Incorporating Psycho-Oncology into GI trials: A/Prof Haryana Dhillon
The unique nature of gastro-intestinal cancers makes them an area for potential psycho-oncology research, according to Associate Professor Haryana Dhillon.
A/Prof Dhillon is Chair of the Scientific Advisory Committee for PoCoG, the Psycho-oncology Co-operative Group. PoCoG conducts large-scale, multi-centre psycho-oncology and supportive care research, with a focus on improving the emotional support and psychological care of people affected by cancer.
“The work we do is interesting, because it spans all the tumour groups, rather than focusing on any particular one,” says A/Prof Dhillon.
“The area we’ve done a lot of work in the recent past has been in terms of decision support tools, so decision aids, and evaluation of decision aids being incorporated into randomised controlled trials.”
The decision support tools help patients to make decisions about their treatment based on what they prefer, taking into account the impact of the treatment and its potential outcomes.
“Rather than telling them what to do, it’s trying to help them work out what’s important for them and what’s the best decision,” says A/Prof Dhillon.
She notes that research around the fear of cancer recurrence or progression could be a particularly useful area for GI cancer patients.
“PoCoG has completed a very successful body of work on fear of cancer recurrence and progression,” she says.
“We have developed an intervention that’s been shown to be effective in reducing fear of cancer recurrence in people with early stage cancers. We’d be interested now to see if that intervention is something that would be suitable for people who had pancreatic cancer or another GI cancer, or even metastatic cancer?”
Another area that A/Prof Dhillon believes has potential to be incorporated into AGITG trials is a program related to distress screening for the management of anxiety and depression.
“We have developed an evidence-based clinical pathway for the management of anxiety and depression,” she says. “We then created an online portal which includes the assessment tool, and a range of other support tools in terms of information for patients’ online cognitive behavioural therapy.”
She says this tool could provide access to psychological assessment and treatment for people who are not able to see a clinical psychologist, do not want to go to a clinical psychologist, or do not have the time to.
PoCoG is also conducting research into alternative ways of asking questions to people when English is not their first language.
“We’re in the process of doing some work looking at how to develop or adapt the kind of symptom questionnaires that we’ve been using in people with English language skills so that they can be delivered in a way that is not language based,” says A/Prof Dhillon.
She stresses the importance of always keeping the patient at the centre of research.
I think the key is always coming back to the patients and their experiences,” says A/Prof Dhillon. “Wanting to make sure that whatever happens to them, their psychological and psychosocial needs are being looked after as well as their physical needs.”
PC4: The role of primary care in GI cancer research
The Primary Care Collaborative Cancer Clinical Trials Group (PC4) conducts research to inform new models of cancer prevention and management in the community.
Dr Jennifer Walker is a senior research fellow and Deputy Lead of PC4. She says that primary care practitioners are a part of every touchpoint throughout cancer patients’ experiences.
“We always talk about primary care being important across the cancer continuum,” she says. “But despite that, GPs don’t see a lot of cancer out of the enormous range of their conditions and symptoms that they see every day.”
“GPs are often the first point of call for suggesting and organising screening, and they give a lot of preventative advice,” she says. “And then at the other end of that, a lot of cancer survivors are now living for a long time, and a lot of GPs are managing them.”
Dr Walker says that one of the challenges for primary care of GI cancers is that they are not part of everyday practice for most GPs. It can be difficult to diagnose GI cancer. Integrating knowledge of the symptoms and side effects relating to treatment is also key to GPs having an immediate response to these, as it can be more efficient than referring them to a specialist.
“It’s becoming well understood that primary care plays an intrinsic role in cancer care and cancer research and if you design cancer research that doesn’t really include primary care, then you’re missing this key component of any type of intervention,” she says. “There has to be a way of developing trials that incorporate primary care, even if it’s at a point of implementation.”