Psychosocial Oncology

Madeline Li, MD PhD

Psychiatrist, Department of Supportive Care

Department of Supportive Care

Department of Medical Oncology

Department of Radiation Oncology

Department of Surgical Oncology

Supportive CareSupportive Care

grief &bereavement

anti-cancertreatments

Longitudinal & Integrated Cancer Care

Cancer Risk

Diagnosis

Supportive Care

CAPO Definition of PSO“Psychosocial Oncology is a professional sub-specialty in oncology. The domain of psychosocial oncology includes the formal study, understanding and treatment of the social, psychological, emotional, spiritual, quality of life and functional aspects of cancer as applied across the cancer trajectory from prevention through bereavement. It seeks to develop and integrate new knowledge and techniques of the psychosocial and biomedical sciences as it relates to cancer care”

CCO Multidisciplinary PSO Team

PsychosocialOncology

PsychosocialOncology

Social Social WorkWork

PsychiatryPsychiatry

RegisteredRegisteredDieticiansDieticians

PsychologyPsychology Advanced Advanced Practice Practice

NurseNurse

Speech and Speech and Language Language

PathologistsPathologists

Rehabilitation Rehabilitation SpecialistsSpecialists

OncologistsOncologists

Volunteer Volunteer ServicesServices

Spiritual Spiritual CareCare

Fitch MI. Providing supportive care. In: Supportive Care Framework: A Foundation for Person-Centred Care. Pembroke (ON): Pappin Communications; 2008. p. 23–24.

Princess Margaret Princess Margaret Psychosocial Psychosocial

OncologyOncologyResearch

Ambulatory Services

Children & Family Support Services

HBB Volunteer Support Program

In-patient Services

Education

• ~1200 referrals/year• Routine distress screening• Individual, marital, family and group-based support

Importance of Psychosocial Care

Severe psychosocial distress is associated with:

– Poor quality of life

– Distress in family caregivers and children

– Desire for hastened death/request for medical assistance in dying

– Worse patient satisfaction with care

– Less treatment compliance

– Greater health care utilization

– Increased mortality independent of medical variables

Distress Assessment and Response Tool: DART

• Screens for– physical symptoms (ESAS)– depression (PHQ-9)– anxiety (GAD-7)– social difficulties (SDI)

• Computerized survey completed by patients in oncology clinics at diagnosis and every 2-3 months

• Intelligently programmed to minimize patient burden• Clinical decision support tool on clinician output to facilitate

PSO referral• Customized with additional patient reported outcome

measures in select tumour sites

Ambulatory/Inpatient Services• Individual and couple outpatient care (psychiatry,

psychology, social work)• Inpatient consult service• Group Interventions (MBCT, iREST)• Tailored treatment (AYA, cancer geriatrics,

neurocognition)• Targeted treatment (CALM, EASI, ASURE)• Music Therapy• UHN MAID

• Screening and selection of volunteers• Specialized training program• Supervision and collaboration with professional staff• Multiple functions

– Clinic-based support– Navigators– Group interventions

• 150 new volunteers trained • Research program evaluating selection and training process and outcomes

Healing Beyond the Body Volunteer Support Program

Family Centered Care

Magic Castle• Therapeutic play

program for children with cancer undergoing radiotherapy and for children whose parents are receiving cancer treatment at PM

Research Program

Research Research TeamsTeams

Quality of LifeQuality of Life

Pain & SymptomPain & SymptomControlControl

Adjustment to Adjustment to Advanced Disease Advanced Disease

and End of Lifeand End of Life

Genetic RiskGenetic Risk

Neurocognitive Neurocognitive Effects/SurvivorshipEffects/Survivorship

Health ServicesHealth Services

Educational Program• Psychiatry residents, social work

students and psychology practicum rotations

• Seminar Program– Grand Rounds– Pain & Symptom Management– Manuscript Review – Research Development– Research in Progress– Palliative Psychiatry

• Elective undergraduate trainees• Fellowship program• Inter-professional education to

oncologists and nurses– Communication skills training– Distress management– PSO education for medical staff

“It is more important to know what sort of person has a disease than to know what sort of disease a person has.”

Psychosocial Oncology:

Tumour-centred care Person-centred care