Academic journal article Psychologische Beiträge

Psychoeducational Intervention Programs for Patients with Cancer

Academic journal article Psychologische Beiträge

Psychoeducational Intervention Programs for Patients with Cancer

Article excerpt

Summary

Research has documented the need for and the efficacy of psychosocial interventions for patients with cancer. Based on a review of the literature and the authors' clinical and research experience, cancer patients may benefit from a variety of psychological intervention programs. A structured, psychiatric intervention consisting of health education, stress management/behavioral training, coping including problem-solving techniques, and psychosocial group support offers the greatest potential for patients newly diagnosed or in the early stages of treatment.

Key words: cancer, psychological interventions.

Introduction

The American Cancer Society reports that there are over eight million cancer survivors in the U.S. and that more than four million have survived for five years or longer (ACS, 1997). Today there is an encouraging trend away from focusing only on terminal care and bereavement towards helping people live as fully as possible with their cancer. A significant amount of research has been done that helps us to understand the psychological distress that patients with cancer and their families experience (Weisman, 1979; Cohen et al., 1982). Numerous articles have also been published regarding differing interventions aimed at helping individuals deal with the diagnosis and treatment of cancer (Fawzy et al., 1995). Evidence is accumulating that some of these interventions may contribute to both psychological (reduction of distress and enhancement of coping and adjustment) and physical health outcomes (reduced side effects, lower rates of recurrence and improved survival) (Spiegel et al., 1989; Ornish et al., 1992; Greer, 1991; Fawzy et al., 1993). An overview of this literature will be presented. A short-term structured, psychoeducational intervention program consisting of health education, stress management, coping skills training, and psychological support will then be offered as an effective model of care for newly diagnosed patients with cancer. We will attempt to elucidate possible mechanisms underlying the positive outcomes of such interventions. Finally, the continuing gaps in our knowledge base requiring future research will be discussed.

Psychosocial Issues

The most frequently studied group in regard to psychosocial issues has been women with breast cancer. Breast cancer patients have been found to manifest greater anxiety and depression than general surgery patients (Maguire, 1976) or women with benign breast tumors (Maguire et al., 1978; Morris et al., 1977). Worden and Weisman (1977) reported that among 40 newly diagnosed breast cancer patients, 20% were notably depressed based upon psychological tests and clinical interviews. In addition to increased anxiety and depression, other life changes have been described in this patient population. For instance, Maguire (1978) found mastectomy patients experienced more sexual problems than did a control group of benign breast tumor patients at four and twelve months post-operatively. Meyerowitz (1980), after comprehensively reviewing the literature on psychological correlates of breast cancer, summarizes the typical responses of this patient group as: a) "Some degree of depression, anxiety and/or anger; b) disruption in everyday life patterns, including marital and/or sexual relationships, and c) considerable fear regarding the danger and mutilation of cancer and mastectomy" (p. 114).

Other cancer patient groups have been studied from a psychosocial viewpoint although not nearly as extensively.

Gordon et al. (1980) followed 308 breast, lung and melanoma patients through the first six months of their disease. The most often noted problems at the time of initial hospitalization were in the area of worry about the disease itself. Negative affect became the predominant concern in the period following discharge. A broader array of problems such as physical discomfort, concern about medical treatment, dissatisfaction with health care service, lack of mobility, financial concerns, family and social problems, worry about the disease, negative affect and body image difficulties was noted at three and six months post discharge. …

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