I attended the IPOS 16th World Congress of Psycho-Oncology and Psychosocial Academy meeting in Lisbon, Portugal in October 2014 and want to give you a brief summary of some of the information I gathered.

IPOS is the International Psycho-Oncology Society and American Psychosocial Oncology Society (APOS) is the American branch. IPOS began in 1984, and I was able to attend the first meeting in Beaune, France. At the time, I had just finished my study and had a poster explaining the study at the conference, which became the book, Breast Cancer in the Life Course: Women’s Experiences (Springer, 1991).

I especially enjoy going to IPOS meetings because there are people there from all over the world! Also, it is interdisciplinary, with many physicians, psychologists, nurses and others, all focused on psychosocial oncology. Unfortunately, not many social workers attend. That is largely because, in many parts of the world, social workers do not often provide psychosocial services in oncology. I think it is very important that North American social workers learn about what is going on in this field in other parts of the world, even though the health systems are very different. I am always inspired to learn about the wonderful things that are being done in other countries. At the same time, I am moved to see what dedicated and wonderful people are working to bring even basic services to those with cancer in the less developed parts of the world.

Psychosocial Oncology Around the World

One interesting session at this IPOS meeting offered an overview of psychosocial oncology in the different continents. The more advanced countries with national health systems have succeeded in getting psychosocial oncology included in their national health goals, and are now working to include training for health providers. Their current goals focus on getting part of the budget allotted to meet their goals and reduce inequities among countries (e.g., Europe, where the poorer countries have many fewer psychosocial oncology services).

Canada provides an especially interesting model for U.S. social workers. (We have members from Canada and perhaps we should more systematically learn from their experiences.) Deborah McLeod, a nurse, said Canada has funding for distress screening, but funding for follow-up interventions is sometimes lacking. Canada is expanding training for health providers via on-line courses and webinars. McLeod also talked about efforts to educate the public about the availability of the psychosocial services.

Australia is not as far along as Canada, but they have a “best practices working group,” which might be an idea we could emulate. The speaker from Australia also mentioned the need for research with cost-benefit analysis for psychosocial services, something I know our members would also value. The presenter from the U.S., Michelle Fingeret, a psychologist, I think, did not mention social workers at all, but did mention the joint position statement on distress screening to which AOSW is a party.

The picture from other areas of the world is, understandably, less rosy regarding psychosocial oncology. In China, for example, the caseloads of oncologists are huge (seeing hundreds of patients a day), so little attention is going in the direction of psychosocial issues. (This is not the case in some of the major cancer centers, of course.)  In Africa, cancers are still being diagnosed very late in the disease, the death rate is high and the number of trained health providers in oncology is very small. (I think the speaker said the number of oncologists in Kenya was less than 10!) 

Distress Screening

Research on distress screening has come a long way! Although there are still some studies that focus on the different ways of measuring distress (e.g., DT, HADS), more studies are now looking at characteristics of distressed patients (e.g., younger patients, women, patients with poor prognosis). Also, of special interest to AOSW members, there are some studies on which distressed patients are most likely to use social services (counseling).

Widespread use of distress screening in many parts of the world makes it possible to begin to compare information and experiences on this issue in different countries and populations. Evidence suggests that while those who use supportive services are more likely to be distressed, many patients with high distress are still not getting services. (Studies show as many as two-thirds of high distress patients do not make use of offered supportive services.) I expect researchers will be looking into this further in future years. Certainly, countries that provide free access to social services (unlimited) have higher rates of service use, but other factors have been found to be relevant, such as access to services (e.g., distance), other resources available to patients (e.g., urban areas may offer many ways to find support, rural areas less so) and timing (patients may need some time after being diagnosed to be ready for these services).

One study showed that persistent follow-up pays off. Most patients with high distress screening scores could be contacted if five follow-up calls were made, and most of those contacted did come in for supportive care at some point.

Interventions

There were a number of sessions dealing with “meaning-centered psychotherapies.” These are manualized interventions (i.e., a very specific set of instructions is used to train and monitor practitioners when the intervention is being evaluated) in both individual and group formats (meaning-centered group psychotherapy).

William Breitbart, a psychiatrist at Memorial Sloane Kettering in New York City and the developer of these interventions, coauthored two books, one on the individual intervention and the other on the group format (Breitbart & Poppito, 2014). The intervention was originally developed for those in advanced stages of cancer. Several papers at IPOS also described offering MCP for different populations (e.g., survivors, end-of-life, various countries). Most of these described early stages of research (e.g., focus groups, feasibility studies) with small samples and very preliminary results.

There was a session on CALM therapy (CALM = Managing Cancer and Living Meaningfully).  A workshop on CALM was offered at the 2015 AOSW Annual Conference. If you missed it, you can contact AOSW Headquarters for more information.

CALM covers four dimensions:

1. Symptom management and communication with health care providers,
2. Changes in self and relations with close others,
3. Spirituality or sense of meaning and purpose, and
4. Thinking of the future, hope and mortality.

Qualitative analysis revealed five beneficial topics that were addressed through CALM:

1. Having a safe place to cope with the disease,
2. Feeling empowered in medical decision-making,
3. Learning how to better communicate with close others,
4. Talking to a neutral, professional person, and         
5. Learning to talk about dying.

A small quantitative study from Germany also showed potential. However, it is too early for conclusions.

This brief summary describes only a small portion of the research presented at the IPOS conference. If you are interested in exploring other topics and presentations, you can see all of the abstracts in the journal PsychoOncology.

I hope you found this summary interesting. If you have any questions or research topics you would like me to explore, please contact me. My next column will be a summary of some of the research presented at the 2015 AOSW 31st Annual Conference.  

References
Breitbart, W., & Poppito, S. (2014). Individual meaning-centered psychotherapy for patients with advanced cancer: A treatment manual. New York: Oxford University Press.

Breitbart, W., & Poppito, S. (2014). Meaning-centered group psychotherapy for patients with advanced cancer: A treatment manual. New York: Oxford University Press.