Around 80% of lung cancer patients experience some level of psychological distress, but regardless of the availability of psychosocial services, nurses can employ simple interventions to reduce the psychological distress of patients and improve their quality of life, according to Andreja C. Skufca-Smrdel, MSc, a clinical psychologist and psychotherapist in the Department of Psycho-oncology at the Institute of Oncology in Ljubljana, Slovenia.
Studies have shown that lung cancer patients experience more distress and have more unmet needs than patients with other malignancies. Part of this distress is connected to the stigmatization of lung cancer patients. The survival statistics and generally poor prognosis in this population are well-known to the public, contributing to the social presentation of lung cancer as a death sentence.
The period after diagnosis is filled with painful emotions and questions, she said at the International Association for the Study of Lung Cancer 17th World Conference on Lung Cancer. Patients have to make very important decisions, and from these initial steps of coping with their disease, psychosocial support is a vital component of comprehensive cancer treatment.
What Is Psychosocial Support?
At the time of diagnosis, lung cancer patients report more psychological concerns than at later stages of treatment, but they are also more willing to enter psychological treatment at this time compared with later on in treatment when physical ailments might prevent them from doing so. Psychological interventions are nonpharmacologic, and key types include cognitive behavioral therapy, supportive psychotherapy, and family therapy. “These interventions are proven to be connected to increased well-being, improved adjustment in coping, and reduction in distress,” she said.
Although different models exist, the basic principle in providing psychosocial support to cancer patients is caring for patients’ basic needs, including adequate communication, informational needs, basic emotional support, screening of needs, and symptom management. “Meeting these needs is the task of all health professionals,” she said. “And the higher the density of distress and unmet need, the more specialized interventions are required.”
A meta-analysis regarding uptake and adherence to psychosocial interventions targeting distress in cancer patients showed that lung cancer patients, at the time of diagnosis, prefer to receive most psychosocial support from nurses rather than other health professionals. But the role of nurses in providing psychosocial support differs greatly from country to country, and, in some countries, no psychosocial education training is provided. “So we have a paradoxical situation,” said Dr Skufca-Smrdel. “The nurses are preferred as the providers of psychosocial support, but they don’t necessarily have the education for it.”
The efficacy of early palliative care and supportive programs is well-known, but their routine inclusion into oncology care still remains a challenge. “These interventions aren’t available to all the patients who need them,” she said.
“We’re trying to do our best for the patients and for ourselves to avoid developing burnout, so what can we do?”
Basic Psychosocial Interventions
Basic psychosocial interventions can be performed by every health professional, regardless of the availability of specialized services, and one of the most basic interventions is providing information. The nurse is a crucial provider of information about treatment course and continuum, support for the coping process, side effects and their management, practical issues, exercise-related information, and support and assistance dealing with fatigue. And at the time of diagnosis and treatment preparation, lung cancer patients have been shown to prefer one-to-one communication with their health professional, despite the surplus of information available to them in modern media.
According to Dr Skufca-Smrdel, good communication skills are vital for healthcare professionals, as they are the cornerstone of comprehensive cancer treatment. Good communication skills are crucial to identifying the special needs of patients and providing appropriate information and psychosocial support, and they are associated with less unmet need in patients and increased informed decisions regarding treatment. “But there’s also benefit for healthcare professionals, as burnout symptoms in health providers are associated with lower confidence in communication skills,” she noted.
Provision of emotional and social support is another important psychosocial intervention. Patients have a need to talk about their concerns regarding treatment, life and death and existential issues, to minimize the feelings of being different or isolated. “Nurses are an important source of this support, in part because patients don’t have the need to protect us from their painful feelings,” she said.
Cognitive behavioral therapy (CBT) is the most widely used form of therapy for cancer patients and has been proved effective in the treatment of depression, anxiety, pain, fatigue, and insomnia, all of which are common in lung cancer patients. Some commonly used CBT interventions include relaxation training, distraction, and realistic goal setting. But again, the accessibility of CBT education for nurses varies widely from practice to practice, she noted.
In caring for the psychosocial needs of cancer patients, it is important to recognize those patients experiencing more distress. When distress goes unrecognized and untreated, needs stay unmet, so systematic distress screening should be standard in comprehensive cancer care. “Screening of unmet needs isn’t routine and still remains a challenge in many healthcare systems, but in all screening programs the role of the nurse is indispensable,” she said.
