- Psychologists for Cancer
Andrea was brought in to my office by her husband. She was suffering from advanced metastatic cancer, so she was not well enough to drive herself. Despite radiation therapy and chemotherapy, new tumors were appearing at the rate of one every four or five days. Andrea wanted me to help her overcome some negative feelings about herself, and to learn how to get deeply relaxed so that she could use "visualization" to create positive attitudes to help fight her cancer.
I receive many similar requests since there is a widespread belief in the community that psychological factors can affect the likelihood of survival in cancer patients. But dealing with these requests puts the psychologist into a very difficult situation. This is because having a positive attitude towards treatment may be crucial (not just helpful) for psychological therapy. Yet some authorities doubt that such therapies make a difference to length of survival. Furthermore, they claim it is unfair to promise people the possibility of improving their physical condition if such improvement cannot actually occur.
Of course the same can be said of many accepted medical therapies, even more so for those in the experimental stage. One big difference between psychological therapies and conventional medical therapies for cancer is that the psychological therapies are virtually always benign. They don't burn you or poison you or involve destruction of body parts as do common medical therapies for cancer. So the risk involved in their use lies in the possibility of a promise unfulfilled rather than in any negative consequences of the treatment itself. Is the risk worth taking?
The scientific case for using psychological therapies with cancer patients is still being developed. Three important steps in making this case are, firstly, to investigate whether psychological factors can affect immune responses, secondly, to show that some of these immune variations are of significance for cancer patients, and thirdly to show that psychological factors contribute to the development of cancer, or to recovery from cancer. Psychologists have been heavily involved in research in the first and the third of these areas.
A substantial body of research has shown that a psychological procedure called "classical conditioning" can be used either to depress or to enhance immunity. In this context classical conditioning involves repeatedly associating some novel neutral stimulus (like a taste) with the presentation of an immune depressing or an immune enhancing drug. After a time, presentation of the stimulus alone may be sufficient to create changes in the immune response. Thus the immune system responds to psychological signals.
One of the most convincing and consistent areas of research concerning psychological effects on cancer concerns the effects of stress on cancer. An enormous number of studies, mostly with animals, has shown that stress is associated with higher rates of initial appearance of cancer, with faster growth of tumors, and with higher likelihood of metastasis (or the spreading) of cancer. This is one of those areas where I am certainly ready to take the results of animal studies very seriously.
My own research at the University of Newcastle in Australia has shown that in normal student populations certain personality factors predict patterns of immune responses, that immune responses fluctuate according to the amount of academic stress, and that being assigned to relaxation training programs dramatically improves immune responding.
It is a big step to go from this kind of research to studies of actual cancer patients. However, there are now results from many hundreds of clinical cases studied in the US, the U K, and Australia, including large scale longitudinal studies, that the authors believe show us that certain life experiences make it more likely that some people rather than others will suffer from cancer, and that some people with cancer will do better than others because of psychological factors.
I have an open mind about such possibilities. Such evidence convinces me that it is worthwhile taking psychological factors into account in dealing with cancer patients. This doesn't mean that any given person who tries such approaches will see an improvement in physical health. But my own preference would be to have access to something that just might make a difference if it were a matter of my own life or death. In any case I have not the slightest doubt that psychological interventions with cancer patients can lead to reductions in stress and pain and increase in general well-being.
It is the very seriousness of cancer that provides the strongest case of all for taking the cancer patient's psychological well being into account. The relaxation/meditation strategies which have been proposed for maximizing the body's own capacity to mount a defense against cancer, are also those which are most likely to give cancer patients a feeling of having some control over their treatment experience. They are likely to increase the ability to deal with the very stressful experiences involved in having cancer, and in having medical treatment for cancer. They are very likely to lead to improvements in the quality of life of cancer patients.
For such reasons I have no reservations about using such approaches with cancer patients. As one of the cancer patients who attended a colleague's relaxation groups put it, " I don’t know what it does for the cancer, but by gee it makes your life feel good". If the patient's physical health improves at the same time, all well and good. But I have seen enough unhappy cancer patients to know that the quality of life is a good place to start from.
This is what I tell those people like Andrea who ask me for help. I know that adequate psychological treatment will improve their lives. It may also help to reduce some of the physical discomforts of cancer, for instance by providing increased capacity to control pain, or through reducing side effects of treatment such as anticipatory nausea and vomiting. I cannot promise that it will help them to recover from cancer, but it just might and I have no qualms about stating that I would be following the very same procedures to the full if I had cancer myself.
More readings will be added to my blog from time to time. Have a quick look now to see the first posting on my blog PSYC1PLUS