The Psycho-Oncology Service, part of the Psychological Medicine Service at St James’s Hospital, aims to provide expert, compassionate care to patients with cancer who are attending the hospital. Affiliated to Trinity College Dublin, the service also provides training for healthcare professionals. Its emphasis is on the early recognition of psychological distress, the delivery of best practice in terms of interventions and the promotion of psychological well-being. Through teaching and teamwork, it seeks to promote a culture of collaboration, compassion and respect, not only for patients but also for all those involved in providing healthcare.
The team operates from a single building on the hospital site, fostering collaboration between clinicians and helping to integrate the response to psychological distress within a medical setting.
The Psychological Medicine Service gives patients access to a broad range of interventions and expertise, ranging from psycho-education and self-directed learning to specific interventions provided by senior clinical nurse specialists, principal clinical psychologists and consultant psychiatrists. The service has led the field in providing innovative educational programmes for healthcare students and clinicians, both locally and nationally.
In constantly striving for excellence, the service has received several national awards, including the HSE Innovations and Quality Award (2005) and Best Hospital Project and An Duais Mhór at the Irish Healthcare Awards (2012). It was the first service to develop a clinical nurse specialist post in general hospital mental health, the first mental health team to develop an intern-training position and the only fully integrated, multidisciplinary psycho-oncology service in Ireland to date.
Many patients who receive a cancer diagnosis experience a range of complex emotions: numbness, shock, fear, anger, guilt and sadness. These emotions can be short-lived, or they can continue and worsen, leading to significant and severe depression or anxiety. The Psychological Medicine Service helps to respond to this distress, developing interventions to match need, through:
In addressing the wide range of symptoms associated with cancer, the team provides expertise in psychological interventions, including Cognitive Behavioural Therapy (CBT) and mindfulness, as well as expertise in psychiatric assessment and medical interventions.
In addition to working with a range of conditions such as depression, anxiety, body-image problems and steroid-induced illness, the service provides a range of specific interventions, some of which are listed below.
Cognitive Behavioural Therapy (CBT) and cancer-related fatigue
The service has developed specific interventions in the area of cancer-related fatigue using CBT techniques, either through one-to-one therapy or manual-guided intervention.
Mindfulness and cancer
The team has developed an intervention based on mindfulness, running mindfulness-based group sessions throughout the year.
Support for patients undergoing bone marrow transplantation
The cancer team recognises the significant psychological effect of bone marrow transplantation. The Psycho-Oncology Service is available throughout the bone marrow transplant process, working closely with the transplant doctors and nurses to ensure patients’ psychological needs are addressed.
Sometimes the treatments used to treat cancer can in themselves, lead to (short-lived) psychological ill-health. This is particularly the case for those receiving high-dose steroids which are key to many treatment regimens for haematological, or blood-related, malignancies. These patients require rapid and specific response from the Psychological Medicine Team, which helps to identify those who may be at risk and then intervene.
Created with guidance from many of patients and their families, information booklets and self-help manuals seek to optimise patients’ abilities to self-care, promoting self-awareness and a sense of control over their treatment and the impact of a cancer diagnosis. In sharing others’ experiences, they help to validate each individual experience and create a sense of community amongst those adjusting to their illness.
Psycho-Oncology and palliative care.
The Psycho-Oncology team works closely with colleagues in palliative care to look after patients at every stage of their illness and ensure that each patient receives an intervention tailored to their specific needs.
Patients with genetic high-risk cancer (BrCaI and II) and others
The team works closely with colleagues in oncology to provide assessment and, where needed, intervention for patients at high genetic or familial risk of cancer. This ranges from a simple, single-visit intervention to more complex care, depending on the needs identified.
Patients undergoing radiation treatment can have specific needs for which they may require referral for assessment. Depending on those needs, follow-up interventions are coordinated by the service for both inpatients and outpatients.
Karen Shine is the lead administrator for the Psycho-Oncology Service, coordinating clinics, teams and meetings. Together with Lorraine Quill, administrator with the Psychological Medicine Service, she provides the first point of contact for many patients and their families and serves as the link for referrers. She has been a key figure in the service since 2005.
Dr John Cooney, MD FRCPI MRCPsych, Clinical Director of the Psycho-Oncology Service, qualified in 1986 from the Royal College of Surgeons in Ireland and trained in internal medicine in the Federated Hospitals scheme in Dublin, from which he obtained membership of the Royal College of Physicians. He also trained in Dublin for membership of the Royal College of Psychiatrists in the United Kingdom. He did his MD in St Bartholomew’s, London, on the relationship between stress and psychiatric/psychological disorders and trained in Cognitive Behavioural Therapy at the Maudsley Hospital, London. He received his higher education in psychiatry from St Bartholomew’s and the Maudsley and was appointed as a senior lecturer/consultant psychiatrist between Guy’s and Lewisham Hospitals, London. He subsequently worked as a specialist in mood disorders in St Patrick’s Hospital, Dublin, before becoming a consultant in the Psychological Medicine Service in St James’s Hospital, focusing on the relationship between physical and mental health.
Dr Anne-Marie O’Dwyer, MD MRCPI MRCPsych, is a consultant psychiatrist with the Psychological Medicine Service and an associate professor at Trinity College Dublin (TCD). She completed her training in both internal medicine (TCD) and psychiatry (Maudsley Hospital, London, and Addenbrooke’s Hospital, Cambridge). She worked as a consultant psychiatrist at the Maudsley before returning to set up the Psychological Medicine Service at St James’s Hospital in 2000. She has also pursued training in psychological interventions (Cognitive Behavioural Therapy) at the Maudsley.
Dr Tara Kingston, MD MRCPsych MSc (CBT), is a consultant psychiatrist with the Psychological Medicine Service. She completed her training in psychiatry in Ireland, received an MD from the Royal College of Surgeons in Ireland and an MSc in Cognitive Behavioural Therapy from Trinity College Dublin. She has published in the fields of first episode psychosis and mindfulness-based cognitive therapy and trained in group analytic psychotherapy. She was appointed as consultant in St James’s Hospital in 2014.
Dr Sonya Collier, BA (mod) D.Clin.Psych Cert CBT,is a principal clinical psychologist with the Psychological Medicine Service and adjunct assistant professor at Trinity College Dublin (TCD). She completed both her undergraduate and doctorate training in TCD before completing specialised cognitive behavioural therapy training in Oxford University. She has worked in St James’s Hospital since 2000.
Patients are usually referred to the Psycho-Oncology Service by their treating cancer team, who will contact the service directly. Patients can also ask to be referred. They will then be seen either in a dedicated outpatient session or on the Haematology Oncology Day Ward, depending on the treatment they are receiving.