Cancer : Psychological and Social Distress

by National Cancer Institute

(Page 2 of 2)

Most patients experience some level of distress, however, only a small percentage receive help. Distress is an unpleasant emotional, psychological, social, or spiritual experience that interferes with the patient's ability to cope with cancer treatment. Patients may experience a range of feelings from normal sadness and fear to deep depression, anxiety, panic, or isolation. These feelings can interfere with a person's ability to relate to family, friends, coworkers, and others during the normal routines of daily living. This is called social distress.

Screening

Health care professionals may have patients complete questionnaires periodically to identify the need for referral to a mental health professional. Key times that distress may become disabling include the time of diagnosis, during cancer treatment, at the end of a long course of treatment, during remission, when the cancer returns, or when beginning palliative care. Patients who are experiencing mild distress may benefit from a referral to a self-help group. Patients who are experiencing moderate to severe distress may require a referral to a mental health professional such as a psychiatrist, psychologist, social worker, or pastoral counselor.

Psychological and Social Assessment

It is important that patients understand the benefits of talking with a mental health professional about their concerns and worries. A patient can expect the health professional to:

• Listen closely to his or her concerns.
• Show an interest in his or her experiences with cancer.
• Ask about his or her family, friends, and other persons who provide support.
• Ask how he or she has been adjusting to the cancer.
• Encourage him or her to continue using coping strategies that are successful.
• Suggest other coping strategies to address his or her concerns.

Patients will be encouraged to continue counseling or psychotherapy as needed.

Psychological and Social Therapies for Distress

Recent studies of psychological and social therapies have shown benefits for cancer patients. These therapies are defined as non-drug treatments offering psychological and educational support, such as:

• Relaxation training.
• Coping strategies.
• Cancer education/information sessions.
• Group social support.

These therapies may be combined in different ways for various lengths of time, in both individual and group formats. To date, these therapies have most commonly been studied in white, middle-to-higher income American women with breast cancer, though they are currently being studied in more patient groups. Cancer patients who receive such therapies show positive benefits compared to those who do not, including lower levels of depression, anxiety, and disease-related symptoms, as well as improved immune system functioning and health habits like exercise. The size of these benefits and how they affect patients' recovery will need more study.

The Adjustment Disorders

Adjustment disorders include behaviors or moods more extreme than expected in reaction to a cancer diagnosis, treatment, recurrence or side effects. These behaviors or moods may result in significant problems in functioning with family, friends, and at work. An adjustment disorder usually begins within three months of the first signs of distress, for example a cancer diagnosis. Some patients may develop a chronic adjustment disorder because they experience multiple causes of distress, one right after another (for example, the cancer diagnosis, the start of treatment, side effects of treatment, completion of treatment, and returning to work). Chronic adjustment disorders may become a more serious mental disorder (for example major depression). This is more common in children and adolescents than in adults.

Treatment

Individual and Group Counseling and Psychotherapy

Treatment that focuses on the patient's thoughts, feelings, and behaviors may be used to relieve emotional distress in individual patients or groups. The following are examples of these techniques:

• Relaxation training.
• Biofeedback.
• Problem-solving.
• Distraction.
• Thought stopping.
• Coping self-statements.
• Mental imagery exercises.

Medications

Counseling or psychotherapy should be tried before medication. If the patient does not improve with short-term psychotherapy or develops a more severe mental disorder, such as depression, the doctor will then prescribe the appropriate medication.

About the Author

www.nci.nih.gov
The National Cancer Institute's research programs are extensive and contain many innovative initiatives. I invite you to explore our Web site to find out more about the exciting work being conducted here at NCI and by NCI-supported scientists throughout the country.