During the last two decades, very significant advances have been made in our understanding and treatment of the psychosocial consequences of cancer. The standard of care in clinical oncology now includes recognition of the psychosocial consequences of cancer, treatment of psychiatric syndromes associated with the disease, and relief of biopsychosocial-spiritual distress and suffering common to the cancer experience for patients and caregivers. Because the scope of the problem is great and the number of dedicated psycho-oncologists is few, comprehensive cancer care is not delivered by specialists alone. Primary oncologists of all disciplines and the growing interdisciplinary subspecialty of psycho-oncology has done much to help establish this standard of care and to develop a research and clinical framework to support it.
Psychosocial oncology is not just another subspecialty. It represents a philosophy of care that seeks to bring together the interdisciplinary team working together to address the particular needs of a patient, family, and community. Implementing such a care delivery model in the culture of our current high-technology hierarchical health care systems can be a real challenge. However, these barriers cannot be allowed to prevent the implementation of a person-centered model of care that has been demonstrated to improve patient outcomes, decrease costs, and enhance health care professional satisfaction. Oncology and psychosocial oncology should take a leadership role in developing and championing this model of health care.
Caring for cancer patients and their families is challenging work. Unfortunately, the data indicate that many of us are experiencing burnout and demoralization. Rather than increasing the burden placed on oncology clinicians, an integral interdisciplinary approach offers us an opportunity to bolster our support systems and enhance our job satisfaction.
These support systems also address the fact that cancer occurs within the complex interaction of multiple systems. Although we are developing increasingly detailed molecular models of cancer pathophysiology, it is also clear that the etiology and effects of cancer extend beyond the objective physical realm. The integral biopsychosociospiritual approach outlined in this text provides a framework for beginning to understand how mind, community, and spirit influence the course of cancer and its impact on patients and their relationships. This integral approach does not challenge the importance of objective biological approaches to the treatment of cancer but serves to broaden our perspective of cancer and provides our patients with a wider range of therapeutic options. Importantly, this approach guarantees that we can always provide our patients with therapeutic options, regardless of their physical prognosis.
Cancer is a lived experience, and not simply a disease. Each year, more than 12 million people worldwide receive a new diagnosis of cancer. Although they share a common medical diagnosis, each and every one of these human beings will have a unique experience of cancer and its impact on their lives. These experiences are lived out in the details of their personal stories—not simply in their laboratory investigations. Cancer will inevitably challenge every life narrative and will leave us transformed in ways we cannot predict. Our role as healers is to accompany our patients as they journey through the challenges and terrors of their illness and to create safe spaces in which they can discover their own potential for healing.
This manual, with contributions from multidisciplinary psycho-oncologists at the University of Texas MD Anderson Cancer Center as well as other colleagues working in the field, is designed to assist in that effort. It is not intended to be a definitive text but is intended to provide oncology clinicians with a readily accessible clinical resource that will assist them in identifying and addressing the unique psychosociospiritual needs of their patients.