Psycho-oncology

Last updated

Psycho-oncology is an interdisciplinary field at the intersection of physical, psychological, social, and behavioral aspects of the cancer experience for both patients and caregivers. Also known as psychiatric oncology or psychosocial oncology, researchers and practitioners in the field are concerned with aspects of individuals' experience with cancer beyond medical treatment, and across the cancer trajectory, including at diagnosis, during treatment, transitioning to and throughout survivorship, and approaching the end-of-life. Founded by Jimmie Holland in 1977 via the incorporation of a psychiatric service within the Memorial Sloan Kettering Cancer Center in New York, the field has expanded drastically since and is now universally recognized as an integral component of quality cancer care. [1] Cancer centers in major academic medical centers across the country[ vague ] now uniformly incorporate a psycho-oncology service into their clinical care, and provide infrastructure to support research efforts to advance knowledge in the field.

Contents

Psycho-oncology deals with psychological reactions to the experience of cancer, the behavioral component of coping with cancer as well as health behavior change including preventive medicine, and social factors that are associated with diagnosis and treatment of cancer, including communication with providers and loved ones and social support. In addition, research related to the influence of psychosocial factors on biological disease-related processes has burgeoned over the past two decades. Much research takes a biopsychosocial approach to account for the interplay between biological, psychological, and social factors in coping with cancer. The integration of psycho-oncology into routine oncologic care represents a major step forward in terms of care for the whole patient.

Psychological

Diagnosis and treatment of cancer is known to influence psychological well-being to a significant degree. Rates of psychological distress are elevated for most individuals who have been diagnosed with cancer when compared to population norms. [2] [3] Common psychological reactions to cancer are mood and anxiety-related concerns. Elevated rates of depression and anxiety in response to a cancer diagnosis is often attributable to uncertainty regarding mortality and well as going through arduous treatments and concerns related to functional interference and body-image or other self-concept related distress. Understanding how individuals react psychologically to cancer is important to support their overall well-being and maximize quality of life during treatment and beyond. While the prevalence of psychological disturbance in reaction to cancer is relatively high when compared to population norms, many individuals report fairly stable psychological well-being through the cancer trajectory and some even report improved psychological well-being.

Depression and anxiety

Common psychological reactions to cancer (same) diagnosis and treatment include depressive symptoms and anxiety. Factors that may contribute to clinically significant anxiety and depression in the context of cancer include threat to life, uncertainty regarding prognosis and treatment outcome, worry regarding toxic treatments, functional impairment as a result of toxic treatments, and physical symptoms themselves, commonly including fatigue, pain, nausea, hair loss, neuropathy, and chemo brain. These topics have been incorporated into psychotherapy treatments tailored to the experience of living with cancer. While the majority of individuals diagnosed with cancer do not exhibit clinically significant symptoms of depression or anxiety, prevalence after cancer diagnosis is substantially higher than population norms. [4] Psychological well-being is not only associated with overall quality of life, but has been shown to be associated with shorter survival. [5]

Coping

Psychological and behavioral responses by individuals to diagnosis and treatment of cancer in an effort to manage the substantial stress and threat to health are of primary interest in the field of psycho-oncology. These responses constitute what can be referred to as one's coping response to a health threat. Cognitive adaptation to cancer is particularly challenging due to the multiple domains that cancer treatment effects. There are two broad categories of coping behavior, including approach-oriented oping and avoidance-oriented coping. [6]

Approach coping construes cognitive, behavioral, and emotion facets of adjustment to cancer including expressing emotions, taking an active role in one's own treatment, remaining active, and discussing difficulties with loved ones. Generally, research supports the idea that the use of approach-oriented coping supports more positive adjustments and psychological well-being than avoidance-oriented coping.

Avoidance coping is an individual's maladaptive attempt to mitigate psychological damage from a stressful event. Emotional suppression and avoidance of discussion related to the topic of cancer, as well as passive behaviors preclude individuals from directly managing the concerns that are giving rise to psychological distress. Many psychological treatments are designed to enhance individuals' ability to implement more adaptive coping behaviors and cognitions and reduce maladaptive coping.

Positive psychological reactions

Benefit finding and post traumatic growth

Benefit finding is a cognitive process in which individuals identify positive contributions that a diagnosis of cancer has made to their lives. It is an example of a positively oriented coping strategy or approach oriented coping strategy. For example, an individual may identify that diagnosis of cancer led them to consider what really matters in life, subsequently leading them to an increased quality of life. Research primary conducted with breast cancer survivors has shown that interventions to increase the identification of benefits to a highly stressful experience like cancer diagnosis can improve quality of life. [7]

Post traumatic growth is significant to cancer diagnosis due to the potentially life threatening nature of the diagnosis. Individuals may be forced to consider their own mortality and may adapt by altering the way they relate to others, the world, and even themselves. [8] Some patients refer to "the gift of cancer" due to it inspiring them to look closely at their lives or deaths and make changes to improve both. [9]

Cancer presents individuals with a major health threat that often challenges one's sense of self as they attempt to navigate changes to their lives as a result of diagnosis and treatment. Meaning making is the effort to restore order and purpose to people's lives that has been changed so drastically by the disease. [10] Meaning making can be a part of a positive growth process that occurs after diagnosis with cancer and is associated with greater quality of life and well-being. [11]

Behavioral

In addition to behavioral responses to cognitive reactions to diagnosis and treatment, the field of psycho-oncology address behaviors associated with risk of developing cancer and behaviors that place individuals at risk of poor disease outcomes. Included in this domain of interest are preventive medicine behaviors of smoking cessation and use of skin protection as well as adherence to treatment regimens.

Health promoting behaviors and preventive medicine

Behavior modification to reduce the risk of developing cancer is a major public health concern due to health care costs associated with individuals being treated for cancer. [12] Behavior change falls squarely within the interests of the field of psycho-oncology due to the psychological factors associated with implementing behavior change. Chief among behaviors that are targeted to decrease individuals' risk for cancer are smoking and alcohol consumption, diet and exercise, and sun exposure. These health behaviors are known to increase the likelihood of developing cancer in addition to myriad other health conditions.

Engagement with screening procedures is also of importance with regard to cancer prevention and in some cancers an underutilized resource. Fear and anxiety are barriers for some to getting screened for cancer. [13] However, cancer screening presents the opportunity to catch tumors that are present in very early stages and avoid intensive, systemic treatments in favor or more acute and localized treatments with a higher cancer of cure (e.g., surgical resection).

Behavioral modification is also relevant to improving the quality of life of those who are living with cancer. For example, a common and debilitating symptom of cancer is fatigue. However, a prescribed treatment for fatigue is to engage in a higher level of physical activity, despite its difficulty. Low intensity and mindful forms of physical exercise have emerged including yoga and tai chi [14] that have been shown to help with fatigue and pain and improve overall physical and psychological quality of life.

Treatment adherence

Historically, terminology related to the uptake of treatment by the patient was referred to as compliance, implying a more passive role on the part of the patient, and a more clearly delineated hierarchy between the doctor and patient. However, modern models of ethical treatment call of more equality between patient and provider and discussion related to treatment has shifted towards adherence. Adherence to medical treatment is of crucial importance to managing cancer effectively and is a topic that largely falls under the purview of psycho-oncology for the cognitive-behavioral causes for lack of treatment adherence. [15] A number of factors can contribute to lack of treatment adherence including toxic side effects, misinformation or lack of understanding of treatment regimen, lack of communication with medical providers, and lack of medical support (e.g., treatment self-management), in addition to psychological factors like depression and anxiety. Treatment adherence has become an increasingly important topic of study in psycho-oncology due to the advent and proliferation of oral antineoplastics. [16] Individuals on oral chemotherapy must manage sometimes complex treatment regimens at home, on their own, and be able to communication effectively with treatment providers to manage toxic side effects that may influence ability or willingness to take the prescribed drug without the assistance of nursing as in traditional intravenous chemotherapy.

Social

Social support and isolation

During a stressful experience such as cancer diagnosis, social connections can provide valuable emotional and practical support. Research in the broader field of Health Psychology has revealed significant influences of social support on the psychological well-being of individuals as well as associations with disease processes, particularly in cardiovascular disease. [17] Patients undergoing treatment for cancer often rely on a social support network of varying size, including spouses, children, friends and other family, to support them through difficult treatments and functional impairment. These types of social support refer to instrumental social support and are related to task-based support. Additionally, the emotional toll that cancer diagnosis can take on a person necessitates a degree of emotional support from the support network. Both instrumental and emotional social support have been shown in research to improve quality of life in patients being treated for cancer. [18]

Conversely, a diagnosis of cancer can be significantly socially isolating for individuals. Life changes including functional impairment may separate people from their friends and family, and a shift from "healthy" to "ill" in terms of self-identity can lead to a sense of social isolation as well. Research has shown that social isolation and perceptions of loneliness have significant negative impact on physical and psychological quality of life in individuals with cancer. [19]

Communication

Communication with medical providers and loved ones has been identified as an important social factor throughout the cancer trajectory. Communication has been shown to be associated with improved medication adherence and satisfaction with care. [20] CBT-based interventions have incorporated strategies for communication with providers about topics including symptom management and prognostic understanding. [21] Additionally, open communication between patients and caregivers is associated with improved quality of life in patients and caregivers. [22] Having an open communication within the family of the cancer patient is also important for the well-being of the entire family. [23]

Biological

Stress pathways to disease

Knowledge from other fields of health psychology, prominently including psychosocial contributors to cardiovascular disease risk and outcomes, led to the exploration of the influence of psychological factors on biological processes associated with cancer. As knowledge of biological processes related to cancer development and progression advance [24] so too does that knowledge of the association between biological processes, namely inflammation and psychological processes. Research has revealed bio-behavioral pathways to disease [25] which indicates that importance of treatment of psychological concerns that emerge as a result of a cancer diagnosis in efforts to reduce the likelihood of cancer progression. Additionally, knowledge continues to advance related to treatment refractory symptoms of cancer including pain and fatigue that may be biobehaviorally driven which has advanced novel treatment approaches. [26]

Psychosocial treatment models

Adaptations of CBT, ACT, other effective interventions

Multiple evidence-based treatments for mood and anxiety disorders in the general population have been adapted to deal with stressors directly related to cancer. Common maladaptive cognitions that are associated with cancer include misinterpreting pain or other physical sensations as cancer progression, or struggling to adapt to the uncertainty of treatment and life after treatment. Cognitive Behavioral Therapy and related psychotherapies are particularly well suited to manage these cognitive concerns that emerge throughout the cancer process and serve to interfere with individuals' quality of life. [27] CBT and adjacent therapies have also been used to support management of chronic pain and fatigue that patients treatment with chemotherapy often experience, helping to improve both their interpretations of the symptoms but also help manage their lives behaviorally in the context of functional impairment. [28] [29] In this context, the influence of improved self-regulation on survival in people with breast cancer and colon cancer was also investigated. [30]

Mindfulness

Mindfulness is a burgeoning area of interest as a common element across multiple modalities in mental health treatment, [31] having shown effectiveness in ameliorating depressive symptoms and anxiety. [32] [33] Mindfulness-based stress reduction specifically intended to help patients with cancer has been proven effective for decreasing levels of cancer-related distress. [34] More recently, digitally delivered psychotherapy is being investigated as a low cost, highly accessible treatment method. [35]

Routine distress screening

With awareness of the prevalence of psychological distress that accompanies a cancer diagnosis and increased efforts to integrate evidence-based psychosocial treatments into overall oncologic care, screening for adjustment to diagnosis and treatment became more widespread. [36] Routine distress screening throughout the cancer process (e.g., diagnosis, treatment, survivorship) is crucial to identifying individuals who are already struggling with symptoms of depression or anxiety or for identifying those at risk for psychological issues related to cancer.[ citation needed ] Historically, communication about psychological adjustment was lacking between patients and providers regarding topics related to adjustment to diagnosis, living with cancer, living cancer-free in survivorship, or transitioning to end of life care.[ citation needed ] The stigmatized nature of psychological concerns made it difficult to identify those patients who could benefit from early intervention to prevent or attenuate symptoms of depression or anxiety that may emerge.

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Pain disorder is chronic pain experienced by a patient in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age, and occurs more frequently in girls than boys. This disorder often occurs after an accident, during an illness that has caused pain, or after withdrawing from use during drug addiction, which then takes on a 'life' of its own.

<span class="mw-page-title-main">Cancer survivor</span> Person with cancer who is still alive


A cancer survivor is a person with cancer of any type who is still living. Whether a person becomes a survivor at the time of diagnosis or after completing treatment, whether people who are actively dying are considered survivors, and whether healthy friends and family members of the cancer patient are also considered survivors, varies from group to group. Some people who have been diagnosed with cancer reject the term survivor or disagree with some definitions of it.

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed for studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and specific phobias.

Mixed anxiety–depressive disorder (MADD) is a diagnostic category defining patients who have both anxiety and depressive symptoms of limited and equal intensity accompanied by at least some autonomic features. Autonomic features are involuntary physical symptoms usually caused by an overactive nervous system, such as panic attacks or intestinal distress. The World Health Organization's ICD-10 describes Mixed anxiety and depressive disorder: "...when symptoms of anxiety and depression are both present, but neither is clearly predominant, and neither type of symptom is present to the extent that justifies a diagnosis if considered separately. When both anxiety and depressive symptoms are present and severe enough to justify individual diagnoses, both diagnoses should be recorded and this category should not be used."

Functional disorder is an umbrella term for a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

An informal or primary caregiver is an individual in a cancer patient's life that provides unpaid assistance and cancer-related care. Due to the typically late onset of cancer, caregivers are often the spouses and/or children of patients, but may also be parents, other family members, or close friends. Informal caregivers are a major form of support for the cancer patient because they provide most care outside of the hospital environment. This support includes:

Mindfulness-based stress reduction (MBSR) is an eight-week evidence-based program that offers secular, intensive mindfulness training to assist people with stress, anxiety, depression and pain. Developed at the University of Massachusetts Medical Center in the 1970s by Professor Jon Kabat-Zinn, MBSR uses a combination of mindfulness meditation, body awareness, yoga and exploration of patterns of behaviour, thinking, feeling and action. Mindfulness can be understood as the non-judgmental acceptance and investigation of present experience, including body sensations, internal mental states, thoughts, emotions, impulses and memories, in order to reduce suffering or distress and to increase well-being. Mindfulness meditation is a method by which attention skills are cultivated, emotional regulation is developed, and rumination and worry are significantly reduced. During the past decades, mindfulness meditation has been the subject of more controlled clinical research, which suggests its potential beneficial effects for mental health, as well as physical health. While MBSR has its roots in wisdom teachings of Zen Buddhism, Hatha Yoga, Vipassana and Advaita Vedanta, the program itself is secular. The MBSR program is described in detail in Kabat-Zinn's 1990 book Full Catastrophe Living.

Cancer-related fatigue is a symptom of fatigue that is experienced by nearly all cancer patients.

Cognitive behavioral therapy for insomnia (CBT-I) is a technique for treating insomnia without medications. Insomnia is a common problem involving trouble falling asleep, staying asleep, or getting quality sleep. CBT-I aims to improve sleep habits and behaviors by identifying and changing the thoughts and the behaviors that affect the ability of a person to sleep or sleep well.

Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not purposefully produced or feigned, and they may or may not coexist with a known medical ailment.

Pediatric psychology is a multidisciplinary field of both scientific research and clinical practice which attempts to address the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting. Psychological issues are addressed in a developmental framework and emphasize the dynamic relationships which exist between children, their families, and the health delivery system as a whole.

Linda E. Carlson is a Canadian clinical psychologist. She is a professor at the University of Calgary, where she holds the Enbridge Research Chair in Psychosocial Oncology.

Margaret Ruth McCorkle FAAN, FAPOS was an American nurse, oncology researcher, and educator. She was the Florence Schorske Wald Professor of Nursing at the Yale School of Nursing.

<span class="mw-page-title-main">Mental health during the COVID-19 pandemic</span> Psychological aspect of viral outbreak

The COVID-19 pandemic has impacted the mental health of people across the globe. The pandemic has caused widespread anxiety, depression, and post-traumatic stress disorder symptoms. According to the UN health agency WHO, in the first year of the COVID-19 pandemic, prevalence of common mental health conditions, such as depression and anxiety, went up by more than 25 percent. The pandemic has damaged social relationships, trust in institutions and in other people, has caused changes in work and income, and has imposed a substantial burden of anxiety and worry on the population. Women and young people face the greatest risk of depression and anxiety.

<span class="mw-page-title-main">Psychosocial distress</span>

Psychosocial distress refers to the unpleasant emotions or psychological symptoms an individual has when they are overwhelmed, which negatively impacts their quality of life. Psychosocial distress is most commonly used in medical care to refer to the emotional distress experienced by populations of patients and caregivers of patients with complex chronic conditions such as cancer, diabetes, and cardiovascular conditions, which confer heavy symptom burdens that are often overwhelming, due to the disease's association with death. Due to the significant history of psychosocial distress in cancer treatment, and a lack of reliable secondary resources documenting distress in other contexts, psychosocial distress will be mainly discussed in the context of oncology.

References

  1. ↑ Holland JC, Bultz BD (January 2007). "The NCCN guideline for distress management: a case for making distress the sixth vital sign". Journal of the National Comprehensive Cancer Network. 5 (1): 3–7. doi:10.6004/jnccn.2007.0003. PMID   17323529.
  2. ↑ Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001). "The prevalence of psychological distress by cancer site". Psycho-oncology. 10 (1): 19–28. doi:10.1002/1099-1611(200101/02)10:1<19::aid-pon501>3.0.co;2-6. PMID   11180574. S2CID   22156310.
  3. ↑ Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L, MacRae JH, Martin M, Pelletier G, Robinson J, Simpson JS, Speca M, Tillotson L, Bultz BD (June 2004). "High levels of untreated distress and fatigue in cancer patients". British Journal of Cancer. 90 (12): 2297–304. doi:10.1038/sj.bjc.6601887. PMC   2410292 . PMID   15162149.
  4. ↑ Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CL (February 1983). "The prevalence of psychiatric disorders among cancer patients". JAMA. 249 (6): 751–7. doi:10.1001/jama.249.6.751. PMID   6823028.
  5. ↑ Petticrew M, Bell R, Hunter D (November 2002). "Influence of psychological coping on survival and recurrence in people with cancer: systematic review". BMJ (Clinical Research Ed.). 325 (7372): 1066. doi:10.1136/bmj.325.7372.1066. PMC   131179 . PMID   12424165.
  6. ↑ Roth S, Cohen LJ (July 1986). "Approach, avoidance, and coping with stress". The American Psychologist. 41 (7): 813–9. doi:10.1037/0003-066x.41.7.813. PMID   3740641.
  7. ↑ Stanton AL, Danoff-Burg S, Sworowski LA, Collins CA, Branstetter AD, Rodriguez-Hanley A, et al. (October 2002). "Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients". Journal of Clinical Oncology. 20 (20): 4160–8. doi:10.1200/JCO.2002.08.521. PMID   12377959.
  8. ↑ Barskova T, Oesterreich R (2009). "Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: a systematic review". Disability and Rehabilitation. 31 (21): 1709–33. doi:10.1080/09638280902738441. PMID   19350430. S2CID   28906803.
  9. ↑ Bill Briggs (January 21, 2016). "The gift of cancer? Perspectives vary widely". Fred Hutch News Service. Retrieved 2023-04-11.
  10. ↑ Lee V (July 2008). "The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning". Supportive Care in Cancer. 16 (7): 779–85. doi:10.1007/s00520-007-0396-7. PMID   18197427. S2CID   8664938.
  11. ↑ Park CL, Edmondson D, Fenster JR, Blank TO (October 2008). "Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs". Journal of Consulting and Clinical Psychology. 76 (5): 863–75. doi:10.1037/a0013348. PMID   18837603.
  12. ↑ Gotay CC (January 2005). "Behavior and cancer prevention". Journal of Clinical Oncology. 23 (2): 301–10. doi:10.1200/JCO.2005.06.069. PMID   15637393.
  13. ↑ Consedine NS, Magai C, Krivoshekova YS, Ryzewicz L, Neugut AI (April 2004). "Fear, anxiety, worry, and breast cancer screening behavior: a critical review". Cancer Epidemiology, Biomarkers & Prevention. 13 (4): 501–10. doi: 10.1158/1055-9965.501.13.4 . PMID   15066912. S2CID   9264648.
  14. ↑ Zeng Y, Luo T, Xie H, Huang M, Cheng AS (February 2014). "Health benefits of qigong or tai chi for cancer patients: a systematic review and meta-analyses". Complementary Therapies in Medicine. 22 (1): 173–86. doi:10.1016/j.ctim.2013.11.010. PMID   24559833.
  15. ↑ DiMatteo MR, Lepper HS, Croghan TW (July 2000). "Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence". Archives of Internal Medicine. 160 (14): 2101–7. doi: 10.1001/archinte.160.14.2101 . PMID   10904452.
  16. ↑ Greer JA, Amoyal N, Nisotel L, Fishbein JN, MacDonald J, Stagl J, Lennes I, Temel JS, Safren SA, Pirl WF (March 2016). "A Systematic Review of Adherence to Oral Antineoplastic Therapies". The Oncologist. 21 (3): 354–76. doi:10.1634/theoncologist.2015-0405. PMC   4786357 . PMID   26921292.
  17. ↑ Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B (July 2016). "Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies". Heart (British Cardiac Society). 102 (13): 1009–16. doi:10.1136/heartjnl-2015-308790. PMC   4941172 . PMID   27091846.
  18. ↑ Nausheen B, Gidron Y, Peveler R, Moss-Morris R (November 2009). "Social support and cancer progression: a systematic review". Journal of Psychosomatic Research. 67 (5): 403–15. doi:10.1016/j.jpsychores.2008.12.012. PMID   19837203.
  19. ↑ Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D (March 2015). "Loneliness and social isolation as risk factors for mortality: a meta-analytic review". Perspectives on Psychological Science. 10 (2): 227–37. doi:10.1177/1745691614568352. PMID   25910392. S2CID   20381556.
  20. ↑ Zolnierek KB, Dimatteo MR (August 2009). "Physician communication and patient adherence to treatment: a meta-analysis". Medical Care. 47 (8): 826–34. doi:10.1097/MLR.0b013e31819a5acc. PMC   2728700 . PMID   19584762.
  21. ↑ Greer JA, Park ER, Prigerson HG, Safren SA (January 2010). "Tailoring Cognitive-Behavioral Therapy to Treat Anxiety Comorbid with Advanced Cancer". Journal of Cognitive Psychotherapy. 24 (4): 294–313. doi:10.1891/0889-8391.24.4.294. PMC   3018827 . PMID   21234281.
  22. ↑ Waldron EA, Janke EA, Bechtel CF, Ramirez M, Cohen A (June 2013). "A systematic review of psychosocial interventions to improve cancer caregiver quality of life". Psycho-oncology. 22 (6): 1200–7. doi:10.1002/pon.3118. PMID   22729992. S2CID   23263520.
  23. ↑ Gabriel, Israel; Creedy, Debra; Coyne, Elisabeth (2020-06-28). "A systematic review of psychosocial interventions to improve quality of life of people with cancer and their family caregivers". Nursing Open. 7 (5): 1299–1312. doi:10.1002/nop2.543. ISSN   2054-1058. PMC   7424465 . PMID   32802350.
  24. ↑ Hanahan D, Weinberg RA (March 2011). "Hallmarks of cancer: the next generation". Cell. 144 (5): 646–74. doi: 10.1016/j.cell.2011.02.013 . PMID   21376230.
  25. ↑ Antoni MH, Lutgendorf SK, Cole SW, Dhabhar FS, Sephton SE, McDonald PG, Stefanek M, Sood AK (March 2006). "The influence of bio-behavioural factors on tumour biology: pathways and mechanisms". Nature Reviews. Cancer. 6 (3): 240–8. doi:10.1038/nrc1820. PMC   3146042 . PMID   16498446.
  26. ↑ Bower JE, Lamkin DM (March 2013). "Inflammation and cancer-related fatigue: mechanisms, contributing factors, and treatment implications". Brain, Behavior, and Immunity. 30 Suppl: S48–57. doi:10.1016/j.bbi.2012.06.011. PMC   3978020 . PMID   22776268.
  27. ↑ Osborn RL, Demoncada AC, Feuerstein M (2006). "Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses". International Journal of Psychiatry in Medicine. 36 (1): 13–34. doi:10.2190/EUFN-RV1K-Y3TR-FK0L. PMID   16927576. S2CID   30677566.
  28. ↑ Syrjala KL, Jensen MP, Mendoza ME, Yi JC, Fisher HM, Keefe FJ (June 2014). "Psychological and behavioral approaches to cancer pain management". Journal of Clinical Oncology. 32 (16): 1703–11. doi:10.1200/JCO.2013.54.4825. PMC   4031190 . PMID   24799497.
  29. ↑ Kwekkeboom KL, Cherwin CH, Lee JW, Wanta B (January 2010). "Mind-body treatments for the pain-fatigue-sleep disturbance symptom cluster in persons with cancer". Journal of Pain and Symptom Management. 39 (1): 126–38. doi:10.1016/j.jpainsymman.2009.05.022. PMC   3084527 . PMID   19900778.
  30. ↑ Kröz M, Reif M, Büssing A, Zerm R, Feder G, Bockelbrink A, et al. (September 2011). "Does self-regulation and autonomic regulation have an influence on survival in breast and colon carcinoma patients? results of a prospective outcome study". Health and Quality of Life Outcomes. 9: 85. doi: 10.1186/1477-7525-9-85 . PMC   3192663 . PMID   21961625.
  31. ↑ Hofmann SG, Sawyer AT, Witt AA, Oh D (April 2010). "The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review". Journal of Consulting and Clinical Psychology. 78 (2): 169–83. doi:10.1037/a0018555. PMC   2848393 . PMID   20350028.
  32. ↑ Zainal NZ, Booth S, Huppert FA (July 2013). "The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis". Psycho-Oncology. 22 (7): 1457–65. doi: 10.1002/pon.3171 . PMID   22961994.
  33. ↑ Cramer H, Lauche R, Paul A, Dobos G (October 2012). "Mindfulness-based stress reduction for breast cancer-a systematic review and meta-analysis". Current Oncology. 19 (5): e343-52. doi:10.3747/co.19.1016. PMC   3457885 . PMID   23144582.
  34. ↑ Rouleau CR, Garland SN, Carlson LE (2015). "The impact of mindfulness-based interventions on symptom burden, positive psychological outcomes, and biomarkers in cancer patients". Cancer Management and Research. 7: 121–31. doi: 10.2147/CMAR.S64165 . PMC   4457221 . PMID   26064068.
  35. ↑ Subnis UB, Farb NA, Piedalue KL, Speca M, Lupichuk S, Tang PA, et al. (May 2020). "A Smartphone App-Based Mindfulness Intervention for Cancer Survivors: Protocol for a Randomized Controlled Trial". JMIR Research Protocols. 9 (5): e15178. doi: 10.2196/15178 . PMC   7248798 . PMID   32390591.
  36. ↑ National Comprehensive Cancer Network (24 November 2018). "NCCN Distress Management Guidelines". NCCN.org.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.