"Apple Blossoms"

Lorna Ritz, Amherst, Mass.    Oil on linen,      1992

It took enormous discipline to alter my attitude more towards the positive, having suffered four cancer surgeries and follow-up treatments over a 20-year period. But I am now functioning better than ever, lavishing in my health. I paint as though I have only this day to touch paint and see color. I constantly make new discoveries by thoroughly indulging my curiosities.

My paintings, being seasonal as I finally realize, document time through my study of color in the landscape. My reaction to facing the unknown, suddenly, and not recognizing myself in the mirror, and having pain, was to paint as though there was no tomorrow.

© Lorna Ritz 1992

Improving life for survivors of cancer

Psychologists are conducting research on interventions to help survivors overcome post-traumatic stress syndrome and fatigue.

By Lisa Rabasca
Monitor staff

A 40-year-old cancer sur- vivor who received a bone-marrow trans- plant to treat his leukemia would have flashbacks of receiving radiation treatment whenever he heard the sound of the generator at work. Colors that reminded him of the hospital would trigger nausea, sweating and chills. At home two years after his treatment ended, he'd wake up in the middle of the night not knowing if he was in his bedroom or at the hospital. He forbade his family from bringing a Christmas tree into the house because the smell reminded him of the pine-scented lotion he used in the hospital.

Like a handful of cancer survivors he was diagnosed with post-traumatic stress disorder (PTSD) after a bone-marrow transplant he had nearly three years ago to treat his leukemia. Clinical studies show that 13 percent of adult bone marrow transplant survivors have PTSD symptoms. The cancer survivor was able to reduce his PTSD symptoms by working with a psychologist who taught him relaxation techniques and cognitive coping strategies.

Today he no longer has intrusive thoughts or experiences chills, sweats or flashbacks, says Katherine DuHamel, PhD, assistant professor at the Derald H. Ruttenberg Cancer Center at Mount Sinai School of Medicine in New York City, who treated the patient's PTSD.

As more people are surviving cancer treatment, psychologists like DuHamel are developing interventions that help them lead fuller lives. Last year the National Cancer Institute (NCI) set aside $15 million for new research into the physical and emotional well-being of cancer survivors who live five or more years after their diagnosis.

These studies focus on quality-of-life issues such as the social, emotional and physical changes experienced by cancer survivors, the mental health consequences of surviving cancer, and the physical and psychological side effects bone-marrow transplants have on adult leukemia patients. The American Cancer Society is also funding studies that look at the physical and emotional health of cancer survivors.

Psychologists, in particular, are studying two of the most common side effects facing cancer survivors--PTSD symptoms and fatigue--and testing interventions to treat these symptoms.

"We've gone from 'Gee, we're happy people survive,' to investigating how they survive, to trying to improve the quality of their survival," says Paul Jacobsen, PhD, program leader for psychosocial oncology at the Moffitt Cancer Center and associate professor of psychology at the University of South Florida in Tampa.

Beating PTSD

DuHamel of the Ruttenberg Cancer Center is studying whether relaxation training and cognitive coping strategies will reduce PTSD symptoms in adult leukemia patients who have had bone-marrow transplants. The American Cancer Society is funding this project.

In a previous study, DuHamel and her colleagues Meredith Smith, PhD, assistant professor at the Ruttenberg Cancer Center and William Redd, PhD, associate director of the Ruttenberg Cancer Center, interviewed 111 adult survivors and found that 13 percent experienced PTSD symptoms. From that study, they developed and pilot-tested a 10-session, trauma-focused intervention that teaches patients to use relaxation techniques and cognitive coping strategies to reduce PTSD symptoms. They're testing their intervention through a randomized clinical trial at Mount Sinai School of Medicine. Patients receiving the intervention will be assessed before the intervention, one week after the intervention and three months later, Redd says.

"The study will show whether interventions can help people adjust better after their treatment and alert medical staff and patients that there are things that can be done to ameliorate these symptoms," Redd says.

Helping parents cope

Redd is also working on a study to examine whether mothers of hood cancer survivors who have had bone-marrow transplants experience PTSD. Clinical studies show that parents are more likely to experience PTSD symptoms than their ren because often the ren are diagnosed at a young age and recall little of their treatment.

A pilot study found that of the 65 mothers who completed a self-report PTSD questionnaire, 6.2 percent had suffered from PTSD and another 20 percent had PTSD-related symptoms, Redd says.

Now, NCI is funding a five-year study to identify the factors that put mothers of cancer survivors at risk for developing PTSD and help psychologists to develop interventions for treating these symptoms. The study includes patients at Mount Sinai, Sloan-Kettering Institute for Cancer Research in New York City, Dana-Farber Cancer Institute in Boston, Children's Memorial Hospital in Chicago and Stanford University Medical Center. About 400 mothers will be periodically interviewed from the time their is hospitalized for the transplant to 18 months after treatment, says Sharon Manne, PhD, an adjunct associate professor at the Ruttenberg Cancer Center, who is working with Redd.

Meanwhile, Anne Kazak, PhD, is studying the effectiveness of a one-day intervention for the families of all hood cancer survivors. NCI is funding her study.

The intervention, known as "Surviving Cancer Competently: An Intervention Program" (SCCIP©), combines cognitive-behavioral and family therapy to reduce symptoms of distress and improve family functioning. The intervention helps families identify and change beliefs that could lead to negative consequences, says Kazak, director of psychosocial services in the division of oncology at The Children's Hospital in Philadelphia. Kazak is also a professor in the department of pediatrics at the University of Pennsylvania School of Medicine.

For example, if parents are worried their will have a relapse, the family may feel increased fear and anxiety. The intervention teaches them to manage that fear by:

* Accepting the uncontrollable. (My must return to the clinic for check-ups.)

* Focusing on the controllable. (By going to the clinic for check-ups, we are making sure my is as healthy as possible.)

* Using the positive. (My is currently in remission.)

SCCIP was tested on 19 families in a pilot study and the results will be published in the summer 1999 Family Process (Vol. 38, p. 175­191). Meanwhile, the intervention is also being tested through a randomized clinical trial at The Children's Hospital.

Telling survivors what to expect

Psychologists are also studying ways to help breast-cancer survivors who were treated with chemotherapy to deal with fatigue after their treatment ends. Although breast-cancer survivors tend to cope well, there are issues that come up after treatment that they need to be aware of, says Julia Rowland, PhD, director of psycho-oncology research and co-director of the psycho-oncology program at Georgetown University.

An initial study of 864 breast-cancer survivors at Georgetown Medical School and the University of California, Los Angeles, School of Medicine, found that a subset of women are fatigued long after their chemotherapy treatment ends. Often this makes them anxious, Rowland says, because they fear their disease is coming back. While most women cope well during their treatment, many feel distressed, sad and worried about their futures when the treatment ends.

"All of these factors argue for an intervention that educates women about what's normal and what can be done to feel good about coping, responding to others and the ability to integrate the cancer experience into who you are post-treatment," says Rowland.

Along with colleagues at the University of California, Los Angeles, the University of Southern California and the University of Kansas, she is testing an intervention for breast-cancer survivors that addresses issues such as fatigue, early menopause, social and work demands and sexual functioning after treatment through written materials, a videotape and a counseling session. NCI is funding the four-year study to test the intervention in a randomized clinical trial.

The study will compare the impact of the women's adaptation, functioning and health care use in three different intervention groups: One group will receive only written materials. A second group will get the written material plus a videotape. The third group will receive written materials, the videotape and a single one-on-one counseling session along with a follow-up phone call.

Interventions designed to help cancer survivors lead better lives can have a significant impact on a patient's lifestyle, says Rowland.

"Cancer is a genuine crisis in anyone's life," she says, "and like the Chinese proverb about the word crisis, it's one of great danger, but also one of great opportunity."

It's an opportunity, she says, for patients to assess their health and make substantive lifestyle changes. And, for psychologists, it's a unique opportunity for them to use their skills to provide behavioral interventions to help cancer patients lead better lives.



Read our privacy statement and Terms of Use

Cover Page for this Issue

PsychNET®
© 1999 American Psychological Association

APA Home Page . Search . Site Map