tered in 2005. Among the 1,000 U.S. psychiatrists who work primarily with the medically ill, approximately 100 identify oncology as a significant focus of their clinical work, and work with cancer patients either on a full-time basis or as a part of their clinical care or research. Control of symptoms that reduce quality of life, such as severe anxiety, depression, and delirium, often requires management with psychopharmacologic interventions and awareness of drug–drug interactions in the context of complex oncologic treatment.

Psychiatric residents must rotate for a period of time, after internship, through the inpatient and outpatient units, where they learn the common psychiatric disorders of chronically medically ill patients and their psychological and psychopharmacological management. Post-residency clinical fellowships of 1 or 2 years can be taken in psychiatric and psychosocial oncology at a few major academic cancer centers. There are several formal psycho-oncology training programs that offer fellowships to physicians (e.g., Memorial Sloan-Kettering Cancer Center, Mount Sinai Ruttenberg Cancer Center, Dana-Farber Cancer Institute, University of Pennsylvania).

Rehabilitation and Employment-Based Counseling

Master’s-level counselors trained in specialized areas of counseling who work outside of oncology settings may be of assistance to cancer survivors. Rehabilitation counselors may help cancer survivors deal with the personal, social, and vocational effects of cancer-related disabilities. They may assist cancer survivors as they go back to work or reassess career options. Counseling may be available at worksites through corporate Employment Assistance Programs (EAPs). EAPs often employ social workers and other professional counselors who can provide short-term counseling and appropriate referrals to community resources. A demonstration project called the Individual Cancer Assistance Network (ICAN), sponsored by Bristol-Myers Squibb Foundation, trained 141 community-based counselors and EAP providers in Florida in a “face-to-face” and distance-learning program in psychosocial oncology. Efforts are underway to expand the program and use the core curriculum, developed by CancerCare, and the American Psychosocial Oncology Society (APOS), to train professionals who already have counseling skills to be oncology sensitive (Alter, 2005).

Marriage, Family, and Sex Counseling

Marriage and family therapists may work with individuals, couples, or families in dealing with cancer in the context of the family system. Marriage and family therapy is short-term, solution-focused therapy, and usually



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