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The International Psycho-Oncology Society
(IPOS)
Jimmie C. Holland, M.D.
Wayne E. Chapman Chair in Psychiatric Oncology
Memorial Sloan-Kettering Cancer Center
New York, New York
• To improve the “human” side of cancer care on a global
basis
IPOS: Founded 1984
IPOS: 1984
• Foster international communication• Educate professionals in psychosocial care across countries• Advocate for making psychosocial an integral part of total cancer care• Examine social, cultural factors that impact quality of life and care
An International Survey of Physician Attitudes and Practice in Regard to Revealing the Diagnosis of Cancer
Jimmie C. Holland, M.D.,
Natalie Geary, B.A.,
Anthony Marchini, B.A., and
Susan Tross, Ph.D.
Psychiatry Service
Memorial Sloan-Kettering Cancer Center
New York, New York, 10021
Cancer Investigation, 5(2), 151-154 (1987)
Oncologists Estimated Percentage of Physicians in Their Country Who Disclose Cancer Diagnosis
N = 90 oncologists; 20 countries
Tell to the Patient:
LOW% HIGH%
Africa AustriaFrance DenmarkHungary FinlandIran NetherlandsPanama New Zealand
Portugal Norway
Spain Switzerland
Sweden
Tell to the Family:
High % estimated by majority of physicians
IPOS: 2005
Education• Conducted 7 World Congresses
2006, Venice• > 25 national psycho-oncology societies• International journal, 1992
Psycho-Oncology• Text books in English, Spanish, Italian,
and Japanese
IPOS: 2005
Education 2004 Website: www.ipos-society.org
• Core curriculum online – FREE
• 4 lectures, with European School of Oncology in
Italian GermanFrench HungarianSpanish English
IPOS: 2005
• Requested to become an NGO of World Health Organization
• Rationale: to add a psychological, social and behavorial
dimension to WHO national cancer control programs
WHO Priority Action Plan forNational Cancer Control Programs
Resources
A B C
Low Medium High
Prevention
Early diagnosis
Screening/therapy
Pain/palliative care PSYCHOSOCIAL
WHO Cancer Prevention Program
• Depends on changes in life style and exposures: must alter BEHAVIOR
• Psychological and social factors are critical considerations in prevention education which must be culture and language-sensitive
• Behavioral scientists needed (Tobacco Cessation)
WHO Cancer Control ProgramEarly Diagnosis
• Fatalistic attitudes, fear of stigma of cancer, and ignorance are problems, especially in developing countries
• Public education requires attention to psychological, social, cultural, and behavioral factors
WHO Cancer ControlScreening
• Participation in screening require attention to local social attitudes, beliefs, trust in procedures/staff, and awareness of cultural factors
• Requires knowledge of community, beliefs, and fears
WHO Priorities for National Cancer Control Programs
• Pain/Palliative Care
• Pain is often the primary focus• Psychological issues are often not identified and treated as an equally important aspect of end-of-life care
• Need for more participation of psycho-oncologists in end-of-life for clinical and research collaboration
In Palliative Care
• Encourage recognition, diagnosis and treatment of psychosocial and psychiatric problems
• Develop standards and clinical practice guidelines for psychological care
IPOS Goals in Palliative Care
National Programs
Standards and Guidelines
Australia United Kingdom
Canada United
States
US Example: 1999
A Multidisciplinary Panel (NCCN) • Chose “DISTRESS” as an encompassing
word to cover psychosocial/ psychiatric and spiritual
• A rapid one-item screening question• Standards care and Clinical Practice
Guidelines for mental health,
social work, clergy
DISTRESS CONTINUUM
NormalDistress
FearsWorriesSadness
SevereDistress
Depression,AnxietyFamily
Spiritual
STANDARDS OF CARE FOR MANAGEMENT OF DISTRESS - 1
• Distress should be recognized, monitored, documented and treated promptly at all stages of disease
• All patients should be screened for distress at their initial visit and as clinically indicated
• Screening should identify the level and nature of the distress
• Distress should be assessed and managed by evidence or consensus-based clinical practice guidelines
Adapted, NCCN
BRIEF SCREENING TOOL AND PROBLEM LIST
Practical problems
__ Housing
__ Insurance
__ Work/school
__ Transportation
__ Child care
Family problems
__ Partner
__ Children
Emotional problems
__ Worry
__ Sadness
__ Depression
__ Nervousness
Spiritual/religious concerns
__ Relating to God
__ Loss of faith
__ Other problems
10
9
8
7
6
5
4
3
2
1
0
During the past week,
how distressed have you been?
ExtremeDistress
NoDistress
Please indicate your level of distress on the thermometer
and check the causes of your distress.
Physical problems
__ Pain
__ Nausea
__ Fatigue
__ Sleep
__ Getting around
__ Bathing/dressing
__ Breathing
__ Mouth sores
__ Eating
__ Indigestion
__ Constipation/diarrhea
__ Bowel changes
__ Changes in urination
__ Fevers
__ Skin dry/itchy
__ Nose dry/congested
__ Tingling in hands/feet
__ Feeling swollen
__ Sexual problems
DISTRESS LADDER:MANAGEMENT BY STANDARDS & PRACTICE GUIDELINES
DISTRESSScale (0–10)
Adapted from WHO Analgesic Ladder
≥ 5
< 5
Canada
June, 2004 The National Cancer Council
• Distress added as the 6th vital sign
(temperature, pulse, respiration,
blood pressure, pain, distress) • To be asked about routinely at patient
visits
Major Barriers in Every Country
• Poor to absent funding
• Absence of oversight and accountability (changing in Australia, Canada, UK)
• Awareness of the importance to patients and families (especially in palliative care)
Mehnert and Koch, 2003
Action Item - 1
• IPOS, with WHO, seeks to bring the psychosocial domain into global cancer control programs
• IPOS advocates for national standards and clinical practice guidelines
Action Item - 2
• IPOS provides oversight of global efforts
• Collate international data for cross-cultural studies
• Promotes multidisciplinary multi-national research
Action Item - 3
Establish WHO-supported international standards and guidelines
• For use by national societies to impact
policies on service delivery• To provide professional training standards • To influence national funding priorities• To impact governmental agencies via
WHO, UICC, IARC •To foster research for evidence-based care
“What we value can be seen in what we measure.”
Dr. Robert McMurtry
“Public Policy, Human Consequences: The Gap Between Biomedicine and Psychosocial Reality” Canada Oncology Exchange, 2003
PAIN DISTRESS
8th WORLD CONGRESS8th WORLD CONGRESSPSYCHO-ONCOLOGYPSYCHO-ONCOLOGY
"Multidisciplinary Psychosocial Oncology: Dialogue and Interaction"
18 - 21 October 2006Palazzo del Cinema
Venice, Italy
Details will continue to be posted on the conference website at
www.ipos2006.it