LUIGI GRASSI

Clinica Psichiatrica Università di Ferrara

This new section aims to offer a space and visibility to psychooncology, which has been active for at least twenty years but only recently has been more specifically considered in the health system. It is a human and complex area, as all the disciplines with a "relational basis" are, and it is characterized by the strong integration between the several professional disciplines which operate in oncology. Psychooncology, which some author tend to consider as sub-specialty of oncology, other authors as a sub-specialty of consultation-liaison psychiatry, others as a sub-specialty of clinical psychology, actually is a discipline on (and in) the border, with its multiple interaction with other specialties which constitute the fabric of psychooncology itself: oncology, and psychiatry, psychological and social sciences, general medicine and palliative medicine, to cite only some.

It is certain that psychooncology today is a quite definite branch and cannot be considered as an area for special or exclusive interest of specialistic cancer centers. The interaction between health professionals while working with cancer patients and their families, and the psychooncology training of these professionals in terms of biopsychosocial approach, communication skills, psychooncology interventions and continuity of care is something that is and should be possible in every cancer center, from the university hospitals to day-hospital cancer units in small hospitals, from organized palliative care services to home-care services provided by primary care physicians.

As for many other branches of medicine and psychiatry, psychooncology has suffered the negative effects of several factors: policy, ideological and health strategies, and cultural, social and psychological phenomena have not considered the psychosocial consequences caused by cancer and its treatments. Psychiatry, by focussing attention almost exclusively on patients with severe mental disorders (or "major" disorders) had risked remaining in an alienated by the multiple expression of psychological distress (not "minor" at all) and losing the opportunity for a constructive and enriching dialogue with the other medical disciplines. Oncology, in turn, by focussing attention almost exclusively on the fight against cancer, as a medical disease to be known in its biologiocal essence and on this ground defeated, has worked on a technical level far from the "human reality", with the risk of losing contact with the real patients and clinical care (in its etimology of to be inclined towards). It is also true that psychiatry and oncology share common denominators: first, the problem, not always solvable, of dealing with common prejudices, such as cancer = death, on the one side, and mental illness = psychological death (madness), on the other, with all the possible consequences in terms of communication (e.g. the communication of the diagnosis of cancer and the communication of the diagnosis of schizophrenia), assistance (e.g. the sense of hopelessness in the relationship with terminally cancer patients and with chronically ill psychiatric patients). Second, the psychiatric implications of cancer (e.g. the psychiatric morbidity secondary to cancer) and, the risk of developing cancer in subjects with psychiatric disorders (the often forgotten area of medical health and health-risk behavior of psychiatric patients). Third, the importance for a staff approach to patients, as a way to define the aims, to find a space for listening and to make interventions which take into account the specific and individual patient’s needs, Furthermore, the involvement of the families in the care process and the tendency to a domiciliary approach for the cure and the care of the patients. Fourth, the development of "intermediate service" between the home and the hospital (e.g. the residence psychiatric units and the hospices, with their significant differences in terms of mission and aims of intervention).

For the abovementioned reasons, the creation of a psychooncology section, among the other sections dedicated to the several dimensions of psychiatry, has a precise and very important meaning. The section will have regular papers, concerning epidemiology, research, clinical data and including review and literature abstracts. We have considered it useful to dedicate part of the section to interviews with international experts in the field of psychooncology, in order both to discuss complex and innovative areas and to explore the cultural (and cross-cultural) issues in psychooncology. The Web has facilitated the growing of psychooncology, as well as of many areas; thus a series of links with the most significant psychooncology web-sites has been inserted in order to make it easier for the reader to gather information, lectures on line, and training programs developed in psychooncology services or units. The section will be regularly updated and it can extend its aims according to the feedback, comments and papers which hopefully will come in the near future, along the path of our "psychooncology project".