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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
typically very challenging physically to patients, requiring some combination of surgery, radiation, or chemotherapy for months or years. Even when treatment has been completed and no cancer remains, the frequently permanent, serious residua of cancer and/or the side effects of chemotherapy, radiation, hormone therapy, surgery, and other treatments can permanently impair cardiac, neurological, kidney, lung, and other body functioning, necessitating ongoing monitoring of cancer survivors’ health and many adjustments in their daily living. Eleven percent of adults with cancer or a history of cancer (almost half of whom are age 65 or older) report having one or more limitations in their ability to perform activities of daily living such as bathing, eating, or using the bathroom, and 58 percent report other functional disabilities, such as the inability to walk a quarter of a mile, or to stand or sit for 2 hours (Hewitt et al., 2003). Long-term survivors of childhood cancer are at particularly elevated risk compared with others their age. Nearly 20 percent of those who survive 5 years or more report limitations in activities such as carrying groceries, climbing a flight of stairs, or walking a block (Ness et al., 2005). Significant numbers of individuals stop working or experience a change in employment after being diagnosed or treated for cancer (IOM and NRC, 2006).
Not surprisingly, significant mental health problems, such as depression and anxiety disorders, are common in patients with cancer (Spiegel and Giese-Davis, 2003; Carlsen et al., 2005; Hegel et al., 2006). Studies have also documented the presence of symptoms meeting the criteria for post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSS) in adults and children with cancer, as well as in the parents of children diagnosed with cancer (Kangas et al., 2002; Bruce, 2006).2 These mental health problems are additional contributors to functional impairment in carrying out family, work, and other societal roles; poor adherence to medical treatments; and adverse medical outcomes (Katon, 2003).
Patients with cancer (like those with other chronic illnesses) identify a number of other problems that adversely affect their health care and recovery, including poor communication with physicians, lack of knowledge about their illness and its management, lack of transportation to health care appointments, financial problems, and lack of health insurance (Wdowik et al., 1997; Eakin and Strycker, 2001; Riegel and Carlson, 2002; Bayliss et al., 2003; Boberg et al., 2003; Skalla et al., 2004; Jerant et al., 2005; Mallinger et al., 2005). Fifteen percent of households affected by cancer report having left a doctor’s office without getting answers to important
These mental health problems are not unique to cancer patients. Populations with other chronic illnesses, such as diabetes, heart disease, HIV-related illnesses, and neurological disorders, also have higher rates of depression, adjustment disorders, severe anxiety, PTSD or PTSS, and subclinical emotional distress (Katon, 2003).