Psychological expertise in the national cancer plan: an implicit ingredient?

Posted on by nwelch

Author: Hilly Webb-Peploe, Consultant Clinical Psychologist

The national cancer plan published in February prioritises both quantity and quality of life. The same month, a systematic review found “psychosocial (psychological) interventions appear to improve survival in cancer patients, with effect sizes comparable in magnitude to effects previously reported in the literature for medical cancer treatments such as chemo-, radio- and hormone therapy1”. In July, psychological understanding and skills, embedded into practice, were recommended in improving palliative and end-of-life care by the Parliamentary and Health Service Ombudsman2. Perhaps it’s time that psychological expertise is no longer seen as the optional “cherry-on-top”, but the enabling and enriching “yeast” embedded throughout cancer services?

Psychological distress is associated with cancer mortality3. Cancer increases suicide risk4. Psychological factors are stronger predictors of quality of life and health status than disease characteristics in colorectal cancer5. They affect screening uptake, access to investigations, decision-making, treatment tolerance, symptom burden and healthcare usage6, 7. 40 to 85% of items on quality-of-life measures most frequently used in the UK are either substantially or partially related to psychological variables8. Alongside intervening for broad definitions of distress and mental health needs, psychological professions provide assessment and evidence-based interventions for symptoms such as fatigue, pain, sleep, cancer-related-cognitive-impairment and menopausal symptoms.

Psychological support is explicitly named in the plan under the supportive oncology mandate. It is also core to prehabilitation: of the 54 recommendations in the 2025 prehabilitation guidelines9, the provision of specialist psychological interventions is one of only eight recommendations graded “high” and “strong”, with embedded psycho-oncology services recommended to provide these. 

Personalised care assessments include mental health, creating an obligation for a pathway for these needs rather than a dead end. The commitment to assess and intervene for psychological distress and psychological factors in symptom burden requires psychological expertise for the “what” and “how” of identification, stratification, differentiation and escalation, as well as a pathway end point. Needs assessments need to be meaningful and not just work best for patients who need them least10. As the CNS workforce grows and new neighbourhood roles develop, so too do needs for training, supervision and consultation on psychologically informed approaches, psychological skills and contextualised and individualised behaviour change, that have been core activities for embedded, specialist psychological expertise in cancer for over 20 years, where it exists.

As task shifting advances, it should not be the case that psychological care is predominantly seen as a “supportive”, non-clinical task for the unregistered workforce. Rather, it’s endoscopists who mitigate procedural anxiety and prevent re-traumatisation for people with prior adverse experiences. It’s surgeons who calibrate and individualise diagnostic discussions to address cognitive misconceptions and establish realistic expectations that optimise recovery. It’s oncologists who hold prognostic uncertainty and patients’ existential distress, who understand patients’ values and crucially why those values are important11, when deciding on treatment de-escalation. It’s AHPs who understand why their patients aren’t motivated to engage in rehabilitation and know how to respond. It’s CNSs who work with the nuanced interaction of physical and psychological factors in patients’ symptom burden.

Clinical psychologists don’t have a monopoly on psychological expertise, nor do they offer a panacea. But when they are structurally and relationally integrated in cancer services they can provide training, supervision, consultation and joint working across the spectrum of severity and complexity of psychological needs for multifactorial problems in complex systems. They are also uniquely placed to provide clinical governance and quality assurance for psychological practice in NHS systems. And whilst AI may have access to the breadth and depth of scientific knowledge in human cognition, emotions and behaviour, historically the preserve of psychologists, if digitalisation is used to replace rather than augment access to psychological care, it will not (yet?) have the clinical judgement that supersedes algorithmic processes when individualised, relational care is needed, or where variables have interacting weightings of differing importance. We risk underserving those with the highest needs who stand to benefit most from specialist psychological approaches.

Recent work on reducing inequalities in cancer for people with severe mental illness has involved clinical psychology in its design and implementation12 and embedding psychological expertise is not new. Community learning disability teams have been exemplars of clinical psychologists leading, designing and integrating the psychological and behavioural into place-based healthcare for many years. 

However, there are caveats: pursuing something directly has a way of changing the nature of it; we should be contextualising, not unnecessarily pathologizing, distress and we should be building systems that also prevent and mitigate distress by design. 

The bio-psycho-social model in healthcare has existed for many decades. As the social determinants of health rightly get increasing attention, may we also not overlook the “psycho”. As the experience of healthcare becomes increasingly transactional, may we also prioritise the relational, the human interactions that constitute healthcare and that are part of the outcome too.

References

  1. Asakawa-Haas, K.D., Spiegel, D., Bossert, L. et al. Psychosocial interventions indicate prolonged survival in cancer patients in a systematic review, meta-analysis, and multiverse meta-analysis of randomized controlled trials. Commun Psychol 4, 49 (2026). https://doi.org/10.1038/s44271-026-00414-x  FREE Full Text
  2. Parliamentary and Health Service Ombudsman. Conversations that matter most: improving communication in end of life care. Jul 2026. Conversations that matter most: improving communication in end of life care 
  3. Batty G, Russ T, Stamatakis E et al. Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies. BMJ 2017;356:j108 https://doi.org/10.1136/bmj.j108  
  4. Heinrich, M, Hofmann, L, Baurecht, H. et al. Suicide risk and mortality among patients with cancer. Nat Med 28, 852–859 (2022). https://doi.org/10.1038/s41591-022-01745-y
  5. Foster C, Haviland J, Winter J, et al. Pre Surgery Depression and Confidence to Manage Problems Predict Recovery Trajectories of Health and Wellbeing in the First Two Years following Colorectal Cancer: Results from the CREW Cohort Study. PLoS ONE 2016. 11(5): e0155434. doi:10.1371/ journal.pone.0155434P
  6. Van Beek F, Wijnhoven L, Holtmaat K, et al. Psychological problems among cancer patients in relation to healthcare and societal costs: A systematic review. Psycho-Oncology. 2021 Nov;30(11):1801-1835. doi: 10.1002/pon.5753. 
  7. de la Osa, C, Gonzalez-Alpizar, L, Jimenez Hamann, M. Holistic approach to adult patient care: Integrated psychology pilot for acute care. Professional Psychology: Research and Practice. 2024; vol 5(5); 436-443. https://dx.doi.org/10.1037/pro0000586
  8. Brown L, Kroenke K, Theobald D, et al. The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psycho-Oncology. 2010 Jul;19(7):734-41. doi: 10.1002/pon.1627. 
  9. Macmillan Cancer Support. Prehabilitation for people with cancer: clinical and implementation guidelines. Prehabilitation resources for healthcare professionals, Macmillan Cancer Support. 2025. prehabilitation-for-people-with-cancer-clinical-and-implementation-guidelines
  10. Briggs L, Corner J, Blake H. Perceived Value of Holistic Needs Assessment in Supporting the Needs of Women With Breast Cancer. Cancer Nursing, 2023;48(1), E39-E46. https://doi.org/10.1097/NCC.0000000000001270
  11. Sadie Thomas-Unsworth (personal communication, July 2026).
  12. RM Partners NW & SW London Cancer Alliance. Cancer SMART service launched to reduce health inequalities. 2025. Cancer SMART service launched to reduce health inequalities – RM Partners.

Declaration of Interests
Co-chair of the psychology working group for Macmillan-NIHR-CPOC Prehabilitation for people with cancer: clinical and implementation guidelines.

Co-chair elect of the Psycho-Oncology, Cancer and Palliative Care Psychology Group (PSYCAP), Association of Clinical Psychology-UK.

Disclaimer
The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any affiliated institutions.