NEW YORK (Reuters Health) - Only a minority of patients with advanced cancer are referred by their cancer doctor for specialized psychological care, even if they're clearly distressed, results of a study from Canada indicate.

Among a group of 326 patients being treated in a comprehensive cancer center for advanced lung or gastrointestinal cancer, only one third were referred for psychosocial care to a social worker, psychologist or psychiatrist, Dr. Gary Rodin and colleagues report in the Journal of Clinical Oncology.

"Further, more than half of those with clinically significant levels of depression were not referred for psychosocial care of any kind throughout the course of their disease," Rodin told Reuters Health.

"These findings are of concern because they demonstrate that the majority of cancer patients with advanced disease and clinically significant levels of depression may not be referred for psychosocial care, despite mounting evidence for its benefit," said Rodin, who is chief of the department of psychosocial oncology and palliative care at Princess Margaret Hospital, Toronto, Ontario.

Patients who were unmarried and living alone were more likely to be referred, "which may be understandable in terms of their potentially greater social need and distress," Rodin reported.

However, amongst those with elevated levels of distress, there was a remarkable age difference in referral rates, with all of the patients younger than 40 years old referred for psychosocial care compared with only 22 percent of those aged 70 or older.

"The five-fold difference in referral rates between younger and older patients raises the possibility of age bias in the referral for psychosocial care," Rodin said.

"These findings," he concludes, "draw attention to the need for routine screening for distress in cancer patients, for the institution of more routine mechanisms that integrate psychosocial care in cancer treatment settings and for further research to elucidate the potential barriers to psychosocial care in older cancer patients."

SOURCE: Journal of Clinical Oncology, online December 28, 2008.

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