L’intégration de la psycho-oncologie dans les formations en cancérologie. Les recommandations de la Société Française de Psycho-Oncologie (SFPO)

As a result of medical progress in cancer treatments, psychosocial care-related aspects also need to be further developed in order to answer growing requests of patients and their families, as well as to deal with oncological healthcare teams greater expectations from mental health specialists. Improving knowledge in psycho-oncology practice among all professionals working in onco-hematology can help to bridge this gap, and this goal can be achieved through the implementation of training. With this aim, the 30th Congress of the SFPO brought together a multidisciplinary expert group for defining psycho-oncology training guidelines based on professional expertise and analysis of literature. All healthcare professionals working in oncological settings are concerned — psychologists, psychiatrists, doctors and nurses; however, each professional has their unique duties, and training can help to identify and clarify their specific role in psychosocial care. Training has to include the specific issues of multidisciplinarity and to be both initial and continuous. For instance a solid training in psychopathology is revealed as a main requirement for psychologists, enabling delivery of well-structured psychological interventions regardless of the specific aspects of each situation. Keeping an up-to-date information level concerning the progress made in cancer treatments is also stressed by these guidelines and so it is the adjustment to the multiple constraints of cancer care organization in order to make psychological care available for all the patients. Training of psychologists and psychiatrists should assure four main axes: clinical practice, institutional work, teaching and research. These guidelines also establish recommendations for training of other healthcare professionals, more precisely about communication skills and screening for patients’ psychosocial needs, distress and vulnerability.     

Public participation in the design of educational programmes for cancer nurses: a case report

Genuine involvement of the public in planning, monitoring and evaluation of health care is a prerequisite to a better quality of service. Similarly users of health services and their carers can contribute much to the planning and delivery of professional education, although this contribution has only recently been acknowledged in any strategic way by nursing educational and professional bodies. This paper provides one example of user and carer involvement in the design of continuing education and higher education in cancer care nursing within the University of Leeds School of Healthcare Studies. The author reflects upon the positive aspects and some of the challenges presented in the achievement of public involvement in nurse education.     

Retrospective Analysis of Emotional Burden and the Need for Support of Patients and Their Informal Caregivers after Palliative Radiation Treatment for Brain Metastases

Cancer burdens not only the patients themselves but also their personal environment. A few studies have already focused on the mental health and personal needs of caregivers of patients. The purpose of this retrospective analysis was to further assess the emotional burden and unmet needs for support of caregivers in a population of brain metastasis patients. In the time period 2013–2020, we identified 42 informal caregivers of their respective patients after palliative radiation treatment for brain metastases. The caregivers completed two standardized questionnaires about different treatment aspects, their emotional burden, and unmet needs for support. Involvement of psycho-oncology and palliative care was examined in a chart review. The majority of the caregivers (71.4%, n = 30) suffered from high emotional burden during cancer treatment of their relatives and showed unmet needs for emotional and psychosocial support, mostly referring to information needs and the involvement in the patient’s treatment decisions. Other unmet needs referred to handling personal needs and fears of dealing with the sick cancer patient in terms of practical care tasks and appropriate communication. Palliative care was involved in 30 cases and psycho-oncology in 12 cases. There is a high need for emotional and psychosocial support in informal caregivers of cancer patients. There might still be room for an improvement of psychosocial and psycho-oncological support. Care planning should cater to the emotional burden and unmet needs of informal caregivers as well. Further prospective studies in larger samples should be performed in order to confirm this analysis.     

Implementing personalized pathways for cancer follow-up care in the United States: Proceedings from an American Cancer Society–American Society of Clinical Oncology summit

A new approach to cancer follow-up care is necessary to meet the needs of cancer survivors while dealing with increasing volume and provider shortages, knowledge gaps, and costs to both health care systems and patients. An approach that triages patients to personalized follow-up care pathways, depending on the type(s) and level(s) of resources needed for patients’ long-term care, is in use in the United Kingdom and other countries and has been shown to meet patients’ needs, more efficiently use the health care system, and reduce costs. Recognizing that testing and implementing a similar personalized approach to cancer follow-up care in the United States will require a multipronged strategy, the American Cancer Society and the American Society of Clinical Oncology convened a summit in January 2018 to identify the needed steps to move this work from concept to implementation. The summit identified 4 key strategies going forward: 1) developing a candidate model (or models) of care delivery; 2) building the case for implementation by conducting studies modeling the effects of personalized pathways of follow-up care on patient outcomes, workforce and health care resources, and utilization and costs; 3) creating consensus-based guidelines to guide the delivery of personalized care pathways; and 4) identifying and filling research gaps to develop and implement needed care changes. While these national strategies are pursued, oncology and primary care providers can lay the groundwork for implementation by assessing their patients’ risk of recurrence and the chronic and late effects of cancer as well as other health care needs and resources available for care and by considering triaging patients accordingly, referring patients to appropriate specialized survivorship clinics as these are developed, helping to support patients who are capable of self-managing their health, setting expectations with patients from diagnosis onward for the need for follow-up in primary care and/or a survivorship clinic, and improving coordination of care between oncology and primary care.     

La place des proches en onco-hématologie,utopie ou réalité ?

A cancer diagnosis has a significant impact not only on the patients, but also on their caregivers. There is no universal definition for the term “caregivers” and it may include spouses, partners, children, relatives, or friends. Caregivers are often the primary source of support and their role changes as the patient’s needs change. Caregivers work with the health care team and have an important role in improving the patient’s health quality of life. But caregivers often neglect their own well-being, including psychological, physical, social, financial, or spiritual issues. This article will attempt to provide an understanding of the multifaceted role of caregivers in cancer care, describe the impact of this role on the caregiver’s quality of life, describe interventions, and formulate proposals for providing support to non-medical persons caring for patients with cancer.     

Patient Educational Needs of Patients Undergoing Surgery for Lung Cancer

There often exists a discrepancy between the information health care professionals (HCPs) provide to patients in preoperative teaching sessions and the information patients perceive as important. This study’s purpose was to determine what information patients undergoing a lung cancer surgical resection wanted to learn before and after their surgery and also to uncover the information HCPs currently provide to these patients. Ten patients were interviewed preoperatively and postoperatively, and eleven HCPs involved in both their preoperative and postoperative care were interviewed. Emerging themes were noted. Patients reported that the most helpful aspects of the preoperative education included surgical details and the importance of physiotherapy, including exercises. Postoperatively, patients wished they had known more about postoperative pain. HCPs provided information that they felt prepared, informed and empowered their patients. Overall, patients expressed satisfaction with the information they received; they felt prepared for their surgery but not for postoperative pain control.     

The relationship between available support, unmet needs and caregiver burden in patients with advanced cancer and their carers

Caregiver burden is an increasing problem with patients surviving longer and more care tasks falling to informal caregivers. While research has identified patient and caregiver variables associated with caregiver burden, less research has focused on aspects of the care environment. The present study investigated the available support and unmet needs of 57 patients with advanced cancer, 45 of their carers and 40 of their health professionals. Carers and patients consistently identified higher levels of available support for the patient than health care professionals, with carers identifying higher levels of support than patients. Carers also identified more patient unmet needs than health care professionals, who in turn identified more than patients. Surprisingly, available support did not increase over 6 months and there was a tendency for unmet needs to decrease over time. Low available support, high unmet needs and a larger discrepancy between carer and patients' reports of patients' unmet need predicted negative aspects of caregiver burden. These results suggest that health care professionals underestimate available support to patients and both patients and health care professionals underestimate patients' unmet needs in comparison to carers. Carers' reports of patients' unmet needs are important to consider as they were associated with high levels of caregiver burden, including poorer caregiver health. Health care professionals should encourage opportunities for carers to discuss their views of the ongoing needs of patients with advanced cancer.     

The research priorities of patients attending UK cancer treatment centres: findings from a modified nominal group study

Members of the public are increasingly consulted over health care and research priorities. Patient involvement in determining cancer research priorities, however, has remained underdeveloped. This paper presents the findings of the first consultation to be conducted with UK cancer patients concerning research priorities. The study adopted a participatory approach using a collaborative model that sought joint ownership of the study with people affected by cancer. An exploratory, qualitative approach was used. Consultation groups were the main method, combining focus group and nominal group techniques. Seventeen groups were held with a total of 105 patients broadly representative of the UK cancer population. Fifteen areas for research were identified. Top priority areas included the impact cancer has on life, how to live with cancer and related support issues; risk factors and causes of cancer; early detection and prevention. Although biological and treatment related aspects of science were identified as important, patients rated the management of practical, social and emotional issues as a higher priority. There is a mismatch between the research priorities identified by participants and the current UK research portfolio. Current research activity should be broadened to reflect the priorities of people affected by the disease.     

Cancer Care Management through a Mobile Phone Health Approach: Key Considerations

Greater use of mobile phone devices seems inevitable because the health industry and cancer care are facingchallenges such as resource constraints, rising care costs, the need for immediate access to healthcare data of typessuch as audio video texts for early detection and treatment of patients and increasing remote aids in telemedicine.Physicians, in order to study the causes of cancer, detect cancer earlier, act in prevention measures, determinethe effectiveness of treatment and specify the reasons for the treatment ineffectiveness, need to access accurate,comprehensive and timely cancer data. Mobile devices provide opportunities and can play an important role inconsulting, diagnosis, treatment, and quick access to health information. There easy carriage make them perfecttools for healthcare providers in cancer care management. Key factors in cancer care management systemsthrough a mobile phone health approach must be considered such as human resources, confidentiality andprivacy, legal and ethical issues, appropriate ICT and provider infrastructure and costs in general aspects andinteroperability, human relationships, types of mobile devices and telecommunication related points in specificaspects. The successful implementation of mobile-based systems in cancer care management will constantlyface many challenges. Hence, in applying mobile cancer care, involvement of users and considering their needsin all phases of project, providing adequate bandwidth, preparation of standard tools that provide maximummobility and flexibility for users, decreasing obstacles to interrupt network communications, and using suitablecommunication protocols are essential. It is obvious that identifying and reducing barriers and strengtheningthe positive points will have a significant role in appropriate planning and promoting the achievements of mobilecancer care systems. The aim of this article is to explain key points which should be considered in designingappropriate mobile health systems in cancer care as an approach for improving cancer care management.     

‘Admission into a helping plan’: a watershed between positive and negative experiences in breast cancer

Cancer patients are in an exposed situation that raises certain psychosocial needs in contact with health care. Previous studies have mainly investigated these needs by assessments on pre‐defined categories. Objective: The purpose of the present study is, from the patients' perspective, to identify breast cancer patients' psychosocial needs, and to synthesise them in a model reflecting the core of these needs. Methods: Seventy‐one patients treated with radiation therapy were consecutively included and repeatedly interviewed about their experiences of health care. ‘Critical incidents’ where identified from the interviews and analysed due to the similarities–differences technique in grounded theory. Results: Four categories of needs where detected: ‘access’, ‘information’, ‘treatment’ and ‘how approached’. These categories and their properties merged into a core category—‘admission into a helping plan’. These findings are well understood in terms of attachment theory. In times of immanent danger and stress people strive to find a ‘safe haven’ to attach to. Cancer patients' ‘safe haven’ can be described as ‘a helping plan’. It is not the result of a separate patient–caregiver relationship but is created by a pattern of individual experiences from all kind of contacts with the health‐care system as a whole. Conclusions: The presented model of patients needs as converging into ‘admission into a helping plan’ may serve as an easily comprehendible model for caregivers, guiding them to contribute to the patient's feeling of security and trust, and thus to the patient's own ‘hope work’. Copyright © 2009 John Wiley & Sons, Ltd.     

De l’hospitalité: prise en charge de patients polynésiens atteints d’hémopathies malignes

The Department of Haematology and Medical Oncology at the Hôtel-Dieu hospital in Paris has been treating Polynesian patients suffering from haematological diseases since May 1985. Based on our clinical experience, our purpose is to consider — from a healthcare worker’s point of view — the special requirements of caring for this population, the effect of cultural factors on the healthworker-patient relationship and the necessity of having specific knowledge to take care of these patients and their families.     

Measurement and Practical Aspects of Quality of Life in Breast Cancer

There are many aspects of quality of life which are non-intuitive and need to be studied to get information for the improvement of cancer treatment. There is general agreement that quality of life should be measured as an important end-point in clinical trials, especially when palliative treatment is intended. The present paper summarizes the main aspects of measurement of quality of life as well as the results of quality of life studies concerning breast cancer. Many practical problems in our health care system clearly undermine the quality of life of cancer patients. The Finnish Hospital League ran a project to identify factors affecting quality of life in the treatment of breast cancer. Four important aspects are discussed, i.e. individual treatment choices, communication, psychological support and continuity of care. Most of the findings are likely to be generalizable within a Nordic cultural context, although Finland still devotes fewer resources to psychosocial support than do other Nordic countries.     

晚期肺癌患者选择姑息支持和临终关怀的影响因素

晚期肺癌患者在某一时点是否选择姑息支持和临终关怀受到包括医学、社会和精神心理等诸多方面相关因素的影响。对这些影响因素的了解和分析,有助于患者和家属相对冷静、客观、全面、有序地权衡利弊,作出明智选择,也有助于医护人员在医疗实践中给予患者和家属充分地理解和支持,同时为卫生宣教工作的开展和相关政策的制定提供一定参考。     

Supporting oncology health professionals: a review

Background

Caring for patients with cancer can be both personally rewarding and stressful. Confrontation with suffering, working with people facing complex life-threatening illness, demanding treatment regimens and frequent death of patients are challenging for many clinicians. Responding to the emotional needs of patients and families is often perceived as among the most stressful. These emotional sources of stress can be compounded by organisational factors and work demands. The resulting emotional impact can have an adverse effect on clinicians’ performance in and satisfaction with their professional roles, their own health and well-being and the quality of patient care.

Objective

The objective of this paper was to review the factors contributing to emotional stress and burnout in health professionals and identify evidence-based strategies to support health professionals in their role, with illustrations of current Australian initiatives on how to apply these in clinical practice.

Results

Research to date indicates the contribution of a combination of individual and contextual factors in the development of these emotional adjustment problems, reflecting an interaction of clinicians’ personal attributes and aspects of their work that influence risk to such stress and “burnout” among cancer clinicians. Evidence-based strategies to address these problems and promote resilience among clinicians include skills development through training and mentorship, particularly in communication skills and psychosocial care. Such training and mentorship can lead to improvements in clinicians’ stress management and confidence in their role, as well as to patient outcomes through improved response to patients’ concerns and suffering.

Conclusion

No single strategy is likely to be successful in alleviating stress related to work in oncology. Interventions must be multi-faceted, flexible and incorporate attention to the complex inter-relationships of clinicians, their personality and experiences, patients and health care systems. Mentorship and clinical supervision can provide personal support, maintenance of skills and promote reflective practices and translation of these skills into everyday practice. Service models that also reduce professional isolation and promote inter-disciplinary team function are discussed, with illustrations of current initiatives in Australia.     

Cancer and mental health—a clinical and research unmet need

BackgroundPoor mental health is the largest single source of disability in the UK, and co-morbid health problems, particularly with cancer, raise total health care costs significantly.MethodsThis study examined what research is being conducted into the intersection between cancer and mental health. Research papers captured by the intersection of sub-field filters—‘mental disorder’ and ‘cancer’—were studied from the Web of Science over a 10-year period (2002–2011).ResultsThere were 1463 papers dealing with the dual presence of cancer and mental disorder. They amounted to 0.26% of cancer research and 0.51% of mental health research over the 10-year period, indicating that their intersection receives little research attention. Eighty per cent of papers were concerned with the effects of cancer on mental health rather than the reverse; a few (5%) looked at the post-traumatic stress suffered by carers of cancer patients. Of cancer types, breast dominated (21%), followed by prostate (5%), lung (3%), oral (2%) and colorectal (2%) cancer. The area of mental health most studied in cancer was unipolar depression.ConclusionsThe paucity of research that exists at the intersection of cancer and mental health requires attention from policymakers and funders in order to address an important trans-disciplinary gap in health care research.     

The Role of General Practitioners in Cancer Care: A Mixed Method Design

The aims of this study were to identify the current role of general practitioners (GP) and the unmet needs of cancer patients in primary care. First, we conducted individual interviews with 10 cancer patients. Next, we developed a questionnaire, which was distributed among cancer patients across Estonia. Altogether, 113 questionnaires were returned. We observed that while the patients were satisfied with their GP’s work, they mostly preferred to discuss cancer-related problems with oncologists. The role of GPs in regard to other diseases was perceived as very important, also patients found it relevant to consult all investigations with their primary health care physician. The main problems experienced by the patients were a lack of proper accessible information about their disease and its inadequate presentation by doctors, as well as problems with coordination between primary and secondary health care providers. In conclusion, we can say that even treatment of cancer is centralised to oncology clinics, patients also contact their GPs during cancer care. Therefore, GPs should be aware of patients’ general health and comorbid medical problems. Better communication between primary and secondary health care doctors as well as more integration of GPs in cancer care is needed.     

Hematology and oncology clinical care during the coronavirus disease 2019 pandemic

New York City has been at the epicenter of the coronavirus disease 2019 (COVID-19) pandemic that has already infected over a million people and resulted in more than 70,000 deaths as of early May 2020 in the United States alone. This rapid and enormous influx of patients into the health care system has had profound effects on all aspects of health care, including the care of patients with cancer. In this report, the authors highlight the transformation they underwent within the Division of Hematology and Medical Oncology as they prepared for the COVID-19 crisis in New York City. Under stressful and uncertain conditions, some of the many changes they enacted within their division included developing a regular line of communication among division leaders to ensure the development and implementation of a restructuring strategy, completely reconfiguring the inpatient and outpatient units, rapidly developing the ability to perform telemedicine video visits, and creating new COVID–rule-out and COVID-positive clinics for their patients. These changes allowed them to manage the storm while minimizing the disruption of important continuity of care to their patients with cancer. The authors hope that their experiences will be helpful to other oncology practices about to experience their own individual COVID-19 crises.     

Parents' decision-making preferences in pediatric oncology: the relationship to health care involvement and complementary therapy use

This study investigated how parents' preferred level of control in treatment decision-making is related to their personal health care involvement and to their decision to use complementary therapies (CTs) for their child. One hundred-eighteen parents of pediatric oncology patients completed an anonymous CT survey. The Krantz Health Opinion Survey (KHOS) was used to determine parents' preferred involvement in personal health care, and the Control Preferences Scale for Pediatrics (CPS-P) measured preferred role in pediatric treatment decision-making. Unlike previous studies of adult cancer patients, most parents preferred active or collaborative decision-making. The KHOS and CPS-P were significantly correlated, indicating that parents' preferred role in children's treatment decisions was related to their own personal health care involvement. Forty-six percent of parents used CTs for their child, and 33% began using a new CT after diagnosis. The hypothesized relationship between CT use and parents' own health care involvement was partially supported. Preference for control in decision-making was not associated with CT use. These findings provide validation for the newly developed CPS-P and indicate that parents' decisions to use CT for their child are related in part to individual health care preferences.     

Oncologists experience with second primary cancer screening: current practices and barriers and potential solutions

Objectives: Screening for second primary cancer (SPC) is one of the key components of cancer survivorship care. The aim of the present study was to explore oncologists’ experience with promoting second primary cancer screening. Methods: Two focus group interviews were conducted with 12 oncologists of diverse backgrounds. Recurrent issues were identified and placed into thematic categories. Results: Most of the oncologists did not consider SPC screening promotion as their responsibility and did not cover it in routine care. All of the study participants had experience with unexpected SPC cases, and they were under emotional tress. There was no systematic manner of providing SPC screening. Oncologists usually prescribe SPC screening in response to patients’ requests, and there was no active promotion of SPC screening. Short consultation time, limited knowledge about cancer screening, no established guideline for SPC screening, and disagreement with patients about oncologists’ roles were major barriers to its promotion. An institution-based shared care model was suggested as a potential solution for promoting SPC screening given current oncology practices in Korea. Conclusion: Oncologists could not effectively deal with the occurrence of SPC, and they were not actively promoting SPC screening. Lack of knowledge, limited health care resources, and no established guidelines were major barriers for promoting SPC screening to cancer survivors. More active involvement of oncologists and a systematic approach such as shared-care models would be necessary for promoting SPC screening considering increasing number of cancer survivors who are vulnerable.