The Future in Psychosocial Oncology: Screening for Emotional Distress - the Sixth Vital Sign

Bejoy C. Thomas; Barry D. Bultz


Future Oncol. 2008;4(6):779-784. 

In This Article

Abstract and Cancer Care in 2020: Three Key Players


This article explores the possible future of psychosocial oncology. Advancements in treatment and the concomitant increase in survivorship, combined with a highly educated patient population, will result in huge demands on an already strained healthcare system. Role changes and paradigm shifts will be required in order to cope with these challenges. Issues with current treatment silos and fragmented care systems are presented, and the role of a biopsychosocial approach is discussed.

Cancer Care in 2020: Three Key Players

Future Patient. It has been speculated that in the future, an increase in consumerism in medicine may lead to patients being more assertive in treatment decisions and better informed of novel therapies. The influence of the internet is already quite evident in this respect. Blogs, RSS feeds and podcasts on medicine are becoming increasingly commonplace.[1,101,102] Information services like Google™ Scholar[103] and Elsevier's Scirus,[104] are proving to be reliable gateways for patients to obtain medical information.[2] Indeed, research on practices such as 'Googling' for a diagnosis or treatment option have even been documented in peer-reviewed literature.[2,3] There has also been a paradigm shift in scientific societies and associations moving their journals to open-access models (see BioMed Central),[105] the net effect being a bypass of traditional referral pathways through global information networks.[4] In an age where many resources are accessed on-demand, the informed patient, having a very short attention span, will be on the search for treatment on demand.[106]

Treatment of the Disease. Newer therapies promise to be more selective and focused, have fewer side effects and may be administered on prolonged timelines, perhaps even for the remainder of the patient's life.[4] Advancements in chemotherapy may become an integral part of the multidisciplinary treatment approach, or perhaps even the backbone of curative treatment,[5] and pharmacogenetics will enable oncologists to tailor chemotherapy treatment to the individual patient. Cancer will become a highly prevalent but manageable chronic disease akin to other chronic illnesses.[4,6]

Healthcare System. Spiraling healthcare costs and ever increasing out-of-pocket expenses for patients,[7] combined with a very real shortage of physicians,[8,9,10,11] paints an unpleasant future for oncology. In the next 15 years, cancer prevalence is expected to double in developed countries[12] owing to improved rates of survival,[4] and with an aging population, cancer incidence is also set to increase.[13] Even in the best-case scenario, the projected patient demand for oncologists is expected to be at least 40% greater than the supply.[14]

Synthesis. Advancements in treatment and the concomitant increase in survivorship, combined with a highly educated patient population, will result in increased demands on an already strained healthcare system. A feasible solution is to incorporate a process that not only identifies the pitfalls and caveats in the system, but also provides the physician with additional means to intervene.


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