Despite the well-known physical and emotional impact cancer has on patients’ lives, the psychological and social aspects of cancer care have lagged far behind that of biological treatment. The long-held stigma related to cancer, combined with the stigma associated with mental illness, likely accounts for this discrepancy. However, the pendulum has been tipping in the positive direction since 1997, when NCCN established the first panel to examine the problem, and developed standards of care and the first clinical practice guidelines.1 The appointed NCCN Distress Management Panel addressed the stigma directly, suggesting that the words psychiatric and psychological were stigmatized, and that clinicians should find a more “normal” word when inquiring about psychological issues in routine care.
The word distress emerged as a word broad enough to encompass the emotions related to the psychological, physical, social, and spiritual aspects of coping with cancer. The panel suggested that all new patients be screened for distress, similar to screening for pain. A similar scale ranging from 0 to 10 was proposed, called the Distress Thermometer, with an accompanying Problem List to target the reason for the distress. This form provided an easy way to question patients in the waiting room, with follow-up by doctors or nurses of those who scored above a certain level of distress. Similar brief screening tools are also used.2
In the 1990s, many patients with cancer were complaining about poor psychosocial support in the context of their cancer care. The Institute of Medicine (IOM) studied the problem and, in 2008, declared that a new quality standard for cancer care should be established: one that included the psychosocial domain. This was based on peer-reviewed studies supporting the efficacy of psychosocial interventions.3
This new standard has been endorsed by the International Psycho-Oncology Society, the International Union Against Cancer, and 57 global cancer organizations. The global endorsement supports the integration of the psychosocial into routine cancer care and recognition of distress as the sixth vital sign after pain.4
The ASCO Quality Oncology Improvement Initiative provided helpful support for the IOM standard by incorporating several questions into their self-audits of oncology practices that rate the quality of psychosocial care provided.5
Further support came in 2012, when the American College of Surgeons Commission on Cancer (ACoS) endorsed the IOM report. ACoS outlined a stepwise procedure for ensuring that the 1500 centers they oversee establish programs to fully integrate the psychosocial domain by 2015.6 In the interim, clinics and centers are to form a multidisciplinary committee to develop procedures that begin the implementation of the new standard.
Holland JC, Andersen B, Breitbart WS et al.. NCCN Clinical Practice Guidelines in Oncology: Distress Management. Version 3, 2012. Available at: NCCN.org. Accessed August 1, 2012.
Carlson LE, Waller A, Mitchell AJ. Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol 2012;30:1160–1177.
Adler N, Page A, eds. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: Institute of Medicine, The National Academies: 2007.
Holland J, Watson M, Dunn J. The IPOS New International Standard of Quality Cancer Care: integrating the psychosocial domain into routine care. Psychooncology 2011;20:677–681.
Jacobsen PB, Kadlubek P, Neuss MN. Preliminary evaluation of quality of psychosocial care indicators: results from the Quality Oncology Practice Initiative (QOPI) [abstract]. J Clin Oncol 2009;27(Suppl):Abstract 6534.
American College of Surgeons. Cancer Program Standards (CPS) 2011 Project. Available at: http://www.facs.org/cancer/coc/cps2011.html. Accessed July 10, 2012.
Kornblith AB, Dornell JM, Herndon JE et al.. Telephone monitoring of distress in patients aged 65 or older with advanced cancer: a CALGB study. Cancer 2006;107:2706–2714.