Physicians Play Critical Role in Emotional Aspects of Care of Cancer Patients

I read with dismay statements made by and attributed to Winfield Boerckel, CSW, a Cancer Care, Inc. information support systems coordinator and a lung cancer support group facilitator, in the March 2001 issue of ONI ("Relieving the Symptoms of Lung Cancer and Its Treatment").

The article states that Mr. Boerckel "pointed out that the physician is generally not the right person from whom to seek emotional support." In a quote, Mr. Boerckel said: "It is important to see physicians as being there to provide information and treatment… Communications with the physician should focus on getting information about disease and treatment."

It is quite unfortunate that Mr. Boerckel does not view the physician as the "right person" to provide emotional support to the patient. Who then is the right person, if not the physician? While a multidisciplinary approach to patient care should be the norm for cancer patients, the role of the physician must always include attending to the emotional aspects of patient care.

A physician may choose with the patient and family to explore ways of obtaining additional emotional support, psychosocial evaluation, psychiatric intervention, etc. Referrals may be made to mental health professionals. Similarly, patients and families may readily identify the need for additional help, through individual, family, or group psychotherapy or pharmacotherapy.

All physicians understand the importance of the emotional aspects of cancer and its treatment. Certainly, we need better and more consistent screening of all cancer patients to identify distress. We know, for example, that it is often very difficult to separate out the vegetative symptoms of depression from the side effects of various oncologic treatments.

Screening instruments such as the NCCN Distress Thermometer[1] will allow busy clinicians to routinely identify those patients who are having emotional problems and then triage those patients to the appropriate level of care.

At the University of Michigan Comprehensive Cancer Center, we try to identify patient and family distress and work in a cooperative, multidisciplinary manner to address both physical and emotional needs.

While patients and families may get additional support and psychosocial evaluation and care, the physician is always listening for and attending to the emotional needs of the patient. Although cancer centers are busy and there are time limitations, focusing on the psychosocial issues of cancer is central to quality care.

Physicians should not delegate the emotional aspects of care to other clinicians, as Mr. Boerckel suggests. Certainly, other professionals can and should help in the multidisciplinary approach to patient care. The bond, however, between a doctor and patient[2] goes beyond the technical aspects of chemotherapy, radiotherapy, surgery, etc. It is a critical element of patient care and always includes the emotional care of the patient.

References:

1. Holland J, Benedetti C, Breitbart W, et al: NCCN Practice Guidelines for the Management of Psychosocial Distress. Oncology 13:5A:113-147, 1999.

2. Tasman A, Riba M, Silk K (eds): The Doctor-Patient Relationship in Pharmacotherapy: Improving Treatment Effectiveness. New York, NY, Guilford Publications, 2000.