Phyllis Butow

Background: Treatment uptake for depression and anxiety in psycho‐oncology is low. Blended psychological therapy (BT), which combines self‐guided digital content with clinician‐delivered sessions, may improve treatment access and engagement. In Australia, no BT program exists in routine cancer care. Objective: To co‐design a BT intervention clinically appropriate for anxiety/depression treatment in cancer patients and investigate its potential acceptability and feasibility for implementation in psycho‐oncology in Australia. Method: Qualitative, co‐design focus groups were conducted via videoconference with psycho‐oncology psychologists in two stages: co‐design of a cancer‐specific BT model prototype (stage I) and confirmation of prototype content and structure acceptability (stage II). Participants provided iterative feedback on cancer‐specific CBT elements to include in the BT intervention. Data were analyzed using an Interpretive Description approach. Results: Fourteen clinicians participated across five co‐design workshops. In stage I, identified themes were: (i) importance of the intake interview and orientation to the program; (ii) the prominent role of face‐to‐face contact in the BT model; and (iii) suitability of content for digital delivery. Stage II themes were: (i) feasibility of BT in psycho‐oncology; and (ii) perceived importance of face‐to‐face for improved content delivery. The resulting BT intervention model (“iCanBlend”) had a higher dose of face‐to‐face over digital sessions to promote treatment engagement and enhance duty‐of‐care online. Conclusion: Overall, iCanBlend was acceptable and clinically appropriate for the cancer context in Australia, although feasibility was not confirmed, given participants' preference for face‐to‐face support for digital content. Future research is required with clinicians and patients to determine usability.

Objective: Little is known about the impact of treatment availability on the spiritual wellbeing of advanced cancer patients. The aim of this study was to examine the relationships between spiritual wellbeing and patient anxiety, depression, hope, and fear of cancer progression, depending on whether advanced cancer patients were able to access novel therapies. Methods: Australian adult advanced cancer patients who had exhausted all therapeutic options were recruited to undergo comprehensive genomic profiling (CGP) to determine whether a novel treatment was available. Questionnaires were administered prior to testing and within 2 weeks of receiving CGP results. Spiritual wellbeing was measured using the FACIT‐Sp‐12. Structural equation modeling was used to examine the predictive and mediating relationships among spiritual wellbeing at both time points, mediated by anxiety, depression and hope subscales at time 1 on the fear of cancer progression. Results: Both questionnaires were completed by 397 patients. A total of 238 (60%) patients had actionable CGP results. At baseline, the spiritual wellbeing constructs of meaning, peace and faith were identified as explanatory variables. At time 1, measures of spiritual wellbeing (meaning, peace and faith), and of hope, anxiety and depression, were identified as mediating variables for the outcome of fear of cancer progression. The test results were non‐significant in the model. Conclusions: The level of spiritual wellbeing in advanced cancer patients undergoing CGP was not impacted by test results but influenced a number of patient outcomes. Efforts to support patient spiritual wellbeing in such cohorts is recommended.

Psycho-oncology focuses on improving psychosocial, spiritual, functional and emotional needs of people with cancer and their caregivers. Head and neck cancers (HNC) develop in the inner surfaces of...

Background/Objectives: (P)rehabilitation, comprising structured exercise, nutritional optimisation, and/or psychological support delivered pre- or postoperatively, has demonstrated efficacy in improving outcomes across the cancer care continuum. However, access remains limited. Technology-enabled (p)rehabilitation offers a novel solution with the potential to enhance equity and continuity of care. This systematic review aimed to evaluate the efficacy of technology-enabled (p)rehabilitation on perioperative and patient-reported outcomes among individuals undergoing thoracic and/or abdominopelvic cancer surgery. Methods: Six databases were search from inception to October 2024. Eligible studies were randomised controlled trials (RCTs) comparing technology-enabled (p)rehabilitation with usual care, placebo, or non-technology-based interventions in adults undergoing thoracic and/or abdominopelvic cancer surgery. Outcomes included postoperative complications, hospital readmissions, hospital length of stay (LOS), quality of life (QoL), pain, anxiety, depression, fatigue, distress, and satisfaction. Higher scores indicated improved QoL or worse symptom severity. Risk of bias was assessed using the revised Cochrane tool, and evidence strength was determined using GRADE methodology. Relative risks (RR) and mean differences (MD) were calculated using random-effects meta-analysis. Results: Seventeen RCTs (18 publications, n = 1690) were included. Trials most commonly evaluated application-based platforms (n = 8) and the majority exhibited some risk of bias. Technology-enabled (p)rehabilitation was associated with a significant reduction in LOS (MD = 1.33 days; 95% CI: 0.59–2.07; seven trials), and improvements in pain (MD = 6.12; 95% CI: 3.40–8.84; four trials), depression (MD = 2.82; 95% CI: 0.65–4.99; five trials), fatigue (MD = 10.10; 95% CI: 6.97–13.23; three trials) and distress (MD = 1.23; 95% CI: 0.30–2.16; single trial) compared with controls. Conclusions: Technology-enabled (p)rehabilitation shows promise in reducing LOS and improving selected patient-reported outcomes following thoracic and abdominopelvic cancer surgery. Although evidence is limited due to the small number of studies, modest sample sizes, methodological heterogeneity, and intervention variability, the overall findings justify further investigation. Large-scale, adequately powered clinical trials are required to confirm efficacy and guide clinical effectiveness and implementation studies.

Background: Despite effective cancer-specific interventions for depression and anxiety, treatment uptake is low. Blended psychological therapy (BT) may improve access to treatment and enhance uptake and adherence as it combines patient-driven, online therapy with therapist-facilitated sessions. Research supports the acceptability and feasibility of BT in a noncancer context, but evidence in psycho-oncology is limited. The aim of this study was to explore psycho-oncology stakeholders' (service managers, psychologists) views on the feasibility and acceptability of BT and potential implementation of BT models into psycho-oncology care in Australia. Method: Qualitative, semistructured telephone interviews were conducted with psychologists working clinically with patients with cancer and psycho-oncology service managers. Interviews were analyzed using a framework analysis approach and mapped against the Consolidated Framework for Implementation Research domains. Results: Twenty-two clinicians (17 psychologists, 5 managers) were interviewed. An overarching theme of trust was identified, underpinned by 3 themes: (i) influence of system factors on readiness to change; (ii) treatment engagement; (iii) autonomy and empowerment. Participants shared concerns about service over-reliance on the BT digital component but also recognized its potential in expanding service reach. The use of digital technology was perceived as a barrier to patient engagement but also trusted for providing flexible access. In addition, participants voiced concerns regarding duty-of-care and lack of autonomy to deliver therapy but noted that BT could optimize clinician time and resources. Conclusion: Overall, BT was feasible and acceptable. Future research will incorporate stakeholders' preferences for and evaluation of a cancer-specific anxiety and depression BT intervention.

Background: Blended therapy (BT) combines digital with face-to-face psychological interventions. BT may improve access to treatment, therapy uptake, and adherence. However, research is scarce on the structure of BT models. Objective: We synthesized the literature to describe BT models used for the treatment of psychological disorders in adults. We investigated whether BT structure, content, and ratio affected treatment efficacy, uptake, and adherence. We also conducted meta-analyses to examine treatment efficacy in intervention-control dyads and associations between treatment outcomes versus BT model structure. Methods: PsycINFO, CINAHL, Embase, ProQuest, and MEDLINE databases were searched. Eligibility criteria included articles published in English till March 2023 that described digital and face-to-face elements as part of an intervention plan for treating psychological disorders in adult patients. We developed a coding framework to characterize the BT interventions. A meta-analysis was conducted to calculate effect size (ES; Cohen d and 95% CIs) regarding pre- and posttreatment outcomes in depression and anxiety versus BT structure. The review was registered with PROSPERO and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Searches identified 8436 articles, and data were extracted from 29 studies. BT interventions were analyzed and classified according to mode of interaction between digital and face-to-face components (integrated vs sequential), role of the components (core vs supplementary), component delivery (alternate vs case-by-case), and digital materials assignment mode (standardized vs personalized). Most BT interventions (n=24) used a cognitive behavioral therapy approach for anxiety or depression treatment. Mean rates of uptake (91%) and adherence (81%) were reported across individual studies. BT interventions were more effective or noninferior to treatment as usual, with large spread in the data and a moderate to large ES in the treatment of depression (n=9; Cohen d=–1.1, 95% CI –0.6 to –1.6, P<.001, and z score=–4.3). A small, nonsignificant ES was found for anxiety outcomes (n=5; Cohen d=–0.1, 95% CI –0.3 to 0.05, P=.17, and z score=–1.4). Higher ESs were found in blended interventions with supplementary design (depression: n=11, Cohen d=–0.75, 95% CI –0.56 to –0.95; anxiety: n=8, Cohen d=–0.9, 95% CI –0.6 to –1.2); fewer (≤6) face-to-face sessions (depression: n=9, Cohen d=–0.7, 95% CI –0.5 to –0.9; anxiety: n=7, Cohen d=–0.8, 95% CI –0.3 to –1.3); and a lower ratio (≤50%) of face-to-face versus digital sessions (depression: n=5, Cohen d=–0.8, 95% CI –0.6 to –1.1; anxiety: n=4, Cohen d=–0.8, 95% CI 0.006 to –1.6). Conclusions: This study confirmed integrated BT models as feasible to deliver. We found BT to be effective in depression treatment, but anxiety treatment results were nonsignificant. Future studies assessing outcomes across different psychological disorders and therapeutic approaches are required. Trial Registration: PROSPERO CRD42021258977; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258977

Objectives Paramedics have the potential to make a substantial contribution to community-based palliative care provision. However, they are hindered by a lack of policy and institutional support, as well as targeted education and training. This study aimed to elicit paramedics’, palliative care doctors’ and nurses’, general practitioners’, residential aged care nurses’ and bereaved families and carers’ attitudes and perspectives on how palliative paramedicine can be improved to better suit the needs of community-based patients, their families and carers, and the clinicians involved in delivering the care. Design In this qualitative study underpinned by a social constructivist epistemology, semistructured interviews were conducted. Setting and participants 50 participants with palliative paramedicine experience, from all jurisdictions of Australia. Participants were interviewed between November 2021 and April 2022. Results All participants suggested paramedics play an important adjunct role in the provision of palliative and end-of-life care in home-based settings. Three levels of opportunities for improvement were identified: macrolevel (policy and frameworks; funding and education; accessing medical records and a widening scope); mesolevel (service-level training; interprofessional understanding and communities of practice and community expectations) and microlevel (palliative care subspecialty; debriefing and self-care and partnering with families). Conclusion To enhance paramedic capacity to provide palliative care support, improvements targeting systems, services, communities and individuals should be made. This calls for stronger inclusion of paramedicine in interdisciplinary palliative care and greater investment in both the generalist and specialist palliative paramedicine workforce.

Psycho-oncology was defined in 2002[1] by one of the founders of this discipline, Dr. Jimmie Holland, as “the psychological, social, behavioral, and ethical aspects of cancer,” incorporating: Psycho-oncology, by its very nature, is interdisciplinary and multifocal, with interests in many areas, including patient-centered and family-centered care,[2] shared decision-making,[3] medical ethics,[4] medical communication,[5] behavioral medicine,[6] psychiatry/psychology interventions,[7] symptom control and supportive care,[8] end-of-life care,[9] and psycho-neuroimmunology.[10] The importance of psycho-oncology research and practice has been well-recognized internationally, due to the existential, physical, and psychosocial challenges of cancer diagnosis, treatment, and treatment-related side effects.[11] [12] Such challenges result in high rates of distress, psychological morbidity (such as anxiety and depression), and suicide among the cancer population.[13] The largest study to date comparing mental health rates in cancer patients with that in the general population[14] reported a 1.3-fold increased prevalence rate for any mental disorder, and a 2-3-fold increased prevalence rate of depression in cancer patients. The suicide rate in the first 6 months after a cancer diagnosis has been reported to be seven times than that of the general population.[15] Practical difficulties (such as financial, travel, and work-related challenges), the need to take in a large volume of unfamiliar and threatening information and make difficult decisions in the context of uncertainty, and for some, advice to change long-held behaviors, add to this burden.[11] [12] Furthermore, mental health challenges can extend into survivorship, in response, for example, to ongoing treatment or long-term side effects.[16] Therefore, the incorporation of psychosocial assessment and management into routine cancer care has been internationally advocated, with many organizations issuing clinical practice guidelines and pathways for cancer psychosocial care.[17] [18] [19] [20] [21] Many systematic reviews[22] [23] [24] have concluded that psychosocial interventions are effective in reducing psychological morbidity in cancer patients, while a recent analysis of population-based data from the U.S. noted a reduction in suicide rates since the introduction of better psychosocial care into cancer centers.[15] However, the majority of research papers and clinical guidelines have been published in affluent Western countries such as the United States of America, Canada, the United Kingdom, the Netherlands, and Australia. Low- and middle-income countries (LMICs) face significant additional challenges in cancer care, including low literacy and health literacy among their populations and fewer resources available for health services.[25] Currently in India, while a number of institutions provide professional degrees in psycho-oncology[26] and psycho-oncology professionals are employed in comprehensive cancer centers, pain and palliative units, and nongovernmental organizations across the country, separate psycho-oncology-focused services are still lacking.[26] While psychosocial care has been recognized as a priority within the palliative care subspecialty in India and other LMICs, evidence of implementation into cancer care within these countries is poor.[20] Cultural differences in approaches to health care and family responsibilities may also impact the applicability of Western models of care.[27] For example, in India and other Asian countries, the family may be accorded cancer decisional control to protect the patient from distressing information and ensure decisions are in the best interests of the family as a whole.[27] Thus, the primarily patient-centered models of care used in the West may not be appropriate in India.[27] In the light of the differences discussed above, the current special issue on psycho-oncology research and practice in India and Indonesia is very welcome, to provide alternative perspectives and solutions within psycho-oncology that match the resources and cultural preferences of LMICs. This special issue encompasses a wide range of psychosocial oncology research. It includes descriptive work documenting common mental health conditions presenting to cancer psychosocial services, and in children with cancer in Indonesia; coping styles used in response to different mental health presentations; and unmet needs in oral cancer survivors. The results of these studies can guide the provision of mental health services in India and LMIC more broadly. Several papers focus on distress and burnout in cancer health professionals, particularly during the coronavirus disease pandemic. Overall, levels of distress and burnout were high, particularly in those with less than 10 years of experience, and who had previously experienced mental health problems.[28] These papers highlight the importance of supporting the supporters, and ensuring that staff have access to appropriate and destigmatized support services. One small randomized controlled trial is reported of an exercise intervention for oral cavity cancer patients, finding it to be effective in reducing fatigue and fatigue impact. Exercise has been highlighted as an effective intervention for fatigue in randomized trials internationally,[29] but this impact has not been previously evaluated in India in this population. Finally, two papers focus on the delivery of care, the first documenting the most common cancers in India mapped against the delivery of services, highlighting disparities between need and services. The second focuses on the role of integrated cancer services in providing optimal care to people with cancer presenting with complex problems. The role of allied health such as nutritional and mental health care was highlighted. Overall, this body of work will contribute to the growing discipline of psycho-oncology in India and LMIC. Moving ahead,...

Tumor mutation profiling (MP) is often conducted on tissue from biopsies conducted for clinical purposes (diagnostic tissue). We aimed to explore the views of patients with cancer on who should own tumor biopsy tissue, pay for its storage, and decide on its future use; and determine their attitudes to and predictors of undergoing additional biopsies if required for research purposes. In this mixed methods, cross-sectional study, patients with advanced solid cancers enrolled in the Molecular Screening and Therapeutics Program (n = 397) completed a questionnaire prior to undergoing MP (n = 356/397). A subset (n = 23) also completed a qualitative interview. Fifty percent of participants believed they and/or relatives should own and control access to diagnostic tissue. Most (65.5%) believed the government should pay for tissue preparation. Qualitative themes included (1) custodianship of diagnostic tissue, (2) changing value of tissue across time and between cultures, (3) equity regarding payment, and (4) cost-benefit considerations in deciding on additional biopsies. Policy and regulation should consider patient perspectives. Extension of publicly funded health care to include tissue retrieval for clinical trials should be considered.

Background: Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill‐equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers. Objective: To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO‐pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting. Methods: The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including “think-aloud” interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3). Results: The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small “snackable” sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface. Conclusions: The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care.