section 12 Psychosocial Interventions for Cancer
by P Henry 18Feb26
In the last 20 years, there have been many psycho-oncological projects. Variants of PNI (Psychoneuroimmunology) have been successfully used in cancer treatment.
PNI describes the connection of interactions in an individual’s psychology and emotions to their immune, neurological and biochemical functions. The individual’s emotional and behaviour affects cancer initiation, progression, and therapeutic outcomes[1].
From the theories and traditional practices some techniques evolved over time, others were created[2]. Stress is perceived differently, individuals vary in how they accept treatment, therapists have different personal styles with different theoretical frameworks: comparison confounds definitions. Their clinical outcomes are the best measurement.
Where PNI is available, it is usually unintegrated with Standard Oncological Care (SCO). This disconnection increases uncertainty and lessens its restorative potency.
Having individual or group therapy is often a financial as well as a structural issue. We focus on group work as it is more cost effective and public health services are more ready to support it. A specialist named nurse for each patient can screen aberrations.
A group could better hold the tenuous and precarious situation of a cancer patient. It could explain treatment parameters and guide common suffering experience issues. The patient there would be provided by both external and internal learning experiences. The therapeutic alliance, crucial to psychodynamics, would be covered through the group members’ emotional bonding while learning to have shared commitment, orientation and adherence to the group’s purposes of support and healing[3]. Group leaders can further adjust cohesion[4] understanding both useful and maladaptive patterns presented. The issues presented by individuals and in group, portrayed in their reciprocal interactions[5], are indicative of some underlying vulnerabilities.
There are a range of treatments that fall under group PNI[6]. Two notable public psycho-oncological services are the Tom Baker Cancer Centre (described in sec. 6) and Cunningham’s earlier work with Ontario’s Princess Margaret Cancer Centre (below).
Adjusting Services Practices
Using psychosocial groups for emotional and educational support is low cost and has high positive results. These groups could explain preliminaries, having patient discussion, clinical issues, offering various therapeutic possibilities, while dealing with their emotional shocks of cancer. The consultant, having described the specific diagnosis, would have more time for review and encouragement. A triangulation of cooperation between the patient, consultant and group could offer more possibilities.
Group co-leaders, one having medical, the other psychological skills, could inform and comfort members. Reducing stress with relaxation exercises, the co-leaders could ensure a flow of inclusive dynamic interactions, address defensive intrusions and nurture individual egos that were damaged by the cancer shock and medicalisation. It would address static tendencies, frozen spontaneity and negative thinking patterns. Emotional expression and cathartic discharge could occur appropriately, while not allowing one patient to dominate, facilitated by the co-leaders and group resonance.
Some people and cancers require follow-ups. These could be done online, reducing institutionalisation. While there are no magic solutions for cancer, this PNI would improve skills, outcomes, reduce costs of SCO due to improved compliance, with its therapeutic gains while helping avoid costly relapses and loss of QoL.
Cunningham’s experiences can refine our groupwork activities.
Dr Cunningham ran psychological groups from the 1980s. His PNI approaches were flexibly adapted to his findings. His groups included psychoeducation, reducing stress (CBT), interpersonal interactions with other psychosocial interventions. His five stated categories were[7]: providing information, emotional support, behavioural training in coping skills, psychotherapy (of various kinds), and existential/spiritual therapeutics.
Existential/spiritual elements, difficult to be categorical about, were an essential part of the dimensions of a person’s life, along with their physical, psychological and social issues. It was their personalised experiences[8] impacting upon their health[9]. He used discussions and meditations to include it into his groups. The improved outcome was measurable[10]. His patients showed better QoL and often lived beyond their medical expectation[11].
Cunningham had three major qualities emerging: “authenticity,” or a clear understanding of what was important in one’s life; “autonomy,” the perceived freedom to shape life around what was valued; and “acceptance,” a perceived change in mental state to enhanced self-esteem, greater tolerance for and emotional closeness to others, and an affective experience described as more peaceful and joyous”.[12]
Upon retirement he continued his work through charities, setting up centres that offered further complementary cancer treatments. They used staged learning [13] including compassion with psychoeducation, experiential work with stress reduction techniques. Homework and reading were combined with group meetings. This normalised lives while reducing isolation, improved inter-connectivity, a sense of self-spirituality, bolstered authenticity, to achieve healing and improved outcomes.
[1] Bridging psychoneuroimmunology (PNI) and cancer…. (Apr25) Min Yan, K W Kelley et al. Brain Behav and Immunity Integrative 10.
[2] Adjuvant psychological therapy for patients with cancer…. (14Mar1992) S Greer et al. BMJ. 304(6828)
[3] Psychotherapeutic interventions and contemporary developments…. (4Jan18) W Burbridge-James and M Iwanowicz. BJPsych Adv 24(1).
[4] Cohesion in Group Therapy. (2011) G M. Burlingame et al. Psychotherapy 48 (1)
[5] The Developing Ego and the Emerging Self in Group Therapy. (1987) D Flapan, G Fenchel.
[6] Varied treatments with outcome and follow ups: Adjuvant Psychological Therapy for Patients with Chronic Physical Illness (2007) T M. Brown. in Evidence-based Psychotherapies …. The Psychoimmunology of Cancer. (23May02) C E Lewis et al (eds).
[7] Group psychological therapy for cancer patients…. (Jul95) A J Cunningham. Support Care Cancer 3(4).
[8] The Healing Journey. (2010) A.J Cunningham
[9] Spirituality in Serious Illness and Health. (12Jul22) T A Balboni et al. JAMA 328(2). Religion, spirituality, and health…. (16Dec13) HG Koenig. ISRN Psychiatry.
[10] Group Psychological Therapy for Cancer Patients…. (1996) A J Cunningham, etal. Int J of Psych in Med. Integrating spirituality into a group psychological therapy program for cancer patients. (Jun05) A J Cunningham. Integr Cancer Ther 4(2). Group psychological theryap for Cancer patients…. (Jul1995) A J Cunningham. Sup Care Can 3(4)
[11] Association of involvement in psychological self-regulation with longer survival in patients with metastatic cancer…. (Fall2000) A J Cunningham et al. Adv Mind Body Med16(4). A prospective, longitudinal study of the relationship of psychological work to duration of survival in patients with metastatic cancer. (Jul-Aug 2000) A J Cunningham et al. Psychooncology 9(4). A careful investigation of an important phenomenon. (Jul-Aug1999) A J Cunningham, C V Edmonds, G A Lockwood. Psychooncology8(4).
[12] How psychological therapy may prolong survival in cancer patients…. (3Sept04) A J Cunningham, Ke Watson. Integr Cancer Ther 3(3)
[13] Hopespring https://www.hopespring.ca/about_us/history. Wellspring https://wellspring.ca/programs/healing-journey/. Deep-Abiding-Prayer-course-May-22-for-SJP.pdf.
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