Cancer care today often provides state-of-the-science biomedical treatment, but fails to address the psychological and social (psychosocial) problems associated with the illness. This failure can compromise the effectiveness of health care and thereby adversely affect the health of cancer patients. Psychological and social problems created or exacerbated by cancer—including depression and other emotional problems; lack of information or skills needed to manage the illness; lack of transportation or other resources; and disruptions in work, school, and family life—cause additional suffering, weaken adherence to prescribed treatments, and threaten patients' return to health.

A range of services is available to help patients and their families manage the psychosocial aspects of cancer. Indeed, these services collectively have been described as constituting a "wealth of cancer-related community support services."

Today, it is not possible to deliver good-quality cancer care without using existing approaches, tools, and resources to address patients' psychosocial health needs. All patients with cancer and their families should expect and receive cancer care that ensures the provision of appropriate psychosocial health services. This report recommends ten actions that oncology providers, health policy makers, educators, health insurers, health plans, quality oversight organizations, researchers and research sponsors, and consumer advocates should undertake to ensure that this standard is met.

Contents

• The National Academies
• Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting
• Reviewers
• Foreword
• Preface
• Acknowledgments
• Summary
  • ABSTRACT
  • PSYCHOSOCIAL PROBLEMS AND HEALTH
  • STUDY CONTEXT
  • STUDY SCOPE
  • FINDINGS GIVE REASON FOR HOPE
  • CONCLUSIONS
  • RECOMMENDATIONS FOR ACTION
  • REFERENCES
• 1. The Psychosocial Needs of Cancer Patients
  • CHAPTER SUMMARY
  • THE REACH OF CANCER
  • CANCER-INDUCED PHYSICAL STRESSORS
  • PSYCHOSOCIAL PROBLEMS
  • OBSTACLES TO MANAGING PSYCHOSOCIAL STRESSORS
  • PURPOSE, SCOPE, AND ORGANIZATION OF THIS REPORT
  • REFERENCES
• 2. Consequences of Unmet Psychosocial Needs
  • CHAPTER SUMMARY
  • PSYCHOSOCIAL STRESSORS AND THEIR EFFECTS ON PATIENTS
  • ALTERATIONS IN BODY FUNCTIONING DUE TO STRESS
  • ADVERSE EFFECTS ON FAMILIES AND THE LARGER COMMUNITY
  • CONCLUSIONS
  • REFERENCES
• 3. Psychosocial Health Services
  • CHAPTER SUMMARY
  • A DIVERSITY OF SERVICES
  • EVIDENCE OF EFFECTIVENESS
  • READY AVAILABILITY OF KEY SERVICES
  • REFERENCES
• 4. A Model for Delivering Psychosocial Health Services
  • CHAPTER SUMMARY
  • EFFECTIVE DELIVERY OF PSYCHOSOCIAL HEALTH CARE
  • A UNIFYING MODEL FOR CARE DELIVERY
  • A RECOMMENDED STANDARD FOR CARE
  • ANNEX 4-1 EMPIRICALLY VALIDATED MODELS OF AND CLINICAL PRACTICE GUIDELINES FOR THE EFFECTIVE DELIVERY OF PSYCHOSOCIAL HEALTH SERVICES
  • REFERENCES
• 5. Implementing the Standard of Care
  • CHAPTER SUMMARY
  • APPROACHES TO THE DELIVERY OF PSYCHOSOCIAL HEALTH SERVICES
  • RECOMMENDATIONS
  • REFERENCES
• 6. Public- and Private-Sector Policy Support
  • CHAPTER SUMMARY
  • SUPPORTS FOR AND CONSTRAINTS ON INTERVENTIONS TO DELIVER PSYCHOSOCIAL SERVICES
  • SUPPORTS FOR AND CONSTRAINTS ON SERVICE AVAILABILITY
  • USE OF PERFORMANCE MEASUREMENT TO IMPROVE THE QUALITY OF PSYCHOSOCIAL HEALTH CARE
  • CONCLUSIONS AND RECOMMENDATIONS
  • REFERENCES
• 7. Preparing the Workforce
  • CHAPTER SUMMARY
  • A LARGE AND DIVERSE WORKFORCE
  • WORKFORCE EDUCATION IN BIOPSYCHOSOCIAL APPROACHES TO CARE
  • EDUCATIONAL BARRIERS TO PSYCHOSOCIAL HEALTH CARE
  • CONCLUSIONS AND RECOMMENDATION
  • REFERENCES
• 8. A Research Agenda
  • CHAPTER SUMMARY
  • A TAXONOMY AND NOMENCLATURE FOR PSYCHOSOCIAL HEALTH SERVICES
  • EFFECTIVENESS AND HEALTH SERVICES RESEARCH
  • REPORT EVALUATION
  • REFERENCES
• Appendixes
  • A Committee Member Biographies
  • B Study Methods
  • C Recommendations from Prior Selected Reports

This study was supported by Contract No. N01-OD-4-2139 between the National Academy of Sciences and the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Suggested citation:

Institute of Medicine (IOM). 2008. Cancer care for the whole patient: Meeting psychosocial health needs. Nancy E. Adler and Ann E. K. Page, eds. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.