Cancer Survivors Send Distress Call

It Starts With a Conversation

Editor's Note: In 2007, the Institute of Medicine (IOM) published a report, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs,^[1] in which it outlined the numerous sources of psychosocial distress associated with cancer and its treatment. These sources of patient distress, which include lack of information or skills necessary to manage their cancer; emotional problems, such as anxiety or depression; a lack of transportation or other resources; and disruptions to work, school, and family life are believed to contribute to poor adherence to prescribed treatments and a slower return to health.

It is considered a standard of good-quality cancer care to address the psychosocial health needs of cancer patients and cancer survivors, and to provide appropriate psychosocial health services. However, healthcare providers do not consistently recognize, adequately treat, or refer patients to services that could meet their psychosocial needs. Laura P. Forsythe, PhD, MPH, and colleagues recently published a study^[2] that examined this issue from the point of view of cancer survivors. Medscape Oncology recently spoke with Dr. Forsythe about the findings of this study and its implications for the care of cancer survivors.

Medscape: Can you summarize the goals of your study?

Dr. Forsythe: The first steps in meeting the psychosocial needs of cancer survivors are to have effective communication between healthcare providers and cancer survivors, to assess each survivor's unique psychosocial needs, and to determine how best to address those needs. However, we don't know whether psychosocial care is, in fact, being provided according to the IOM recommendations.

This study used population-based data from the 2012 National Health Interview Survey to characterize survivors who reported having a discussion with healthcare providers about the psychosocial effects of cancer and who reported using professional counseling and support groups (PCSGs), and to assess barriers to PCSG participation. We also tested associations between receipt of psychosocial care and satisfaction with care.

Medscape: What did you find?

Dr. Forsythe: More than one half of survivors (55.1%) neither reported having discussions with healthcare providers about psychosocial needs, nor used PCSGs; 34.1% reported provider discussions only, 4.4% reported use of PCSGs only, and 8.9% reported both. This leaves an estimated 7.6 million cancer survivors in the United States who did not discuss with a healthcare provider how cancer might affect their psychosocial functioning.

Certain patient subgroups (non-Hispanic black persons, married survivors, breast cancer survivors, those treated with chemotherapy, and those who had been involved in clinical trials) were more likely to report having had discussions with healthcare providers about psychosocial needs. Other subgroups (Hispanic persons, survivors aged 40-49 years, breast cancer survivors, those diagnosed within the past year, those treated with radiation, and survivors who had participated in clinical trials) were more likely to report PCSG use. Survivors who reported any psychosocial care were more likely to be "very satisfied" with how their needs were met.

Few survivors reported having had a conversation with their healthcare providers about their psychosocial needs.

Medscape: What findings surprised you most?

Dr. Forsythe: I was surprised by how few survivors reported having had a conversation with their healthcare providers about their psychosocial needs. In particular, even among survivors who were diagnosed in the past 5 years or within the past year, fewer than one half reported having these conversations with healthcare providers.

This was unexpected, because attention to the psychosocial concerns of cancer survivors has grown dramatically. The IOM report on cancer survivorship has been very influential in bringing attention to the issue, and at the same time, literature on this topic has been growing. Clinical interest is increasing as we get more and more evidence that psychosocial issues are both common and associated with important health effects down the road for survivors.

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