Financial considerations may hinder the use of psychosocial care among cancer patients. Indeed, research has debated the extent to which patients are willing to pay for the costs associated with successful psychosocial interventions. A recent article in the Journal of Clinical Oncology, however, suggests that cost-effective programs are not only attainable, but that they also have promising implications for the well-being of distressed cancer patients.
Researchers in the Netherlands followed 156 cancer patients over 12 months (Jansen et al 2017). All patients reported elevated symptoms of distress at baseline and were randomized to receive a Stepped Care intervention program or care-as-usual. The Stepped Care program consisted of the following four steps: 1) watchful waiting for two weeks; 2) guided self-help; 3) face-to-face problem-solving therapy; and, 4) specialized psychological intervention such as cognitive behavioral therapy and/or psychotropic medication. The study’s findings showed that, compared to distressed patients who received care-as-usual, those who completed the Stepped Care program had higher quality of life and lower costs associated with care. In this way, the Stepped Care program represents an opportunity for patients to improve their psychosocial health in a way that does not also burden them financially.
At the same time, we cannot take for granted that the Stepped Care approach would be equally effective for all patients. For example, timing is important. More severely distressed individuals may require immediate intervention, and would fare poorly in a two week holding period, such as the first step of the Stepped Care program involves. Relatedly, severe symptoms of distress may be particularly salient in the first year following diagnosis (Buzaglo et al., ASCO Survivorship 2016). The urgency of an intervention—and, likewise, its effectiveness—may, therefore, vary as patients navigate different stages of the disease process.
Research must continue to make strides in identifying the types of programs and interventions that are both financially feasible and psychosocially beneficial for a diverse group of cancer patients. Efforts should also be made to address the successful implementation of these programs and interventions. Oftentimes, implementation is highly varied, leading to inconsistency in patient outcomes and costs.
Integrating psychosocial support into cancer care and advocating for patient-centered care are two critical tenets of the Cancer Support Community. In line with this mission, we have developed the CancerSupportSource®, a multidimensional distress screening tool that can be used to identify patients at risk for distress or anxiety and connect them with resources. Using this tool, our research efforts have yielded rich data on the ways that pain management and treatment decision-working, for example, are associated with distress for patients. The experience of cancer is dynamic and highly personal. Psychosocial care should be the same.
In conclusion, we applaud the recent attention to financial burden surrounding psychosocial care. Efforts to identify and implement cost-effective solutions are necessary for the overall health and well-being of cancer patients. We encourage researchers and clinicians to continue working towards identification and implementation of programs that can be tailored to meet each individual patient’s psychosocial and financial needs.