Abstract
Background: Advanced cancer is associated with multiple profound and practical challenges, including physical suffering and support needs. Depressive symptoms and other manifestations of distress are common in this population. At present, little professional support is available to help to alleviate the psychological distress of patients and families living with the burden of advanced cancer. Effective interventions and their integration into local health systems are needed to meet this challenge. Managing Cancer and Living Meaningfully (CALM), a brief psychotherapy intervention for patients with advanced cancer. Research conducted in Canada has demonstrated its feasibility, acceptability and effectiveness in reducing and preventing depressive symptoms, in managing distress related to death and dying, and in preparing for the end of life. Research is needed to demonstrate the feasibility and acceptability of CALM in Latin America, a developing region comprised of 35 different low- and middle-income countries in South and Central America, where more than one million people are presently in need of end-of-life care. Aim: Review evidence for psychosocial oncology interventions in Latin America and the potential applicability and implementation of CALM therapy in patients with advanced Cancer in this setting. Methods: We used an iterative search process to locate information about psychological interventions for patients with advanced cancer in South/Central/Latin America. Multiple searches were performed in Medline, Google Scholar, National Guidelines Clearinghouse, Trip Database, Redalyc, Scielo, and Latindex for terminology describing cancer, end-of-life, psychology, and psychological interventions. In the larger resources, we added either limits or search terms for Latin America. Results: The literature identified describes psychological interventions for patients with cancer, including psychoeducation, support therapies, group therapies, cognitive behavior therapy, spirituality and hypnosis. However, very few of these interventions were specifically designed for patients with advanced cancer. The majority of articles describe psychological/ psychotherapeutic interventions being implemented in Europe, North America, and Australian settings and we could identify only two papers describing psychological interventions being applied in an advanced cancer setting in Latin America. Conclusion: The availability and practice of psychological interventions in advanced cancer in Latin America are scarce. However, interest in applying such interventions appears to be growing. The application of the CALM intervention in multiple cultures and international settings suggests that it may be feasible and acceptable and effective in Latin America. Research is needed to demonstrate this and to support advocacy for its implementation in this region.
Highlights
Advanced disease that is progressive and associated with the threat of impending death, may trigger fears of dependency and suffering, and raise questions for patients about the meaning of life, and how to continue to live while facing death [1]
We identified a chapter in a Chilean text book that reviewed research in psycho-oncology in Peru [36]
We found 4 articles that were written by two authors from different continents: 2 United States-Latin American articles, 1 Australian-Latin American article, and 1 Spain-Latin American article [37,38,39,40]
Summary
Advanced disease that is progressive and associated with the threat of impending death, may trigger fears of dependency and suffering, and raise questions for patients about the meaning of life, and how to continue to live while facing death [1]. The term “double awareness” [2] has been used to describe the capacity of individuals to sustain and negotiate the dialectical tension of remaining engaged in the world, while preparing for impending death This capacity can be supported by psychotherapeutic interventions, which help patients accept the reality of death and remain committed to life [3]. Little professional support is available to help to alleviate the psychological distress of patients and families living with the burden of advanced cancer. Effective interventions and their integration into local health systems are needed to meet this challenge. Research is needed to demonstrate this and to support advocacy for its implementation in this region
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