Psychosocial Oncologists Committed to Ending Disparities in Cancer Care
Patients with cancer and their care supporters may experience many forms of physical and mental distress throughout their cancer trajectory. As an integral component of cancer care, psychosocial oncology helps cancer patients and their loved ones, address the psychological, behavioral, emotional, and social issues that may arise.
The American Psychosocial Oncology Society (APOS) is the nation’s only multidisciplinary organization dedicated to the psychosocial care of individuals affected by cancer and has a thriving network of professionals working to enhance psychosocial oncology research, education, and clinical practice.
APOS hosts an annual conference attended by over 500 professionals who come together to share new research and innovation. It also offers a wealth of education, career, and other resources to its individual and institutional members.
Advocating for Diversity, Equity, Representation and Inclusion
Among APOS’s core values is a commitment to “advocating for diversity, equity, representation and inclusion in advancing the science and practice of psychosocial oncology care, recognizing the rights of all those affected by cancer to receive comprehensive person and family-centered care.”
Kelly Irwin
“As psycho-oncology professionals, we know firsthand how disparities in cancer diagnosis, treatment, and survivorship affect health outcomes across our communities,” said Kelly Irwin, MD, APOS president and faculty psychiatrist at the Massachusetts General Hospital (MGH) Cancer Center, where she also serves as the director of MGH’s Collaborative Care and Community Engagement Program, a research and clinical program focused on improving cancer outcomes for people with severe mental illness. “Even as cancer care has advanced dramatically over recent decades with precision medicine and targeted therapeutics, we recognize that not all patients are benefitting equally, including those with mental illness.”
More than 15 million Americans are estimated to have a mental illness and people with a mental illness die two to three decades earlier than the general population. According to Dr. Irwin, people with pre-existing mental health conditions are one of the least visible groups in the efforts to promote cancer equity and ameliorate cancer disparities.
“Although people with a mental illness are not more likely to be diagnosed with cancer, they are two to four times more likely to die from many common cancers, in part due to inequities across the cancer care continuum,” she said. “They face decreased access to screening, tobacco treatment, multidisciplinary consultation, guideline-concordant care, and palliative care.”
Additional disparities in cancer care for people with a mental illness are tied to the inability to participate in clinical trials, which often can be the only way for someone to access lifesaving cancer care. Half of clinical trials exclude people with pre-existing mental health conditions.
Financial Toxicity and Its Impact on Psychosocial Cancer Care
Even when mental health services are made available to people living with cancer, not everyone can afford treatment, according to Dr. Irwin, who said that people in lower socioeconomic brackets face higher rates of mental health needs. In addition, many insurance providers do not cover mental health services, leading to additional costs for patients and their loved ones.
“There are often higher rates of trauma, anxiety, and post-traumatic stress disorder among lower socioeconomic populations,” she said. “Add a life-altering illness like cancer into the mix and it can lead to a cumulative burden with more out-of-pocket costs, which makes it harder to transition to survivorship.”
Dr. Irwin noted that one of the most vulnerable times for cancer patients in terms of their mental health is when they finish acute treatment and become cut off from the support systems available through their cancer center. She pointed to community-based organizations and patient advocacy organizations as a critical bridge, providing the mental health care patients need to transition back to their lives.
Increasing Access to Psychosocial Oncology Care
APOS believes that all patients with cancer deserve access to psychosocial cancer care as recommended by the Commission on Cancer. However, psychosocial cancer care can be difficult to access outside of academic medical centers that integrate psychosocial care into their care delivery systems.
APOS seeks to change that paradigm and make sure that no matter where a clinician works, they can access best practices and a supportive community of peers when managing complex psychosocial issues. That means bringing together interdisciplinary groups of all professionals tasked with caring for people with cancer and meeting their psychosocial needs, including social workers, nurses, psychologists, psychiatrists, oncologists, palliative care providers, and other clinicians.
“APOS brings all these professionals together to share best practices, cutting edge research, and clinical innovation, and to collaborate on the steps we can take to ensure that everyone affected by cancer has the access they need to expert care,” Dr. Irwin said.
Dr. Irwin pointed to her work at MGH, where an evidence-based collaborative care intervention delivery model has increased access to psychosocial care for cancer patients. Within this model, clinicians screen cancer patients for mental illness at the time of their cancer diagnosis. Patients with serious mental illness are connected directly to a psychiatrist and social work team who address barriers to care and collaborate with the oncology team.
“This model improves psychosocial outcomes and is also associated with the patient being more likely to receive guideline-concordant cancer care, which is associated with improved survival,” she concluded. “It is a good example of the many ways psychosocial oncology is developing innovative strategies to reach a vulnerable population that may not proactively present with distress.”
Editor’s Note: Are you or a loved one living with cancer and/or a behavioral health condition and need assistance affording your treatments? The HealthWell Foundation offers a range of financial assistance funds that may help. For more information and to determine eligibility visit healthwellfoundation.org/disease-funds/
**If you or someone you know needs immediate help, please call 988 or visit https://988lifeline.org for the Suicide and Crisis Lifeline.**
