Wendy Mager & Jamie L. Studts
Departments of Psychology & Behavioral Science
University of Kentucky
Psychologists in the field of psychosocial oncology look ahead with special anticipation to the 1999 annual APA convention, since it will offer a unique opportunity for highlighting their work before the general APA membership. Cancer has been selected as one of the major themes for the convention, which is to be held August 20th-24th in Boston, MA. Although psychosocial oncology is far too broad a field to give adequate coverage in this short space, a brief overview may serve as a helpful prelude to the upcoming convention.
Psychosocial oncology aims to understand the psychosocial and behavioral factors in cancer etiology, prevention, detection, and treatment, and in long-term physical and emotional recovery from cancer. The field has grown rapidly in the 45 years of its existence. Emphases within the field have varied with the times, reflecting advances in medical technology as well as changes in attitudes toward cancer. The current state of psychosocial oncology can be described as well-grounded in rigorous scientific research and ripe with practical implications. The future of the field looks quite promising for clinicians and researchers alike.
The notion that psychology could inform our understanding of cancer was first introduced in the mid-1950s. Classic articles by Stephenson & Grace (1954) and Bard & Sutherland (1955) suggested a role for stress in cancer incidence and provided the first description of psychological adaptation to cancer. These works were important for the theoretical foundation they set and the subsequent research they inspired.
Understandably, early psychosocial oncology research was strongly influenced by the fact that most cancer patients died from their disease. Psychologists were primarily interested in learning how to help cancer patients cope with their impending death. Psychiatrists like Elizabeth Kubler-Ross were particularly influential in the 1970s, for their contributions to our understanding of psychological processes of the terminally ill.
The last 10-15 years have witnessed great strides in biomedical aspects of cancer care. Better detection and more effective treatments, especially for childhood cancers, have led to improved survival rates. Psychosocial research has therefore shifted toward a focus on behavioral factors in cancer prevention, detection, and progression, as well as enhancing quality of life for cancer survivors.
It is estimated that 80-90% of all cancers could be prevented or substantially better controlled if behavior was more consistent with current knowledge about cancer. A host of behavioral risk factors for cancer have been identified (e.g., smoking, physical inactivity, high-fat diet, sun exposure). Interventions to help people make lifestyle choices which decrease their cancer risk is an important aspect of psychosocial oncology. The field is also attempting to pinpoint psychological or behavioral factors that promote early cancer detection practices. Caryn Lerman's work on psychological aspects of genetic testing and counseling has been pivotal. Other researchers are attempting to improve compliance with cancer screening recommendations.
Perhaps the most thoroughly studied area of psychosocial oncology is psychosocial adjustment following a cancer diagnosis. In the initial disease phase, psychosocial concerns center around mood disturbance, treatment decision-making, and management of physical distress. For example, William Redd's research in the early 1980s on hypnotic control of anticipatory nausea for chemotherapy is particularly noteworthy. Other researchers have described common cognitive and emotional processes as they unfold in the weeks and months after a cancer diagnosis. Rates of psychiatric disturbance have been documented, as have factors influencing the degree of psychological distress that is experienced. Jimmie Holland, Shelley Taylor, Barbara Andersen, Michael Andrykowski, and Vicki Helgeson are among the leading figures to provide theoretical and empirical guidance in this arena.
Recent research on structured psychosocial group interventions for cancer patients has yielded exciting findings. David Spiegel and Fawzy Fawzy have demonstrated that participation in such groups significantly improves patients' coping, mood, and overall quality of life. Additionally, participation may also improve immune functioning and other factors affecting disease progression.
Not surprisingly, as the interdisciplinary field of psychosocial oncology has developed, channels for professional communication and association have also emerged. Two organizations that cater to professionals interested in psychosocial oncology include Division 38 of APA (Health Psychology) and the Society of Behavioral Medicine. Leading journals in the field include Health Psychology, Annals of Behavioral Medicine, Journal of Psychosocial Oncology, Psycho-Oncology, and Cancer.
Clearly, the work of psychosocial oncologists has led to important advances in cancer prevention, detection, treatment, and recovery. Given the thriving state of current research in this area, it seems that progress is likely to continue. This is a field which is sufficiently broad enough to appeal to a wide range of students. Regardless of your particular research or clinical interests, we urge you to take advantage of the opportunity to learn more about psychosocial oncology at this year's APA convention.
This article first appeared in the Summer 1999 Edition of the APAGS
Newsletter, Vol. 11(3)
