“Yes, I have cancer, but I'm also lonely”; tackling a common problem in cancer care

In this issue, we tackle a number of emotional aspects of cancer care. Emotional distress is common in cancer patients; cancer type and extent of disease are important determinants (Strong et al., 2007). A range of psycho-oncology interventions has demonstrated effects on emotional distress and quality of life (Faller et al., 2013). Carolan, Smith, Davies, and Forbat (2018) examine the factors which influence help-seeking behaviour in patients with emotional distress. They describe the concept of “normality”; patients either seek or decline help, based on a quest for a return to normality in their lives. Their decisions will be a function of the context of their lives—and may change over time. The authors suggest this gives clinicians important management clues, and advocate a “systems thinking approach” in designing management strategies.

Psychosocial problems, as well as symptoms such as urinary incontinence and sexual dysfunction, are also common after treatment for prostate cancer (Gore, Kwan, Lee, Reiter, & Litwin, 2009)—yet the needs of these patients are often neglected. Interventions based in primary care have shown some promise in addressing psychosocial needs, but there are ongoing challenges in identifying those men with unmet needs post-treatment, and designing interventions which are both acceptable and cost-effective (Watson et al., 2018). Dunn et al. (2018) examine the issue of cancer support groups—in this case, for prostate cancer. Their qualitative study identified a number of experiences of prostate cancer patients which underline the need for such groups, including men's feelings of isolation and neglect by the health system. The groups are an important community resource, and the authors argue that an understanding of the groups' values and purpose is vital if their contribution to patient well-being is to reach its full potential.

Lung cancer is often invested with rather negative emotions; a sense of “nihilism” has often been expressed in relation to lung cancer prevention and treatment (Chambers et al., 2012). Lung cancer places a huge burden on health services worldwide; screening of high-risk groups, using low-dose computed tomography screening, offers the prospect of improved survival (Horeweg et al., 2014), but at present, we lack the evidence to effectively target screening—lung cancer risk prediction models are an identifiable way forward but, to date, lack the necessary precision (Tammemägi, 2015). Indeed, there are significant evidence gaps in many aspects of lung cancer early diagnosis and management. Rankin et al. (2018) tackle “evidence-practice gaps” in lung cancer; there is disconnect between “best practice” and “actual practice” in many areas of health care—given the huge global burden of lung cancer, it is especially important to improve the evidence base, and encourage practice which is compliant with this evidence. Their review highlights challenges across the lung cancer journey—including timely diagnosis and referral, under-utilisation of available treatments, psychosocial support and multidisciplinary team management. Lung cancer lags behind some other cancers in terms of survival improvements over the last decade; it is vital that available evidence is better utilised in the early detection and management of this challenging illness.

And so to loneliness, there is a growing recognition that loneliness is something we should systematically look for, and treat, in cancer patients (Adams et al., 2017). Carers of cancer patients may also be at risk of social isolation and loneliness; holistic approaches which take account of patients' social environment are vital in addressing loneliness and other related psychosocial factors with negative impacts on cancer outcomes and quality of life (Sahin, 2012). How often do healthcare providers take into account the effects of loneliness in their cancer patients? It is a common experience amongst cancer survivors, yet it can be difficult for clinicians to identify loneliness in their patients, compounded by a lack of any consistent approach or measuring instrument. Cunningham, Kroll, and Wells (2018) describe the development of a cancer-related loneliness assessment tool. Establishing loneliness in a more systematic and rigorous way would help in the development of more effective patient-centred approaches addressing this common problem.

Continuing with the theme of “the mind” in cancer care, there has been a significant growth in “mindfulness” interventions in cancer patients over the past decade; mindfulness promotes the concept of “inhabiting the present” and can be used as a technique to reduce a number of negative cancer-related affects, including fear over cancer treatments, or reduced life expectancy. Mindfulness interventions have evolved from “Theravada Buddhism” and vipassana or “insight” meditation—they include both formal and informal meditation practices and show promise in a number of aspects of cancer management, although their potential and usefulness (and how they might be best targeted) are still the subject of ongoing research (Haydon, Boyle, & Bower, 2018; Shennan, Payne, & Fenlon, 2011). What do patients think of these approaches? Tate, Newbury-Birch, and McGeechan (2018) undertook and systematic review of qualitative evidence and found that patients often encounter challenges in engaging with mindfulness techniques, but such techniques can help in identifying coping strategies; importantly, mindfulness techniques need to accommodate individual patients' characteristics and perspectives.

The European Journal of Cancer Care has, over many years, encouraged research into multidisciplinary approaches to cancer control. Multidisciplinary teams (MDTs) have emerged as a “gold standard” of cancer care around the world—although there is considerable variation in their format and modes of working (Prades, Remue, Van Hoof, & Borras, 2015). Multidisciplinary cancer care is now endorsed by cancer organisations in Europe and around the world (Borras et al., 2014). Dubois et al. (2018) have analysed patterns of MDT meetings for seven common cancers—their analysis shows an increase over time in the proportion of individual patients discussed at MDT meetings. Nevertheless, barriers to further use of MDT approaches, including administrative burden, do exist, and the authors advocate more research to identify and overcome such barriers.

And finally, there is a growing body of research on symptom appraisal—the way in which people interpret and respond to symptoms which may indicate cancer. Symptom appraisal may underpin differences in stage at presentation (that is, some people may respond more rapidly, leading to an earlier staging in their cancer diagnosis); it may also explain socio-demographic differences in response to symptoms—which may, in turn, lead to differences in cancer survival (Whitaker, Scott, & Wardle, 2015). Indeed, targeted interventions have been advocated to reduce avoidable delays in cancer diagnosis and minimise socio-economic group inequalities (McCutchan, Wood, Edwards, Richards, & Brain, 2015). Dobson, Russell, Brown, and Rubin (2018) examined the context of people's lives and how they influenced symptom appraisal and help-seeking. Contextual factors, including the type of symptom(s) experienced, discussion of symptoms with others and the social responsibilities people held during symptomatic periods, appeared to influence the patient interval—highlighting the importance of taking these factors into account when designing early cancer diagnosis strategies. So, once again, plenty of interest for our readers, and we hope you enjoy this issue of EJCC. As always, your feedback is welcome.