No abstract

In the United States, a total of 1,479,350 new cancer cases and 562,340 deaths from cancer were estimated to occur in 2009. 1 All patients experience some level of distress associated with the diagnosis and treatment of cancer at all stages of the disease. Surveys have found that 20% to 40% of patients with newly diagnosed and recurrent cancer show a significant level of distress. 2 However, fewer than 10% are actually identified and referred for psychosocial help. 3 Many cancer patients who are in need of psychosocial care are not able to get the help they need due to the under recognition of patient's psychological needs by the primary oncology team and lack of knowledge of community resources. The need is particularly acute in community oncology practices that The NCCN

The integration of psychosocial care into the routine care of all patients with cancer is increasingly being recognized as the new standard of care. These NCCN Clinical Practice Guidelines in Oncology for Distress Management discuss the identification and treatment of psychosocial problems in patients with cancer. They are intended to assist oncology teams identify patients who require referral to psychosocial resources and to give oncology teams guidance on interventions for patients with mild distress to ensure that all patients with distress are recognized and treated.

No abstract

Context: Patients on investigational clinical trials and their caregivers experience poor quality of life (QOL), which declines as the disease progresses. Objective: To examine the effect of a standardized cognitive-behavioral problem-solving educational intervention on the QOL of patients enrolled on investigational clinical trials and their caregivers. Design: Prospective, multi-institution, randomized trial. QOL was measured repeatedly over 6 months. Participants: Patients were simultaneously enrolled onto phase 1, 2, or 3 Institutional Review Board (IRB)-approved cancer clinical trials. Intervention: Intervention arm dyads participated in three conjoint educational sessions during the first month, learning the COPE problem solving model. Nonintervention arm dyads received usual care. Outcome Measures: Global QOL was measured by the City of Hope Quality of Life Instruments for Patients or Caregivers; problem solving skills were measured by the Social Problem Solving Inventory-Revised. Results: The results are reported using the CONSORT statement. The analytic data set included 476 dyads including 1596 patient data points and 1576 care giver data points. Patient QOL showed no significant difference in the rate of change between the intervention and usual care arms ( p ¼ 0.70). Caregiver QOL scores in the intervention arm declined, but at less than half the rate in the control arm ( p ¼ 0.02). Conclusions: The COPE intervention enabled the average caregiver to come much closer to stable QOL over the 6-month follow-up. Future studies should enroll subjects much earlier in the cancer illness trajectory, a common patient/caregiver theme. The maximum effect was seen in caregivers who completed the 6-month follow-up, suggesting that the impact may increase over time.

No abstract

Screening involves an intervention that impacts patients, clinical systems, the institution and staffing levels of psychosocial providers. Provision of scarce resources, active engagement of key professionals and administration will only occur if the stakeholders have a clear sense of the benefits for them. Implementing a screening program creates culture change and culture change not only takes time, but active engagement, patience and persistence.

Initial results suggest that the CaNDI has strong psychometric properties and may be a useful addition to cancer patient needs assessment, research and care.