Last month, I attended the very first conference of the Psycho-Oncology Co-Operative Research Group (PoCoG) to learn about cutting-edge research taking place in psycho-oncology.
The PoCoG was established in 2005 in response to the recognized need to improve outcomes for cancer patients by developing and facilitating high-quality, collaborative, and clinically relevant research.
The conference opened with a presentation by Professor Phyllis Butow of the University of Sydney, on the history of psycho-oncology research in Australia. She explained that research has shifted from largely descriptive studies identifying adverse psychosocial outcomes and unmet needs in cancer patients to complex and challenging randomized controlled trials of sustainable supportive care and communication interventions.
Professor Thomas Hack of the University of Manitoba in Canada talked about addressing the information needs of newly diagnosed cancer patients. Evidence shows favorable outcomes in consultation recordings, including reduced anxiety, enhanced learning and recall, more informed decision making, and enhanced communication with health professionals.
Despite these established advantages, the uptake of this intervention in oncology practice has not been widespread. Barriers to consultation recording may include the low perceived value, high cost, and legal/privacy concerns. But evidence derived from consultation recording has been shown to protect the oncologist in legal disputes.
Professor David Kissane of Monash University in Melbourne performed a meta-analysis of the impact of depression on cancer mortality. The research showed that adherence to medical treatment reduced the risk of poor outcomes by 26 percent. Social support is relevant to adherence to treatment, and the facilitation of support groups was proven to be effective in reducing depression in cancer patients.
Professor Suzanne Chambers of Griffith University in Australia raised the issue of risk stratification. The burning question we need to ask ourselves: Which cancer patients need intervention, and which do not? Chambers highlighted the fact that psycho-oncology is not seen as a core business, and that there is tension between scientific models of research and experimental knowledge.
As for my personal reflection following this conference, I would raise the question of how we can promote equitable access to care. Integrative care needs simple services, and we need to think differently about how we can improve access.
Traditionally, followup has been undertaken by oncologists and general medicine professionals. To improve outcomes in cancer care, we need to use our scarce healthcare resources more efficiently. This includes pathways of care, treatment summaries and care plans, information and education to promote self-management, rapid access to specialist care, remote monitoring, and effective care coordination.