Outlined by David W. Kissane (for the IPOS Council of Past Presidents)
At its 16th World Congress of the International Psycho-Oncology Society (IPOS) held in Lisbon, Portugal, the IPOS Council of Past Presidents (CPP) led a plenary presentation that set out to celebrate the first 30 years of our society and discipline.
As Chair of the CPP, David Kissane welcomed nine of the ten prior Presidents to the podium and explained that the session was developed to tell the life story of IPOS as seen through the eyes of its past presidents. Two lines of continuity were followed in parallel – the first was the growth of the discipline, unpacking the state of the science that had been unfolding in recent decades, while the second was the story of the growth of the society itself. This account is reproduced here for the historical record.
The early beginnings
Jimmie Holland, as Foundation President, began by describing the early work of Loma Feigenberg at Stockholm’s Karolinksa Hospital in the 1940s, when he began to conduct psychotherapy with the dying. His seminal book was Terminal Care: Friendship Contracts with Dying Cancer Patients [L Feigenberg, 1980]. (https://goo.gl/2D3IGI)
In the 1950s, Arthur Sutherland at Memorial Sloan-Kettering Cancer Center in New York led seminal studies of patients managed by colostomy and mastectomy, and described the impact of leukemia treatment on the patient and their family.
Thanatology further developed in the 1960s with Avery Weisman’s study at the Massachusetts’s General Hospital in Boston, known as Project Omega, and culminating in the book, On Dying and Denying: A Psychiatric Study of Terminality [A Weisman, 1972] https://goo.gl/nu6BPY). From these early key centers of psychosocial study, clinical programs developed, which have been sustained at these leading institutions today.
Early conferences of those interested in psycho-oncology began to occur. For instance, in 1975, Bernie Fox convened a meeting in San Antonio. Other scholars in the United Kingdom like Tim McElwain, Keith Pettingale and Peter Maguire became generative in their scholarship. In 1977, Jimmie Holland moved to Memorial Sloan-Kettering Cancer Center in New York, which had been Sutherland’s home institution. She sponsored further regular meetings in New York, and helped establish the International Psycho-Oncology Society (IPOS) in 1984. In parallel, the British Psycho-Oncology Group (later BPOS) was first formed in 1983, the American Psycho-Oncology Society met annually in conjunction with the Academy of Psychosomatic Medicine, and eventually the First IPOS World Congress was chaired by Robert Zittoun in France in 1992.
The epidemiology of psychiatric disorders among patients with cancer became established with the cooperative PSYCOG study led by Derogatis in 1984 (http://goo.gl/DTNIkQ) to help define patients’ clinical need [ Derogatis et al, 1984]. Lea Baider reviewed how studies of the impact of cancer on the couple and family were systematically undertaken and ultimately culminated in the book Cancer and the Family [Baider, Cooper & Kaplan De-Noor, 1996] (https://goo.gl/AKWHQs). The impact of coping, beliefs, communication and gender were steadily examined and care of the elderly patient with cancer grew naturally out of this systemic lens.
Consolidation in the 1990s
Meanwhile, consolidation of the discipline was further heralded by journals like the Journal of Psychosocial Oncology (1983, editor Zabora) and Psycho-Oncology (1991, editors Holland & Watson).The Handbook of Psychooncology (1989, eds Holland & Rowland) (https://goo.gl/WBJfBL )heralded the later textbook of Psycho-Oncology (3rd Ed 2015). The second IPOS World congress was held in Kobe, Japan in 1995, only months after an earthquake had affected the area. Congresses settled into an early biannual pattern, in New York (1996), Hamburg (1998) and Melbourne (2000). News of the Society was regularly transmitted from Dr Holland’s office by the ever willing Mr Toni Manchini in the form of IPOS Newsletters.
Uwe Koch described how coping research had been strong in psycho-oncology, with movement beyond examination of stressors to consideration of coping styles, as well as individual and social resources. Further qualitative research into coping was needed to make sense of the complexity as disease progression occurred and cumulative challenges continued to tax the individual with cancer.
The 4th World Congress was held in Hamburg in 1998 and Hiromi Kawano from Kobe Japan was honored with the Arthur Sutherland award for his early leadership in Japan. Dr Margit von Kerekjarto was an early President of IPOS from Germany (1988-1990) and she worked to integrate psycho-oncology into the German Cancer Society. We honor her today as a deceased past president.
The ability of the mind and interventions like group therapy to extend survival became one exciting academic focus toward the end of the last century. Replication trials of supportive-expressive group therapy (Spiegel et al, 1989) failed however to show any survival advantage. David Kissane explained how these studies had high rates of married participants, likely to be well supported socially, whereas poorer survival is identified in single, isolated and depressed patients. Clinical programs have expanded considerably from the impetus that many of these group therapy studies generated.
IPOS established a set of awards for the discipline: The Sutherland Award for lifetime contribution, The Fox Award for research excellence, The Fisman Award for clinical leadership and The Kawano Award for early career scholarship. Discussion of annual congresses and educational academies emerged early in the 21st century as a professional management company, led by Elliott Graham, was brought in to manage the affairs of IPOS.
The New Millennium
Social myths, such as that stress, personality traits or depressed mood cause cancer, led to an important body of epidemiological work based at the Danish Cancer Society, which used linkages between national data bases to design cohort studies that have laid a solid body of evidence arguing that the mind does not cause cancer. Christoffer Johansen pointed to how critical this knowledge is to empower clinicians to protect patients from guilt and self-blame when cancer is diagnosed. Behavioral science has also made great progress in cancer control, exemplified by smoking cessation, preventive cancer screening programs and attention to poorer clinical outcomes in underserved communities.
The IPOS Educational Academies were established in conjunction with annual World Congresses as a means for international experts to train clinicians in evidence-based interventions and scientific issues that would further the development of the discipline. These flourished following the Copenhagen (2004) and Venice (2006) Congresses. An application was commenced for IPOS to be recognized by the World Health Organization (WHO) as an official Non-Government Organization (NGO) working to promote psychosocial cancer care. It took a full decade for this NGO status to be recognized by the WHO in 2014.
One means for psycho-oncology to influence the whole of cancer care has been through communication skills training (CST), which was well developed for Europe by scholars such as Peter Maguire, Darius Razavi and Lesley Fallowfield, amid many others. Whether breaking bad news, discussing prognosis or end-of-life care, CST has been a major pathway to promote humanistic care with empathy and due attention to psychosocial and cultural needs.
The IPOS Federation was formed in 2006 by Luigi Grassi to bring together what are currently 28 national psycho-oncology societies from 26 countries into a unified voice. This empowers attention to standards of care and the development of the discipline so that all cancer patients and their families throughout the world receive optimal psychosocial care at all stages of disease and survivorship. An on-line curriculum in eight languages was sponsored by the European School of Oncology.
As studies of coping with cancer unfolded, the contribution of meaning to the adaptation of the patient with cancer became clearer, and this spawned the development of newer models of psychotherapy, which aim to grow a person’s sense of meaning and purpose. The adaptation of psychotherapy interventions to optimally suit the patient with cancer has represented a major stream of unfolding science across these decades.
The familial basis of many cancers highlights the psychosocial challenges associated with cancer prevention, screening, genetic testing and prophylactic surgeries. Psycho-oncology has delivered care alongside clinical genetics service to promote optimal adaptation as patients come to terms with their risk status.
The IPOS Human Rights Task Force was established by William Breitbart to advance the cause that psychosocial cancer care is a basic human right. A declaration about this human right was adopted at the 16th World Congress in Lisbon.
IPOS also became a partner organisation of the UICC and with Jeff Dunn (Secretary of IPOS) elected to the UICC council, we are working together to improve global cancer care.
IPOS Press was established by Maggie Watson as a publishing arm for IPOS to further advance the dissemination of knowledge about the discipline. The IPOS Handbook of Psychotherapy in Cancer Care (2011, eds Watson & Kissane) (https://goo.gl/NdXMtz ) became one illustration of the emerging role of IPOS Press. As IPOS matured, its governance was steadily moved from an early group of pioneers to a society run by an elected board, with a range of subcommittees sharing the work across countries. An international community of psychosocial care providers has truly emerged and IPOS has launched a program of sponsored educational academies being delivered in countries like India, Russia and Nigeria to grow the mission of psychosocial cancer care.
The effort to ensure that psychosocial care does reach patients with cancer and their families led to guideline development, distress screening and service development programs, with tiered models of care provision. Making distress the sixth vital sign after pain was championed by Barry Bultz and has been adopted by many countries to ensure that patients’ needs are recognized. Survivorship care and preventive behavioral interventions to optimize lifestyle change are further examples of the reach and maturation of psycho-oncology as a discipline.
The future of IPOS is a confident and solid one, based on its steady and ever maturing growth across these past three decades. The recognition by the WHO of IPOS as an NGO aided our celebration of IPOS’s first 30 years in Lisbon at its 16th World Congress. We are a truly international society, whose vision and mission are on track, as the still relatively young discipline of psycho-oncology consolidates its important contribution to cancer care.