In a series of papers on cancer and mental health, published in The Lancet, The Lancet Psychiatry and The Lancet Oncology – depression was found to be 2 to 6.5 times more common at any point in time in cancer patients than in the general population; however they are undertreated. A series of case studies, involving more than 21,000 people, showed that cancer patients with psychiatric issues respond well to treatment, particularly psychotherapy. While other studies have shown similar results (the psychological stress of cancer), The Lancet-The Lancet Psychiatry-The Lancet Oncology series well illustrates the hopefulness of the situation — that is, with proper care, these patients can improve dramatically.
Recognizing the great unmet mental health needs of cancer patients, the Mental Health Program at The Scarborough Hospital made it a priority to provide enhanced services to this patient population. In partnership with Centennial College (and a federal grant for health care innovation using technology) a web-based e-therapy platform was designed to provide internet assisted Mindfulness Based Stress Reduction (MBSR) to cancer patients that allow them to access services on their own schedule. The e-therapy approach and platform is adaptable, flexible and individualized to suit the unique needs of each patient.
Psychosocial distress in cancer patients exists on a continuum ranging from normal "situational stress" to major depressive disorder. To effectively match patient needs with treatment interventions, we provide a continuum of services. This model allows us to leverage technology to provide flexible services and manage increasing volumes. Patients referred to the program are triaged by the mental health nurse into various levels of support, from very low intensity to higher intensity, leaving more direct therapist time for complex patients who have more intense distress. This model includes five "steps" (or levels) of support.
Step one: Mindfulness. (An introduction to our MH services.)
Pre-recorded Mindfulness Meditation sessions through MP3 players while receiving chemotherapy.
Step two: Empowered self-help.
Evidence-based resources from a cancer specific App Library.
Step three: Peer support with therapist intervention.
Therapist-guided peer support through a specially designed Web Chat Room.
Step four: e-Mindfulness.
Internet-assisted Mindfulness program.
Step five: Traditional Mindfulness groups.
Traditional Mindfulness groups (with online resources as augmenting the group work).
Healthcare institutions are constantly thinking about ways to improve services to better meet the needs of patients, while still providing services that are accessible, effective, and efficient. The stepped-care program that TSH is implementing for oncology patients shows how innovation and creativity can help reduce barriers and improve access to care
1. Sharpe, M, Walker, J, Holm Hansen, C, et al. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet. 2014; (published online Aug 28.)
2. Walker, J, Holm Hansen, C, Martin, P et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol. 2014; (published online Aug 28).
3. Walker, J, Holm Hansen, C, Martin, P et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry. 2014; (published online Aug 28.)
4. Brown, LF, Kroenke, K, Theobald, DE, Wu, J, and Tu, W. The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology. 2010; 19: 734–741
5. Rodin, G. Effective treatment for depression in patients with cancer. Lancet Psychiatry. 2014; (published online Aug 28.)
Title: Patient Care Director- Mental Health
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