CAPO Digest

Moorey, S. (2013). “I know they are distressed. What do I do now?” Psycho-Oncology,22, 1946-1952.

Journal Website: http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

Author Website: http://www.national.slam.nhs.uk/stirlingmoorey/

Stirling Moorey has been at the forefront of psychotherapy research in palliative cancer care, and he is particularly known for his work in cognitive behaviour therapy (CBT). In this personal perspective, Moorey describes the evolution of psychotherapy research in oncology as a movement through three phases. The first consisted of identifying the prevalence of psychosocial problems and the corresponding need for interventions. The second, which is still in early stages but is making great strides, has tested treatment protocols derived from mental health research, as well as those developed specifically within cancer care. The third phase has to do with the dissemination of effective interventions, which in a Canadian context would be known as knowledge translation. Like other guidelines for screening and intervening with distress, including CAPO’s own depression guideline, Moorey proposes a stepped-care approach for people who have psychological problems of differing severity. Some basic communication skills should be part of the training of all professionals, but brief psychotherapy, internet, and telephone counselling have a place for providers with additional expertise. Patients with the most serious difficulties should be seen by team members with some specialization in mental health.

Importantly, Moorey introduces the concept of “first aid CBT,” which comprises a core set of therapeutic techniques for defining and explaining problems, devising simple behavioural experiments, and applying time-limited problem-solving. In Moorey’s opinion, this type of approach can be implemented by various members of the treatment team, and is even applicable in palliative care. Moorey, a psychiatrist, then describes the success of his own recent research in training nurses in the model.

Why I like this article: The tone of this paper is one of thoughtful reflection as it provides a personal overview of the literature; it is not intended to be a rigorously scientific systematic review. However, it outlines a sensible and practical way to conceptualize how to intervene with distressed patients. Since CBT is currently the predominant form of psychotherapy in the community generally, there is a place for more clinicians in cancer care to have a basic sense of how it works and how it can be applied to their patients. First aid CBT is probably a concept whose time has come.

Prepared by Dr. Keith Wilson

Digest Commentators:

Amanda Wurz, ACSM-CPT, MSc, PhD candidate, University of Ottawa
Anika Petrella, RP, MA, PhD candidate, University of Toronto

Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto

Evidence for why exercise and physical activity is important for individuals diagnosed with cancer is well established. However, pervasive uncertainty remains about how to connect this population to relevant services and resources (i.e., who should be involved/responsible and where to refer to). To address this gap, Santa Mina et al. (2018) proposed a model or pathway that goes beyond the what and systematically delineates how individuals diagnosed with cancer can be engaged in exercise programming and physical activity promotion. In addition, the authors tackle an existing barrier related to the lack of knowledge surrounding accessible services and resources by describing what is currently available across North America.

The proposed pathway is depicted visually and described utilizing empirical evidence and clinical knowledge. At the beginning of the pathway are healthcare providers (e.g., oncologists, family physician, nurses, psychologists, social workers), who are described as playing a critical role in enhancing access to exercise programming and physical activity promotion resources for individuals diagnosed with cancer. Following this, the pathway forks to illustrate the parallel steps for exercise engagement (i.e., referral to a qualified exercise professional and screening/risk stratification) and/or physical activity promotion.

Notably, Santa Mina et al. (2018) adopt a person-centred approach considering facilitators and barriers faced by individuals diagnosed with cancer, acknowledge the entire healthcare team by emphasizing a shared model of responsibility, and incorporate services (e.g., exercise programming) alongside self-management and behaviour change resources (e.g., online education). Thus, the emergent model is amenable to modification based on the individual and context. Finally, the authors flag areas requiring further attention/clarification (e.g., exploring home-based exercise programming) and conclude by encouraging future investigation of the applicability and economic sustainability of the pathway.

Why we liked this article: First, the pathway was developed by a team of leading experts in the field of exercise, physical activity, rehabilitation, and cancer survivorship and represents an important step to bridging the gap between what to do (i.e., recommend/refer individuals diagnosed with cancer to exercise/physical activity) and how to do it (i.e., specific steps, guidance, and access to resources). Second, the authors clearly underscore that individuals diagnosed with cancer are not static throughout survivorship. As such, a non-prescriptive approach, acknowledging potential fluctuations in health status, changes in self-motivation and empowerment, and differing needs with regards to addressing barriers over time was adopted. The fluidity and flexibility inherent in this model have the potential to significantly impact the wellbeing of individuals from cancer diagnosis onward across a variety of contexts.

Citation: Santa Mina D, Sabiston C, Au D, Fong AJ, Capozzi LC, Langelier D, Chasen M, Chiarotto J, Tomasone J, Jones J, Chang E, & Culos-Reed SN. (2018). Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement. Current Oncology, 25(2):149-162.

Journal website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927786/