How many people with distress or
depression receive psychosocial care
in cancer settings?
………………An updated meta-analysis

...
Daily Mail
Screening
Symptoms
Help-seeking
Diagnosis
Treatment
Aftercare
Context
Millions Living with Cancers (2010 SEER)

14

13

12
9.6

10

8
6.6

6
4.6

4

3

2

0
:1970

:1980

:1990

http://seer.ca...
Prevalence of depression in Oncology settings

Proportion meta-analysis plot [random effects]

0.5600 (0.4572, 0.6592)

Ci...
“Most Pressing Issue”
Leicester
N=540
Rates of medical care?
Baseline treatment and diagnosis rates
Chances of No Treatment for Colorectal
Ca (2011)
14

12

10

8

6

4

2

0
No m ental
disorder

Substance
abuse disorder

...
Chances of No Diagnosis for Colorectal Ca
(2011)
10
9
8
7
6
5
4
3
2
1
0

No Mental
Disorder (n
559,971)

Substance Use
Dis...
Dx Mental Health?
Are mental health diagnosed?
100.0
5.9
11.1

90.0

Comment: Slide illustrates diagnostic
accuracy according to score on DT

25.9
38.7

80.0

43.5

11.8...
Rx Mental Health?
Are mental health treated?
12mo Service Use (NIH, 2002)
40
34.6
32.7

35

Cancer n=4878
No Cancer n=90,737

30
25
19.1

20

16.1
% Receiving Any trea...
Receipt of Care

Receipt of
Any Help

Receipt of
Individual Support

Receipt of
Information

Receipt of
Group
Clinician Intervention (n=540)
Diagnosis Yes

Diagnosis No

Distress

59% helped

20% helped

Anxiety

33% helped

17.5% h...
Updated meta-analysis
Distress
Want Help
Offered help
Received care
Proportion meta-analysis (n=1844)
PATIENTS……….. Want Help?plot [random effects]
Shim et al (2008) [Distressed]

0.66 (0.52...
CLINICIANS. Who Offers Psychosocial Help? (n=2557)
Proportion meta-analysis plot [random effects]

Söllner et al (2004)

0...
How Many Patients Receive Psychosocial Help?
Proportion meta-analysis plot [random effects]
Kadan-Lottick et al (2005)

0....
What Help is wanted
Bow el m ovem ent constipation

“Desire for Help”
City of Hope
n=4000

23.4%

Questions and fe ar about end of life

24.0%...
Inequalities in care?
Are mental health concerns disproportionately ignored?
1660 Cancer Patients in Florida (Jacobsen, 2010)
Emotional Wellbeing Assessed

100

90

95

97

Pain Assessed

93
90

86

...
Where Next??
Addressing the gap
IPOS - Receipt of Psyccare-alex_j_mitchell_rotterdam
IPOS - Receipt of Psyccare-alex_j_mitchell_rotterdam
IPOS - Receipt of Psyccare-alex_j_mitchell_rotterdam
Upcoming SlideShare
Loading in …5
×

IPOS - Receipt of Psyccare-alex_j_mitchell_rotterdam

744 views

Published on

Oral presentation from Rotterdam (15th IPOS) on quality of care in cancer

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
744
On SlideShare
0
From Embeds
0
Number of Embeds
6
Actions
Shares
0
Downloads
11
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • University professor, 37, dies from lung cancer after string of doctors dismissed symptoms as 'anxiety and depression'
    Lisa Smirl, 37, saw three doctors with a range of symptoms over a year
    Had been suffering from shortness of breath, weight loss and arm pain
    Despite this, doctors dismissed her symptoms as psychological
    By the time cancer was diagnosed it had spread throughout her body
    Cambridge-educated lecturer died last month, a year after being diagnosed
    By Anna Hodgekiss
    PUBLISHED: 11:24, 8 March 2013 | UPDATED: 15:56, 8 March 2013
    467
    View comments
    A university professor died of lung cancer aged 37 after doctors repeatedly dismissed her illness as 'purely psychological'.
    Lisa Smirl, 37, saw three different doctors with a range of symptoms over a year-long period but they were dismissed as anxiety and depression.
    By the time cancer was finally diagnosed it had spread throughout her body and was terminal.
    Dr Smirl, who was married to a medical doctor and lived in Leeds and Brighton, kept a heartbreaking online blog about her treatment.
    Misdiagnosis: Despite Lisa Smirl seeing three doctors with symptoms, her lung cancer was repeatedly written off as 'anxiety and depression'
    Shortly after her diagnosis, she wrote: 'How is it possible that a 36-year-old, health [obsessed] conscious, occasionally social smoking, middle class, fiance of a doctor can develop metastatic lung cancer unnoticed. How?!?
    'What the consultant told us was that not only was it the c-word, but that it was everywhere.
    'My brain, my bones, my liver. While in some ways this was a terrible surprise, in another it was a huge relief.
     
    More...
    Five-year-old who fell unconscious outside medical centre was turned away 'because he wasn't a patient'
    'Talented' football striker, 27, died after suffering a fatal stroke caused by too many 'headers'
    Heartbreaking generosity of parents who gave away £22,000 raised for seriously ill daughter to help little boy they've never met walk for first time
    'For the last year I'd been battling a range of bizarre and seemingly disparate symptoms that had forced me in September 2011 to go on sick leave from my job as a lecturer (assistant professor).
    'The diagnosis at the time was anxiety and/or depression. And while I was both anxious and depressed, this was due to the increasingly disabling symptoms that my doctor kept insisting were purely psychological.
    'So I was actually grateful for a medical diagnosis that confirmed there were objective, physical reasons behind my illness.'
    Cambridge-educated Dr Smirl, who was originally from Canada, wrote how she first experienced shortness of breath and wheezing in late 2010, which was wrongly diagnosed as asthma.
    Not psychological: Lisa Smirl said in her blog she was relieved to have a concrete diagnosis even though it was of cancer
    In spring 2011, she was referred to a physiotherapist for shoulder and arm pain and started experiencing 'visual migraines' - losing her vision for half an hour - in June.
    By September 2011, Dr Smirl was so sick she was forced to leave work, having been diagnosed with depression and anxiety and put on anti-depressants.
    But despite a dramatic weight loss, she claimed three different family doctors refused to consider her symptoms in connection with each other.
    Relief: Dr Smirl wrote a blog on her diagnosis, saying she was 'actually grateful' for a medical diagnosis that confirmed there were 'objective, physical reasons' behind her symptoms
    She wrote: 'Still, despite my pleas, and a dramatic weight loss, none of my doctors (and I saw three different family practitioners) would consider my symptoms in conjunction with one another - insisting that they were all common, unrelated problems (migraines, asthma, depression, back pain).'
    In November 2011, she misread her asthma prescription and took ten times the recommended amount - but the drug made no difference to a violent cough.
    Her doctor finally sent her for a routine X-ray and within hours, she was given the devastating news that she had cancer.
    On her blog, called Stage V - as stage IV of cancer is considered terminal - she describes her journey from 'a woman diagnosed with "anxiety" to one with metastatic cancer'.
    Dr Smirl wrote: 'I can't prove it, and this is just my opinion, but I have no doubt in my own mind that my misdiagnosis was in large part due to the fact that I was a middle aged female and that my male doctors were preconceived towards a psychological rather than a physiological diagnosis.
    'It is so easy to say that someone's symptoms are "anxiety" related if they are a little bit complicated, unclear or unusual. Don't repeat my mistakes.
    'You know when something is wrong. Find another doctor that you connect with and who takes your concerns seriously. Get referrals. Get tested. Refuse to be dismissed.'
    Dr Smirl worked in the global studies department at the University of Sussex between 2009 and 2012, but took early retirement.
    Despite battling the disease, she maintained an honorary lectureship in the department until her death on February 21.
    She also completed a Great North Run to raise funds for the Roy Castle Lung Cancer Foundation in November 2012.
    A blog post from November 3 2012, marking the one year anniversary of Lisa's lung cancer diagnosis
    Professor Richard Black, head of the school of global studies at the University of Sussex, led tributes.He said: 'Lisa was a fantastic colleague and friend, a great teacher and researcher and truly inspirational in the way she dealt with her illness.'
    Professor Justin Rosenberg, head of international relations, added: 'Lisa was an outstanding colleague who shared her intellectual and personal vivacity with academics and students alike.'
    West Sussex PCT and the Brighton and Sussex University Hospitals Trust were unable to confirm that they were involved with Lisa's treatment.
    Read more: http://www.dailymail.co.uk/health/article-2290128/University-professor-37-dies-lung-cancer-doctors-dismissed-symptoms-anxiety-depression.html#ixzz2XtulhdlM Follow us: @MailOnline on Twitter | DailyMail on Facebook
  • Agency for Healthcare Research and Quality. Your Guide to Choosing Quality Healthcare. [June
    16, 2008]. Accessed at http://www.ahrq.gov/consumer/qnt/qntqlook.htm
  • Affiliations of authors: Epidemiology and Surveillance Research Department,
    American Cancer Society, Atlanta, GA (AJ, MJT, MMC, EW); Division of Cancer
    Prevention and Control, National Center for Chronic Disease Prevention and
    Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
    (HKW, CE, UAA); Division of Vital Statistics, National Center for Health Statistics,
    Centers for Disease Control and Prevention, Hyattsville, MD (RA); Division of
    Cancer Control and Population Sciences, National Cancer Institute, Bethesda,
    MD (LAGR, BKE); North American Association of Central Cancer Registries,
  • Two surprises => rate stable and rate in pall
    We identi. ed 70 studies with 10 071 individuals across 14 countries in
    oncological and haematological settings. Prevalence of depression by DSM or ICD criteria was 16·3% (13·4–19·5); for
    DSM-de. ned major depression it was 14·9% (12·2–17·7) and for DSM-de. ned minor depression 19·2% (9·1–31·9).
    Prevalence of adjustment disorder was 19·4% (14·5–24·8), anxiety 10·3% (5·1–17·0), and dysthymia 2·7% (1·7–4·0).
    Combination diagnoses were common; all types of depression occurred in 20·7% (12·9–29·8) of patients, depression
    or adjustment disorder in 31·6% (25·0–38·7), and any mood disorder in 38·2% (28·4–48·6). There were few
    consistent correlates of depression: there was no e. ect of age, sex, or clinical setting and inadequate data to examine
    cancer type and illness duration.
  • Karen Clark Matt Loscalzo City of Hope
  • J Am Geriatr Soc. 2011 Jul;59(7):1268-73. doi: 10.1111/j.1532-5415.2011.03481.x. Epub 2011 Jul 7.
    Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer.
    Baillargeon J, Kuo YF, Lin YL, Raji MA, Singh A, Goodwin JS.
    Source
    Departments of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 775555, USA. jbaillar@utmb.edu
    Abstract
    OBJECTIVES:
    To evaluate the extent to which preexisting mental disorders influence diagnosis, treatment, and survival in older adults with colon cancer.
    DESIGN:
    Retrospective cohort study.
    SETTING:
    The Surveillance, Epidemiology and End Results (SEER)-Medicare linked database.
    PARTICIPANTS:
    Eighty thousand six hundred seventy participants, aged 67 and older with a diagnosis of colon cancer.
    MEASUREMENTS:
    The association between the presence of a preexisting mental disorder and the stage of colon cancer at diagnosis, receipt of cancer treatment, and overall and colon cancer-specific mortality were assessed using Cox proportional hazards regression and logistic regression.
    RESULTS:
    Participants with mental disorders were more likely to have been diagnosed with colon cancer at autopsy (4.4% vs 1.1%; P<.001) and at an unknown stage of cancer (14.6% vs 6.2%; P<.001); to have received no surgery, chemotherapy, or radiation therapy (adjusted risk ratio (ARR)=2.09, 95% confidence interval (CI)=1.86-2.35); and to have received no chemotherapy for Stage 3 cancer (ARR=1.63, 95% CI=1.49-1.79). The rate of overall mortality (hazard ratio (HR)=1.33, 95% CI=1.31-1.36) and colon cancer-specific mortality (HR=1.23, 95% CI=1.19-1.27) was substantially higher in participants with a preexisting mental disorder than in their counterparts. All of these associations were particularly pronounced in participants with psychotic disorders and those with dementia.
    CONCLUSION:
    Public health initiatives are needed to improve colon cancer detection and treatment in older adults with mental disorders.
    © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
    PMID:
    21732924
    [PubMed - in process]
  • J Am Geriatr Soc. 2011 Jul;59(7):1268-73. doi: 10.1111/j.1532-5415.2011.03481.x. Epub 2011 Jul 7.
    Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer.
    Baillargeon J, Kuo YF, Lin YL, Raji MA, Singh A, Goodwin JS.
    Source
    Departments of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 775555, USA. jbaillar@utmb.edu
    Abstract
    OBJECTIVES:
    To evaluate the extent to which preexisting mental disorders influence diagnosis, treatment, and survival in older adults with colon cancer.
    DESIGN:
    Retrospective cohort study.
    SETTING:
    The Surveillance, Epidemiology and End Results (SEER)-Medicare linked database.
    PARTICIPANTS:
    Eighty thousand six hundred seventy participants, aged 67 and older with a diagnosis of colon cancer.
    MEASUREMENTS:
    The association between the presence of a preexisting mental disorder and the stage of colon cancer at diagnosis, receipt of cancer treatment, and overall and colon cancer-specific mortality were assessed using Cox proportional hazards regression and logistic regression.
    RESULTS:
    Participants with mental disorders were more likely to have been diagnosed with colon cancer at autopsy (4.4% vs 1.1%; P<.001) and at an unknown stage of cancer (14.6% vs 6.2%; P<.001); to have received no surgery, chemotherapy, or radiation therapy (adjusted risk ratio (ARR)=2.09, 95% confidence interval (CI)=1.86-2.35); and to have received no chemotherapy for Stage 3 cancer (ARR=1.63, 95% CI=1.49-1.79). The rate of overall mortality (hazard ratio (HR)=1.33, 95% CI=1.31-1.36) and colon cancer-specific mortality (HR=1.23, 95% CI=1.19-1.27) was substantially higher in participants with a preexisting mental disorder than in their counterparts. All of these associations were particularly pronounced in participants with psychotic disorders and those with dementia.
    CONCLUSION:
    Public health initiatives are needed to improve colon cancer detection and treatment in older adults with mental disorders.
    © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
    PMID:
    21732924
    [PubMed - in process]
  • Maria Hewitt, Julia H. Rowland Mental Health Service Use Among Adult Cancer Survivors: Analyses of the National Health Interview Survey Journal of Clinical Oncology, Vol 20, Issue 23 (December), 2002: 4581-4590
    From the National Cancer Policy Board, Institute of Medicine, Washington,
    DC, and Office of Cancer Survivorship, National Cancer Institute,
    National Institutes of Health, Bethesda, MD.
  • Agency for Healthcare Research and Quality. Your Guide to Choosing Quality Healthcare. [June
    16, 2008]. Accessed at http://www.ahrq.gov/consumer/qnt/qntqlook.htm
  • Karen Clark Matt Loscalzo City of Hope
  • In an audit of medical records of 1660 patients seen in Florida cancer centres, Jacobsen et al (2010) found that only 52% contained evidence of an assessment of psychosocial wellbeing
    Jacobsen PB, Shibata D, Siegel EM, Lee JH, Fulp WJ, Alemany C, Abesada-Terk G Jr, Brown R, Cartwright T, Faig D, Kim G, Levine R, Markham MJ, Schreiber F, Sharp P, Malafa M. Evaluating the quality of psychosocial care in outpatient medical oncology settings using performance indicators. Psychooncology. 2011 Nov;20(11):1221-7. doi: 10.1002/pon.1849. Epub 2010 Sep 27.
  • FIGURE 2.4. Survival of 2,819 breast cancer patients from the Surveillance, Epidemiology, and End Results Program
    of the National Cancer Institute, 1983–1998. Calculated by the life table method and strati fi ed by race.
  • IPOS - Receipt of Psyccare-alex_j_mitchell_rotterdam

    1. 1. How many people with distress or depression receive psychosocial care in cancer settings? ………………An updated meta-analysis Alex J Mitchell ajm80@le.ac.uk www.twitter.com/_alexjmitchell Consultant in Psycho-oncology and Hon SnR University of Leicester
    2. 2. Daily Mail
    3. 3. Screening Symptoms Help-seeking Diagnosis Treatment Aftercare
    4. 4. Context
    5. 5. Millions Living with Cancers (2010 SEER) 14 13 12 9.6 10 8 6.6 6 4.6 4 3 2 0 :1970 :1980 :1990 http://seer.cancer.gov/faststats/ :2000 :2010
    6. 6. Prevalence of depression in Oncology settings Proportion meta-analysis plot [random effects] 0.5600 (0.4572, 0.6592) Ciaramella and Poli (2001) 0.4900 (0.3886, 0.5920) Massie et al (1979) 0.4850 (0.4303, 0.5401) Bukberg et al (1984) 0.4194 (0.2951, 0.5515) Passik et al (2001) 0.4167 (0.2907, 0.5512) Baile et al (1992) 0.4000 (0.2570, 0.5567) Morton et al (1984) 0.3958 (0.2577, 0.5473) Hall et al (1999) 0.3722 (0.3139, 0.4333) Burgess et al (2005) 0.3317 (0.2672, 0.4012) Jenkins et al (1991) Mj 15% Mn 19% Adj 20% Anx 10% Dysthymia 3% 0.7750 (0.6679, 0.8609) Levine et al (1978) 70 studies involving 10,071 individuals;14 countries. 16.3% (95% CI = 13.9% to 19.5%) Plumb & Holland (1981) 0.3182 (0.1386, 0.5487) Green et al (1998) 0.3125 (0.2417, 0.3904) Kathol et al (1990) 0.2961 (0.2248, 0.3754) Hosaka and Aoki (1996) 0.2800 (0.1623, 0.4249) Fallowfield et al (1990) 0.2565 (0.2054, 0.3131) Golden et al (1991) 0.2308 (0.1353, 0.3519) Spiegel et al (1984) 0.2292 (0.1495, 0.3261) Evans et al (1986) 0.2289 (0.1438, 0.3342) Grandi et al (1987) 0.2222 (0.0641, 0.4764) Maunsell et al (1992) 0.2146 (0.1605, 0.2772) Berard et al (1998) 0.2100 (0.1349, 0.3029) Joffe et al (1986) 0.1905 (0.0545, 0.4191) Berard et al (1998) 0.1900 (0.1184, 0.2807) Devlen et al (1987) 0.1889 (0.1141, 0.2851) Leopold et al (1998) 0.1887 (0.0944, 0.3197) Akizuki et al (2005) 0.1797 (0.1376, 0.2283) Razavi et al (1990) 0.1667 (0.1189, 0.2241) Gandubert et al (2009) 0.1597 (0.1040, 0.2300) Alexander et al (1993) 0.1333 (0.0594, 0.2459) Kugaya et al (1998) 0.1328 (0.0793, 0.2041) Payne et al (1999) 0.1290 (0.0363, 0.2983) Ibbotson et al (1994) 0.1242 (0.0776, 0.1853) Prieto et al (2002) 0.1227 (0.0825, 0.1735) Morasso et al (1996) 0.1121 (0.0593, 0.1877) Desai et al (1999) [early] 0.1111 (0.0371, 0.2405) Silberfarb et al (1980) 0.1027 (0.0587, 0.1638) Costantini et al (1999) 0.0985 (0.0535, 0.1625) Morasso et al (2001) 0.0985 (0.0535, 0.1625) Ozalp et al (2008) 0.0971 (0.0576, 0.1510) Love et al (2002) 0.0957 (0.0650, 0.1346) Alexander et al (2010) 0.0900 (0.0542, 0.1385) Coyne et al (2004) 0.0885 (0.0433, 0.1567) Kawase et al (2006) 0.0851 (0.0553, 0.1240) Walker et al (2007) 0.0831 (0.0568, 0.1165) Grassi et al (1993) 0.0828 (0.0448, 0.1374) Grassi et al (2009) 0.0826 (0.0385, 0.1510) Reuter and Hart (2001) 0.0761 (0.0422, 0.1244) Lee et al (1992) 0.0660 (0.0356, 0.1102) Pasacreta et al (1997) 0.0633 (0.0209, 0.1416) Sneeuw et al (1994) 0.0540 (0.0367, 0.0761) Singer et al (2008) 0.0519 (0.0300, 0.0830) Katz et al (2004) 0.0500 (0.0104, 0.1392) Mehnert et al (2007) 0.0472 (0.0175, 0.1000) Lansky et al (1985) 0.0455 (0.0291, 0.0676) Derogatis et al (1983) 0.0372 (0.0162, 0.0720) Hardman et al (1989) 0.0317 (0.0087, 0.0793) Massie and Holland (1987) 0.0147 (0.0063, 0.0287) Colon et al (1991) 0.0100 (0.0003, 0.0545) combined 0.1730 (0.1375, 0.2116) 0.0 0.3 0.6 proportion (95% confidence interval) 0.9
    7. 7. “Most Pressing Issue” Leicester N=540
    8. 8. Rates of medical care? Baseline treatment and diagnosis rates
    9. 9. Chances of No Treatment for Colorectal Ca (2011) 14 12 10 8 6 4 2 0 No m ental disorder Substance abuse disorder Other m ental disorder Mood disorder Any m ental disorder Psychotic disorder Dem entia Baillargeon J, et al Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer. J Am Geriatr Soc. 2011 Jul;59(7):1268-73.
    10. 10. Chances of No Diagnosis for Colorectal Ca (2011) 10 9 8 7 6 5 4 3 2 1 0 No Mental Disorder (n 559,971) Substance Use Disorder (n 53,443) Other Mental Disorder (n 59,322) Mood Disorder (n=8261) Any Mental Disorder (n 520,699) Psychotic Disorder (n 53,576) Dementia (n 57,267) Baillargeon J, et al Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer. J Am Geriatr Soc. 2011 Jul;59(7):1268-73.
    11. 11. Dx Mental Health? Are mental health diagnosed?
    12. 12. 100.0 5.9 11.1 90.0 Comment: Slide illustrates diagnostic accuracy according to score on DT 25.9 38.7 80.0 43.5 11.8 38.1 22.2 46.7 59.6 70.0 21.4 14.3 14.3 21.4 72.4 Judgement = Non-distressed 60.0 33.3 19.4 50.0 26.1 40.0 Judgement = Unclear Judgement = Distressed 19.0 82.4 24.4 66.7 30.0 20.0 57.1 25.0 41.9 15.8 30.4 10.0 11.8 71.4 Three 40.7 Four Five Six 28.9 Two 42.9 15.4 0.0 Zero One Seven Eight Nine Ten
    13. 13. Rx Mental Health? Are mental health treated?
    14. 14. 12mo Service Use (NIH, 2002) 40 34.6 32.7 35 Cancer n=4878 No Cancer n=90,737 30 25 19.1 20 16.1 % Receiving Any treatment for Mental Health 14 15 10 11.7 11 7.2 5.7 6.3 5.7 5 6.4 5 8.9 7.7 6.5 6.2 3.9 5 2.3 3.2 1.8 75+ y ea rs 6574 ear s 4564 y y ea rs 1844 con diti o ns hro nic me di ca l 3c 2c hro nic me di ca l con diti o ns con diti o n hro nic me di ca l 1c con d iti No c hr o ni cm edi cal Me n ta l Ill No ons Hea l th th eal Il l H Me nt a l Al l P atie nt s 0 Two explanations=> Maria Hewitt, Julia H. Rowland Mental Health Service Use Among Adult Cancer Survivors: Analyses of the National Health Interview Survey Journal of Clinical Oncology, Vol 20, Issue 23 (December), 2002: 4581-4590
    15. 15. Receipt of Care Receipt of Any Help Receipt of Individual Support Receipt of Information Receipt of Group
    16. 16. Clinician Intervention (n=540) Diagnosis Yes Diagnosis No Distress 59% helped 20% helped Anxiety 33% helped 17.5% helped Depression 39% helped 22% helped Anger 30% helped 24% helped Any of above 46% helped 20% helped
    17. 17. Updated meta-analysis
    18. 18. Distress Want Help Offered help Received care
    19. 19. Proportion meta-analysis (n=1844) PATIENTS……….. Want Help?plot [random effects] Shim et al (2008) [Distressed] 0.66 (0.52, 0.77) van Scheppingen et al (2011) [Distressed] 0.57 (0.44, 0.70) Mitchell et al (2012) [Distress or Depressed] 0.56 (0.48, 0.64) Sharpe et al (2004) [Depressed] 0.49 (0.41, 0.58) Luutonen et al (2011) [Depressed] 0.47 (0.36, 0.58) Carlson et al (2010) [Distressed] 0.46 (0.41, 0.51) Söllner et al (2004) [Distress] 0.43 (0.33, 0.54) Tuinman et al (2008) [Distressed] 0.43 (0.34, 0.53) Graves et al (2007) [Distressed] 0.33 (0.27, 0.40) Ryan et al (2011) [Depressed] 0.32 (0.22, 0.43) Morasso et al (2010) [Distressed] 0.31 (0.16, 0.50) Clover et al (2010) [Distressed] 0.29 (0.24, 0.35) Baker-Glenn et al (2010) [distressed] 0.27 (0.20, 0.35) combined 0.43 (0.37, 0.49) 0.0 0.2 0.4 0.6 proportion (95% confidence interval) 0.8
    20. 20. CLINICIANS. Who Offers Psychosocial Help? (n=2557) Proportion meta-analysis plot [random effects] Söllner et al (2004) 0.97 (0.91, 0.99) Morasso et al (2010) 0.82 (0.66, 0.92) Mitchell et al (2012) [help or referral] 0.52 (0.46, 0.59) Fritsche et al (2004) 0.51 (0.40, 0.61) Shimizu et al (2005) 0.50 (0.41, 0.58) Plass and Koch (2001) 0.47 (0.38, 0.56) Bramsen et al (2008) 0.45 (0.35, 0.55) van Scheppingen et al (2011) [help or referral] 0.32 (0.21, 0.45) Siedentopf et al (2009) 0.23 (0.19, 0.28) Kadan-Lottick et al (2005) 0.22 (0.17, 0.27) Ellis et al (2009) [Referral] 0.42 (0.31, 0.54) Bogaarts et al (2011) [Referral] 0.38 (0.27, 0.49) Keller et al (2004) [Referral] 0.34 (0.23, 0.46) Carlson et al (2010) [Referral] 0.30 (0.25, 0.35) Shimizu et al (2009) [Referral] 0.25 (0.18, 0.33) Verdonck-de Leeuw et al (2009) [Referral] 0.21 (0.05, 0.51) Mitchell et al (2012) [Referral] 0.19 (0.14, 0.25) van Scheppingen et al (2011) [Referral] 0.14 (0.07, 0.25) combined 0.40 (0.31, 0.50) 0.0 0.2 0.4 0.6 0.8 proportion (95% confidence interval) 1.0
    21. 21. How Many Patients Receive Psychosocial Help? Proportion meta-analysis plot [random effects] Kadan-Lottick et al (2005) 0.89 (0.77, 0.96) Plass and Koch (2001) 0.60 (0.46, 0.72) Siedentopf et al (2009) 0.46 (0.35, 0.58) Fritsche et al (2004) 0.43 (0.28, 0.59) Bogaarts et al (2011) 0.38 (0.27, 0.49) Söllner et al (2004) 0.35 (0.26, 0.45) Shimizu et al (2005) 0.28 (0.18, 0.41) Shimizu et al (2009) 0.25 (0.18, 0.33) Merckaert et al (2009) 0.21 (0.17, 0.25) Morasso et al (2010) 0.16 (0.05, 0.33) Sharpe et al (2004) 0.15 (0.10, 0.22) McDowell et al (2010) 0.14 (0.11, 0.18) combined 0.35 (0.25, 0.46) 0.0 0.2 0.4 0.6 proportion (95% confidence interval) 0.8 1.0
    22. 22. What Help is wanted
    23. 23. Bow el m ovem ent constipation “Desire for Help” City of Hope n=4000 23.4% Questions and fe ar about end of life 24.0% Finding reliable head&neck inform ation 24.2% Losing control 24.8% Needing help coordinating m y m edicalcare 25.3% Feeling irritable or angry 25.5% Finding com m unity resources 27.1% 27.5% Insurance Feeling anxious or fearful 29.2% Talking w ith healthcare team 29.6% Managing my em otions 29.7% Fee ling dow n or depresse d 30.7% Pain 30.8% Fatigue 32.9% Understanding m y treatm ent options 33.9% Side-effects of treatme nts 34.9% Finances 35.0% Sleeping 36.5% Supplem ents w hile on treatm ent 37.1% Worry about the future 0.0% 37.6% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%
    24. 24. Inequalities in care? Are mental health concerns disproportionately ignored?
    25. 25. 1660 Cancer Patients in Florida (Jacobsen, 2010) Emotional Wellbeing Assessed 100 90 95 97 Pain Assessed 93 90 86 84 84 88 88 88 84 82 80 74 73 70 60 57 55 50 50 47 47 38 40 34 30 26 20 14 12 10 0 A B C D E F G H I J K Mean Psychooncology. 2011 Nov;20(11):1221-7. doi: 10.1002/pon.1849. Epub 2010 Sep 27.
    26. 26. Where Next?? Addressing the gap

    ×