Psychosocial Care for Cancer Patients

Abstract

Psychosocial distress is understood as a continuum ranging from normal distress levels such as fear, grief etc. up to high levels of distress and psychiatric comorbidity [5]. A recently published study on 4 weeks prevalence of psychiatric disorders in cancer patients in Germany showed an average prevalence rate of 36% of any psychiatric diagnosis across all diagnoses and treatment settings [6]. The 4-week total prevalence for any mental disorder was 31.8% (95% confidence interval (CI) 29.8–33.8%) with highest rates for anxiety disorder (11.5%; 95% CI 10.2–12.9%), adjustment disorder (11.1%; 95% CI 9.7–12.4%), or mood disorder (6.5%; 95% CI 5.5– 7.5%). The highest prevalence for mental disorders was found in patients with breast cancer (41.6%; 95% CI 36.8–46.4%). Against this background and based on our knowledge about distress and psychiatric comorbidity in cancer patients, psychosocial care of cancer patients follows a structured stepped-care model starting with an early assessment and identification of a patient’s psychosocial distress, psychiatric comorbidity, and individual needs [2, 7]. Standardized and internationally validated instruments are available to assess psychosocial distress [8]. However, recently published results showed that early detection of distress and referral to psychosocial care does not automatically show a positive effect on a patient’s quality of life and therefore should be embedded in a stepped-care program [9]. The stepped-care model comprises systematic identification of needs, integrated delivery of psychosocial care by care managers ranging from counseling to individual psychotherapy, and appropriate specialist supervision. The German Guideline for Psychooncology published in January 2014 is an evidence-based guideline for psychosocial assessment, counselling, and treatment of adult cancer patients. It follows the basic principles of care mentioned above [2]. Based on a systematic review for psycho-oncological interventions, relaxation techniques, psychoeducation, individual psychotherapy, group psychotherapy, as well as psychotherapeutic interventions with couples have been proven to be effective with a high level of evidence (LOE 1a) in terms of reducing anxiety and depression and improving quality of life [10]. Rationale of Psychosocial Care for Cancer Patients