling insufficiently
trained in communication skills

 Group therapy: There is tremendous scope to harness the therapeutic potential of

groups for cancer patients. However, the majority of patients do not choose to
attend group support programmes when they are available. The liaison-
consultation psychiatrist needs to be skilled in creating a positive group culture to
facilitate this.
 Pharmacist's role in meeting the psychosocial needs of
cancer patients using complementary therapy.

Complementary therapy is commonly used amongst cancer patients. The motivation

for cancer patients to use complementary therapy is complex. Pharmacists are often
called on to advise patients on the use of herbs and dietary supplements. However, they
do not routinely address the psychosocial needs that motivate the patients to use these
products. The most common factors involved are increased anxiety, need for information,
maintenance of hope, a sense of control, negative experience with conventional medicine,
and perceived holistic nature of complementary therapy. Pharmacists are in a position to
identify and address some of the psychosocial issues, either directly or through referral to
appropriate psychosocial counsellors. This includes screening for patients with significant
anxiety, helping search for accurate information on conventional and complementary
treatments, and maintaining a sense of hope and self control. The opportunity to provide
basic psychosocial training to pharmacists should be explored, so that they may
systematically assess and address the more common, simple psychosocial issues in cancer
patients who seek to use complementary therapy. Given the propensity of distress in
cancer patients, in general, this may provide potential benefits for patients seeking
conventional and complementary therapies

THE FUTURE

The future development of psycho-oncology as a specialist consultation-liaison

discipline hinges upon advancement in two areas: the implementation of established
research findings and the development of training. Firstly, with the weight of evidence
clearly showing the benefits of psychological therapy and with their lack of harmful side-
effects, this form of intervention should be advocated and provided for all patients who
will accept it. The time lag between researchers establishing the effectiveness of an
intervention and its routine clinical use should not be extended unnecessarily: efforts now
need to be focused on the creation of practical working arrangements that allow for the
incorporation of psycho-social interventions within hospitals. It has been recommended
that psychosocial modalities need to be placed on the same footing as other adjunctive
medical treatments, with the principle guiding our recommendations to patients being the
likelihood of benefit, not whether there is overt distress and not simply whether the
patient asks for help