San Francisco, CA—There is no shortage of research on psychosocial issues in patients with cancer, but implementation of this evidence in clinical practice has a long way to go, according to data presented at the 2019 Supportive Care in Oncology Symposium.
“We have a robust body of observational, mechanistic, and interventional research on psychosocial issues and problems with people with cancer,” said Paul B. Jacobsen, PhD, FASCO, Associate Director, NCI Division of Cancer Control and Population Science. “But we haven’t systematically studied how to take this evidence and apply it in the real world.”
Many interventions have demonstrated efficacy in well-conducted randomized trials, he said, and their findings show the benefits of interventions. In addition, said Dr Jacobsen, the field has seen a growing workforce that is trained in the delivery of psychosocial care, and clinical guidelines have been developed for distress management by different organizations.
There are also other models for delivering psychosocial care, including the collaborative care model for the treatment of depression. This approach involves the integration of care managers and consultant psychiatrists, with primary care physician oversight, to manage mental disorders as chronic diseases rather than as acute symptoms.
“This is a model that could be very applicable to community practices, where there may be limited availability of mental health professionals, but somebody in the practice who could serve as a care manager,” said Dr Jacobsen. “Even though this model has been adapted for cancer care and has demonstrated robust evidence for reducing depression severity in people with cancer, it has not been widely adopted.”
One possible explanation for the lack of real-world application is that the majority of interventions tested in psychosocial care have focused on the individual.
“Very few studies have considered the role of providers or members of the clinical team, the healthcare clinic in which this care is going to be delivered, the healthcare systems that the clinics work in, and the community settings, which will be very important in resource-limited settings,” he explained. “Very, very few studies of a pragmatic nature have been conducted in the field of psychosocial care today.”
As opposed to clinical effectiveness research that deals only with evidence-based interventions and their effects on outcomes, said Dr Jacobsen, implementation science offers a way to consider systematically what strategies should be used to implement this intervention. There is also the issue of cost.
“Very few studies of psychosocial care have actually looked at costs—not only the cost of the intervention but the cost of implementing it,” Dr Jacobsen said. “The issue of sustainability is critical, as well. What’s the likelihood that a practice will take this new form of delivery of care and continue to use it after your research study is done? To what extent can you produce enduring change in clinical practice?”
There are, of course, many things that clinicians still need to learn with respect to psychosocial aspects of care—there are new forms of therapy producing new side effects and psychosocial issues, and there are gaps in terms of interventions. However, the more pressing need is implementation of the evidence that is already there, he said.
“We have collaborative care for depression that’s just sitting there waiting to be implemented, and there are many step-care models that will be very applicable for widespread delivery of psychosocial care,” he concluded. “If we expand the scope of research, I think we have the potential to generate the kind of real-world evidence that is going to drive additional positive changes in policy and practice for psychosocial care.”