The International Psycho-Oncology Society (IPOS)

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The International Psycho-Oncology Society(IPOS)
Jimmie C. Holland, M.D. Wayne E. Chapman Chair in
Psychiatric Oncology Memorial Sloan-Kettering
Cancer Center New York, New York
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IPOS Founded 1984

• To improve the human side of cancer care on
  a global basis

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IPOS 1984

• Foster international communication
• Educate professionals in psychosocial care
  across countries
• Advocate for making psychosocial an integral
  part of total cancer care
• Examine social, cultural factors that impact
  quality of life and care

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• An International Survey of Physician Attitudes
  and Practice in Regard to Revealing the Diagnosis
  of Cancer
• Jimmie C. Holland, M.D.,
• Natalie Geary, B.A.,
• Anthony Marchini, B.A., and
• Susan Tross, Ph.D.
• Psychiatry Service
• Memorial Sloan-Kettering Cancer Center
• New York, New York, 10021
• Cancer Investigation, 5(2), 151-154 (1987)

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Oncologists Estimated Percentage of Physicians in
Their Country Who Disclose Cancer Diagnosis

• N 90 oncologists 20 countries
• Tell to the Patient
• LOW HIGH
• Africa Austria
• France Denmark
• Hungary Finland
• Iran Netherlands
• Panama New Zealand
• Portugal Norway
• Spain Switzerland
• Sweden
• Tell to the Family
• High estimated by majority of physicians

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IPOS 2005

• Education
• Conducted 7 World Congresses 2006, Venice
• gt 25 national psycho-oncology societies
• International journal, 1992
• Psycho-Oncology
• Text books in English, Spanish, Italian, and
  Japanese

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IPOS 2005

• Education
• 2004 Website www.ipos-society.org
• Core curriculum online FREE
• 4 lectures, with European School of Oncology in
• Italian German
• French Hungarian
• Spanish English

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IPOS 2005

• Requested to become an NGO of World
  Health Organization
• Rationale to add a psychological, social and
  behavorial dimension to WHO national cancer
  control programs

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WHO Priority Action Plan forNational Cancer
Control Programs
Resources A B
C Low Medium High Prevention Early
diagnosis Screening/therapy Pain/palliative care
PSYCHOSOCIAL
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WHO Cancer Prevention Program

• Depends on changes in life style and exposures
  must alter BEHAVIOR
• Psychological and social factors are critical
  considerations in prevention education which
  must be culture and language-sensitive
• Behavioral scientists needed
• (Tobacco Cessation)

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WHO Cancer Control ProgramEarly Diagnosis

• Fatalistic attitudes, fear of stigma of
  cancer, and ignorance are problems, especially
  in developing countries
• Public education requires attention to
  psychological, social, cultural, and behavioral
  factors

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WHO Cancer ControlScreening

• Participation in screening require attention
  to local social attitudes, beliefs, trust in
  procedures/staff, and awareness of cultural
  factors
• Requires knowledge of community, beliefs, and
  fears

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WHO Priorities for National Cancer Control
Programs

• Pain/Palliative Care

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In Palliative Care

• Pain is often the primary focus
• Psychological issues are often not identified
  and treated as an equally important aspect of
  end-of-life care
• Need for more participation of
  psycho- oncologists in end-of-life for clinical
  and research collaboration

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IPOS Goals in Palliative Care

• Encourage recognition, diagnosis and treatment
  of psychosocial and psychiatric problems
• Develop standards and clinical practice
  guidelines for psychological care

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National Programs

• Standards and Guidelines
• Australia United Kingdom Canada United States

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US Example 1999

• A Multidisciplinary Panel (NCCN)
• Chose DISTRESS as an encompassing word to
  cover psychosocial/ psychiatric and spiritual
• A rapid one-item screening question
• Standards care and Clinical Practice
  Guidelines for mental health, social work,
  clergy

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DISTRESS CONTINUUM

• NormalDistress
• Fears
• Worries
• Sadness

SevereDistress Depression, Anxiety Family Spir
itual
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STANDARDS OF CARE FOR MANAGEMENT OF DISTRESS - 1

• Distress should be recognized, monitored,
  documented and treated promptly at all stages of
  disease
• All patients should be screened for distress at
  their initial visit and as clinically indicated
• Screening should identify the level and nature of
  the distress
• Distress should be assessed and managed by
  evidence or consensus-based clinical practice
  guidelines
• Adapted, NCCN

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BRIEF SCREENING TOOL AND PROBLEM LIST
Please indicate your level of distress on the
thermometer and check the causes of your distress.
During the past week, how distressed have you
been?

• Practical problems
• __ Housing
• __ Insurance
• __ Work/school
• __ Transportation
• __ Child care
• Family problems
• __ Partner
• __ Children
• Emotional problems
• __ Worry
• __ Sadness
• __ Depression
• __ Nervousness
• Spiritual/religious concerns
• __ Relating to God

Physical problems __ Pain __ Nausea __ Fatigue __
Sleep __ Getting around __ Bathing/dressing __
Breathing __ Mouth sores __ Eating __
Indigestion __ Constipation/diarrhea __ Bowel
changes __ Changes in urination __ Fevers __ Skin
dry/itchy __ Nose dry/congested __ Tingling in
hands/feet __ Feeling swollen __ Sexual problems
ExtremeDistress
NoDistress
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DISTRESS LADDERMANAGEMENT BY STANDARDS
PRACTICE GUIDELINES
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DISTRESSScale (010)
lt 5
Adapted from WHO Analgesic Ladder
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Canada

• June, 2004 The National Cancer Council
• Distress added as the 6th vital sign
  (temperature, pulse, respiration, blood
  pressure, pain, distress)
• To be asked about routinely at patient visits

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Major Barriers in Every Country

• Poor to absent funding
• Absence of oversight and accountability
  (changing in Australia, Canada, UK)
• Awareness of the importance to patients and
  families (especially in palliative care)
• Mehnert and Koch, 2003

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Action Item - 1

• IPOS, with WHO, seeks to bring the psychosocial
  domain into global cancer control programs
• IPOS advocates for national standards and
  clinical practice guidelines

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Action Item - 2

• IPOS provides oversight of global efforts
• Collate international data for cross- cultural
  studies
• Promotes multidisciplinary multi-national
  research

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Action Item - 3

• Establish WHO-supported international standards
  and guidelines
• For use by national societies to impact
  policies on service delivery
• To provide professional training standards
• To influence national funding priorities
• To impact governmental agencies via WHO,
  UICC, IARC
• To foster research for evidence-based care

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• What we value can be seen in what we
  measure.
• Dr. Robert McMurtry
• Public Policy, Human Consequences The
  Gap Between Biomedicine and Psychosocial
  Reality
• Canada Oncology Exchange, 2003

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PAIN
DISTRESS
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8th WORLD CONGRESS PSYCHO-ONCOLOGY
"Multidisciplinary Psychosocial Oncology
Dialogue and Interaction"
18 - 21 October 2006 Palazzo del Cinema Venice,
Italy
Details will continue to be posted on the
conference website at www.ipos2006.it