July 2011
International Psycho-Oncology Society’s (IPOS) - Statement on Standards and Clinical Practice Guidelines in Cancer Care, July 2010

The International Psycho-Oncology Society (IPOS) proposes endorsement of the following statement on standards and clinical practice guidelines in cancer care:

IPOS International Standard of Quality Cancer Care:

  1. Quality cancer care must integrate the psychosocial domain into routine care.
  2. Distress should be measured as the 6th Vital Sign after temperature, blood pressure, pulse, respiratory rate and pain.  

Over the past several years, the health care organisations in a number of countries including Australia, Canada, the European Union, and the United States of America have recognized the importance of incorporating psychosocial care into national cancer treatment plans. Core recommendations state that there should be assessment of need and provision of appropriate psychosocial support as part of quality cancer care.

In 2007 in the US, the Institute of Medicine (IOM), National Academies of Science, a respected national public health policy body, reported that the strong evidence base for efficacy of psychosocial intervention in cancer care now mandates the establishment of a new quality standard of cancer care. In the UK, the National Institute of Health and Clinical Excellence (NICE) (2004) provided a guideline to be incorporated into the National Cancer Plan requiring the assessment of, and provision of care for, psychosocial needs in all cancer patients.

The landmark IOM Report stated that the psychosocial domain must be integrated into routine cancer treatment. An Alliance to Implement Quality Psychosocial Cancer Care has formed with over 30 professional and advocacy organisations endorsing efforts to assure the new standard is implemented in oncology practice. The Alliance seeks to educate both patients and families and professionals about the new mandate. A novel way to implement the psychosocial care standard was proposed by the Canadian Strategy for Cancer Control (2004) and Accreditation Canada (2009) by recommending that when taking routine vital signs, Pain should be the 5th Vital Sign and Distress should be the 6th Vital Sign assessed using a standardised pragmatic method (e.g., patient reported on a 0 – 10 scale).

At the June 2009 IPOS Board meeting, members unanimously endorsed the concept that Distress be named the 6th Vital Sign in oncology. Vital signs are an essential part of routine patient care and are essential to the patient’s case presentation and support of their well-being. In 1999, due to significant impact on patients, Pain was endorsed as the 5th Vital Sign.

Prevalence rates of distress in cancer patient populations have been well documented in the literature.  The negative impact of distress on cancer patients, families and the community is a primary concern for clinicians, scientists, educators and numerous cancer support organizations.

The International Psycho-Oncology Society believes that endorsing Distress as the 6th Vital Sign will raise awareness of distress as an essential component of the patient experience and will act as a call to action for care providers and the health system as a whole to assure psychosocial care for patients.

The International Psycho-Oncology Society is the multidisciplinary international body responsible for the psychological, social and behavioural issues in cancer care.  IPOS has determined that there is sufficient evidence and experience available to propose a new international quality standard which could have a synergistic effect upon international and national efforts to improve psychosocial cancer care.

Elliot Graham
Executive Director, International Psycho-Oncology Society (IPOS)




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