What does supportive care look like in practice?

Now that you had a general introduction to supportive care, it’s time to take a closer look at what it looks like in practice. If you have already watched the scene above, you will have seen that Martina meets with her practice nurse (Jackie) for the first time. At this point in the case, Martina is concerned about her husband’s welfare – particularly his concerns about the possibility that Martina’s cancer may return.

The important thing to note here is that support is available to patients and their families. This activity focuses on the types of services available, including the psychosocial aspects of supportive care.

The psychosocial aspect of supportive care

Up to 25-30% of cancer patients develop some form of psychological distress during the survivorship phase. The most common disorders include:

• Adjustment disorders
• Post-traumatic stress
• Depression
• Anxiety

These are generally triggered by:

• Fear of cancer recurrence
• Body image issues
• Sexuality and fertility concerns
• Stigmatisation and discrimination
• Social relationships
• Returning to work
• Anger and guilt

An experience of cancer can serve to trigger or exacerbate pre-existing psychological conditions in patients, their family members and carers. Risk factors for psychological disorders in cancer patients include:

• History of psychiatric illness in the individual or family
• Poor social networks
• Personality factors such as social introversion
• Stressful life events

Part of the PCP’s role in cancer survivorship is identifying and managing the range of emotions that come with a cancer diagnosis and survival, be it directly or indirectly. By recognising risk factors associated with psychological distress, PCPs can help facilitate early interventions and provide referrals, where appropriate.

It is also important that PCPs pay attention to the needs of carers, family members and children of people living with cancer because they can experience similar distress levels to cancer patients themselves. Research has shown that 25-35% of caregivers develop symptoms of emotional distress, and 15% may experience depression, irrespective of age, sex, ethnicity or stage of the disease.

Yet, fewer than 10% of cancer patients and/or their family with identified psychological needs are referred to help, with reasons including:

• Inappropriate timing of referrals
• PCPs not completing the necessary follow up including: * asking about supportive care needs * skillfully introducing supportive care services * being aware of the supportive care services in their area.

Finding a way to discuss physiological and psychological difficulties can be very difficult. A useful tool is the National Comprehensive Cancer Network Distress Thermometer, which is validated and widely used for identifying such issues. A tool like this can be used as a prompt by the PCP to encourage open and positive communication, and it may also guide clinical decision making and lead to identifying issues and referring as necessary.

Now that you have had a brief introduction to supportive care, read pages 7-10 of the Australian Clinical practice guidelines for the psychosocial care of adults with cancer – Summary of Evidence.

Consider exploring one of the guidelines listed by reading the background evidence that supports the statement. eg. If you chose to explore the statement from Chapter 3.3 – Emotional and social support, on “Appropriate counselling improves the well-being of people with cancer”, to find the evidence that supports this statement refer to reference 15 by Devine et al on “The effects of psychoeducational care provided to adults with cancer: meta-analysis of 116 studies.

If you’re interested in learning more about psychosocial care, please refer to the resources in the ‘See Also’ section below.

Reference: Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, de Wit N, Zimmermann C. (2015). The expanding role of primary care in cancer control. The Lancet Oncology, 16(12), 1231-1272. DOI: 10.1016/S1470-2045(15)00205-3