the international psycho-oncology society (ipos) jimmie c. holland, m.d. wayne e. chapman chair in...

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