Transcript Psychological impact of cancer

Parity of Esteem
Psychological impact of cancer
Dr Tony Branson – SCN Medical
Director, Cancer
Psychological impact of cancer
• Cancer can cause mental illness
• Cancer can exacerbate mental illness
• People with mental illness get cancer
• Mental illness causes cancer
Psychological impact of cancer
 At diagnosis – around 50% have depression/anxiety severe
enough to impact negatively on their daily lives.
 About 25% continue to experience distress during the
following 6 months
 > year post diagnosis, around 10-15% of patients

experience symptoms severe enough to warrant
intervention by Level 4 practitioners.
Up to x 2 more likely to commit suicide
 < 10% detected by hospital staff
 If undetected = untreated = could progress / entrenched
Prevalence, associations, and
adequacy of treatment of major
depression in patients with cancer: a
cross-sectional analysis of routinely
collected clinical data
Jane Walker PhD a † , Christian Holm Hansen PhD c †, Paul Martin MSc b, Stefan Symeonides PhD
d, Ravi Ramessur BMBCh a, Prof Gordon Murray PhD e, Prof Michael Sharpe MD a
The Lancet 28 August 2014
Prevalence, associations, and
adequacy of treatment of major
depression in patients with cancer
21151 pts –prevalence of major depression
• Lung cancer
13.1%
• Gynae cancer
10.9%
• Breast cancer
9.3%
• Colorectal cancer
7.0%
• GU cancer
5.6%
Prevalence, associations, and
adequacy of treatment of major
depression in patients with cancer
73% of patients with major depression were
not receiving potentially effective treatment
Integrated collaborative care for comorbid
major depression in patients with cancer
(SMaRT Oncology-2): a multicentre
randomised controlled effectiveness trial
Prof Michael Sharpe MD a † , Jane Walker PhD a †, Christian Holm Hansen PhD b, Paul Martin
MSc c, Stefan Symeonides PhD d, Prof Charlie Gourley PhD d, Lucy Wall MD d, Prof David Weller
PhD e, Prof Gordon Murray PhD e, for the SMaRT (Symptom Management Research Trials)
Oncology-2 Team
The Lancet 28 August 2014
Integrated collaborative care for
comorbid major depression in
patients with cancer
Randomised trial of an integrated treatment
programme for major depression in cancer patients
- 500 pts randomised
Depression care
253
Usual care
247
Integrated collaborative care for
comorbid major depression in
patients with cancer
Results
Response (≥50% reduction in symptom checklist
depression score at 24 weeks)
Usual care
17%
Depression care
62%
p=0.0001
Psychological impact of cancer
• Management of Cancer should include
assessment of psychological state
• Management of psychological conditions may
be an important part of Cancer treatment
• Patients with mental illness should have as
good treatment as anyone else but it may
need to be different.
Network approach
• Network developed strategy in 2005 to
achieve the outcomes
• Lead by Psychology Group
– With NSSG’s
– Cancer Nurses
– Third Sector
– Palliatives care Group
• Upskilling current workforce and recruitment
to specialised posts
NICE guidance
– There are four key levels of psychological support:
•
• Level 1: Effective information giving, compassionate
communication and general psychological support;
•
• Level 2: Psychological interventions, such as anxiety management,
problem solving;
•
• Level 3: Counselling, theoretically driven psychological
interventions, such as cognitive behavioural therapy and solution
focused therapy; and
•
• Level 4: Specialist psychological and psychiatric interventions.
Education and Training
• Sage and Thyme
– Communication skills training
• Holistic Needs Assessment
– At 4 key stages
• Advanced Communication Skills training
– For all MDT members
• Psychological Screening and basic Psychological
techniques
– Regionally agreed training for specific MDT members
• Intermediate Cognitive Therapy Skills
Survivivorship
Living with and beyond cancer
1.8 million increasing to 3 million
the projected increase in cancer survivors by
2030
47.3% of survivors express a fear of their
cancer recurring
Corner stones of an effective
cancer survivorship programme
1.
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3.
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Assessment
Information
Supported self-management
‘Open door’ access to clinical team
Automated booking of surveillance tests
Specialist clinics for treatment side effects
Promotion of health and well-being