1. The International Psycho-Oncology Society (IPOS)
Jimmie C. Holland, M.D.
Wayne E. Chapman Chair in Psychiatric Oncology
Memorial Sloan-Kettering Cancer Center
New York, New York
7th World Congress 2004*

3. IPOS: Founded 1984
To improve the “human” side of cancer care on a global basis

4. IPOS: 1984 Foster international communication
Educate professionals in psychosocial care across countries
Advocate for making psychosocial an integral part of total cancer care
Examine social, cultural factors that impact quality of life and care

5. An International Survey of Physician Attitudes and Practice in Regard to Revealing the Diagnosis of Cancer
Jimmie C. Holland, M.D.,
Natalie Geary, B.A.,
Anthony Marchini, B.A., and
Susan Tross, Ph.D.
Psychiatry Service
Memorial Sloan-Kettering Cancer Center
New York, New York, 10021
Cancer Investigation, 5(2), (1987)

6. Oncologists Estimated Percentage of Physicians in Their Country Who Disclose Cancer Diagnosis
N = 90 oncologists; 20 countries
Tell to the Patient:
LOW% HIGH%
Africa Austria
France Denmark
Hungary Finland
Iran Netherlands
Panama New Zealand
Portugal Norway
Spain Switzerland
Sweden
Tell to the Family:
High % estimated by majority of physicians

7. IPOS: 2005 Conducted 7 World Congresses 2006, Venice
Education
Conducted 7 World Congresses , Venice
> 25 national psycho-oncology societies
International journal, 1992
Psycho-Oncology
Text books in English, Spanish, Italian, and Japanese

8. IPOS: 2005 Education 2004 Website: www.ipos-society.org
Core curriculum online – FREE
4 lectures, with European School of Oncology in
Italian German
French Hungarian
Spanish English

9. IPOS: 2005 Requested to become an NGO of World Health Organization
Rationale: to add a psychological, social and behavorial dimension to WHO national cancer control programs

10. WHO Priority Action Plan for National Cancer Control Programs
Resources
A B C
Low Medium High
Prevention
Early diagnosis
Screening/therapy
Pain/palliative care
PSYCHOSOCIAL

11. WHO Cancer Prevention Program
Depends on changes in life style and exposures: must alter BEHAVIOR
Psychological and social factors are critical considerations in prevention education which must be culture and language-sensitive
Behavioral scientists needed
(Tobacco Cessation)

12. WHO Cancer Control Program Early Diagnosis
Fatalistic attitudes, fear of stigma of cancer, and ignorance are problems, especially in developing countries
Public education requires attention to psychological, social, cultural, and behavioral factors

13. WHO Cancer Control Screening
Participation in screening require attention to local social attitudes, beliefs, trust in procedures/staff, and awareness of cultural factors
Requires knowledge of community, beliefs, and fears

14. WHO Priorities for National Cancer Control Programs
Pain/Palliative Care

15. In Palliative Care Pain is often the primary focus
Psychological issues are often not identified and treated as an equally important aspect of end-of-life care
Need for more participation of psycho- oncologists in end-of-life for clinical and research collaboration

16. IPOS Goals in Palliative Care
Encourage recognition, diagnosis and treatment of psychosocial and psychiatric problems
Develop standards and clinical practice guidelines for psychological care

17. National Programs Standards and Guidelines
Australia United Kingdom Canada United States

18. US Example: 1999 A Multidisciplinary Panel (NCCN)
Chose “DISTRESS” as an encompassing word to cover psychosocial/ psychiatric and spiritual
A rapid one-item screening question
Standards care and Clinical Practice Guidelines for mental health, social work, clergy

19. DISTRESS CONTINUUM Normal Distress Fears Worries Sadness
Severe Distress
Depression,
Anxiety
Family
Spiritual

20. STANDARDS OF CARE FOR MANAGEMENT OF DISTRESS - 1
Distress should be recognized, monitored, documented and treated promptly at all stages of disease
All patients should be screened for distress at their initial visit and as clinically indicated
Screening should identify the level and nature of the distress
Distress should be assessed and managed by evidence or consensus-based clinical practice guidelines
Adapted, NCCN

21. BRIEF SCREENING TOOL AND PROBLEM LIST
During the past week,
how distressed have you been?
Please indicate your level of distress on the thermometer
and check the causes of your distress.
Practical problems
__ Housing
__ Insurance
__ Work/school
__ Transportation
__ Child care
Family problems
__ Partner
__ Children
Emotional problems
__ Worry
__ Sadness
__ Depression
__ Nervousness
Spiritual/religious concerns
__ Relating to God
__ Loss of faith
__ Other problems
Physical problems
__ Pain
__ Nausea
__ Fatigue
__ Sleep
__ Getting around
__ Bathing/dressing
__ Breathing
__ Mouth sores
__ Eating
__ Indigestion
__ Constipation/diarrhea
__ Bowel changes
__ Changes in urination
__ Fevers
__ Skin dry/itchy
__ Nose dry/congested
__ Tingling in hands/feet
__ Feeling swollen
__ Sexual problems
Extreme Distress
No Distress
BRIEF SCREENING TOOL AND PROBLEM LIST

23. DISTRESS LADDER: MANAGEMENT BY STANDARDS & PRACTICE GUIDELINES
≥ 5
DISTRESS Scale (0–10)
< 5
Adapted from WHO Analgesic Ladder

24. Canada June, 2004 The National Cancer Council
Distress added as the 6th vital sign (temperature, pulse, respiration, blood pressure, pain, distress)
To be asked about routinely at patient visits

25. Major Barriers in Every Country
Poor to absent funding
Absence of oversight and accountability (changing in Australia, Canada, UK)
Awareness of the importance to patients and families (especially in palliative care)
Mehnert and Koch, 2003

26. Action Item - 1
IPOS, with WHO, seeks to bring the psychosocial domain into global cancer control programs
IPOS advocates for national standards and clinical practice guidelines

27. Action Item - 2 IPOS provides oversight of global efforts
Collate international data for cross- cultural studies
Promotes multidisciplinary multi-national research

28. Action Item - 3
Establish WHO-supported international standards and guidelines
For use by national societies to impact policies on service delivery
To provide professional training standards
To influence national funding priorities
To impact governmental agencies via WHO, UICC, IARC
To foster research for evidence-based care

29. “What we value can be seen in what we measure.”
Dr. Robert McMurtry
“Public Policy, Human Consequences: The Gap Between Biomedicine and Psychosocial Reality”
Canada Oncology Exchange, 2003

30. PAIN
DISTRESS

31. 8th WORLD CONGRESS PSYCHO-ONCOLOGY
"Multidisciplinary Psychosocial Oncology:
Dialogue and Interaction"
October 2006
Palazzo del Cinema Venice, Italy
Details will continue to be posted on the conference website at