Review of the history and development in the field of psychosocial oncology

Psychosocial oncology is a multi-disciplinary field of practice and, as a recently developed speciality, covers the psychological, social and behavioural dimensions of cancer. We describe the historical background and changing ethos in medical practice in order to understand factors that contributed to the emergence of this new discipline. Modern psychosocial oncology covers a number of topics; the diagnosis and management of psychological morbidity and distress across the cancer continuum from diagnosis through survivorship and, for some patients, terminal illness, the recognition that behaviour and lifestyle contribute to cancer risk and prognosis, the need to include families and carers alongside patients in a comprehensive model of supportive cancer care. Best practice, based on evidence and nationally and internationally accepted guidelines, is being integrated into national cancer plans, and services are briefly described. Future challenges include the need to recognize that the behavioural and mental health sciences have a role to play in comprehensive cancer care and that multi-disciplinary care, which includes psychosocial care, is the best model for ensuring patients needs are comprehensively and adequately met. The return of modern medicine to a more holistic person-focused ethos is needed in order to put the patient back into patient-centred cancer care

The validity of the distress thermometer in prostate cancer populations

Background The Distress Thermometer (DT) is widely recommended for screening for distress after cancer. However, the validity of the DT in men with prostate cancer and over differing time points from diagnosis has not been well examined. Method Receiver operating characteristics analyses were used to evaluate the diagnostic accuracy of the DT compared with three commonly used standardised scales in two prospective and one cross-sectional survey of men with prostate cancer (n = 740, 189 and 463, respectively). Comparison scales included the Impact of Event Scale - Revised (IES-R, Study 1), the Hospital Anxiety and Depression Scale (HADS, Study 2) and the Brief Symptom Inventory-18 (BSI-18, Study 3). Results Study 1: the DT showed good accuracy against the IES-R at all time points (area under curves (AUCs) ranging from 0.84 to 0.88) and sensitivity was high (>85%). Study 2: the DT performed well against both the anxiety and depression subscales for HADS at baseline (AUC = 0.84 and 0.82, respectively), but sensitivity decreased substantially after 12 months. Study 3: validity was high for the anxiety (AUC = 0.90, sensitivity = 90%) and depression (AUC = 0.85, sensitivity = 74%) subscales of the BSI-18 but was poorer for somatization (AUC = 0.67, sensitivity = 52%). A DT cut-off between ≥3 and ≥6 maximised sensitivity and specificity across analyses. Conclusions The DT is a valid tool to detect cancer-specific distress, anxiety and depression among prostate cancer patients, particularly close to diagnosis. A cut-off of ≥4 may be optimal soon after diagnosis, and for longer-term assessments, ≥3 was supported

Gender and Caregiving

There has also been extremely limited funding available for the essential research that will inform interventions and programs to understand how to best support women and men in their caregiver roles. Hopefully, the changing demographics relating to age and increased budgetary implications for the healthcare system and consumer demand will motivate increases in support for such basic and essential information. Since gender is one of the most basic biological and psychosocial characteristics of individuals, knowledge of caregivers’ gender can be the first step toward understanding the complexities of cancer caregiving. Once intergender variations are more fully and objectively understood, additional components of the caregiver should be studied, such as; intragender differences, culture, age, race/ethnicity, relationship characteristics, stage in life span, and other demographics. Another important factor to be considered is the alignment of expectations and demands of the caregiver and the care recipient. This “fit” is essential for both the caregiver and care recipient's quality of life and can be gained through honest and open communication, education, and a deep understanding of the innate differences between men and women and how these differences are magnified in times of stress. For example, female caregivers report more emotional distress overall; however, male caregivers suffer more physically. In female caregivers, her selfefficacy is highly related to how well she copes as a caregiver. For male caregivers, the emotional state of the care recipient is an important component in how he will cope as a caregiver. The areas of interdependence in the caregiver experience are more common than there are differences. However, to benefit from the unique contributions of women and men, there need to be honest, open, and respectful negotiations over higher levels of reciprocity and conscious choices made about what each individual is capable and willing to provide. The selfawareness afforded to modern women and men through the development of the cerebral frontal cortex, communication skills, education, understanding, social values of equality, and an inherent belief in the worth of all human life creates, an environment where men and women can make conscious decisions about what it means to reach their full potential, independently and interdependently. Never before have women and men been able to use history, science, and technology in a society that increasingly values the equality of the sexes to make conscious and deliberate decisions about how to benefit from our shared values while fully exploiting the synergies of our individual biological, psychological, social, and spiritual inclinations. The caregiver experience is a microcosm of how men and women continue to evolve together and how we are recreating each other through our increasing respect and commitment to enhancing the humanity of both