The importance of psychological support for cancer patients

davorkust
Apr 17
6 min read

Authors: Dr. Vanja Putarek, MA in Psychiatry, Antonija Vrdoljak, MA in Psychiatry.

According to the International Agency for Research on Cancer (IARC), cancer is one of the leading causes of death in the world. The number of cancer patients is increasing rapidly every year. For example, in 2012, there were about 14 million new cases of cancer in the world, and in 2018 there were about 17 million. According to predictions, in the next 15 years or so, the number of cancer patients should equal the number of people suffering from cardiovascular diseases. Among those suffering from cancer, there are slightly more men than women (52%:48%). The prevalence (i.e. the total number of patients) and incidence (i.e. the number of new cases) of cancer are highest in more developed areas of the world (North America, Australia, Western and Northern Europe), while cancer mortality is highest in Central and Eastern Europe, Central and Eastern Asia, and Eastern and Southern Africa. Croatia is located "side by side" with the areas with the highest prevalence and incidence of cancer, but is among the countries with the highest mortality from cancer.

The lower mortality rate from cancer in more developed areas of the world compared to less developed areas is certainly due to the quality of care for cancer patients. During treatment, the emphasis is on eliminating the type of cancer that has been diagnosed. The most common cancer is lung cancer, followed by colon cancer, breast cancer and prostate cancer. Due to the increasing number of cancer patients, oncology is currently the most propulsive branch of medicine, and treatment methods are also increasingly advancing. However, quality care should be holistic, that is, it should include medical treatment to improve a person's physical health, but also work on nutrition and lifestyle, as well as work on mental health. Mental health is an often neglected component in working with cancer patients, which can have numerous negative consequences, which we will discuss below. The field that studies the mental health of people with cancer and investigates possible psychological influences on the course of the disease is called psycho-oncology.

According to foreign researchers, about 30% of cancer patients have some form of more pronounced and long-lasting psychological difficulties, the most common of which are chronic stress, depression and anxiety, while most patients experience at least temporary fear, anxiety and low mood. There are numerous causes of chronic stress in cancer patients. For example, stress is present due to the patient's exposure to an uncertain and largely uncontrollable situation, i.e. the person does not know what the outcome of the treatment will be and is left in the hands of experts who care about his/her recovery. As the disease progresses, the person becomes more and more dependent on others, which further reduces the sense of control over his/her own life. As a result, one of the basic psychological needs is violated, the need for autonomy, for making free and independent choices and managing one's own destiny. In addition, cancer patients face a major change in lifestyle and work performance, as well as various bureaucratic procedures, all of which contribute to chronic stress. During exposure to chronic stress, neuroendocrine processes occur in the body, such as a long-term increase in cortisol levels (a hormone secreted by the adrenal cortex), which affects the immune system, or the body's ability to fight disease. Therefore, the nervous, endocrine and immune systems are interconnected, so it is important to also work on psychological health (i.e. the nervous system) in the treatment of cancer so that the immune system functions optimally. Stress can be reduced by increasing the level of psychological resilience of the individual, learning to cope effectively with problems, and relaxation techniques are often used.

The aforementioned difficulties that contribute to the development of chronic stress also contribute to the occurrence of depressive and anxiety disorders. Since cancer patients are at real risk for their lives, it is difficult to determine the level of depression and anxiety that is higher than expected for the individual's condition. The duration of the illness and the duration of anxiety-depressive symptoms are usually taken into account, as well as the level of dysfunction that is present. Anxiety-depressive symptoms most often include frequent worries about one's own future and coping with the illness, but also the future of loved ones, and fear of the possibility of the disease returning in people who have undergone treatment. Anxiety can make it more difficult to fight the illness, and fear of the consequences of treatment can lead to avoiding procedures that could help a person on the path to recovery. Anxiety can also increase the experience of pain, thus having an additional negative effect on patients, while depression can reduce patients' motivation to take care of themselves and follow medical instructions. Therefore, as part of the treatment of people suffering from cancer, it is necessary to work to reduce anxiety and depressive symptoms.

One of the physical symptoms that cancer patients fear and worry about is the sensation of pain, which is present in most patients at some stage of the disease. Pain constantly reminds the patient of their diagnosis and is one of the consequences of cancer that acts as a stressor and contributes to anxiety-depressive disorders. Pain treatment is an important component of cancer treatment because its reduction or elimination contributes to better mental health of the person, and often involves distracting attention from the sensation of pain, relaxation, imagination, etc.

Since one of the possible outcomes of cancer treatment is death, it is not surprising that cancer patients also experience existential distress, i.e. questions about the meaning of life, the fairness of the illness, and the fear of death. Psycho-oncologists can provide support to a person in such a state, helping them to cope with the emotions that arise from it, and to accept and prepare for the next steps in treatment.

Experts can make a big difference in preparing for treatment and coping with its physical and physiological consequences. In addition to worries and fears, there is apathy, increased levels of tension and anxiety, changes in the amount of sleep and appetite. The biological consequences of cancer and the unpleasant side effects of treatment are often reduced by medication, but various psychological techniques aimed at changing behavior can also help. Finally, oncology patients often lack social support, whether instrumental (i.e. help with tasks) or emotional, which can encourage loneliness and increase the level of depression. Psychologists can represent a trusted person for them, but also teach them how they can provide support for themselves and how they can seek it from loved ones.

Some research has linked poor mental health to cancer, but the evidence is still scant, and most findings suggest a reverse causality, with a diagnosis of cancer leading to poor mental health. However, as noted earlier, poor mental health can have a negative impact on physical health, slowing recovery from cancer treatment or increasing the risk of recurrence.

Therefore, mental health is an important factor in all phases of the fight against cancer, from accepting the diagnosis, through persistence in treatment, motivation to search for information about the disease and treatment options, coping with the emotional consequences of the diagnosis, reducing physical discomfort, all the way to seeking social support and improving the quality of life. Therefore, it is not surprising that many of the world's leading institutes for the treatment of people with cancer have seen the usefulness of psycho-oncology and psychological support during treatment. For example, the Mayo Clinic provides integrative cancer treatment and psychologists are part of their medical teams; Memorial Sloan Kettering Cancer Center offers patients individual counseling and counseling for couples and families; Johns Hopkins Kimmel Cancer Center emphasizes the role of psychologists and social workers in coping with the disease and planning the course of treatment and all related life changes. A similar approach is advocated by other influential institutions focused on cancer research and treatment, such as the University of Texas MD Anderson Cancer Center, Abramson Cancer Center and Roswell Park Cancer Institute. Modern treatment guidelines routinely include a triage process, during which each patient undergoes a procedure to assess their psychological state and determine whether they need some form of psychotherapy. It is optimal to repeat these procedures several times, at critical moments in the development of the disease.

In conclusion, modern medicine increasingly emphasizes that treatment focused exclusively on one aspect of an individual or a disease is not enough, but rather requires a broader, holistic and comprehensive approach based on scientifically proven facts, which involves acting on both the physical and emotional symptoms of the disease, with an emphasis on improving the patient's quality of life.