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Benefits of psychotherapy
Psychotherapy may include group and individual therapy, pastoral counseling, family counseling, cognitive behavioral therapy, meditation, and mutual support groups. Biofeedback, muscle relaxation, hypnosis, and guided imagery may help them cope with anxiety and fatigue. Support groups allow cancer patients to talk about their illness and treatment, to express and manage fears of isolation and death, and to receive empathy and advice from others going through the same experience. (For more information about support groups, see Resources.)
Help for the family
Cancer patients and their families are probably not getting all the psychological treatment they could use. According to a recent British study, only 25% of cancer patients who need help for mild or moderate depression are receiving it. The symptoms are not always reported by patients or recognized by physicians. Cancer patients and their families should work with psychotherapists to understand the disease and its treatment. The therapist must be able to distinguish normal reactions to cancer from symptoms of psychological distress. Several studies have found that oncologists often have difficulty detecting indirect communication and emotional cues in their patients. Special training has been recommended to help them learn how to acknowledge their patients' distress, explain the treatment better, and answer questions clearly.
Survival through psychotherapy?
A few studies have shown similar results with briefer forms of psychotherapy. In one of these, 34 patients with melanoma received information, advice, and stress management training in six weekly group meetings. Five to six years later, 7 in the experimental group and 13 in a control group receiving standard care had a recurrence; 3 in the experimental group and 10 in the control group had died. German researchers found an effect of brief individual counseling for hospitalized patients with gastrointestinal cancers. After two years, 49% of patients who received counseling and 67% of a control group had died -- a difference greater than chance.
These studies have many critics, some of whom believe that the experimental and control groups were not properly matched, especially for the stage of the disease, or that the results were a statistical coincidence. Other investigators have found no life-sustaining effects of psychotherapy. One large randomized controlled study of women with breast cancer, published in the New England Journal of Medicine, compared standard medical care to standard care plus four years of weekly group therapy with relaxation training. The treatment reduced depression, anger, and anxiety, but had no effect on the death rate. While research continues, the effects of psychological treatment on cancer survival remain doubtful.
These questions are being pursued by a new discipline called psychooncology, which studies the cognitive and emotional responses of cancer patients and their families.
At present there is no good evidence that an individual patient's attitudes or manner of coping can affect the physical process of cancer. The promise of psychosocial treatment is not to extend life but to enhance its quality.
- Cancer and the mind; Harvard Mental Health Letter; Jul 2003; Vol. 20; Issue 1.
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