Reach Out and Communicate with Your Psycho-Oncology Interdisciplinary Team

Elizabeth Archer-Nanda, DNP, APRN, PMHCNS-BC, psychiatric nurse specialist at the Norton Cancer Institute, would like you to pick up the phone and call your cancer patient’s oncologist to set aside just one hour to round with him or her and brainstorm how to help your patient have the best possible quality of life.

Integration of mental health and cancer treatments dates back to the early 1930s. Psychosocial aspects of prevention, etiology, diagnostics, treatment, and rehabilitation of cancer define psycho-oncology. It is characterized by interdisciplinary medicine, as well as cooperation between medical and nonmedical professionals. Thirty-sixty percent of cancer patients experience psychosocial distress and/or psychiatric disorders.

In 2015, the Commission on Cancer will begin requiring that all cancer centers screen and assess for any underlying psychosocial, emotional, or psychological health problems and refer patients for appropriate interventions.

Archer-Nanda shared the outcomes from her doctoral study project on psycho-oncology at the American Psychiatric Nurses Association 28th Annual Conference, held October 22-25, 2014, in Indianapolis, IN.

Archer-Nanda looked at the impact of evidence-based interventions on patient depression outcomes in an integrated behavioral oncology program. She said that patients “are not themselves” when mind and body suffer. So there is a need for a gold standard for measuring depression, anxiety, and other psychological difficulties in cancer patients and in other settings as well.

• The purpose of her study was to evaluate patient outcomes for individuals receiving services in behavioral oncology by:
• Implementing use of the PHQ-9 at each visit with a behavioral oncology provider
• Assessing patient outcomes for changes in depression scores
• Examining opportunities for program improvement by reviewing clinical interventions by providers and identifying opportunities for integration of psychiatric practice guidelines

Every good study has a good theoretical framework. Archer-Nanda’s study focused on the theory of stress and coping. Many factors impact a person’s ability to react to stressful situations and through understanding this, providers can more easily help cancer patients deal with their diagnosis.

She conducted the study at Norton Cancer Institute in Louisville, KY, where a multidisciplinary team of 35 physicians and 22 nurses monitored 41 cancer patients for a six-month period beginning on January 1, 2013. Providers screened for depression and included a treatment plan and rationale, goals of care, and plan for follow-up. Data was analyzed using Stata College Station, TX, version 12.0.

Seventy-eight percent of patients were married, Caucasian females with a mean age of 58, who were seen for 5.5 visits. All areas showed some improvement after intervention and four categories of PHQ-9 scores showed statistically significant reductions for depression after intervention, indicating high quality care:

• I was feeling down, depressed or hopeless
• Trouble with sleep
• Feeling bad about yourself or that you’re a failure or you’ve let your family down
• Difficulty with psychomotor agitation or retardation

The sample size was representative for this integrated psycho-oncology program. And steps were taken to minimize interpretation bias, but it did have a small sample size. Nonetheless, this program is a model for evidence-based approaches to care in an integrated oncology setting.