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Psychiatric Issues in Cancer
working of the body’s neuro-endocrine, immune and other systems. disorders, are common.
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These mental health problems are additional
The term neuropsychoimmunology was first mentioned in the literature contributors to functional impairment in carrying out family, work and
in 1939. Since then, there has been tremendous growth in interest and other societal roles, poor adherence to medical treatments and
research in this area. There is still much more to discover about the adverse medical outcomes.
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In summary, people diagnosed with
study of the interactions among behaviour, the brain and the body’s cancer and their families must not only live with and manage the
immune system. Inflammation (an immune response) has been linked changes and risks posed to their physical health, but also overcome
to a spectrum of conditions associated with ageing, including psychosocial obstacles that can interfere with their healthcare and
cardiovascular disease, osteoporosis, arthritis, type 2 diabetes, certain diminish their health and functioning.
lymphoproliferative diseases and cancers (including multiple myeloma,
non-Hodgkin’s lymphoma and chronic lymphocytic leukaemia), Patient–Physician Communication
Alzheimer’s disease and periodontal disease.
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We know that patients Effective communication is essential to any relationship; therefore, it
undergoing certain cancer treatments (e.g. interferon or interleukin-2 is no surprise that a significant portion of psycho-oncology research
[IL-2] treatment) are at higher risk of developing depression, and there is dedicated to better understanding how healthcare providers and
is a positive relationship between depression and circulating levels of patients communicate. There are several different aspects of
proinflammatory cytokines. With better understanding we may be able communication that can influence what comprises the most effective
to predict which patients are more likely to become depressed based and empathetic way to convey and receive information for different
on certain aspects of their immunological profile.
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As a consequence, people. A study of 529 Japanese cancer outpatients revealed that 50%
the possible enhancement of immune function by behavioural of them wanted specific information about their life expectancies,
strategies has generated considerable interest. Researchers have used while 30% did not want any such information at all.
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The personality
a number of diverse strategies to modulate immune function, including characteristics of the care-giver communicating the information may
relaxation, hypnosis, exercise, classic conditioning, self-disclosure, also influence the interaction. Libert discovered that physicians with
exposure to a phobic stressor to enhance perceived coping an internal locus of control (who believe their actions directly
self-efficacy and cognitive behavioural therapy (CBT), and these influence outcomes) make greater changes in their communication
interventions have generally produced positive changes. Although it is styles with patients after communication skills training than those
not yet clear to what extent these positive immunological changes with an external locus of control (who believe that outcomes are
translate into any concrete improvements in relevant aspects of health, influenced by fate or karma).
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According to some patients, healthcare
that is alterations in the incidence, severity or duration of malignant providers sometimes insufficiently communicate information about
disease, the preliminary data are promising. This brings me to the idea diagnosis, prognosis, treatment options and symptom management in
of incorporating psycho-oncology in tumour board meetings. Should ways that are understandable to and enable action by patients.
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such meetings and discussions occur with each individual cancer Effective communication depends on culture, personality and many
tumour board or should cancer treatment start to be looked at other aspects, not just content of thought.
holistically? There may be a benefit to looking at cancer treatment in
terms of the whole body as opposed to separate organs or organ A part of effective communication involves knowing more about how
systems. Psycho-oncologists strive to do this, and with similar patients make choices. In a study by Vogel, breast cancer patients who
collaboration from medical oncologists a better understanding of the wanted the physician to make the decision and patients who wanted
effects of cancer physically and mentally across the whole body may to make the decision on their own were more likely to have their
be achieved, which in turn may engender more treatment options and preferences met than patients who wished to share the decision. The
hopeful possibilities for cancer patients. availability of treatment choice and the level of depression influenced
the preferred decision-making preference.
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The most frequent
Distressed emotional states also often generate additional somatic subjects relating to cancer that engender uncertainty in patients and,
problems, such as sleep difficulties, fatigue and pain, which can consequently, create an atmosphere of difficult decision-making are
confound the diagnosis and treatment of physical symptoms.
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Patients disease-related issues (prognosis/diagnosis, treatment), risk
with major depression also have higher rates of unhealthy behaviours communication issues (deciphering information, role in the medical
such as smoking, a sedentary lifestyle and overeating compared with dyad, physician’s trustability) and aspects of coping with life
non-depressed patients. Additionally, dysphoric mood and anxiety states considering the disease (mastering requirements, social integration,
can hinder behaviour changes and adherence to treatment regimens causal attribution).
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Since communication is the foundation of the
(cancer regimens are often complex) by impairing cognition and patient–provider relationship, communication skills training is needed
motivation and decreasing coping abilities. for all cancer-related providers. This may cost institutions and group
practices more money, but the return on the investment will be evident
Eleven per cent of adults with cancer or a history of cancer (almost very quickly as patients feel more secure in their communications with
half of whom are >65 years of age) report having one or more providers and, hence, are likely to be more open, honest and adherent
limitations in their ability to perform activities of daily living such as to treatments.
bathing, eating or using the bathroom, and 58% report other functional
disabilities such as the inability to walk a quarter of a mile or to stand Care-giver Burden
or sit for two hours.
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Almost 20% of those who survive for five or more Although family and loved ones often provide substantial amounts of
years report limitations in activities such as carrying groceries, emotional and logistical support and hands-on personal and nursing
climbing a flight of stairs or walking a block.
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Significant numbers of care, they often do so a great personal cost, themselves experiencing
individuals stop working or experience change in employment after depression, other adverse health effects and an increased risk of
being diagnosed or treated for cancer. Not surprisingly, significant premature death.
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Care-givers providing support to a spouse who
mental health problems, such as depression, anxiety and adjustment report strain from doing so are 63% more likely to die within four
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