Psychological Management

of
Cancer
Stage 1 usually means that a cancer is relatively small and contained within
the organ it started in.
Stage 2 usually means the cancer has not started to spread into surrounding
tissue but the tumour is larger than in stage 1. Sometimes stage 2 means that
cancer cells have spread into lymph nodes close to the tumour. This depends
on the particular type of cancer.
Stage 3 usually means the cancer is larger. It may have started to spread into
surrounding tissues and there are cancer cells in the lymph nodes in the area.
Stage 4 means the cancer has spread from where it started to another body
organ. This is also called secondary or metastatic cancer.
• Psychological Interventions in cancer care is found to be very efficacious
in:
improving emotional and functional adjustment
reducing disease symptoms and treatment side effects

• Psychological Interventions for cancer patients enhance their immune

functioning and health outcomes.

• Although a number of interventions (group therapy, education, structured

and unstructured counseling, cognitive behavior therapy) improve
psychosocial outcomes, only relaxation training and guided imagery have a
beneficial impact on conditioned and physical side effects of cancer
treatment.
• Patients of cancer come to psychologists with concerns
amenable to cognitive and behavioral treatments.

• Patients Concerns includes:

depression
anxiety
conditioned aversive response to chemotherapy
express ones emotions
explore the meaning of cancer
experience interpersonal support

• Psychological interventions intergrates supportive and

expressive therapies with cognitive and behavioral
approaches.
Cognitive Therapy

• Moorey, Greer, and colleagues (1989) adopted cognitive

therapy for patients with cancer.

• Greater focus on emotional expression.

• Therapist encourages emotional expression and helps the

patient develop ways of containing affect, such as scheduling
of worry and grief.

• Cognitive restructuring is often employed to help the patient

manage their emotions.
• Cognitive strategies involve understanding the personal
meaning of thoughts about the illness, treatment, death and
dying.

• Patient is engaged in evaluating their thoughts in terms of their

usefulness and their basis in reality.

• Through treatment the patient learns to identify and challenge

those beliefs that represent distortions of reality and that are
destructive to the patient’s wellbeing.
Behavior Therapy

• Behavioral techniques used as a part of treatment:

relaxation
attentional distraction
activity scheduling

• Relaxation Techniques:
progressive muscle relaxation training
passive relaxation
Used in managing stress and treatment side effects.
• Attentional Distraction:
focus the patient’s awareness on engaging in enjoyable activities, such as
computer games, crafts, or puzzles.

• Activity Scheduling:
focus on increasing the patient’s involvement in enjoyable an rewarding
pursuits.

Therapist and patient develop a list of activities, including those that

provide a sense of mastery and those that provide a pleasurable
experience.
Other Interventions

• Other Interventions include: training in problem solving,

social skills, and coping.

• Supportive expressive and existential approaches to group

psychotherapy with patients with cancer have been used.

• Existential therapies focus on the meaning of the patient’s

experience with cancer and on the patient’s personal growth
towards living in the present in spite of facing loses and the
probability of death.
• Spira (1997) points out that support available in a group
facilitates the existential therapy process.

• The involvement of others in the same situation reduces social

isolation and offers support in confronting difficult issues,
such as loss of health and disability.

• The treatment focus varies, including diverse topics such as

coping with treatment, reevaluating life’s priorities, and
considering death and dying.
 Specific Intervention Targets

• Conditioned Aversive Responses

• Pain

• Sleep Disturbance

• Sexual Dysfunction

• Grief and Bereavement

• Patient and Professional Communication Problems

Conditioned Aversive Responses

• Includes: Conditioned anxiety, taste aversion, nausea,

vomiting, and immunosuppression, occurring in response to
chemotherapy.

• Treatment of conditioned aversive responses to chemotherapy

involves the use of relaxation training in conjunction with
systematic desensitization.

• Other approaches employed include: stress inoculation,

hypnosis, and preparative information.
Pain

• Cancer pain can be related to diagnostic tests, treatment

toxicities, or tumor invasion of bones, nerves, or organs.

• Two thirds of patients with advanced cancer experience pain.

• Pain Control: Medical Management.

• Behavioral Approaches to Cancer Pain Management:

relaxation, visualization, hypnosis, distraction, music, and
cognitive coping.
Sleep Disturbance

• Insomnia is common among cancer patients.

• Insomnia in cancer patients may be related to pain, depression,

or hot flushes requiring medical and psychiatric treatment.

• Psychological Interventions:
education about sleep hygiene
schedule and environmental adjustment
stimulus control
relaxation
focused attention
Sexual Dysfunction

• Some types of cancer and cancer treatments have profound

effects on a couples sexual functioning and relationship.

• Couple therapy focuses on helping the couple understand

change in sexual function with cancer and its treatments.

• During patient's recovery from cancer treatment, the

psychologists may use sexual dysfunction treatment
approaches, such as sensate focus as couples gradually resume
greater sexual activity.
Grief and Bereavement

• Worden’s tasks of Mourning Model:

accepting the reality of the loss
experiencing the pain of grief
adjusting to an environment where the deceased is missing
withdrawing emotional energy from the deceased and
reinvesting it in other relationships

• Many patients find comfort and stability in understanding the

intensity, duration, and breadth of the feelings associated with
grief.
Patient and Professional Communication Problems

• It influences medical decision making, compliance with

treatment, psychological distress, and quality of life.

• Both patient and professionals contribute to communication

problems, but in working with the patient it is important for
the psychologist to help the patients improve their ability to
communicate with their physician.
 Selected Intervention Modalities

• Group Interventions

• Partner and Family Treatment

• Psychological Preparation for Cancer Treatment

• Innovative Approaches
Group Interventions

• Evidence is present to support the efficacy of support groups,

psychotherapy groups, and coping skills groups in improving
psychological and social well being in cancer patients.

• Groups may have beneficial impact on immune functioning and

health outcomes.

• Same psychological interventions may be employed in

individual and group therapy sessions.

• Groups have the advantage of providing feedback and support

from others who are experiencing cancer and its treatment. It is a
powerful source of affirmation and communication.
Partner and Family Treatment

• Psychologist may want to combine individual and family

therapy when appropriate, as it may reduce delay in treatment,
excessive referrals and fragmentation of treatment.

• Family members have exposure to extreme stress similar to

that of the cancer patient. Interventions for such members may
be provided to lend support and clarification of emotional
responses.

• Importance of family therapy:

increase communication
increase appreciation, affection and warmth
negotiating roles and responsibilities disrupted by illness
Psychological Preparation for Cancer Treatment

• Interventions have been developed to prevent high level

distress associated with cancer treatment.

• Targets: Patients undergoing surgery, chemotherapy, and

radiation therapy.

• Content of preparative programs:

education about upcoming treatment
relaxation training
hypnosis
attentional distraction
cognitive restructuring
Innovative Approaches

• Home Visits

• Telephone Contact

• Computer Linkages
THANK YOU