Psychosocial Oncology May Benefit From System Reform

PALM SPRINGS, Calif--The United Kingdom, not unlike the UnitedStates, is undergoing a period of radical change in the organizationof cancer services, the status of the medical professionals deliveringthose services, and the climate for conducting clinical research,Ann Cull, PhD, said at the American Society for Psychiatric Oncology/AIDSmeeting.

Such changes are creating a crisis for psychosocial oncology,but may also open up new opportunities, as the need for psychosocialservices and research to help control cost becomes apparent, shesaid.

The National Health Service, the UK's central socialized medicinedelivery system, is being gradually dismantled, Dr. Cull said,and replaced by local health trust organizations.

With the intent of establishing primary care physicians as theprincipal providers of services to cancer patients, the governmentis setting up "cancer units" in district hospitals designedto manage patients with common cancers under the direction ofpractice guidelines.

Larger designated cancer centers will be responsible for handlingthe full range of cancer diagnoses, as well as providing specialistand consultant services, said Dr. Cull, a clinical psychologistand researcher at the Western General Hospital, a regional cancercenter in Edinburgh.

Although the rationale behind the development of this new structurefor cancer care delivery appears to be directed toward improvingstandards of care, she said, members of the oncology communityworry that these changes will lead to a "leveling down"of services.

"In the area of psychosocial oncology, where the provisionof services is somewhat patchy even in the cancer centers, thereis concern about how these smaller cancer units will be able toprovide comprehensive care," she commented.

Dr. Cull pointed out that the extra expense associated with clinicalresearch is also being more carefully scrutinized as hospitalstake on independent management status, albeit under the umbrellaof the National Health Service.

A More Optimistic View

Against this backdrop, the role for psychosocial oncology researchmay look bleak, Dr. Cull said, but she also pointed out more positiveways of looking at these changes. For example, the increased relianceupon a market economy gives choices to the health-care consumer,which may translate into greater patient empowerment.

Increasingly in the UK, she noted, health-care providers and patientsare recognizing that treatments need to be evidence based as wellas cost effective. "These parameters create unprecedentedopportunities for researchers in psycho-social oncology to showtheir colors in a subspecialty that is, by definition, patientcentered, data led, and relatively inexpensive," Dr. Cullsaid.

An important shift in health policy in the UK is away from "cancercure at any price" in favor of strategies directed towardhealth promotion and early detection, she said. Patient-centeredapproaches that developed from the hospice movement in the UKare increasingly influencing the primary care sector as well.

In each of these areas, there is the recognition that psychosocialcare is essential, Dr. Cull said. In fact, the government in theUK is fostering the integration of research and practice, andthree areas have been chosen as psychosocial research priorities:services for those at increased genetic risk, psychosocial outcomesof treatment, and patient's and relative's psychosocial adjustment.

"Psychosocial research is politically correct, welcomed bythe patient, evidence based, and inexpensive," Dr. Cull emphasized.