Exploration of concerns and role of psychosocial intervention in palliative care--a study from India.

Psychosocial and emotional problems occur frequently during the advanced and terminal stages of cancer, and need to be appropriately detected and managed. Patients during terminal phases report numerous fears and often experience anxiety and depression. However, palliative care emphasizes pain relief and symptom control with little attention on psychological distress. In this study, an attempt was made to explore the presence of common concerns in a group of advanced cancer patients. Patients' disclosure of concerns was objectively assessed in 50 consecutive patients having advanced cancer using a shortened version of a concerns checklist. Commonly reported concerns were cancer pain (68%), physical health (60%), finances (54%), and the future (52%). Other concerns were about low mood and sadness (32%), anxiety (24%), being slowed down (40%), and not being able to work (and earn) (40%). The results indicated gender differences for certain concerns. Cancer patients with additional psychiatric diagnoses significantly more often reported concern for physical health, sadness, anxiety, future, work or occupation and being slowed down, rather than for cancer pain, interpersonal relationships, marital relationship, socialization or body image. The emotional distress due to the concerns needs to be alleviated, in order to improve the overall quality of life and help the patient cope with pain and other distressing symptoms.