Psycho-Oncology by Rebecca Frey, PhD

Source:  Gale Encyclopedia of Cancer, published by Thomson Gale

 

Psycho-oncology is a broad-based approach to cancer therapy that treats the emotional, social, and spiritual distress which often accompanies cancer. According to Dr. Jimmie Holland, the founder of psycho-oncology, the field has two major emphases. The first is the study of cancer patients’ psychological reactions to their illness at all stages of its course; the second is analysis of the emotional, spiritual, social, and behavioral factors that influence the risk of developing cancer and long-term survival following treatment. Some psycho-oncologists consider their field a subspecialty of psychiatry while others emphasize its multidisciplinary aspects. In addition to psychiatrists, departments of psycho-oncology in major cancer centers may include nurses, surgeons, bioethicists, social workers, psychologists, clergy, palliative care specialists, and volunteers.

Description

Psycho-oncology is a relatively new addition to the care of cancer patients. It began in the mid-1970s when Dr. Holland returned to the practice of psychiatry after her children were in school. Married to an oncologist, she had noted that her husband’s colleagues focused on the physical effects of the anticancer drugs they were giving their patients to the point of failing to take the patients’ thoughts and emotions into account. To some extent this oversight was part of the medical culture of the 1950s and 1960s; at that time cancer carried a stigma because it had low rates of survival. Many doctors were taught in medical school to withhold a diagnosis of cancer from the patient on the grounds that the disease was virtually a death sentence and the truth would be unbearable. Such highly regarded newspapers as the New York Timeseven refused to print the words “breast cancer” when the founders of the Reach to Recovery program first wanted to insert notices of their meetings.

In the 1970s, however, this attitude of shame and secrecy was reversed, partly because of the patients’ rights movement, but also because newer and more effective treatments for cancer came into use and the number of long-term survivors of cancer increased. In 1977 Dr. Holland started the first full-time psychiatric service in a cancer research center in order to study and treat the emotional and psychological crises experienced by cancer patients. She conducted some of the earliest research studies of the emotional impact of cancer on patients and their families.

In the early 2000s, psycho-oncology has become an accepted part of cancer treatment, with departments of psycho-oncology established in most major cancer centers in Canada and the United States. The field has its own journal, Psycho-Oncology, as well as national and international societies for interested professionals.

Special Concerns

Special concerns in psycho-oncology include the feelings of guilt or anxiety expressed by many cancer patients that they cannot adopt or maintain the positive attitudes that some people believe are essential to fighting cancer. Such patients feel burdened by the notion—sometimes voiced by family members—that their literal survival depends on visualizations (usually visualizations of their immune system combating the cancer) or otherwise acting cheerful and upbeat. In addition, some extreme forms of New Age thought lead some people to “blame the victim” that is, to say such things to cancer patients as, “You must have subconsciously wanted to develop this cancer,” or, “It’s your bad karma—you must have done something bad in a previous existence to deserve this disease.” Psycho-oncologists, however, do not regard mental attitudes toward cancer as the sole factor affecting long-term survival, and they do not insist that patients adopt a one-size-fits-all approach to coping with cancer. Dr. Holland’s list of recommendations for coping with cancer emphasizes flexibility, as she urges patients to:

  • Use coping techniques or patterns that have helped them in the past in dealing with the stresses of life. For example, someone who has been helped by talking through their problems with trusted friends or family members should not suddenly start to keep their problems to themselves in coping with cancer.
  • Take the “one-day-at-a-time” approach in dealing with the symptoms and other problems that cancer brings with it. This approach, which is sometimes called “chunking it down,” helps by keeping large-scale worries about the long-term future manageable.
  • Seek out a doctor with whom they feel comfortable. A doctor/patient relationship based on trust and mutual respect makes it easier to ask appropriate questions and to be a full participant in treatment planning.
  • Continue to draw on religious or spiritual beliefs and practices that have been helpful in the past. Patients who do not consider themselves religious or spiritual may still find comfort in activities that they found meaningful or inspiring, such as the performing arts or nature walks.
  • Keep a notebook for recording dates of treatments, medication side effects, laboratory test results, x-ray findings, etc. This record can be valuable in monitoring or evaluating one’s emotional ups and downs as well as changes in physical health.
  • Keep a journal or diary for expressing feelings and emotional reactions. This record also may be useful in providing perspective.

Psycho-oncologists may also help patients deal with the increasing complexity of cancer therapy, as many patients have treatment teams consisting of several physicians in different subspecialties as well as social workers, nurses, clergy, and other professionals. Some patients experience the sheer number of caregivers involved in their treatment as an additional source of stress.

Treatments

Psycho-oncologists emphasize the importance of treating cancer patients as individuals with unique patterns of emotional responses to the disease as well as unique physical responses to medical and surgical treatments. Consequently, psycho-oncologists tailor their treatment to the needs and concerns of each patient. As of the early 2000s, psycho-oncologists may provide one or more of the following treatments for or services to cancer patients:

  • individual psychotherapy or counseling
  • leading support groups for patients and family members
  • crisis intervention
  • medication management
  • strategies for dealing with pain and other physical symptoms of cancer
  • monitoring the patient’s emotional distress level
  • referrals to a pastoral counselor in the patient’s faith tradition

Many psycho-oncologists use a pain scale, “distress thermometer,” or self-administered questionnaires as a way of identifying the patient’s specific areas of concern as well as monitoring his or her levels of distress at various points in the treatment process. Some commonly used questionnaires are the Mental Adjustment to Cancer (MAC) scale, first published in the United Kingdom in 1987; the Brief Symptom Inventory (BSI); and the Distress Management Screening Measure (DMSM), a newer scale that was tested in the United States in 2003–2004. Sample questions from these self-administered measures, as well as explanations of the treatments offered to cancer patients at different levels of emotional distress, can be found in Distress, a 32-page booklet available free of charge from the American Cancer Society and the National Comprehensive Cancer Network (NCCN).

Psycho-oncologists may also provide specialized counseling in the areas of death and bereavement or sex therapy if they have the appropriate training, or they may refer patients with these needs to qualified counselors in those fields.

Alternative and Complementary Therapies

Most psycho-oncologists support patients’ use of complementary and alternative (CAM) therapies provided that they do not interfere with the patient’s surgery, chemotherapy, or other mainstream treatments. Dr. Larry Dossey, a well-known expert in the field of alternative medicine, thinks that cancer patients are drawn to CAM treatments because they address questions about the larger meaning of illness that many patients have. He says, “The immense popularity of alternative therapies … may be due in large measure to the fact that they help people find meaning in their lives when they need it most.” Significantly, several studies of cancer patients who have integrated CAM approaches into their treatment regimens have not found that these patients are more distressed or more likely to develop psychiatric disorders than patients who rely on conventional treatments alone.

Questions to Ask Your Doctor

  • How do you feel about my use of complementary or alternative therapies as part of my treatment program? Are there any that you would advise against?
  • What reading materials or other resources would you recommend so that I can help myself cope with my symptoms and the side effects of cancer treatment?
  • Where do you fit my emotional, psychological, and spiritual concerns into my treatment regimen?

As of 2005, the National Cancer Institute (NCI) and the National Center for Complementary and Alternative Medicine(NCCAM) are jointly funding clinical trials of several complementary and alternative treatments for cancer. Present trials include studies of yoga, Reiki, acupuncture, massage therapy (for cancer-related fatigue), hyperbaric oxygen therapy,mistletoe extract, and pancreatic enzyme therapy (for pancreatic cancer). Details of these clinical trials are available on the NCCAM website.

New Trends in Research in Psycho-Oncology

Areas of particular concern to psycho-oncologists in the early 2000s include cultural differences that affect people’s patterns of coping with cancer, and the long-term psychological effects of being a cancer survivor. With regard to the first, recent European studies suggest that English-speaking patients and patients from southern Europe have different styles of coping with cancer diagnosis and treatment even though both groups have similar percentages of highly distressed patients. With regard to survivorship, the Behavioral Research Center of the American Cancer Society is conducting a long-term study of cancer survivors’ quality of life, with a special focus on their psychological adjustment and family relationships, to be completed in 2015.

 

Resources

Books

Dossey, Larry, MD. Healing Beyond the Body: Medicine and the Infinite Reach of the Mind. Boston and London: Shambhala, 2001.

Holland, Jimmie, MD, and Sheldon Lewis. The Human Side of Cancer: Living with Hope, Coping with Uncertainty. New York:HarperCollins Publishers, 2000.

Periodicals

Davidson, R., L. Geoghegan, L. McLaughlin, and R. Woodward. “Psychological Characteristics of Cancer Patients Who Use Complementary Therapies.” Psycho-Oncology 14 (June 10, 2004): 187–195.

Hoffman, B. M, M. A. Zevon, M. C. D’Arrigo, and T. B. Cecchini. “Screening for Distress in Cancer Patients: The NCCN Rapid-Screening Measure.” Psycho-Oncology 13 (November 2004): 792–799.

Holland, Jimmie C., MD. “Psychological Care of Patients: Psycho-Oncology’s Contribution.” Journal of Clinical Oncology 21 (December 2003): 253S–265S. This article was originally given as the American Cancer Society Award Lecture at the annual meeting of the American Society of Clinical Oncology in May 2003.

Patenaude, A. F., and M. J. Kupst. “Psychosocial Functioning in Pediatric Cancer.” Journal of Pediatric Psychology 30 (January-February 2005): 9–27.

Sunga, Annette, MD, Margaret Eberl, MD, Kevin C. Oeffinger, MD, et al. “Care of Cancer Survivors.” American Family Physician 71 (February 15, 2005): 699–706.

Organizations

American Psychosocial Oncology Society (APOS). 2365 Hunters Way, Charlottesville, VA 22911. (434) 293-5350. .

Behavioral Research Center, American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) 758-0227 or (404) 329-7772. .

National Comprehensive Cancer Network (NCCN). 500 Old York Road, Suite 250, Jenkintown, PA 19046. (215) 690-0300. . The NCCN is a consortium of 19 major cancer centers in the United States.

Other

American Cancer Society (ACS) and National Comprehensive Cancer Network (NCCN). Distress: Treatment Guidelines for Patients, Version I. Jenkintown, PA: NCCN, 2004.

National Cancer Institute (NCI) and National Center for Complementary and Alternative Medicine (NCCAM). Cancer Facts: Complementary and Alternative Medicine. Bethesda, MD: NCCAM, 2004. .