Barbara L. Andersen Deanna M. Golden-Kreutz
Ohio State University
University of Alabama, Birmingham
The human cost of cancer is staggering. Each year in the United States over 1.4 million individuals are diagnosed and another half million people-one person every 90 seconds- die of the disease (Parker, Tong, Bolden, & Wingo, 1997). Although much of the increase in cancer incidence and mortality over the years appears to be related to advances in early detection as well as the general aging of the population (age is a risk factor; Garfinkel, 1994), Cunningham (1997) noted cancer death rates may now be trending downward (i.e., drop of V&3%) in the United States.
Cancers vary in their prevalence and mortality. Tables 43.1 and 43.2 display data from the United States on the incidence and death rates by specific sites and genders. These data indicate, for example, that the most common diagnoses are breast cancer for women' and prostate cancer for men, but that lung cancer is the number one killer for both sexes (Parker et al., 1997). There is, however, variability across countries. For example, age-adjusted death rates per 100,000 population across sites and gender from 1990 to 1993 ranged from a high of 385 in Hungary to a low of 139 in Albania; the rate for the United States was 276 (see Tables 43.3 and 43.4; Parker et al., 1997). In short, cancer is a significant medical problem that affects the health status of millions of people worldwide.
Research on the psychological, social, and behavioral aspects of oncology began in the early 1950s, however, the knowledge base has significantly expanded during the last 20 years. In particular, research has clarified relations between psychological responses (e.g., personality, mood, coping style, relationships), social factors (e.g., presence/absence of partner, size of social network, level of social support), and behavioral variables (e.g., compliance with treatment, diet, exercise). Contemporary research incorporates these variables and biologic systems (e.g., immune and endocrine) to examine and test their effects on disease course (see F. I. Fawzy et al., 1993, for an example; see Andersen, l&colt-Glaser, & Glaser, 1994, for a discussion).
A brief overview of the biobehavioral aspects of cancer is provided. The chapter begins with a conceptual framework, the biobehavioral model of adjustment to the cancer stressor. Then, descriptive research findings are reviewed within a cancer-relevant time line-from symptom discovery to survivorship or recurrence and death. Aside from reviewing the relevant clinical and empirical data, specific psychological intervention studies are discussed that are designed to reduce stress and enhance coping and adjustment.
The stability of many cancer mortality rates, particularly those with the highest incidence such as lung and breast, makes it imperative that new, innovative steps be taken to improve survival and enhance quality of life. Concurrently, it has become noteworthy to the medical community that psychological interventions result in significant improvements in quality of life (see Andersen, 1992, for a review). Further, both qualitative (e.g., Maier, Wakins, & Fleshner, 1994) and quantitative (e.g., Herbert & Cohen, 1993) summaries of the