IPOS IQ News

PSYCHOSOCIAL CARE IN ONCOHEMATOLOGY IN RUSSIA

General. Department of Psychiatry and Neurology in Hematology (DPNH (Chief Vybornykh D.E. MD, DMSc) and its Clinical Psychology Division (Director Khrushchev S.O. M.Sc)) conduct a wide range of psychosocial care, research and educational activities at the largest hematology hospital in Russian Federation (National Research Center for Hematology, Moscow). DPNH deliver psychosocial care for patients with wide range of hematological disorders (including leukemia, lymphoma and multiple myeloma) at all stages of disease course and treatment. In accordance with well-established standards, interdisciplinary team (physicians, psychiatrist, neurologist, clinical psychologist) conduct in thorough diagnosis and care of all relevant conditions and symptoms for patients and their relatives with special emphasis on individual rehabilitation plan development. During this process we analyze strengths and weaknesses of patient overall adaptation (somatic and psychiatric status, symptoms intensity and manifestations, psychosocial buffers and triggers etc.) to understand underlying causes and prescribe suitable therapy or/and interventions.

Research. DPNH research interests cover a wide range of practical and theoretical issues. DPNH research program core methodology is qualitative and quantitative analysis of specific and general factors affecting patients and their relatives during disease course and treatment. Currently DPNH focuses on: psychosocial factors, mediators and moderators of rehabilitation process (in the biopsychosocial model), psychosocial interventions effectiveness (in RCT studies), cognitive impairments after chemotherapy and bone marrow transplantation (neurological, neurophysiological and neuropsychological aspects), psychological aspects of stigmatization process. DPNH also take part in development of the national standards of psychosocial care, psychosocial screening projects and design e-health systems. Several research projects are funded by federal grants (The Russian Foundation for Basic Research).

Principles. In order to improve quality of care and generate new knowledge DPNH collaborate with Lomonosov Moscow State University, Mental Health Research Center and oncology-hematology hospitals in Moscow, St.Petersburg and other Russian regions. Development and implementation of up-to date standards of psychosocial care and rehabilitation require intensive bilateral cooperation of highly specialized organizations (hospitals, healthcare policy and psychosocial institutions, universities etc.) with well-established program and outlined areas of responsibility. Continuous exchanges of experience and local thought-leaders who share core values provide fertile soil for growth of new quality of care standards. Seminars, lectures, printed and online materials play major role in informational and educational policy. Such measures help to explain physicians and patients how situation and circumstances can be changed for better quality of life and treatment. High level of awareness allows for dissemination of both general standards and projects of specific needs.

Congress. In order to support and catalyze process of implementation of psychosomatic and psychosocial care principles, DPNH organized psycho-hematology/psycho-oncology section at Russian International Hematological Congress (2018). Leading researchers and healthcare professionals were invited to make oral presentations and share best practices. Specialists in psychiatry, neurology, clinical psychology, oncology and hematology from top medical and educational organizations (Lomonosov Moscow State University, National Institute of Mental Health, National Research Center for Oncology etc.) shared their experience with hundreds of medical and healthcare professionals from many Russian regions and other countries. Thanks to congress our psychosomatic and psychosocial community discussed and designed some collaborative projects with other regional clinics and medical centers.

Future directions. National standards for psychosocial care, in general, entail networking and coordination of federal and regional hospitals to the adoption of up-to date care and educational practices and a common healthcare policy. National Society for Psychosomatics and Health Care Management could serve as a central organization to create administrative and institutional resources for development of up to date high standards of psychosocial care.

1. Can you briefly introduce “Conquer Fear study”?

“ConquerFear is a face-to-face, individual intervention to help cancer survivors better manage their fear of cancer recurrence (FCR), based on the Self-Regulatory Executive Function model (S-REF). Delivered by psychologists and psychiatrists in 5 sessions, ConquerFear does not try to eliminate FCR, which is a normal, not irrational fear, but rather to help patients pay less attention to FCR and live life according to their values and goals. ConquerFear was evaluated in a randomized controlled trial, and shown to be more effective than an active, relaxation control intervention (Taking it Easy) in reducing fear of cancer recurrence immediately post the intervention, and at 6 months follow-up. The study was published in JCO.*”:

Butow P, Turner J, Gilchrist J et al. Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence. J Clin Oncol. 2017; 35(36):4066-4077. doi: 10.1200/JCO.2017.73.1257.

2.How common is fear of cancer recurrence among cancer survivors? Is this only matter for long-term survivors? Are there more vulnerable patients (cancer type, age, family history, mental health)? How about patients diagnosed at advanced stage?

“Fear of cancer recurrence is understandably very common. A systematic review by Sebastien Samard showed that about 70% of cancer survivors have mild FCR, about 50% have moderate FCR and about 7-10% have severe FCR, which might be considered a clinical problem requiring intervention. Patients have reported that FCR began as soon as they were diagnosed, but peaks at the time of treatment completion. Most studies have shown that FCR is stable, and does not reduce over time, although very long-term survivors have reported a reduction in FCR. Vulnerability factors include being younger, having symptoms/side-effects (readily interpreted as signs of cancer recurrence), and having a pre-existing anxiety disorder. There is inconsistent evidence that a worse prognosis and more extensive treatment may predict greater FCR, however subjective risk perception is a stronger predictor than objective risk. Patients with advanced disease experience fear of cancer progression (which falls under the general definition of FCR).”

3. How do you measure FCR? Is there any simple way to assess FCR? How often or when do you need to assess FCR? What would you recommend health professionals at clinic to assess FCR?

“There are many measures of FCR. The most commonly used questionnaire is the 42-item Fear of Cancer Recurrence Inventory (FCRI), developed by Simard and colleagues. The FCRI offers a rich clinical insight into FCR, and has a 9-item short form which can be used to measure severity. This measure is probably optimally used by psychologists or other staff offering an intervention to patients, to enable a full clinical understanding of the problem. A number of shorter screening measures have been developed; for example, Gerry Humphris has developed 4- and 7-item screening measures of FCR, which may be more useful as a regular screening tool in the clinic. The international IPOS Special Interest Group in FCR (FoRWaRDS) is currently developing criteria for a clinical diagnosis of FCR, and this may trigger the need for a new questionnaire that reflects these clinical characteristics. FCR can fluctuate, with peaks common when patients are coming for scans or follow-up, when a family member or friend develops cancer, or when cancer is featured in the media. Therefore, it is probably best to measure FCR when the patient is not facing a scan or test. The optimal frequency of measurement may depend on the study question or clinical purpose.”

4.There are many components in your intervention. What do you think the most beneficial to survivors? If you need to choose one, what would you recommend health professionals to try with low resource (no psychiatrist, less time)?

“ConquerFear has a number of components, including values clarification, attention training, detached mindfulness, meta-cognitive therapy and behavioural contracting for follow-up. Our mediation and moderation analysis showed that changing meta-cognitive beliefs about worry (over-valuing worry as a method to ensure vigilance for signs of cancer recurrence, or fearing worry will increase the likelihood of cancer recurrence) was the component most strongly associated with improved FCR. However, this is probably the most complex component for health professionals untrained in cognitive-behavioural therapy or with little time. I believe that doctors and nurses can help a lot by doing a quick screen for FCR, normalising FCR, ensuring patients have the information they want about prognosis and the most likely signs of cancer recurrence, providing patients with links to existing websites about FCR and making referrals to psychologists if the patient has high or clinical FCR. We are currently evaluating a short ten-minute intervention along these lines, delivered by oncologists at the first follow-up appointment, to see if it can prevent or reduce FCR.”

5.What do you think are the gaps and barriers/challenges for managing FCR in current cancer care system? How should try to resolve them?

“Most services do not screen for FCR, or ask patients at follow-up whether they are experiencing FCR, and therefore most FCR goes undetected. As use of patient reported outcomes become more the norm, a few short screening items for FCR, such as Gerry Humphris’ measure, should be included. Doctors and nurses can play an important role along the lines suggested above, to potentially prevent or reduce FCR, and this will likely take only a few minutes. Normalising FCR and responding empathically when patients raise these fears, will help patients feel comfortable discussing FCR and asking for help if needed.”

6.What is your future plan regarding research and practice at FCR?

“There are lots of exciting developments with ConquerFear. Currently colleagues, in collaboration with the original ConquerFear team, are developing an online form of ConquerFear (Ben Smith, Australia), a group version (Bobby Zachariae in Denmark), a version for nurse-delivery (Anne Reb, USA, as well as colleagues in South Korea) and a version for advanced cancer patients (Louise Sharpe in Australia). The FoRWaRDS IPOS special interest group in FCR is conducting a number of important studies to establish clinical criteria for FCR, and to review the literature in different areas. Interventions for partners is an important area of development also.”

7.Any message to cancer survivors experiencing FCR?

“Anyone diagnosed with cancer is likely to worry about their cancer coming back, or recurring, particularly when a scan or follow-up is due. This sort of normal worry is only a problem if it starts to interfere with your life and cause you ongoing distress. If that happens to you, as it does for about one in ten cancer survivors, it is definitely worth telling your oncologist or GP, because there is help available.”

This was based on interview with Dr.Wendy Lam, Conference Co-Chair of IPOS 2018

Meaning of having IPOS at Hong Kong: The coming World Congress is a very special meeting. The last IPOS congress held in Asia was 1993 at Kobe, Japan. The development of psycho-oncology grew tremendously in the past two decades, with evidence of the establishment of local psycho-oncology societies in various countries, including Mainland China, Taiwan, Korea, Japan, and India.

Brief introduction of the program of IPOS 2018: The coming congress will offer a platform for psycho-oncologists particularly those from Asia to get together to share their achievements, as well as, challenges encountered in improving cancer care. The congress theme focuses on integrating and consolidating strategies to optimize psychosocial supportive care services in cancer care from prevention through curative to palliative care. The plenary sessions cover timely topics in research and practice.

MUST see and experience at Hong Kong: For those who are visiting Hong Kong for the first time, it is Asia’s world city, famous for its skyline and harbor views, offering outstanding cultural diversity, vibrant nightlife and cosmopolitan lifestyle and is truly one of the great cities of the world. Furthermore, Hong Kong has many amazing hiking destinations, which are easily accessible by public transportation.

The Centers for Disease Control and Prevention (CDC) has released a new campaign in English and Spanish. The Inside Knowledge campaign raises awareness of the five main types of gynecologic cancer: cervical, ovarian, uterine, vaginal, and vulvar. Inside Knowledge encourages women to pay attention to their bodies, so they can recognize any warning signs and seek medical care.

Link: https://www.cdc.gov/cancer/knowledge/

Several herbal remedies have been studied as a treatment for anxiety, but more research is needed to understand the risks and benefits. In a recent Mayo Clinic’s post, the author discusses what we know and don't know about herbal treatments for anxiety.

Link: https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/expert-answers/herbal-treatment-for-anxiety/faq-20057945

16.11.2018 - 18.11.2018 Amsterdam, Netherland

SIOG Annual Conference is the leading conference for health professionals involved in the treatment of older cancer patients and provides a unique platform for oncologists, researchers, clinical practitioners, geriatricians, radiologists, psychologists, nutritionists, nurses and other healthcare professionals as well as senior cancer survivor advocates who wish to learn, interact and share results and best practice.

Link: http://siog.org/content/siog-2018-annual-conference-0

Lonnie Blanchard is a tongue cancer patient. He decided to have a surgery, and so to lose the biggest part of his tongue. He knew he was going not to be able to talk again. The BBC's Olivia Lace-Evans spent a week with Lonnie's family before his surgery. Despite it is often considered an uncommon cancer, the tongue cancer may deeply affect the patients’ lives. Here you can see the story of Lonnie and his long, touching wait for the surgery.

Link: http://www.bbc.com/news/av/world-us-canada-43786713/in-six-days-i-ll-lose-my-voice-forever

19.10. 2018 - 23.10-.018 Munich, Germany

“Securing access to optimal cancer care”, the ESMO 2018 Congress will take place in Munich, Germany. A multi-professional platform for oncology education and exchange, and for immense international visibility for scientific research, this year the Congress also features a dedicated nursing track through a collaboration with the European Oncology Nursing Society (EONS).

Link: http://www.esmo.org/Conferences/ESMO-2018-Congress

28.06.2018 - 30.06.2018 Vienna, Austria

Multinational Association of Supportive Care in Cancer (MASCC) and the International Society of Oral Oncology (ISOO) meeting is unique in taking a multidisciplinary approach to topics in supportive cancer care. 2018 meeting will feature plenary sessions on cannabinoids for symptom management and cancer therapy, post-chemotherapy cognitive Impairment, and cardiac toxicities secondary to cancer therapies.

Link: https://masccmeeting.org/2018/Pages/default.aspx#.Wt9f2Wf3Mkm

04.05.2018 - 05.05.2018 Lugano, Switzerland

Comprising plenary lectures by a multidisciplinary faculty of international experts and case-based sessions, ESMO Preceptorship courses offer an enriched learning experience, thanks to their small size and emphasis on interaction with fellow participants and faculty.

Link: https://www.eso.net/en/education/future%2devents/esmo-preceptorship-on-immuno-oncology-2018/3-3322-0-