Best support for cancer patients and their loved ones as they approach end-of-life

Nearing the end of life takes an emotional toll on a cancer patient and their loved ones.

Cancer patients face many psychosocial stressors, including dignity loss, existential distress, demoralisation and perceptions of being a burden. These sit in the background of a wide range of psychiatric concerns, from depression and anxiety to posttraumatic stress. Caregivers also face a significant level of psychological distress and anxiety and are at risk of prolonged grief.

People are considered to be approaching the end of life when they are likely to die within the next 12 months. An estimated 49,000 Australians die from cancer every year.

Psychosocial interventions are important as they address emotional, spiritual and practical needs. This creates value, meaning and purpose, helping patients retain a sense of identity while acknowledging the pragmatic needs of finances, housing, and aids to daily living. Implementation of psychosocial interventions to manage psychosocial suffering should be part of best care for every patient facing end-of-life.

The field is rapidly growing and there is much evidence to support its benefits, but we need more research to fully understand how we should best deliver psychosocial interventions.

What type of research is needed? What types of psychosocial interventions are available? And what are the knowledge gaps?

Medical students Nicolle Chew and Ee Lynn Ting, supervised by Dr Lucy Kerr and Associate Professor Philip Russo, set out to answer these questions by conducting an extensive review of the current literature. As part of a project with the Cabrini Monash Department of Nursing Research and Cabrini Intensive Care Research Unit, they found there was a broad variety of interventions, but there was a lack of robust and reliable outcome measures, making it difficult to compare different endof-life psychosocial interventions. Several gaps in the literature were also apparent, such as the need for increased research in middle to low-income populations, interventions addressing social and religious aspects of care, and the impact of COVID-19 on end-of-life interventions.

A/Prof Russo, Head of the Cabrini Monash University Department of Nursing Research commented, “this scoping review has highlighted the gaps in our understanding. Now we can set out to fill those gaps with rigorously designed research, so that the best evidence is driving our care for cancer patients and their loved ones.”