Relationship between psychosocial factors, psychotherapies and the course of cancer
KALLERGIS G. M.D., MADIANOS M. M.D.
Department of Mental Health and Behavioural Sciences, Faculty of Nursing, National and Kapodistrian University of Athens
Cancer is considered one of the few diseases that put man under such high pressure. As a result, psychiatric symptomatology in patients with cancer is two to three times more evident as against the general population. This is partly due to the actual diagnosis or the lengthy treatments, which are usually inflicted on cancer patients (surgery, chemotherapy, radiotherapy).
Apart from the impact of the disease itself on the patient, the questions raised in researchers are the following: a) Is there a correlation between psychological and social parameters and the course of the disease? b) What interferes between the effect of psychosocial factors and the development of cancer? c) Do psychotherapeutic interventions on psychosocial factors have an effect on the actual course of the disease?
This paper aims at addressing those questions by means of reviewing the related bibliography.
Several studies suggest that psychological factors do play a role in the development of cancer. Indeed, it has been found that cancer patients who had a fighting spirit had greater chances of survival compared to those patients who manifested feeling of denial and desperation, or a feeling of hopelessness, whereas similarly, those patients with breast cancer who had a depressive a coping style could not survive the disease.
Extroversion and social activity are associated with better chances of survival. In addition, patients diagnosed with melanoma who did not assert their rights and patients who defined themselves as having high rates of psychosocial stress did not cope well with the disease. Severe stressful life events have been associated with an increase in recurrences for breast cancer patients.
Nevertheless, there are studies that do not associate psycholosocial factors with the course of cancer. Other studies, however, find a low degree of correlation between depression and mortality rates from cancer.
Other studies associate social factors with the survival of cancer patients. Married cancer patients have a higher life expectancy than unmarried patients living alone.
The social supportive network has a positive influence on survival rates, whereas it can have a positive effect on the activation of natural killer cells, which are considered a major component of the human immune system.
Therefore, we could argue that environmental factors, including social support and biological factors such as the strengthening of immune parameters, as already set out, have an effect on the course of cancer.
It seems that the improvement of psychosocial factors make the patient more energetic and receptive to treatment. Furthermore, the intervene in psychoneuroimmune mechanisms that improve immune system mechanisms such as the killer cells.
Psychotherapies are considered to have an effect on the course of cancer, since they alter not only psychosocial factors but also compliance to treatment regarding biological factors (chemotherapy, radiotherapy) as well as strengthen immune system parameters.
The number of studies suggesting that psychotherapeutic intreventions improve immunobiological indicators which show the strengthening of the immunobiological system function, such as T-cells, natural killer cells and cortisone levels in salivary glands, has increased.
Consequently, psychotherapeutic interventions improve the immunobiological indicators, whereas the majority of studies agree that these interventions, either individual, team, family, cognitive-behavioural,a relaxationa or psycho education, can improve psychic symptoms including stress, depression and quality of life.
Compliance seems to play a significant role since it is positively affected by psychotherapeutic interventions.
One of the factors emphasized in these studies is survival, being the only one that can be measured.
Other studies argue that a positive correlation exists between psychotherapeutic interventions and survival, while others purport against it.
Conclusively, we could argue that psychosocial factors do play a role in the development of cancer in patients, even though not all authors agree on that.
Psychosocial factors seem to influence the immunobiological system, the action of killer cells and, ultimately, survival.
Psychotherapeutic interventions can improve:
1) The immunobiological factors
2) Psychic symptoms including stress, depression and quality of life
3) Compliance within therapeutic procedure, which in tum seems to improve the survival parameter.
In terms of the relation between psychoterapeutic interventions and quality of life (survival), some studies consider it positive while others negative.
As regards the quality of life of cancer patients, five years is taken as a reference for success.
In the treatment of cancer patients, therapeutic interventions that govern the biopsychosocial spectrum are combined. Patients may be undergoing surgery, chemotherapy, radiotherapy or they may be taking antipsychotic drugs and psychotherapy.
Some authors suggest a combination of therapeutic interventions called adjuvant intervention, which is the equivalent of adjuvant chemotherapy, which is common practice for the treatment of cancer patients.
Adjuvant therapeutic intervention is recommended to each cancer patient and is consisted of five types of interventions:
1) information, 2) Behavioral education for the treatment of problems, 3) emotional support, 4) psychotherapy (varying types), 5) spiritual - existential therapy.
Adjuvant therapy can adapt to two teams of patients: 1) those with greater psychopathology and 2) those with lesser psychopathology. This is further reinforced by studies, which suggest that «mortality is more dependent on somatic than on psychological factors. Nevertheless, psychological factors seem to reinforce the impact of somatic factors.» Encephalos 2009, 46(3):111-120.
Key words: Psychological factors, psychotherapy, social factors, course of disease, cancer.