Comprehensive cancer care: cancer patients' and oncologists' perspectives on psycho-oncological support

Background. Cancer is a potentially life-threatening disease with increasing survival rates attended by adverse effects on physical and psychological well-being. In routine oncology practice, psychological complaints are often neglected, and many patients who might benefit from psychosocial support do not receive these services. To understand patients’ psychosocial health care needs and towards evidence-based change in clinical practice, patients’ needs are approached from the differing perspectives of the patient and the oncologist.
Methods. We conducted a prospective, observational single-centre study in the Oncology Outpatient Clinic at the University Hospital Basel (Switzerland). Using the Distress Thermometer (DT), patients were routinely screened for psychosocial distress before their first consultation. Oncologists (n=25) then discussed distress and support options with patients (n=333). After the consultation, the oncologist’s perception of the conversation and screening procedure was assessed by means of a questionnaire. The patient’s perception of the conversation, as well as their psychosocial distress, support needs, and uptake of psycho-oncological service, were captured in two semi-structured interviews and questionnaires over a period of four months and analyzed using a mixed-methods approach.
Results. The analysis revealed that more than half of all cancer patients experienced elevated levels of psychosocial distress (DT>=5). Two-thirds of all cancer patients were clear about their intention (yes or no) to use the psycho-oncology service while one third remained ambivalent (maybe). Patient intention was determined by perceived distress, attitude to psychological support, and coping strategies, as well as by other social and professional support. After four months, 23% of all patients had attended the psycho-oncology service (65% with yes intention, 12% with maybe intention, 7% with no intention). Patients who perceived a recommendation from their oncologist or who were not sure if they had perceived a recommendation were more likely to attend the psycho-oncology service than those who clearly did not perceive a recommendation from their oncologist, as were younger patients, highly educated patients, and patients with high distress scores. In almost all cases, oncologists used this distress screening to open the conversation about psychosocial issues in the first consultation. However, patients often failed to recall this conversation, and this failure was predicted by higher age, higher distress, and attaching less importance to talk with the oncologist about distress.
Conclusion. Severity of distress is associated with patient need for psycho-oncological support but is not the only deciding factor. Many patients are ambivalent about psychooncological support and rely on oncologists to recommend these services. Repeated distress screenings, detailed information about the psycho-oncology service during the cancer trajectory, and an explicit recommendation from the treating oncologist to attend psycho-oncological services may improve comprehensive cancer care and prevent adverse effects on long-term psychological well-being among vulnerable cancer patients.