Psychological Aspects of Cancer

• What demographic factors can influence cancer?

  Ethnicity

  Country of residence

  Socioeconomic status (lower SES -> higher risk)
• What are the behavioural factors that influence cancer & progression?

  Smoking

  Diet

  Sexual behaviour

  Alcohol use
• Approx. 1/3 of cancer deaths that occur in US are due to poor nutrition, limited physical activity & obesity.
• What are the different components of patient delay in seeking medical advice?


  Appraisal delay -> deciding symptom indicates illness

  Illness delay -> deciding illness merits a consultation

  Behavioural delay -> making appointment

  Scheduling delay -> time between making appointment & actually seeing doctor
• Fill in the blanks

  A) Appraisal

  B) Illness

  C) Behavioural

  D) Schedule

  E) Treatment

  F) Total delay

  
• What are the psychological risk factors of cancer & progression?

  Stressful life events

  Locus of control & personality factors

  Coping & adjustment to illness

  Psychiatric diagnosis

  Repression of negative emotions
• How does stress impact cancer?


  Contributes to progression of some cancers

  Effect on immune system

  • reduction in activity of NK cells & cytotoxic T cells
  • shift in balance from Th1 to Th2 cytokines
  • -> increase frequenct of tumour promotion
• Stress is NOT related to the development of breast cancer

  HOWEVER

  Stronger evidence that chronic stress can result in faster cancer progression
• What personality traits are linked to cancer initiation & progression?

  Type C

  • Stoicism
  • Perfectionism
  • Over agreeableness

  Increased trisk due to associated behavioural risk factors
• Anger about cancer diagnosis is associated with better prognosis.

  Fighters & deniers have been shown to have better outcomes than accepters & helpless.
• Cancer pts often experience anxiety, depression or PTSD.

  Likelihood is influenced by medical factors (cancer type, severity & prognosis) & individual factors (age, psychological history, life stress & support)
• Stages in experience of cancer (1969)


  1 - recognition/exploratory stage -> recognition of symptoms & diagnosis

  2 - crisis/climax stage -> anixety, depression, altered body image & concern about changing relationships

  3 - adaptation/maladaptation stage -> anter initiation of treatment

  4 - resolution/disorganisation stage -> long term sequelae
• What how is depression linked to cancer?


  Common response in cancer diagnosis

  Associated with cancer onset & mortality

  Likely plays role in cancer progression (high mortality risk in pts with mood-related disorders post-cancer diagnosis)

  Associated with non-compliance
• How does anxiety impact non-compliance?


  No significant association
• How does optimism impact non-compliance?

  Improved adherence

  Positive attitude towards medication
• How does depression impact cancer survival?


  Not significant in cancer progression

  Increased mortality (greater association in older age groups)
• Cancer & cancer treatment can mimic depression (fatigue, insomnia, reduced appetite & cognitive impairment)
• How does cancer link to suicide?

  Increased rate

  Esp in;

  • males
  • age > 65
  • specific cancers (prostate, lung, pancreatic, head & neck)
  • 1st year after diagnosis
• Fill in the blanks

  A) Medical

  B) Demographic

  C) Disease related

  D) Psychosocial

  E) Depression

  
• How does appraisal of cancer influence coping?

  People who appraise cancer as a threat or challenge to be addressed -> more likely to use problem-focused coping strategies, (information gathering, problem solving, accepting responsibility, and seeking supportt) 

  People who appraise the cancer as involving harm or loss -> more likely to use avoidant strategies (denial, distancing, wishful-thinking, and substance use)
• Providing effective treatment for psychological distress in cancer is crucial.
• What is the impact of psychlogical intervation on cancer patients?

  Enhance adaptation in cancer patients -> impacts tumour growth, recurrence & survival

  Interventions are effective in addressing psychosocial aspects of cancer

  • decreased depression
  • decreased pain
  • improved family function
  • improved ability to function in early-stage cancers
  • improves QoL -> enahnces adherence & survival