Question (Q): Since the 70' and the early 80' psycho-oncology has been quite developed in many countries. What is the situation of psycho-oncology in other countries?
Answer (A): The situation for psycho-oncology is "a situation" for psychosocial oncology. I think we have to talk about the psychological and the social dimension of cancer because these two aspects are complimentary to each other. No person is living in a social vacuum and all aspects of behaviour and cognition are closely related to a social context. Thus, the situation in the developing countries are much more tailored to the social situation which is a lack of resources, lack of basic treatment, lack of pain killing medications and relatively difficult circumstances with regard to radiation, chemotherapy and surgery. I think psychosocial aspects are of an enormous importance, even under these circumstances but I am not so familiar with the precise situation. In addition I think it will differ between various parts of the world, nations and within regions.
Q: What are the most important aims of the IPOS for the roesent and the immediate future?
A: The most important aims for IPOS are so many that I difficulties in just give you a short list. First of all we want to vitalize and enlarge our small organisation in order to have some organisational power behind us when we argue for clinical psychosocial guidelines, education of the professionals in psychosocial aspects of cancer care and the integration of the psychosocial dimension in cancer treatment, counselling and rehabilitation. As you see, I give you some indication of what IPOS currently is engaged in and it is my hope that we during the next five years will reach each of these goals in many industrialised societies.
Q: Psychosocial aspects of cancer should recognized by sevral agencies, including the WHO. Are there policies for dissemination of psycho-oncology in within WHO programs?
A: In my opinion the are policies for the dissemination the question is rather to what extent these policies in fact works. The mechanisms by which WHO is disseminating its policies are often slow and the national governments are often hesitant when it comes to the actual implementation of these policies.
Q: Do you see a possible role of the International Societies, including IPOS, in favoring the specific institution of the psycho-oncology as a profession (psycho-oncologist as a recognized health professional figure)?
A: Yes, I think International organisations plays an important role and the initiative taken by IPOS to become a Non Governmental Organisation (NGO) in relation to WHO will surely have impact. When clinical guidelines becomes available the next problem becomes education and here psychosocial oncologists have something to offer.
Q: Epidemiology and clinical studies some times seem to speak different languages. In the setting of individual psychotherapy and in the dual contact wwith the suffering, what emerges from RCT or investigations of large populations seem to loose its importance. At the same time, patients want to have answers that often come from epideiological stuides. The case, for example, is for the role of stress in molding illness progression. How to reconcile these positions?
A: The clinical observations are selected due to a number of cognitive processes including recall bias and selection of patients allocated to different treatment modalities. Research is an instrument that can evaluate the practise you conduct on a day-to-day basis and in my opinion many clinicians forget the importance of data from well-conducted trials. I dont see clinical practise as antagonistic to research but I think that much clinical work is conducted without a strict scientific reason. We all know that support is supportive but we need to know what cancer patients benefit most from this support, how the support should be organised, the content, the timing and so on. In a way, I would argue that you cant have a clinical practise without linking this practise to scientific activities. Epidemiology, RCT and the clinic must be seen as necessary ingredients in the entire cancer treatment spectrum.
Q: What do you think are the areas which benefit more from epidemiological stuides in psychosoocial oncology?
A: Epidemiology can be used in all areas of psychosocial oncology there are no limits
Q: Giving meaning to our existence is one of the deep themes emerging in the contact with cancer patients, as well as all people with life-threatening illness and severe psychiatric disorders too. With reagrd to this, spirituality has been recently investigated by using psychometrci instruments or VAS by research in psychsoocial oncology. What is the opinion of an epidemiologist and at the same time a physician in quantifying this individual and human variable?
A: The theme of spirituality is of a high importance. In line with the overall improvement in survival existential questions become more and more relevant. Patients survive to establish a marital life, get back to work and re-establish their social life. We do know something about this issue but we do not know very much from well-conducted, large, prospective studies. On the other hand, the church as an institution has been the institution that took care of the spiritual dimension. Religion may also exist without a church and spirituality may also exists without a religion. The non-religious person has also spirituality and based on the above mentioned observations this dimension become increasing relevant. Kierkegaard, the Danish philosopher, claimed that spirit or mind was the dimension that took care of the relation between psyche and soma. No matter what you (the patient) believe, or dont, this is a new area for research and clarification. In collaboration with a catholic philosopher (connected to the Gregorian University in Rome) I have just edited a book here in Denmark on the issue of Mind, Belief and Disease. It will be published in January next year in Danish.