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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
For some psychosocial problems, research has not yet identified effective services to resolve them. In other cases, evidence that a remedy works effectively for some populations does not necessarily mean that the same remedy is effective for (is generalizable to) all people in all situations. Moreover, evidence is frequently not as clear as one would like it to be. Findings can be mixed, with evidence of the effectiveness of a service being found in one study but not being replicated in others. Additionally, evidence that a given service is effective does not exclude the possibility that another service is more effective for the same problem or equally effective at lower cost. In such cases, research continues to be needed even for services and interventions whose efficacy is supported by research findings. All of these situations are found in the array of evidence pertaining to psychosocial health services.
Identification of Effective Interventions
For some psychosocial health problems faced by cancer patients, research has not yet identified efficacious remedies. For example, as discussed in Chapter 3, research does not well inform clinicians about how to address effectively continued tobacco use among cancer patients, cognitive impairment among adults treated for cancer, and difficulties with school reentry for children treated for cancer. Further, although cancer is recognized as having a large impact on family members, they are rarely the subject of or included in research on psychosocial health care (Helgeson, 2005). More commonly, research points to the effectiveness of specific psychosocial services, but offers limited evidence about whether a broad spectrum of patients (and family members) benefit equally from those services in all situations.
Determination of Effectiveness in Different Populations and Scenarios
Questions about the effectiveness of many psychosocial services have evolved from addressing whether given services are effective to addressing for whom and under what circumstances specific services are needed and effective (Helgeson et al., 2000; Zebrack and Zeltzer, 2003; Cohen, 2004; Helgeson, 2005; Stanton, 2005). Effectiveness research on psychosocial health services has most often focused on women with breast cancer at the middle to upper middle socioeconomic levels without regard to the amount of psychosocial stress they are experiencing. Services need to be tested with men, in patients with sites of cancer other than breast, across different stages of cancer, with patients experiencing different types and levels of psychosocial needs and stress, and with those from different cultural and socioeconomic backgrounds.