July 28, 2023
Clinical psychology develops treatment for those with mental illness. Clinical health psychology programs are emerging, however, that utilize similar distress-management principles for patients with serious medical illnesses such as cancer.
Shawna L. Ehlers, Ph.D., L.P., a clinical health psychologist at Mayo Clinic in Rochester, Minnesota, explains that the focus of cancer psychology isn't necessarily on mental illness. Oncopsychology focuses on improving health outcomes by helping patients to cope with the stresses associated with their illnesses and treatments.
"The focus is to reduce suffering symptom burden and help people focus on enjoyment and quality of life, despite the fact that they're going through cancer treatment," says Dr. Ehlers. "There's also good evidence that doing so improves traditional outcomes like recurrence and survival."
Dr. Ehlers and her colleagues are working to build out an oncopsychology program built on best evidence science translation (BEST), ensuring the highest quality care possible. The team recently conducted a study applying these BEST principles in a real-world, comprehensive cancer care setting. Results of the study were published in the Journal of the National Comprehensive Cancer Network in June of 2023.
Cognitive behavioral therapy for cancer distress (CBT-C) as a billable service
CBT-C has been associated with survival advantages in previous randomized clinical trials, but has not been tested within billable, clinical settings. Previously, patients have had access to this service primarily through clinical trials. The research team at Mayo Clinic aimed to address the barriers associated with trial-based care by implementing CBT-C as a real-world, billable service.
"We have amazing trials testing these services," says Dr. Ehlers. "Not all patients benefit from that evidence, though. We're testing those trials in the practice setting so we can show others how it can be done in the practice setting."
In the first phase of the research, the team sought input from stakeholders to develop a list of barriers and facilitators to the previously studied "gold standard" CBT-C methods. These barriers and facilitators were used to inform adaptations to the CBT-C model. Adaptations included:
- Expanding indication eligibility beyond breast cancer.
- Reducing the number of sessions to five, for a total of 10 hours of treatment.
- Both removing and adding content.
- Revising some language and images.
Phase 2 of the study continued to inform the content adaptations made to the CBT-C model with user-testing by therapists and patients.
Implementing the adapted CBT-C model
Phase 3 of the research involved real-world implementation of the adapted CBT-C model. Implementation was performed as part of the comprehensive cancer care provided at Mayo Clinic. In this phase, referring physicians ordered a cancer stress management consultation through the electronic health record. After the consultation, eligible patients were invited to participate in the adapted CBT-C program.
Throughout the study period, 100 patients enrolled in CBT-C, and 60 of those consented to research participation. All research participants completed 100% of the adapted CBT-C content. Measures included administrative feasibility of delivery, feasibility of recruitment and retention, feasibility of oncology collaboration, and patient acceptability as measured both quantitatively and qualitatively.
While future research is needed, this study did show that implementation of CBT-C as a billable clinical service was feasible across all measures. Dr. Ehlers and her team suggest further research in diverse patient groups and clinical settings, as well as in remote delivery of services.
Future directions for oncopsychology
The research associated with cancer distress management has led to uptake of oncopsychology services by many top cancer centers. Dr. Ehlers explains that there are four main components of oncopsychology:
- Patient experience.
- Health outcomes.
- Cost and utilization of health care.
- Clinician burnout.
"We're hoping to demonstrate improvements in all four areas as we continue this research," says Dr. Ehlers.
While oncopsychology services are available on a small scale now at Mayo Clinic, Dr. Ehlers and her team are building out formal systems to launch a larger comprehensive oncopsychology program later this year. The new launch provides a unique opportunity to build all elements around the BEST principles as they integrate with the care provided at Mayo Clinic Comprehensive Cancer Center.
For more information
Ehlers, S, et al. Real-world implementation of best-evidence cancer distress management: Truly comprehensive cancer care. Journal of the National Comprehensive Cancer Network. 2023;21:67.
Refer a patient to Mayo Clinic.