Wagner, a member of the working group that reviewed the
accreditation standards for cancer centers. “We can expect to
see an increase in referrals for mental health services, and the
standard will be a very powerful tool for leveraging resources
for psychosocial providers.”
Psychology and physiology
The urgency to mandate distress screenings in cancer centers
ratcheted up when an increasing number of studies began
revealing that mood disorders had the potential to affect disease
One study, for example, showed that breast cancer patients
who participated in weekly group interventions with a
psychologist for one year reduced their risk of breast cancer
recurrence by 45 percent (Cancer, 2008). In the groups, patients
learned such skills as relaxation techniques, positive ways to
cope with stress and strategies to maximize social support.
In a follow-up study of the same patients whose cancer later
recurred, researchers found that those who participated in the
group therapy intervention had a 59 percent reduced risk of
cancer death (Clinical Cancer Research, 2010).
“The psychosocial intervention had positive, long-lasting
effects, reducing negative mood symptoms while at the same
time improving the patient’s immunity response,” says lead
researcher Barbara Andersen, PhD, of the Ohio State University.
“It is important to realize that as the emotions change, the
biology is likely changing as well. Conversely, biologic changes
may impact emotions.”
A similar study explored whether depression could influence
cancer survival in women with metastatic breast cancer. Lead
researcher Janine Giese-Davis, PhD, of the University of Calgary
in Canada, found that women who became less depressed over
time lived an average of 53 months, compared with 37 months
for women who became more depressed over time (Journal of
Clinical Oncology, 2011).
“It is normal to get depressed when [you are] diagnosed with
cancer, but it is important not to stay there because chronic
depression has the strength to impact your physiological
symptoms,” Giese-Davis says. “Our goal is to encourage people
to get help if they are depressed.”
The new distress screening mandate will help with this
goal. It requires facilities to offer distress screening, referral or
provision of care and follow-up for psychosocial distress, but
providers can select their own screening tools, the timing of the
screening and the criteria for referral for psychosocial services.
Such general guidelines aim to give cancer care providers the
flexibility to create programs that fit their institutions best.
At Siteman Cancer Center, for example, when patients score
New opportunities for psychologists
above a five on the Distress Thermometer, nurses or medical
assistants alert the medical team to discuss psychosocial support
options with the patient. After rating their distress level, patients
also indicate any areas that have been a problem in the last
week, such as dealing with children, physical pain or sadness.
At Walter Reed Army Medical Center in Bethesda, Maryland,
clinicians screen all new cancer patients for their level of distress
using the same “thermometer” and notify psychologist Leslie
Cooper, PhD, when patients score four or higher. Cooper, who
works in Psycho-Oncology Service at Walter Reed, then follows
up with the patients to discuss the details of their answers.
The screening recently identified a patient with brain cancer
who was struggling with feelings of panic that reminded him
of his war experience. Cooper helped him understand that his
diagnosis did not necessarily mean he had a short time to live
because treatments were available.
“The screening instrument has been very helpful because
it allows us to help patients talk about their diagnosis and
treatment,” says Cooper. “It provides a vocabulary for thoughts,
feelings and concerns that the patients and medical team can
use to communicate as they discuss the treatment protocol and
what to expect in terms of quality of life.”
While some hospitals have psychologists on staff to treat
oncology patients, many cancer centers have social workers to
meet patients’ psychosocial needs, says Teresa Deshields, PhD,
a psychologist at Siteman Cancer Center. She hopes the new
standard will increase the demand for mental health services
and spur cancer treatment centers to hire more psychologists
to treat patients who are struggling with the emotional aspects
of the disease.
“There’s an important place for psychologists because social
workers are often swamped dealing with practical things and
have little time for counseling or therapy,” she says. “There are a
lot of psychological issues that need more than a practical fix.”
For hospitals that do not have the resources to hire more
psychologists, patients may be referred to mental health
practitioners or community organizations that can offer help
outside the hospital walls.
“This is an opportunity for mental health practitioners to
be proactive and start contacting accredited hospitals about
the valuable services they can provide,” says Vicki Kennedy, an
oncology social worker at the Cancer Support Community, an
international nonprofit organization based in Washington, D.C.
She is one of many health-care providers who say they are
excited about the screening tool’s ability to advance cancer
patient care. “People are not always going to admit that they are
struggling, and the screening is an opportunity to improve the
cancer experience.” n
Heather Stringer is a journalist in San Jose, California.