Developing a preventive psycho-oncology for a global context. The International Psycho-Oncology Society 2018 Sutherland Award Lecture

Abstract

Objective: Growing rates of cancer and survivorship, in situations of severe resource constraints, force a rethink about managing cancer‐related psychosocial distress (CRPD). Here, a prevention‐oriented natural history of distress is proposed, derived from developments in our understanding of the evolution and decay of CRPD.

Methods: The literature indicates that at least four classes or natural histories of CRPD are identifiable. These are described in the context of prevention‐oriented activities in psycho‐oncology: (1) CRPD in persons with good coping resources, resulting from reaction to the diagnosis and treatment lifestyle disruption, which is largely self‐limiting and preferably self‐managed; (2) CRPD arising from residual, or late effects of disease or treatment, potentially persistent and debilitating; (3) CRPD in persons with preexisting coping difficulties; and (4) CRPD arising from existential issues such as mortality and fear of recurrence.

Results: It is hypothesized that different natural histories of CRPD display different evolution, indicating potential causal processes, treatment priorities, and preventive strategies. In particular, the effective management of residual symptoms is crucial to prevent CRPD chronicity. Optimal patient involvement in treatment decision‐making is also required.

Conclusions: There is a need to develop methods to differentiate if, early in the illness trajectory, the distressed patient is not able to self‐manage the stress of cancer diagnosis and treatment. Not all distressed patients want or need help, and addressing just the CRPD may be inadequate where unresolved residual symptoms prevent renormalization after treatment. Improved doctor‐patient communication around treatment decisions is warranted.