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 dataJane 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 aThe 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 TeamThe Lancet 28 August 2014

Integrated collaborative care for comorbid major depression in

patients with cancerRandomised trial of an integrated treatment programme for major depression in cancer patients - 500 pts randomisedDepression care 253Usual care 247

Integrated collaborative care for comorbid major depression in

patients with cancerResults

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

SurvivivorshipLiving 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. Assessment

2. Information

3. Supported self-management

4. ‘Open door’ access to clinical team

5. Automated booking of surveillance tests

6. Specialist clinics for treatment side effects

7. Promotion of health and well-being