2023-10-21 10:33:55
Anyone who has experienced it or been close to someone who has been affected by it knows how devastating the news of having cancer can be, for oneself but also for one’s loved ones. In fact, according to data from the Italian Association of Medical Oncology (Aiom), 20% of people with cancer are affected by depression, 10% by anxiety and over 50% develop psychological distress. Disorders that have a negative impact on the quality of life, adherence to treatments and, therefore, survival of cancer patients. But they are identified and treated only in the minority of cases. In fact, it is estimated that more than 70% of people with cancer with depression receive no treatment for their mental illness. And it is starting from this photograph that the Aiom, on the opening day of the Congress of the European Society for Medical Oncology (Esmo) in Madrid, launches the appeal for a real integration of psychosocial assistance in daily clinical practice, also with the provision of specific resources.
Psycho-oncology, the Irma D’Aria World Congress will be in Italy 21 July 2023
Emotional distress for patients and families
The feelings of depression and anxiety that affect cancer patients are part of emotional distress. “The psychological health of the person who receives the diagnosis of cancer is put to the test by emotional distress, fear of recurrence, concern for family members, difficulties in the social, working, economic and sexual spheres – he explains Gabriella Pravettoni, professor of Decision Psychology at the University of Milan and director of the Psycho-oncology Division of the European Institute of Oncology. “All this can generate different types of psychosocial needs. Often, however, the psychological implications of the disease are left in the background compared to the strictly clinical needs relating to anti-cancer treatments”.
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Cancer patients five times more depressed
Cancer is increasingly a chronic disease. Compared to the 2 and a half million citizens living in Italy in 2006 with a previous diagnosis of cancer, this figure has risen to around 3.6 million in 2020. “The incidence of depression is five times greater in people with cancer compared to general population and can be present in every phase of the neoplastic disease, even in those who have overcome it,” he declares Saverio Cinieri, president of Aiom. Oncologists must be aware of the psychological distress that can affect patients, starting from the moment the diagnosis is communicated. If the information is not provided adequately, the psychological consequences on the patient can be very serious, leading to an increase in levels of anxiety and uncertainty, difficulty in understanding what is said during the visit and negatively impacting adherence to anti-cancer therapies and subsequent choices. Furthermore, the presence of the psycho-oncologist allows oncologists to better manage the caregivers’ needs.”
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An invisible malaise
Unfortunately, the presence of emotional distress often goes undetected. “It happens both due to oncologists’ difficulties in discussing these topics during the visit, and due to the reluctance of the patients themselves to confide them, also due to the stigma still associated with psychological problems. Furthermore, it can be difficult to distinguish between normal reactions to stress in the presence of a serious pathology such as cancer and those that constitute an adaptation disorder,” continues Pravettoni.
The sixth vital parameter
These barriers to recognition do not allow the patient to find a correct balance in their care path and to have their needs resolved. The issue is even more serious for the most disadvantaged groups of the population, such as citizens with lower socio-economic levels, the elderly or those who live alone. “This is why – adds the psycho-oncologist – it is important that each person, at the time of diagnosis and in the different stages of the disease, is subjected to a screening by the psycho-oncologist to evaluate the level of mental distress. The International Society of Psycho-Oncology has highlighted the need to recognize psychosocial support as a universal human right. Emotional distress should be considered the ‘sixth vital parameter’, together with heart rate, respiratory rate, body temperature, blood pressure, blood saturation”.
The impact on adherence to therapy
In Europe, there are an estimated 3.7 million new cases of cancer every year. In 2022, in Italy, there were 390,700. Treatment of mental distress not only has positive implications on mood but also on survival. “Oncology patients with depressive symptoms – underlines Saverio Cinieri, president of Aiom – adhere less to therapeutic protocols. A study investigated the degree of acceptance of adjuvant chemotherapy, i.e. subsequent to surgery, in patients with breast cancer: among women with depression who did not request psychological help, only 51% accepted to undergo chemotherapy. And a meta-analysis, which included 27 studies for a total of 9417 people suffering from different types of cancer, revealed that mortality rates were up to 25% higher in patients with depressive symptoms and up to 39% higher in patients with major or minor depression.”
If the mood goes up, the symptoms are lighter
Various psychological disorders such as depression, anxiety, panic and social isolation can in turn become disabling and negatively affect the quality of life. “In addition to improving emotional well-being and mental health – adds Pravettoni – psycho-oncological treatments have been shown to produce more effective management of cancer-related symptoms and adverse effects of treatment, such as pain and fatigue. There are different paths to treat psychological distress, which lead to targeted decision-making processes, even for people who have not developed cancer but know they are carriers of genetic mutations, such as BRCA, which expose them to a greater oncological risk. To provide detailed information, aimed above all at patients and caregivers, the portal www.psiconcologia.net was created”.
Psychological support for less than one in 5 patients
Unfortunately, in Europe, only 37% of countries allocate a specific budget for psycho-oncological support, with the result that this need for treatment often remains unsatisfied. As in Italy, where the psychologist dedicated to oncology is present, on paper, in around half of the centres, but less than one patient in 5 actually receives this type of support. “Psychosocial support should be considered an essential component of oncology treatment: it aims to alleviate emotional distress and promote well-being – he states Saverio Cinieri, president of Aiom. Therefore, it constitutes a key element of any strategy aimed at improving the quality of life of people with cancer. Despite this widespread awareness and the existence of guidelines recommending evidence-based psychosocial interventions in various countries, many cancer patients do not actually receive them. Even today, these needs too often go undetected and, therefore, are not treated appropriately. Furthermore, the National Oncology Plan 2023-2027 does not provide resources for psycho-oncological assistance”.
Il Beacon Cancer Care Project
The Beacon Cancer Care Project (BEACON) is moving in the direction of improving the current situation, a European initiative coordinated by Prof. Pravettoni who, for this reason and for the great results obtained through numerous research projects, received the parliamentary Intergroup award of the Chamber and Senate “Oncology: Prevention, Research and Innovation”. “The Beacon – explains the psycho-oncologist – aims to identify and reduce disparities in cancer care in Europe. A team of psychologists, oncologists, data scientists and decision makers from different European countries is mapping the main capabilities and skills of oncology centers in the Old Continent regarding the prevention, diagnosis and treatment of oncological diseases”.
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