A cancer survivorship program incorporating psychosocial care: a Hong Kong experience
An article written by Associate Professor Wendy Wing Tak Lam
Locally, patients on active cancer treatment receive routine symptom assessment and management, but symptom monitoring often becomes infrequent beyond the treatment phase. A similar care arrangement applies to patients with advanced or metastatic cancer who cycle on and off treatments to manage disease progression. Furthermore, assessment and management of psychosocial effects are scarcely addressed until patients are referred to a palliative care team for the end of life care when treatment is no longer available. Hence, there is an urgent need to develop a locally acceptable survivorship care model tailored to the needs of patients with advanced or metastatic cancer.
To address this issue, the LKS Faculty of Medicine, The University of Hong Kong, recently obtained funding from the Hong Kong Jockey Club Charities Trust to set up the Jockey Club Institute of Cancer Care (JCICC). The institute aims to integrate psychosocial services into routine cancer care in Hong Kong and develop a locally acceptable survivorship care model tailored to the needs of patients with advanced or metastatic cancer. As part of this effort, the institute developed a multidisciplinary cancer survivorship clinic targeting individuals with advanced or metastatic cancer. The clinic comprises a team of healthcare professionals, including an oncology nurse practitioner, a dietitian, a cancer exercise specialist, and a psychologist/counsellor. During the visit, patients receive a personalized assessment and recommendation on managing physical and psychological symptoms, dietary advice, physical activity, and potential psychosocial issues. The survivorship care program adopts a self-management framework emphasizing problem-solving, decision-making, resource utilization, communication with healthcare professionals, and action planning.
The pilot data from the survivorship clinic showed that most advanced or metastatic cancer patients experience symptom distress, primarily sleep disturbance, fatigue, anxiety, depression, neuropathy, pain, and lack of appetite. Furthermore, many patients had suboptimal weight, highlighting the importance of a multidisciplinary cancer survivorship program to manage symptom distress and promote health maintenance. The survivorship clinic appears feasible and acceptable, with 83% of patients reporting that it was worthwhile attending the clinic and 93% stating they would recommend it to other patients. Of the caregivers who accompanied patients to the clinic, 35% expressed service needs, primarily seeking services in managing stress, support concerning patient care, and practical help as services or resources concerning referral.
The survivorship clinic for advanced or metastatic cancer patients developed by the LKS Faculty of Medicine, The University of Hong Kong, appears feasible, acceptable, and helpful in managing symptom distress and promoting health maintenance. This multidisciplinary approach to cancer care emphasizes self-management skills and incorporates psychosocial services into routine cancer care, providing patients with the support they need to manage their symptoms effectively and improve their quality of life.
Links (note: the videos are in Cantonese with Chinese and English subtitles)
Introduction to JCICC Supportive Care Clinic Service
Exercise tips for people living with advanced cancer
Self-care trips & tips for caregivers of advanced cancer patients
Dr. Lam is a Visiting Scholar at Flinders University, College of Nursing and Health Sciences.
Wendy Wing Tak Lam, RN, Ph.D., FFPH
Associate Professor
Head, Division of Behavioural Sciences, School of Public Health
Director, Jockey Club Institute of Cancer Care
Li Ka Shing Faculty of Medicine
The University of Hong Kong