Optimizing Patient-Centered Psychosocial Care to Reduce Suicide Risk and Enhance Survivorship Outcomes Among Cancer Patients
Year: 2020
Type: editorial
Abstract: In recent decades, substantial advances in cancer treatment and early detection have resulted in enhanced survival among cancer patients. Such advances have elevated the importance of understanding and addressing patient-centered needs related to physical, psychological, and social well-being (1,2). In this issue of the Journal, Han et al. (3) analyzed data from the Multiple Causes of Death database to examine trends in cancer-related suicide from 1999 to 2018. They found that in contrast to rising rates of suicide in the United States, suicide rates have decreased among cancer patients over the last 20 years. Although this decline in suicide rate is encouraging, rates of suicide among cancer patients continue to be higher than the general population (4), highlighting cancer patients as an at-risk group for suicide. The study by Han et al. (3) is an important step in understanding overall suicide trends among cancer patients and sets the stage for further investigation into mechanisms underlying this observed decline. The authors hypothesize that increased access to psychosocial, palliative, and hospice care plays an important role in contributing to the decline in suicide among cancer patients. This is a sound hypothesis and highlights the need to understand more about factors that heighten risk for suicide among cancer patients as well as components of health services—such as psychosocial oncology, palliative, and hospice care—that are most critical in lowering suicide risk among cancer patients. An evidence-based approach to understanding what is working, and for whom, is needed to further accelerate the decline in suicide among cancer patients. For many patients, a cancer diagnosis and treatment represents a major disruption to their abilities to engage in daily activities, paid work, and their family, friend, and religious communities. Cancer patients can experience a lack of social support, social isolation, and loneliness (5). Many patients also experience cancer-related financial hardship related to high medical bills, work disruptions, depletion of assets, or increased debt (6). For example, recent attention to financial toxicity associated with cancer has highlighted the high rates of bankruptcy among cancer patients (7). Cancer patients experience depression at higher rates than the general population (8) and report high levels of sleep disturbance (8), posttraumatic stress (9), anxiety, fear, and worry (10). Importantly, these negative experiences can get carried into survivorship. As Han et al. (3) noted, pediatric cancer survivors are at increased risk of suicide decades after their treatment has ended (11). This highlights the importance of psychosocial services throughout the cancer trajectory. In addition to measures of quality of life and psychological well-being, patients’ psychological experiences are linked to important healthcare delivery outcomes. For example, depression is a robust predictor of treatment adherence and increased use of emergency and inpatient medical services (8). Understanding the contributions of different components of healthcare delivery (eg, improved pain and symptom management, enhancing perceived social connection and support, or reducing financial hardship) is critical for efforts to increase access among patients who most need such intervention. Psychosocial interventions for cancer patients can occur across a spectrum of identified risk, with universal approaches and more targeted interventions for patients at various risk levels. Across risk levels, patients benefit from approaches to cancer treatment that increase their experience of safety and control (these can include provision of information related to support programming, financial resources, and psychoeducational materials). Increased adoption of universal screening practices for distress and suicidal ideation has been a critical advance over recent decades and is important to effectively identify at-risk patients who require more targeted intervention approaches. As of 2015, all Commissions on Cancer-accredited cancer centers were required to implement universal distress-screening practices as standard of care and to develop appropriate referral procedures for those screening positive (12). In addition, the Joint Commission has identified suicide prevention among its patient safety goals, with recommended assessment and monitoring procedures for those identified as high risk for suicide (13). These initiatives may facilitate identification of patients who would otherwise not self-refer for services. A variety of empirically supported interventions for cancer patients has been identified in the literature (14); however, barriers (such as location, physical symptoms, and stigma) exist to service utilization, particularly among populations most at risk for suicide. Research on telemedicine and mobile health has shown promising findings in the efficacy of virtual care in reducing pain and depression (15), and such strategies may be effective in enhancing access and reducing barriers to service utilization. Additionally, collaborative care interventions that use a multidisciplinary approach to treatment of depression in cancer patients (16) as well as integrated models of psychological care have promise to enhance efficacy and reduce stigma of service use. Finally, strategies to enhance equity of access and mitigate disparities should be prioritized. Research has shown that patient- and hospital-level characteristics shape patterns of access to and use of psychological, palliative, and hospice care (17–20). Race, ethnicity, gender, and rural-urban geography have each been shown to play roles in differential needs, preferences, and access to psychological and palliative care in oncology (17-20). It is critical that programs are designed to promote health equity by actively incorporating program design elements to mitigate disparities in access and use. This work was supported by Roswell Park Comprehensive Cancer Center and National Cancer Institute (NCI) grant P30CA16056. Role of the funder: The funders had no role in the writing of this editorial or the decision to submit it for publication. Disclosures: The authors have no conflicts of interest to disclose. Author contributions: Conceptualization, E.G.B., M.P., K.D., and T.F.; Writing-Original Draft, E.G.B. and M.P.; Writing – Reviewing and Editing, E.G.B., M.P., K.D., and T.F. Not applicable.
DOI: 10.1093/jnci/djaa185
Language: English
Topic: Cancer survivorship and care
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3125002686