by P Henry. section 9 Psychosocial Interventions for Cancer
There is a long history of the understanding of body and mind connections[1]. In the early twentieth century various respected clinicians practised body-mind therapies showing clear results.[2]. Theory further coalesced into an interdisciplinary study called psychoneuroimmunology (PNI) in the late 1970s[3]. Its growing clinical research and practice made it more scientifically accepted and it was used at many universities and health institutions[4]. Its application to cancer has been valuable[5], showing how the immune system is hampered or aided: hormones regulated, tumour microenvironment , cell proliferation, and metastasis all altered by emotional effects[6]. PNI can be used in clinical treatments and show neural circuits interactions[7].
PNI can show clinical evidence of the positive applications of psychological interactions with the neural, endocrine and immune systems, and other biological functions[8]. Often biomedical and psychological professions worked together on research.
In 1986 J K Kiecolt-Glaser (psychologist) and Ronald Glaser (virologist) set up 6 teams thatresearched cancer, and other illnesses’ responses to PNI, for the next three decades. They showed how DNA repair was poor with distressed people who had increased cancer susceptibility[9]. Hormone production related to low mood would accordingly reduce or advance cancer proliferation[10]. They detailed how stress can alter cellular DNA repair mechanisms including cell repair, apoptosis and how NK cells have a variety of immune functions including defence against infections[11]. Certain cancers and diseases (including tumours) are most affected by psychological inputs and certain viruses are activated [12]. Negative emotions also affect many illnesses’ outcomes, particularly those lymphoproliferative diseases [13]. Many continued to develop this work[14] including connections to inflammation, the endocrine system, and aetiology issues[15] .
Dr A Cunningham of the Ontario Cancer Institute ran clinical groups, with longitudinal studies, showing psychological input increased cancer (including metastatic) survival rates[16]. He importantly included Quality of Life (QoL) issues both as a product of therapy and a catalyst of results[17]. Over his twenty years of running both mixed and single diagnosis groups, he adjusted interventions appropriately, and emphasised psychoeducational, relaxation exercises, self-help techniques and CBT[18].
There are other clinical evidenced PNI practitioners who use a variety of techniques including supportive group, group CBT, family nights, individual counselling or psychotherapy, expressive groups, hypnosis and educational programmes. There are differences with the length of their follow-up studies and the increase of their patients’ survival rates[19]. Questions of who needed or accepted treatment, types of treatment, reliability of outcome, and cost offset have been regularly reviewed.
Others psycho-oncological treatments include the early practices of Seigal who suggested that “psychotherapy, both group and individual, employs three fundamental approaches: emotional expression, social support, and cognitive symptom-management skills” [20]. Fawzy highlights the need for coping skills[21]. Cassileth [22] identifies the first therapeutic goal as information provision, instrumental support, expressing emotions, increasing coping skills and sense of coherence, and secondly decreasing somatic symptoms while improving personal resources, QoL, coping abilities, enhancing adjustment with acceptance. Lo[23] emphasises PNI potential to relieve distress and promote psychological wellbeing for individuals and caregivers. Dolbeaut[24] showed 203 RCT French breast cancer patients significantly improved when given stress management techniques with information and thematic discussion.
The Royal Marsden Hospital with Cancer Research developed Adjuvant Psychological Therapy (APT) specifically for cancer patients [25]. It offered six individual patient sessions; their spouse was included if appropriate. Sessions dealt with what a patient’s personal meanings and coping strategies were for managing their cancer. CBT and education were used to improve skills and raise self-esteem. Consistent and sustained improvement was lower anxiety was achieved. It is currently being used for increasing QoL, treatment receptivity[26] and preventions of cancer relapse[27].
These different therapies treat cancer, but which is the most useful?
[1] Forming the Mind: Essays on the Internal Senses and the Mind/Body Problem…. (2010) H Lagerlund.
[2] Including F M Alexander, Wilhelm Reich (with many adherents like Gerda Boyesen), Franz Alexander, G F Solomon, and Gabor Maté.
[3] Psychoneuroimmunology (1981) R Ader, D L. Felten and N Cohen. Forword PNI (2014) R Ader and D Cohen. In Wiley-Blackwell Handbook of PNI eds A W. Kusnecov etal. Psychoneuroimmunology: conditioning and stress. (1993) R Ader, N Cohen. Annu Rev Psychol44.
[4] Psychoneuroimmunology Meets Neuropsychopharmacology… (14Sept11) E Haroon et al. Neuropsychopharmacology 37(1).
[5]Cancer as a tool for preclinical psychoneuroimmunology. (Dec21) J C Borniger. Brain, Beh, & Imm. Hea18
Psychoneuroimmunology and cancer …. (16Jan13) P G McDonald et al. Brain Behav Immun. 30.
[6] Psychoneuroimmunology and Cancer…. (2024) S Gezici. Psychoneuroimmunology.
Psychoneuroimmunology and … cancer. (Jun05)) L G Walker et al. Human Psychoneuroimmunology.
[7] Cancer as a tool for preclinical psychoneuroimmunology. (Dec21) J C Borniger. Brain, Beh, & Imm Hea18.
[8] Psychoneuroimmunology (1981) R Ader, D L. Felten and N Cohen. Psychoneuroimmunology: Conditioning and Stress. (Feb1993) R Ader & N Cohen. Annual Review of Psychology 44(1). Robert Adler (28Jan12) S Pincock. The Lancet 379 (9813). Hypothalamic changes during the immune response.(May1977) H Besedovsky et al. European Journal of Immunology.7 (5)
[9] Distress and DNA repair in human lymphocytes. (Dec1985) J K Kiecolt-Glaser et al. J of Behav Med. 8. Methodological issues in behavioral …. (1988) Kiecolt-Glaser& R Glaser. Brain, Behavior, and Immunity 2,
[10] Psychological Influences on Immune Function and Health. (2002) J K. Kiecolt-Glaser et al. J of Consulting and Clin Psych.70(3)
[11] Psychoneuroimmunology and cancer…. (Oct1999) Kiecolt-Glaser, J. K., & Glaser, R. Eur J of Cancer, 11
[12] A biobehavioral model of cancer stress and disease course. (1994) Anderson et al. Am Psych 49(5). 3. Psycho-oncology and cancer…. (2002) J K Kiecolt-Glaser et al. Eur Soc for Med Oncology.
[13] Emotions, Morbidity, and Mortality. (2002) J K Kiecolt Glaser et al. Annu. Rev. Psychol. 53
[14]Psychoneuroimmunology and the research of Kiecolt-Glaser…. (Nov24) W B. Malarkey. Comp Psychoneuroendocrinology 20. Psycho-oncology, Stress Processes, and Cancer Progression. (Jan21) M H Antoni et al. Stress alters the expression of cancer-related genes in the prostate. (5Sept17) I E Flores et al. BMC Cancer(17). Cancer and the Immune System…. (3Jun2015) D Pardoll, Semin Oncol. 42(4). The Psychoimmunology of Cancer. (23May02) C E Lewis et al (eds). Psychoneuroimmunology Meets Neuropsychopharmacology… (14Sept11) E Haroon et al. Neuropsychopharmacology 37(1).
Emotional distress: the sixth vital sign in cancer care (Oct05) B D Bultz et al. J Clin Oncol,
[15] Cancer as a tool for preclinical psychoneuroimmunology. (Dec21) J C Borniger. Brain, Beh, & Imm – Hea18. Neuroendocrine influences on cancer progression. (21Jun12) G N Armaiz-Pena et al. Brain Behav Immun. 30(Suppl). Psychoneuroimmunology Meets Neuropsychopharmacology… (14Sept11) E Haroon et al. Neuropsychopharmacology 37(1).
[16] How psychological therapy may prolong survival in cancer patients…. (3Sept04) A J Cunningham et al. Integr Cancer Ther 3(3). 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). Psychological response to long term group therapy: a randomized trial with metastatic breast cancer patients. (7Apr99) C Edmonds, G Lockwood, A J Cunningham. Psycho-Onco.
Which Cancer Patients Benefit Most from a Brief, Group, Coping Skills Program? (1Dec93) A J Cunningham, Gina A. Lockwood. Int. J Psychiatry of Medicine.
[17] Fighting for life …psychotherapy-assisted self-help in patients with metastatic cancer. (Jun02) A J Cunningham et al. Integr Cancer Ther 1(2). 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).
[18] How Psychological Therapy May Prolong Survival in Cancer Patients…. (1Sept04) A J Cunningham et al. Int Can Ther 3(3). Which Cancer Patients Benefit Most from a Brief, Group, Coping Skills Program? (1Dec93) A J Cunningham, et al. Int. J Psych of Med. A randomized trial of group psychoeducational therapy for cancer patients. (Oct89) A J Cunningham, et al. PEC 14(2). A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer. (Nov/Dec 1998) A J Cunningham,et al. Psycho-Oncology 7(6).
[19] Adjuvant Psychological Therapy for Patients with Chronic Physical Illness (2007) T M. Brown. in Handbook of Evidence-based Psychotherapies …. The Psychoimmunology of Cancer. (23May02) C E Lewis et al (eds).
[20] Psychosocial support for patients with cancer. (15Aug94) D Spiegel. Cancer. 74(4 Suppl).
[21] Psychosocial interventions for patients with cancer: what works and what doesn’t. (Oct99) F I Fawzy. Eur J Cancer 35(11).
[22] The aim of psychotherapeutic intervention in cancer patients. (Jul95) B R Cassileth. Sup Care Can 3(4).
[23] Managing Cancer and Living Meaningfully…. (3Sept15) Chris Lo et al. Randomized Controlled Trial Trials 16:391
[24] The effectiveness of a psycho-educational group after early-stage breast cancer treatment…. (Jun09) S Dolbeault et al. R C T Psychooncology 18(6)
[25] Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. (14Mar1992) S Greer, S Moorey et al. BMJ. 304(6828)
[26] An Evaluation of Adjuvant Psychological Therapy (APT) …. (15Nov17) Masoome Barani et al. Current Psychology 38.
[27] Adjuvant therapy: Treatment to keep cancer from returning. (2May24) Ryan Carr, Mayo Clinic Staff. Mayo Clinic.
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