Psychiatric care in oncology and palliative medicine: new challenges and future perspectives
Authors: Luigi Grassi, Michelle Riba
Journal: World Psychiatry (2021)

The World Health Organization (WHO) reports forecast an increase of cancer incidence of 40% in high-income countries and more than 80% in low-income countries by 2030, and a rise of both mortality and long survivorship. Consequently, the agenda of psychiatry in oncology and palliative medicine needs to be reviewed and updated. The mental health implications of oncologic diseases have been in fact repeatedly stressed in the last 40 years as needing attention in clinical practice, as part of person-centered interdisciplinary care. At least 30% of patients with cancer are reported to receive a psychiatric diagnosis (e.g., major depression, depressive spectrum, stress-related and anxiety disorders), while a higher percentage show other clinically relevant psychosocial conditions (e.g., demoralization, health anxiety, irritable mood)1. Mental health problems amongst patients and their families are associated with reduction of quality of life, impairment in social relationships, longer rehabilitation time, poorer adherence to treatment, abnormal illness behaviour, and possibly shorter survival2. In advanced cancer patients, these problems are even more evident, with a series of significant psychiatric and psychosocial conditions that should be a target of end-of-life care. For these reasons, it has been stated that "it is not possible to deliver good-quality cancer care without addressing patient's psychosocial health needs"3. Today, it is part of the oncology agenda worldwide that psychosocial cancer care should be recognized as a universal human right; that the psychosocial domain should be integrated into routine cancer care; and that distress should be measured as the 6th vital sign after temperature, blood pressure, pulse, respiratory rate and pain in patients with cancer4. The significant advances of research in the area of psycho-oncology have favored the development, implementation and dissemination of evidence-based treatments, both in terms of psychotherapy (e.g., supportive-expressive psychotherapy, cognitive-behavioural and cognitive-existential therapy, meaning centered psychotherapy) and integrated pharmacotherapy for psychiatric disorders and cancer-related symptoms (e.g., pain, hot flashes). However, inequalities exist in the development of psychosocial oncology worldwide. Significant economic constraints within health systems may undermine both the monitoring of distress and the process of referral to mental health services and psychiatric treatment5. A new challenge is represented by the debate on euthanasia and physician-assist­ed death, in which psychiatry and psycho-oncology have a specific role. Also, the im­plications of cancer screening and treatment among people with severe mental illness are an extremely important part of the psycho-oncology and palliative care agenda. The WPA Section on Psycho-Oncology and Palliative Care was founded in the late 1980s with the specific aim of fostering psychiatry and behavioural sciences within all fields of oncology and palliative care. The main goal is to provide optimal psychosocial care to patients at all stages of disease and survivorship, as well as support to families. The Section is committed to collect and disseminate scientific information on the most common psychopathological and psychosocial problems of patients with cancer and their families; and to establish working relations with other organizations in the field of psycho-oncology and palliative care at the international level. Collaboration with other WPA Sections, especially that on Psychiatry, Medicine and Primary Care, has been established over time, with presentations at WPA meetings worldwide and production of books6-8, scientific papers and book chapters. A num­ber of other WPA Sections have the potential to be involved in this collaboration. Today, psycho-oncology and psychiatry in palliative care are recognized as disciplines in themselves, within the wider field of consultation-liaison psychiatry. Many medical student and psychiatry residency programs as well as fellowships in consultation-liaison psychiatry include clinical rotations in psycho-oncology and palliative care. Screening for distress is now an accepted part of protocols in cancer centers and there is a growth of research aimed to better understand how to screen and provide psychiatric care using evidence-based guidelines and protocols9. Our Section has had a leading role in ad­dressing the multiple issues related to patients with co-occurring oncologic and psychiatric conditions. It will continue to work in order to improve the quality of training as well as of clinical care and research in this interdisciplinary area worldwide. Scholarly activities will continue to include opportunities for scientific presentations and training at WPA meetings, as well as collaborative research and clinical projects.