Spiegel and Moore provide an excellent review of the utility of psychological
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. 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. These techniques have an impact on both pain sensation
and the emotional distress caused by pain in addition to enhancing coping
strategies. 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.
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 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
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.
1. Saleeba AK, Weitzner MA, Meyers CA: Subclinical psychological distress
in long-term survivors of breast cancer: a preliminary communication. J
Psych Oncol 14:83-93, 1996.
2. Syrjala KL, Cummings C, Donaldson GW: Hypnosis or cognitive behavioral
training for the reduction of pain and nausea during cancer treatment:
a controlled clinical trial. Pain 48:137-146, 1992.
3. Meyers CA: Psychologic management of cancer pain. Curr Rev Pain
4. Ben-Eliyahu S, Yirmiya R, Liebeskind JC, et al: Stress increases
metastatic spread of a mammillary tumor in rats: evidence for mediation
by the immune system. Brain Behav Immun 5:193-205, 1991.
5. Riley V: Psychoneuroendocrine influences on immunocompetence and
neoplasia. Science 212:1100-1109, 1981.