and Prognosis in Cancer
DAVID SPIEGEL & FAWZY I. FAWZY
Over the last 20 years, research in psycho-oncology has progressed through several important phases to provide clinicians with a framework for understanding and treating the psychological needs of cancer patients. In the initial phase, researchers used observations of the types of distress experienced by cancer patients to develop effective interventions to help with these problems. During this same period, there was growing evidence that both psychological and social factors play roles in the progression of cancer and survival time with cancer. Indeed, by the late 1980s and early 1990s, evidence emerged suggesting that certain negative psychological states can enhance the progression of cancer, whereas social connections and social support may slow its progression. More recently, studies have been conducted to identify mediating immune and endocrine mechanisms for these effects.
This chapter explores the impact of psychosocial variables on cancer recurrence and survival, as well as the evidence that psychosocial interventions can be used to affect the clinical course of this illness. It also examines the evidence that religion and spirituality, as elements of psychosocial support, have a role to play in the support, treatment, and prognosis of cancer patients.
During the late 1970s and early 1980s, descriptive studies began appearing in the literature, documenting both positive and negative psychologi