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Evolution of psycho-oncology reflects ‘emotional, spiritual and social level’ of cancer care

Patients will unnecessarily suffer if their providers do not address psychological symptoms, Donovan said.

“Negative psychological symptoms complicate the patient experience and make it more challenging for patients to cope with diagnosis and treatment,” she said. “This has the potential to lead to poor treatment adherence, poor illness-related outcomes and poor overall quality of life. What is so unfortunate is that many of these symptoms are treatable.”

Pediatric, adolescent concerns

The treatment of pediatric, adolescent and young adult patients presents unique challenges for psychosocial oncologists.

Certain cancer subtypes — such as leukemia or lymphoma — are associated with high cure rates, but concerns remain about long-term treatment effects and psychological health.

Others, such as certain brain tumors or sarcomas, remain associated with high mortality rates, and oncologists may struggle when discussing poor prognoses with children and their families.

Providing psychosocial care to patients with childhood cancers can improve care in all areas, Lori Wiener, PhD, DCSW, LCSW-C, co-director of the behavior health core and head of the psychosocial support and research program in the pediatric oncology branch at NCI’s Center for Cancer Research, told HemOnc Today.

“Seminal studies have shown that children [with cancer] understand what is happening to them, and that they understand the seriousness of their illnesses,” Wiener said. “This changed the field, as before children’s fears often went unattended. For mental health providers such as myself, finding ways to reduce the emotional isolation these children experience was not only a challenge but a welcome opportunity.”

Communicating information to pediatric patients and monitoring for psychological distress can require different strategies than those employed for adults.

“We have to communicate information to pediatric patients in a way that is truthful and developmentally appropriate, and we need to be able to include them in medical decision-making in an age-appropriate way,” Wiener said. “Providing family centered care is essential. The diagnosis of cancer in a child is a life-changing event for everyone in the family and attention to ongoing parental and family needs is required for optimal psychosocial care to be provided.”

Clinicians also should consider the impact of treatment on adolescents and young adults, who can face unique mental health challenges.

A study by Schultz and colleagues, published in Journal of Clinical Oncology, showed that adolescent survivors of childhood cancers exhibited depressive or anxious behavior 1.5 times more frequently than their siblings. Survivors also were 1.7 times more likely to exhibit antisocial behaviors.

Brinkman and colleagues found that emotional, behavioral and social symptoms frequently occurred in adolescent survivors of childhood cancer, and that some of these symptoms related to treatment modalities like cranial radiotherapy and corticosteroids. Further, the presence of these symptoms often correlated with physical late effects of treatment, such as obesity, disease-related pain and sensory impairment.

“Adolescence is a critical period of emotional, behavioral and social development, and cancer need not be present for the development of problems such as depression, social withdrawal or inattention,” Donovan said. “Appropriate follow-up ought to include systematic screenings for problems that include input from survivors and parents, and the development and delivery of interventions designed to ameliorate these problems.”

The timely delivery of services contributes to the psychological outcome of adolescents, Wiener said.

“These are times when developmental and health trajectories can be derailed by significant challenges to physical, psychological and social well-being,” Wiener said. “We have to offer children, adolescents and young adults developmentally appropriate care and education about their disease in a timely fashion.”

A childhood cancer diagnosis affects more than just the child, as well.

“When you’re working with a child, you are looking at the impact on the entire family all along,” Wiener said. “We are working with the mother and father, the siblings, and often extended family members. They are all greatly impacted at the time of diagnosis, throughout treatment, and often well beyond the end of treatment.”