Download Health Psychology – Cancer

Health Psychology – Cancer
What is Cancer?
The other ‘C’ word
1000 to 2000 years BC. Hypocrates gave the name cancer (don’t know if he came up
with ‘the big C’ as well). Probably the disease most people fear the most – the very
word. Roughly 1 in 3 people will develop cancer during their lifetime.
Cancer is a disease of cells where cell reproduction is uncontrolled. This uncontrolled
production often produces tumours or neoplasms.
2 types of tumour.
1. Malignant – which show metastasis (the process of cells breaking off from the
tumour and moving elsewhere). Cancer cells more immature, dysfunctional,
do not adhere to one another as normal cells do. New neoplasms are known as
metastisis.
2. Benign – which do not spread throughout the body
Pain. Tumours can cause substantial pain (tumour creates pressure on normal tissue
and nerves or blocks flow of body fluids).. 40% of cancer victims in the intermediate
stage of disease, and 70 to 90% of those with advanced cancer.
Types of Cancer… actually > 200 varieties.
1. Carcinomas (85 to 90% of all cancer). Cells that originate in tissue cells (ie
organs/skin) that line the outer and inner surfaces of the body
2. Lymphomas – in lymphatic system
3. Sarcomas – arise in connective tissue (eg bones, muscles)
4. Leukemias – originate in the blood, too many white blood cells are found in
blood and bone marrow.
Sites… see ohp “where the disease strikes”
Death rates… see ohp 5 year survival rates for men and women (UK).
Cancer progresses by spreading to different sites, and its growth interferes with
normal development and functioning. Cancer takes most of the nutrients of the organ
and therefore the organ fails.
Once cells cancerous, responsibility for detection and destruction resides with the
immune system. Natural killer cells recognise and destroy, process known as
“immune surveillance”. Cancer develops when immune system deficient or
dysfunctional.
Carcinogens cause mutations or genetic mistakes that alter cell functioning, and are
passed on when those cells reproduce. Carcinogens produce alterations in cells DNA,
or the transportation of amino acids that make up the DNA model. Cancer cells
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characteristically have changed markers and immune system destroy them before they
have a chance to develop into malignant tumours.
Risk Factors.
Cancer has often been called a life-style disease. 75-80% of all cancers caused by
modifiable lifestyle factors and are therefore preventable.
Genetic susceptibility.
Some types of cancer linked to certain genes believed to regulate cellular growth and
development. 10% of breast cancers tied to particular genes – develop cancer before
age 40, cancer in both breasts, cancer in 1st degree relatives.
Viruses
Viruses may alter DNA and thereby cause cell to grow in an unregulated manner.
Hepatitis C Virus causes liver cancer. HPV (human papilloma virus) causes cancer of
cervix/vagina. Human Immunodeficiency Virus (HIV) – Acquired Immune
Deficiency Syndrome (AIDS).
Radiation/ X-rays
Ultra-violet light. Exposure to ultraviolet light (especially from the sun), cause of
skin cancer (50% of Australians some form of skin cancer). Both cumulative
exposure (Locals!) and occasional severe sunburn (British tourists!). However, only
one form, melanoma (cancer of pigmented skin) deadly.
Skin cancer associated with behavioural risk (voluntary exposure to sun over long
period of time), strong genetic component. Light skinned, fair haired, blue eyed
individuals 45x more likely than dark skinned people.
Environmental. Car exhaust systems, occupational hazards (Aspestos – lung cancer;
benzene, pesticides – leukemia), pollution. Synergistic effects (ie environmental
hazards + smoking – multiply disproportionate risk).
Lifestyle Risks
Cancer has often been called a life-style disease. 75-80% of all cancers caused by
modifiable lifestyle factors and are therefore preventable.
Tobacco Use.
 Annual death toll from tobacco estimated to be 2.5 million world wide.
Responsible for 75-80% of lung cancer deaths (and 30% of all cancer deaths).
“Largest single preventable cause of illness and premature death in US (US
surgeon general).
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Tar in cigarettes is a powerful carcinogen. Strong effect on initiation and
promotion of cancer.
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Diet
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Epidemiology. A person who smokes a pack of cigarettes a day is 9-10x more
likely to die of lung cancer than a non-smoker. 2 or more packs per day, risk
25x as great. Also 7x more likely to get cancer of mouth, 2x cancer of bladder
or pancreas, and even high breast cancer.
Poor dietary practices are associated with diseases/cancers of breast, stomach,
uterus, endometrium, rectum, colon, kidneys, small intestines, pancrease, liver
bladder, prostate, mouth, pharynx, thyroid, and esophagus.
Some foods are carcinogenic – natural or additive (Nitrites – food additives in
processed meats). Complicated but fat associated with cancer od breast and
colon.
Cancer promoted by the way food is prepared. Grilling meat or charcoal
formation (polycyclic hydrocarbons) on food surface, known as mutagens (eg
benzopyrene).
Alcohol
 Not as strong as tobacco or diet
 Linked to cancer of tongue, tonsils, esophagus, pancreas and liver
 Frequent users of alcohol 5x more likely to develop pancreatic cancer than
non-drinkers.
 Also synergistic, magnifies other risk factors
 Especially smoking and drinking (eg laryngeal cancer)
Sexual Behaviour
 Especially cancers resulting frm AIDS
 2 most common: Kaposi’s Sarcoma = soft dark blue or purple nodules on skin,
often with large lesions, can be large and disfiguring. Non-Hodgkin’s
lymphoma = tumour spreads through circulatory or lymphatic systems.
 Risk factor for AIDS-related cancers – unprotected sex with an HIV-positive
partner
 For women, early age at 1st intercourse and a large number of sex partner (low
SES) risk factor for development of cancer of the cervix, vagina, and ovary.
Also if their men have multiple sex partners and at an early age. Barrier forms
of contraception – diaphragm condom – will lower risk for cervical cancer.
But offset, having a child early in life protective against breast, ovarian, and
endometrial cancers.
Stress, stressful life events
 Prospective studies but problematic because develop slowly over many years.
Not consistently supported. Self-report of stress.
 Psychosocial intervention and cancer (APA, 2001) “stress may effect progress
of cancer, by impairing immune functioning” and conclude “substantial and
credible evidence exists for the idea that behaviour, emotion, and stress affect
the progression and course of cancer once it is established”.
Suppression of Emotion
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Inability to express emotion
Greer and Morris (1978), women admitted to hospital for biopsy for lump –
40% maliganant. 5 year follow-up shoed suppression or denial of anger
significantly related to increase chance of later diagnosis of cancer.
Personality
 During 1980s, Eysenck and Grossarth-Maticek developed a model for socalled cancer-prone personality. (Others Type C – passive, appeasing,
helpless, other-focused, and unexpressive of emotion).
 Study then in Yugoslavia. Type I – 45% of deaths due to cancer. Poor old
people 59-69 years old, follow-up 10 years later.
 Type 1 people for whom close interpersonal relationships important, who have
non-emotional helplessness, and hopeless reaction to stress.
 Replicated in Heidelberg, Germany among 40 to 60 year olds. But other
researchers very critical, for a number of methodological weaknesses. One –
lots more people died than would expect from a healthy population. Absence
of reliability/validity data for personality categories, and inconsistent scanty
descriptions of the methodology.
Psychological Impact of Cancer
Most common reactions
 Anxiety
 Depressive symptoms
 Feelings of loss of control
 Cognitive (poor concentration, memory, judgment)
 Sexual dysfunction (affect approximately 90% of individuals with cancer)
 Denial (can be useful initially, but also potentially injurious)
 Interpersonal relationships (change in relationships with family and friends)
Diagnosis = major crisis (anger, depression, anxiety, search for meaning). Depression
after receiving diagnosis, but few (6%) are clinically depressed, up to 20% severe.
Larger (47%) for people with other forms of psychiatric disorder, but most cancer
patients don’t suffer serious psychological problems.
Positive aspects.
Taylor (1983) a search for meaning as a significant aspect of adjustment to lifethreatening illness like cancer.
Cordeva et al (2001). Post-traumatic growth in survivors of breast cancer, relating to
others, appreciation of life, spiritual change (doesn’t kill, makes you stronger).
Cancer = psychosocial transition.
Being confronted with one’s mortality may elicit a re-evaluation and redefinition of
life goals and priorities, such that individuals emerge with a greater investment in and
appreciation of life, interpersonal relationships, spirituality, and personal resources.
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“Research that has focused solely on detection of distress and its correlate may paint
an incomplete and potentially misleading picture of adjustment to cancer”
Primary Prevention
1. Control of environmental carcinogens (eg remove asbestos, unleaded petrol,
move all Australians to Canada … or just school policy to wear hats, Slip,
Slop, Slap, shade swimming pools, bans on workplace smoking, anti-pollution
laws.
2. identification of genotypes that increase risk for cancer
3. modification of personal health behaviours
Secondary Prevention
1. Aim to reduce cancer mortality in those who have the disease. Usually by
means of screening programs to detect cancer early, before any obvious
symptoms and before spread.
2. Screening needs to be reliable, acceptable, accessible and must have a
cure/treatment. Eg pap smear tests for cervical cancer (high false-positive
rates produce anxiety). Considerable debate about whether should screen for
prostate cancer, mostly not cost-effective.
3. Detect melanoma early (change in mole or wart), breast self-examination.
Ohp – warning signs.
Between 35% and 55% of patients with cancer symptoms delay 3 or more months
before seeking treatment. Why? Cancer not painful in early stages, those fearful of
cancer delay longer.
Treatment.
 Surgery, radiation (burns, nausea, hair loss, sterility) chemotherapy (powerful
drugs that kill cells which divide very rapidly, targets are cancerous cells,
other cells divide rapidly, eg hair follicles, internal lining – vomiting and
nausea, reduced immunity to infection – sores in mouth. Anticipatory nausea
in 25-50% of chemotherapy patients with repeated treatment (David Spiegal
because treatment is punishment).
Psychology and Cancer
People live much longer than they should. Considerable individual differences, lots
of self-help books.
“Fighting spirit”. Social support.
 Spiegel (1993) sample of women with metaststic breast cancer (ie advance)
randomly assigned 83 to regular treatment of regular treatment plus
participation in support group.
 In support group, weekly 90-minute sessions free to express fear etc, for 1
year. Followed participants for 10 years. Had expected emotional benefits,
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but lived 18-months longer on average. All but 3 died. Group therapy lived
nearly 2x as long as non-treatment (19 months and 37 months). As of 4 years
post-treatment, all controls died, whereas 1/3 treatment still alive.
Edelman, Craig, and Kidman (2000). Review of psychotherapy and survival time of
cancer patient. 8 randomised control trials of psychological interventions on patient
survival. 3 support, 5 don’t. Conclude “ to date, a direct relationship between
psychological intervention and patient survival time has not bee conclusively
demonstrated”.
Surgery – amputation of limb for bone cancer, breast (all or part), colon cancer –
colostomy, surgical opening in abdomen.
Radiation/Chemotherapy – fatigue, sterility, anticipatory nausea - one chemotherapy
nurse remarked that she saw one of her patients in the supermarket. She said “hello”
and the patient threw up in the aisle (psyc interventions = hypnosis, relaxation,
systematic desensitisation).
Psychological treatment
 Counselling for anger, depression, anxiety
 Relaxation training for reducing pain, insomnia and nausea
 Self-instructions – learn to talk to self in constructive rather than negative
manner.
 Problem-solving skills.
Support groups for cancer patients (fear of recurrence)
Individual counselling (CBT)
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