Psycho-oncology: Where have we been? Where are we going?

This article reviews the development of the subspeciality of psyche-oncolog y and its contributions to patient care, encouraging more attention to and research into the care of the total patient: the physical, psychological, s ocial and spiritual aspects of care. The result is enhanced quality of life as the patient is studied in the domains of Living that are important, ext ending across the continuum of care from diagnosis to palliative care. In a ddition, cancer prevention and early detection depends largely on changing attitudes and behaviours that put people at greater risk. This is an import ant area of research for psycho-oncologists. In the past two decades, resea rch has contributed to our understanding of the psychological responses tha t accompany a cancer diagnosis. Oncologists better recognise psychological distress and psychiatric disorders such as anxiety, depression and delirium (in hospitalised patients) as frequent comorbid disorders. The development of valid assessment tools for the patients' self-report has been important . Increasingly, outcome measures in controlled trials of new therapies incl ude quality of Life, and no longer look at survival alone. The future will continue to bring new challenges to psyche-oncology as patients face new ch allenges in treatment. A major aim of the next century will be to bring thi s integrated approach to all patients in an affordable manner. (C) 1999 Els evier Science Ltd. All rights reserved.