Cancer and its treatments have the potential to significantly impact on mental health, physical health and socio-economic status (finances, employment) in multiple ways. We know that 58% of people diagnosed with cancer feel their emotional needs are not looked after as much as their physical needs (Macmillan, 2006). Evidence also shows that cancer patients have a 55% higher risk of suicide than those without cancer (Calati et al, 2017).
There are several psychosocial factors that can get in the way of a person going for screening (cervical, breast), or going for tests and investigations that could be important for early diagnosis. Anxiety, panic, fear, past traumas, bereavements and loss, low mood or depression, or social isolation can all create barriers to treatment.
If a person does not receive the right psychosocial support it can become harder to stick to demanding cancer treatments, or to focus on their cancer rehabilitation with physiotherapists, occupational therapists or speech and language therapists. A significant impact can also be seen if a person does not have their emotional or psychological needs met. It can affect how they manage the consequences of cancer and its treatment, their quality of life, clinical outcomes and ultimately how well they recover from cancer and its treatments.
There are also strong economic arguments for addressing psychological needs routinely with physical health problems. A Health Foundation report (August 2018) identified that patients most able to manage a mental health condition, as well as physical health conditions:
- experienced 49% fewer emergency admissions than those who were least able.
- had a length of stay in hospital 41% shorter compared to those least able
- 32 % fewer A & E attendances
- 18 % fewer GP appointments
So why is it so difficult to get people to focus on not just the physical side of cancer and its treatment but the psychosocial side? Why are they too often treated as totally separate issues? Why are we not listening more to the voices of those with cancer who constantly talk about the biggest challenges being psychological ones or the ‘mental battle’? Why isn’t cancer psychosocial support considered an essential part of the cancer pathway rather than a non-essential ‘luxury’?
We knew that across London the psychosocial needs of those affected by cancer were not being adequately met and that it had not been clear for services and patients where they can seek support and how they can be referred. Therefore, over the last three years the Transforming Cancer Services Team has had a partnership with Macmillan Cancer Support to fund a unique programme of work to develop a Pan London approach to psychosocial support across the whole region. This work, led by myself, primarily focused on developing an integrated pathway to deliver excellent psychosocial support for all of those affected by cancer from diagnosis, through treatment, living with and beyond cancer and end of life care. Through engagement with service users, service providers and commissioners, we have co-designed a wholly integrated pathway to improve patient experience and outcomes. We know that this pathway has already supported the development and improvement of psychosocial services across several parts of London and to help with this, we have also developed a suite of documents to support clinical leaders, system leaders and commissioners across London to improve psychologically informed cancer care. This includes comprehensive commissioning guidance, a template business case and service specification, as well as detailed mapping of psycho-oncology provision across the region.
So what’s the biggest challenge now going forward? It has to be keeping this work on the agenda when cancer waits targets and early diagnosis are priorities.
Improving survival is essential but we also need to ensure that those living longer are living better lives too.
Dr Philippa Hyman, Macmillan Mental Health Clinical Lead