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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
An estimated one-third to one-half of patients undergoing active treatment for cancer experience pain resulting from the illness, its treatment, or co-occurring illnesses. This pain often is not fully eliminated despite the administration of analgesics and other therapies, in part because it is often undertreated. Moreover, pain may continue to be a problem even when there is no longer any sign of cancer. AHRQ’s 2002 evidence review documented the contribution of cancer-related pain to fatigue, impaired function, and a range of other psychosocial dimensions of health (Carr et al., 2002).
Limitations in Activities of Daily Living
The physical impairments and disabilities, as well as fatigue and pain, experienced by patients with cancer often lead to an inability to perform the routine activities of daily living that most people take for granted. Activities of daily living are defined as those age-appropriate physical and cognitive activities that individuals generally perform for themselves as part of their daily self-care. For adults, these include such activities as bathing, using the toilet, dressing, preparing meals, and feeding oneself. Instrumental activities of daily living include such tasks as using a telephone, shopping, paying bills, and using transportation. In the United States, adults with a prior diagnosis of cancer6 are more likely than those of similar age, sex, and educational level without such a diagnosis to report needing help with activities of daily living (Yabroff et al., 2004). NHIS data for 1998–2000 show that cancer survivors without any other chronic illnesses were more than twice as likely as individuals without a history of cancer or other chronic illness to report limitations in their ability to perform activities of daily living and significantly more likely to have other functional limitations (Hewitt et al., 2003). Long-term survivors of childhood cancer are at particular risk. Nearly 20 percent of more than 11,000 such individuals (median age 26, range 5–56) diagnosed between 1970 and 1986 who survived 5 years or more reported limitations in activities such as lifting heavy objects; running or participating in strenuous sports; carrying groceries; walking uphill or climbing a flight of stairs; walking a block; or eating, dressing, bathing, or using the toilet. These limitations occurred at nearly twice the rate found in their siblings without cancer. Fewer (3, 7, and 8 percent, respectively) reported limitations in ability to eat, bathe, dress, or get around their home by themselves; perform everyday household chores; or hold a job or attend school. However, these rates were five to six times higher than those seen in their siblings without cancer (Ness et al., 2005).