We need to better understand the emotional impact of cancer

Why the emotional distress and psychological burden of cancer care is important…

Being told that you have cancer is a life-changing event – it brings fears of intense pain, loss of control, stigmatisation and death (Holland et al. 1989). That’s why emotional distress is globally recognized as the sixth vital sign in cancer care, being a core indicator of a patient’s health and wellbeing (Bultz & Carlson, 2005). Emotional distress or anxiety symptoms in cancer patients don’t fit the usual clinical definitions of common mental disorders. Studies have shown that, during the time of cancer diagnosis, about 30% of patients suffer from psychological distress, and up to 70% will experience some level of anxiety or depression throughout their experience with cancer. However, in clinical practice, psychological distress is often overlooked and undertreated (Absolom et al. 2011; Mitchell et al. 2011; Singer et al. 2010, 2013; Vehling et al. 2012).

Emotional distress is globally the sixth vital sign in cancer care, a core indicator of a patient’s health and well-being, but is often overlooked. Culturally, clinical aspects of cancer care are perceived to be most important and valued. Conversely, psychosocial care of cancer remains stigmatized and the least valued. Neglecting psychological distress can lead to negative effects for patients, including significant impairment, reduction in quality of life, compliance of medical treatment, and potentially increased risk of mortality (Linden et al., 2012). This is why cancer patients around the world are calling for psychological care to be fully recognized as a central part of cancer treatment (GarciaPrieto, 2018). It is therefore important to identify and support patients not just in clinical but psychosocial aspects. But supporting patients and carers through their cancer experience to improve pharmacological treatment outcomes requires an understanding of the trajectory of emotional distress throughout the illness.

A collaboration to help transform cancer care in Singapore

Given the importance of the emotional aspects of cancer care, Cerner Enviza is proud to be collaborating with the National Cancer Centre Singapore (NCCS) on a research study to better understand this issue. This collaborative study focuses on assessing the effects of timely cancer detection on the quality of life of colorectal and breast cancer patients in Singapore. By combining NCCS's clinical expertise with Cerner Enviza's real-world qualitative and psycho-oncology expertise, we aim to transform cancer care and improve patient care and, hopefully, outcomes. This patient-centered research seeks to understand whether and how early detection leads to improved patient experiences; including reduced stress, alleviated anxiety symptoms, and an enhanced overall quality of life.

Cerner Enviza's proprietary Psycho-Onco EMotional anxiety (POEM) framework will underpin the research to comprehensively explore and understand the psychological factors driving and maintaining anxiety symptoms through the cancer experience and evaluate the psychosocial impact of living with cancer.

A model of the psychological factors that affect anxiety in cancer care

Cerner Enviza’s POEM framework is a model of cancer-related anxiety to elucidate the psychological factors that drive and maintain symptoms of anxiety in the context of an ongoing cancer threat. The POEM Framework is a patient-centric model that synthesises the importance of pre-existing characteristics, aspects of the cancer experience, cognitive factors, coping attempts, and contextual factors in the development and/or maintenance of anxiety. The cancer experience is categorised by uncertainties about prognosis, the most appropriate treatment, fear of progression/recurrence, and possible future impacts.

The 2 parts of the POEM framework are designed to help to:

• - Identify and understand the specific behaviors/ aspects of the cancer experience that are causing anxiety.
• - Understand a person’s perception of self – their identity and roles, and how it impacts their behavior towards management and cancer care.
• - Explore core beliefs, fears, threat perceptions and tolerance of uncertainty to help address and alleviate them.
• - Identify communication patterns and social constraints between healthcare professionals (HCPs), patients, and caregivers to improve communication and establish trusting relationship.

Studying the psychological effects of a cancer diagnosis allows us to understand the cognitive response to the inherent threat of cancer, which is crucial in explaining the subsequent emotional response including anxiety. A better understanding of these effects may enable prioritization and designing of better and more targeted solutions and interventions.

Supporting cancer patients and their caregivers throughout their cancer experience requires an understanding of the nature and trajectory of emotional distress during their illness. Together, Cerner Enviza and NCCS aim to gain a deeper understanding of the real-life experiences and unmet needs of living with the illness in order to assess its impact and identify areas where patients and carers can be better supported.