Over the past decade much progress has been made in raising awareness of mental health as an important aspect of the cancer experience requiring screening and then treatment. The concept of measuring distress as a “sixth vital sign” in cancer was endorsed at the UICC in 2010 and subsequently many cancer led organisations internationally have endorsed this approach. Importantly, the terminology of distress was considered more acceptable for patients.
From a treatment perspective the continuing emphasis on diagnostic criteria associated with psychopathology is well established and derives in part from original applications in mental health. The limitations of this pathology-based approach still inform the debate about both screening and traditional psychological treatments developed within the paradigm of psychopathology (e.g., Cognitive Behavioural Therapy) are still frequently applied.
This presentation argues for a shift in emphasis towards a trans-diagnostic approach to diagnosing and treating the psychosocial impact of cancer in order to better reflect the everyday experiences of people with cancer, given that dominant themes include impacts of disease, treatment burden, chronic illness, functional loss, loss of health and life opportunities, managing relationships, and/or dealing with advanced disease and preparing oneself and ones family for death. Trans-diagnostic approaches would explicitly acknowledge these experiences as both normal and adaptive despite significant psychological suffering, distress, and trauma. For the majority of people with cancer, the prevalence and experience of subclinical mood disturbance, symptomatic distress and existential concerns will likely be more distressing. Arguably less progress has been made in defining why a person should be referred for psychosocial support, and which psychological interventions and approaches will be of most benefit to people with cancer.
Such an approach allows a rethink of screening and referral and generate a new dialogue about which psychological supports a) best address the existential and experiential crisis that ensues for many people diagnosed with cancer b) de-pathologise the psychological impacts of cancer experience and c) explore a preventative approach that will proactively support patients to manage the burden of illness and treatment and d) improve the framework for health care clinicians to better assess and refer the person with cancer.