Transcript 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.

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
IPOS: Founded 1984
• To improve the “human” side of
cancer care on a global basis
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
France
Hungary
Iran
Panama
Portugal
Spain
Austria
Denmark
Finland
Netherlands
New Zealand
Norway
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
French
Spanish
German
Hungarian
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 for
National Cancer Control Programs
Resources
A
Low
Prevention
Early diagnosis
Screening/therapy
Pain/palliative care
B
Medium
C
High
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 Program
Early 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 Control
Screening
• 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
In 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 psychooncologists in end-of-life for clinical
and research collaboration
IPOS Goals in Palliative Care
• Encourage recognition, diagnosis
and treatment of psychosocial
and psychiatric problems
• Develop standards and clinical
practice guidelines for
psychological 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
Normal
Distress
Severe
Distress
Fears
Worries
Sadness
Depression,
Anxiety
Family
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
During the past week,
how distressed have you been?
Extreme
Distress
10
9
8
7
6
Please indicate your level of distress on the thermometer
and check the causes of your distress.
Practical problems
__ Housing
__ Insurance
__ Work/school
__ Transportation
__ Child care
Family problems
__ Partner
__ Children
5
4
3
2
1
No
Distress
0
Emotional problems
__ Worry
__ Sadness
__ Depression
__ Nervousness
Spiritual/religious concerns
__ Relating to God
__ Loss of faith
__ Other problems
BRIEF SCREENING TOOL AND PROBLEM LIST
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
≥5
DISTRESS
Scale (0–10)
<5
Adapted from WHO
Analgesic Ladder
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 crosscultural 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 CONGRESS
PSYCHO-ONCOLOGY
"Multidisciplinary Psychosocial Oncology:
Dialogue and Interaction"
18 - 21 October 2006
Palazzo del Cinema
Venice, Italy
Details will continue to be posted on the conference website at
www.ipos2006.it