Spiegel and Moore provide an excellent review of the utility of psychological
therapeutic tech
niques in cancer patients. These techniques are frequently viewed with
alarm by the medical community because of unsubstantiated claims that they
improve survival in cancer patients. Patients who expect such techniques
as visual imagery to change the course of their illness may experience
poorer psychological adjustment and needless guilt. However, it is a shame
to "throw the baby out with the bath water." Psychological techniques
have a significant role to play in the treatment of cancer patients.
The cancer experience may result in lasting adverse effects on quality of life, even in long-term survivors. For instance, mild emotional distress persists in women who have been free of disease for 5 years after the diagnosis of breast cancer.[1] People facing an illness such as cancer can improve the quality of their lives and contribute to their medical treatment by becoming actively involved. Good nutrition, use of stress management techniques, management of symptoms such as pain and nausea, and access to information all help enhance physical and mental health.
Cancer patients often request psychological interventions, such as visual imagery, as adjunctive treatment. Research is needed to determine whether these techniques have an impact on medical complications (such as infections), length of survival, and, most importantly, quality of survival.
Psychological Techniques for Symptom Management
Psychological techniques, such as hypnosis, are effective treatments for nausea and pain.[2] These techniques have an impact on both pain sensation and the emotional distress caused by pain in addition to enhancing coping strategies.[3] Behavioral techniques have also been shown to reduce medical costs for patients with pain by decreasing the number of physician visits and disability payments .
However, these techniques are of limited value in young children and in older patients who, for psychological or cognitive reasons, have difficulty actively participating in the process and practicing the techniques. In addition, there is a lack of information about which specific techniques are most useful in individual cases.[3]
Psychological Techniques as Adjuncts to Cancer Treatment
It is not uncommon for cancer patients to wonder whether they caused their cancer because of the stress that they experienced in the past. It is known that unrelieved stress can decrease immune function, cause changes in hormone levels and neurotransmitters, and promote unhealthy habits, such as excessive eating, smoking, and alcohol(Drug information on alcohol) use. Many studies that have documented reductions in immune function as a result of stress have also shown an improvement in immune function with the use of relaxation techniques and visual imagery.
However, the relationship of this type of research to cancer is not straightforward. Most cancers do not develop because of a faulty immune system. The main risk factors for developing cancer continue to be a family history of cancer, smoking, overexposure to sun, diet, and exposure to toxic substances.
Nevertheless, there is some evidence that uncontrolled stress may have an impact on the course of cancer. Research has shown that unrelieved stress increased the rate of growth and spread of tumors in animals.[4,5] However, if the animals had control over the stress, the tumors did not grow or spread so rapidly.
It is safe to say that stress has a negative impact on physical and psychological health and quality of life. Whether psychological techniques have sufficient impact on physical functioning to alter the biology of disease is less likely. However, well-designed studies correlating the use of psychological techniques and changes in immune function parameters, time to tumor progression, survival, and quality of life will hopefully be forthcoming because of special funding for exploratory grants for alternative medicine being awarded by the National Institutes of Health.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
