Interventions for Clients Coping with Cancer

Benefits of psychotherapy
We may know little about the role of emotions in the onset and progress of cancer, but we do know that cancer patients have to confront pain, fatigue, and the fear of death while making tough decisions. They sometimes have to undergo treatments that make them feel temporarily worse and may even cause distressing mood and cognitive changes. Studies suggest that psychotherapy and support groups can enhance their lives by reducing depression, anxiety, and isolation, and enabling people to convey their needs better to their doctors and families. The result, often, is less suffering, lower cost, and shorter hospital stays.

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
Family members often suffer emotionally as much as cancer patients themselves. As more patients are treated at home and in ambulatory units instead of in hospitals, the family has more work to do. Family members may become isolated and financially strapped. They must decide how much of their time and their lives to devote to the care of the patient, and how to make room for their own needs while doing so. Support groups and psychotherapy may help them to help the patient and relieve their own distress.

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?
It would be a breakthrough in the treatment of cancer if psychotherapy could prolong lives as well as reduce suffering. That hope first came to light more than 20 years ago in a study of group psychotherapy for women with breast cancer. A group of women assigned at random to professionally led group meetings for a year were compared to a group that received only standard medical care. Prolonging life was not the study's original purpose, so the researchers were surprised to discover that women in the therapy groups survived, on average, almost twice as long as the controls -- 3 years versus 18 months. After 4 years, when all the patients in the control group had died, a third of the women in the support groups were alive.

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.

Prospects
In future studies of the psychological aspects of cancer, researchers will be paying more attention to age; sex; the type and stage of cancer; and the influence of social class, culture, and heredity. They will discover more about which patients and families can make best use of psychotherapy and social services, and which aspects of the doctor-patient relationship are most important in the treatment of cancer. Research on the psychological treatment of cancer patients may even turn out to be helpful for the understanding of mood and cognitive disorders in physically healthy people.

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.

Personal Reflection Exercise #2
The preceding section contained information regarding cancer and psychotherapy. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 9
What is the benefit of support groups for cancer patients? Record the letter of the correct answer the CE Test.