Interventions which have established roles in managing significant distress in people affected by cancer are summarised below.58
Cognitive behavioural therapy
- Includes cognitive, cognitive behavioural and behavioural therapies. Teaches skills in problem-solving, reframing attitudes, e.g. challenging “black and white” thinking, coping with stress and anxiety. Relaxation therapy, guided imagery or cognitive skills might be used in dealing with stressful situations such as particular treatments, or to reduce nausea associated with chemotherapy. Techniques to enable gradual adaptation might also be included.
- Improvement in emotional distress, coping, anxiety, depression and a psychiatric morbidity; Decrease in nausea, vomiting and insomnia; increase in control over illness.
Supportive psychotherapy
- Encourages the expression of emotions, validates the experiences of the individual, and offers support through empathetic listening and encouragement, and provision of information. Reflects on the strengths of the individual and encourages use of adaptive coping techniques. Sometimes called supportive, existential or supportive-expressive.
- Improvement in mood, coping and physical and functional adjustment.
Group therapy
- Places emphasis on sharing of experiences among patients with a comparable stage of disease. Participants feel that their experiences are validated, and they can contribute in a meaningful way to the well-being of other members of the group. Can use cognitive behavioural or supportive psychotherapy, and include educational and information components.
- Improvement in mood, coping and adjustment, anxiety and depression; positive immune function changes.
Family therapy
- Enhances communication, cohesion and conflict resolution within the family system, including the needs of children. Can use cognitive behavioural or supportive psychotherapy.
Couples therapy
- Targets problems and issues within the couple relationship. Can use cognitive behavioural or supportive psychotherapy.
- Reduces levels of depression and psychological distress. Beneficial in increasing sexual satisfaction.
Telephone counselling
- Provides geographically-isolated patients with an opportunity for cognitive behavioural or supportive psychotherapy interventions. Also useful for providing casework support, e.g. reassurance, information provision and referral.
Other therapies
- Other therapies may include art therapies, e.g. music, painting, reading and poetry, wellness programs, medication, hypnosis, acupuncture, relaxation, exercise, prayer, laughter etc.
- Improvement in mood, coping, anxiety, depression, breathing; Reduction in nausea and pain.
Other specialist services
- Includes speech therapy, physiotherapy, occupational therapy, dentistry, endocrine therapy, plastic surgery, reconstructive surgery, nutritionist, fertility services, specialised pain services.
- Target specific physical symptoms or impairment resulting from the disease or treatment. Assists in reducing pain, restoring or improving physical functioning or appearance.
The Tiered Intervention Model for Psychosocial Interventions provides a framework which can guide the implementation of psychosocial care (Hutchison, Steginga and Dunn, 2006).5 This framework, adapted in Table 3, is based on the concept of triage or treatment matching following screening to match the level of distress and expressed need to an appropriate level and provider of care. This generic approach can be adapted to any cancer setting through a scoping of existing services to meet the needs at the various levels of the model.59
Table 3: Tiered Intervention Model for Psychosocial Interventions
Adapted from Hutchison, Steginga & Dunn (2006, p.534)59 and Department of Health, Western Australia (2008, p. 21)60
| Level of Distress / Complexity of Need | Level of Intervention | Methods | Appropriate services | Possible target areas / Example of psychosocial issue |
| For all people affected by cancer and minimal to mild distress | Universal care Information and advice |
General information Information about treatment and specific or common problems |
Primary care team Tele-based cancer help-lines Print, electronic and audio-visual patient education resources |
Information about medical treatments Coping with treatment side-effects How to talk to / assist a family member with cancer Practical concerns |
| Mild to moderate distress | Supportive care Psycho-education, emotional support and / or triage |
Psycho-education combined with emotional support for mild distress Peer support Decision support |
Tele-based cancer help-lines Hospital or community-based support programs, e.g. psycho-education programs, peer support programs, cancer social worker, cancer nurse |
Treatment decision making Communicating with health professionals Problem solving specific issues Coping with emotions Social isolation |
| Moderate distress | Extended care Focused counselling with psycho-education and coping skills training |
Focused individual, couple, family or group counselling including psycho-education and support | Programs / therapy provided by trained health professional e.g. Social worker, psychologist, psychiatrist, nurse with specific training in supportive care interventions | Adjustment to cancer / grief Stress management Communication skills Partner support skills Coping skills |
| Moderate to severe distress | Specialist care Narrow focus with skilled therapist |
Psychotherapy, couple and relationship therapy, or family therapy with mental health practitioner | Cognitive behavioural, interpersonal and supportive expressive therapy by mental health professionals with experience in oncology e.g. Psychologist, psychiatrist, sex therapist, grief therapist Pharmacotherapy by primary care physician or psychiatrist |
Mood and anxiety disorders Trauma, relationship and sexuality problems |
| Severe distress | Acute care Broad focus, specialist services or multidisciplinary team |
Therapy with specialist mental health professional to deal with multiple problems | Specialist community or hospital based mental health or psycho-oncology team e.g. Psychologist, psychiatrist, family therapist, multidisciplinary mental health services | Multiple, complex or severe problems Suicide ideation Personality issues Severe couple problems Family system problems |
Learning Activities
Based on the screening and assessment undertaken with Jane, consider which supportive care interventions may be appropriate to support her psychological wellbeing.
Next: Interventions to manage symptoms and treatment effects