Irma Verdonck-de Leeuw*, VU University Medical Center / VU University, Amsterdam, Netherlands Anne-marie Krebber, VUmc, dept of Otolaryngology / Head & Neck Surgery, Amsterdam, Netherlands Pim Cuijpers, VU University, dept of Clinical Psychology, Amsterdam, Netherlands Remco De Bree, VUmc, dept of Otolaryngology / Head & Neck Surgery, Amsterdam, Netherlands Annemieke Van Straten, VU University Dept of Clinical Psycholgoy, Amsterdam, Netherlands Filip Smit, VU University dept Clinical Psychology, Amsterdam, Netherlands Rene Leemans, VUmc dept of Otolaryngology / Head & Neck Surgery, Amsterdam, Netherlands Track: Research Presentation Topic: Web 2.0 approaches for clinical practice, clinical research, quality monitoring Presentation Type: Oral presentation Submission Type: Single Presentation Building: MECC Room: 0.8 Rome Date: 2010-11-30 01:00 PM – 02:30 PM Last modified: 2010-11-23

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Background: In the Netherlands, government policy statements and the recent guidelines “Cancer Rehabilitation” and “Screening for the need for psychosocial care” reflect broad scientific and social support for a structured, integrated approach to cancer care. Because the number of cancer patients living with cancer is expected to increase dramatically in the near future, the need for cancer care will increase accordingly. However, cancer care providers may lack the operational and organizational means to deliver cancer care in a structured, comprehensive, and cost-effective manner. Alternatively, care can be organized according to stepped care principles in which several evidence-based interventions are offered in a structured way while a care manager carefully monitors the recovery of the patients. This has the potential to improve the efficiency of supportive cancer care.
Objective: To gain insight in levels of emotional distress and need for psychosocial care among head and neck cancer patients in order to develop a stepped care strategy.
Methods: A touch screen computer system (OncoQuest) measuring anxiety, depression and quality of life was developed and implemented in clinical practice enabling structured monitoring. A prospective study was carried out to assess prevalence of emotional distress before treatment and during follow-up. A cross-sectional study was performed on the need for psychosocial care, peer support, and e-health.
Results: Low levels of distress at baseline or follow-up were noted in 64%; 18% had normal scores at baseline and developed distress at follow-up; 11% had high levels at baseline and returned to normal scores at follow-up, and 7% had persistent distress. No patients were referred to psychosocial care at times of diagnosis and at follow-up, 21% were referred. The need for psychosocial care and peer support by patients was limited; the majority used the Internet frequently. A stepped care strategy targeting emotional distress was developed including: 1. Watchful waiting, 2. Internet-based self-help, 3. Problem Solving Therapy by a nurse, and 4. Specialized psychological intervention/medication.
Conclusions: A high level of emotional distress is common and few patients are referred to psychosocial care. A stepped care approach including guided self-help via the Internet may be beneficial for cancer patients. A broad multidisciplinary team is needed to develop a stepped care strategy in cancer patients. A randomized controlled trial is ongoing to assess cost-efficacy of this stepped care strategy targeting emotional distress in cancer patients.