Psycho-oncology is a field of interdisciplinary study and practice at the intersection of lifestyle, psychology and oncology. It is concerned with aspects of cancer that go beyond medical treatment and include lifestyle, psychological and social aspects of cancer. Sometimes it is also referred to as psychosocial oncology or behavioral oncology because it deals with psychosocial and behavioral topics. The field is concerned both with the effects of cancer on a person's psychological health as well as the social and behavioral factors that may affect the disease process of cancer and/or the remission of it.
This is where the effects of:
- Chemobrain or post-chemotherapy cognitive impairment "PCCI" would be addressed.
- Radiation induced cognitive decline issues.
- Placebo effect and the nocebo effect will be studied.
- Self care issues are studied.
- Transition to survivorship phase of cancer journey (See: Cancer survivor)
Psycho-oncology, as a subspeciality, addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease and that of their families and caretakers (called oncopsychology); and the psychological, behavioral and social factors that may influence the disease process (called psychosocial-oncology).
Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology.
The appearance of a family illness involves some changes and these in turn, involves the generation of new family needs, needs that naturally are going to be changing throughout its life cycle.
The psycho-oncology is provided the following objectives:
- Conduct a comprehensive care that takes into account aspects: physical, emotional, social and spiritual, which inevitably will lead to attention to both individual and family and society.
- The patient and family are the unit to be treated: emotional support and communication with the patient, family and treatment team must be through a frank and honest.
- Promoting autonomy and dignity of the patient with the sense of preserving and restoring all abilities, both practical and emotional and relational patients.
- Active therapeutic concept: incorporating a rehabilitative attitude towards the patient's full recovery.
- Importance of the environment, atmosphere of respect, comfort, support and communication have a decisive influence in controlling symptoms.
Early studies of psychological adjustment to cancer addressed issues of communication and management of guilt (Abrams, 1953; General Hospital in Boston, Massachusetts, 1950). Almost simultaneously, Arthur Sutherland in 1952 established the first unit of psychiatry oncology at the Cancer Center Memorial Sloan-Kettering (MSKCC) in New York, it has evolved to the modern Department of Psychiatry and Behavioral Sciences.
There is an international society, the International Psycho-Oncology Society, that is "dedicated to fostering the science of psychosocial and behavioral oncology and improving the care of cancer patients and their families throughout the world".
The fear of cancer recurrence (FCR) can contribute to a reduced quality of life and psychological impairment and is reported to occur in between 42-70% of cancer survivors at clinically significant levels.
Pediatric psycho-oncolology is a sub-field of psychological research and practice that lies at the intersection of psycho-oncology and pediatric psychology. It is primarily concerned with improving psychosocial outcomes among children and adolescents who have been diagnosed with cancer.
Advances in the treatment of pediatric cancers has resulted in significant gains in 5 year survival rates, increasing from 58.6% (1974-1976) to 78.9% (1995-2001) However, even after successfully completing treatment, concerns remain about the quality of life of youth diagnosed with cancer. One domain of functioning that is of particular concern is that of peer relationships. A recurrent finding in the literature indicates difficulties in social interaction for youth diagnosed with cancer; with a recent meta-analysis indicating an effect size of 0.58 for social problems. Survivors of childhood cancer have been identified as being more socially isolated and withdrawn than their peers or siblings as well as engage in less than half the number of social activities as their peers. Impairments in social functioning are particularly important given the impact of this domain on other areas of functioning, including overall social, emotional and cognitive growth. Poorer social functioning in youth (as demonstrated by fewer peer relationships, relationships of lower quality, isolation, and/or peer rejection) has been associated with: depressive symptoms, school dropout, and lower economic success in adulthood.
Research in pediatric psycho-oncology
Research on pediatric psycho-oncology includes studies of:
- Peer relationships
- Short and long-term psychosocial outcomes
- Health outcomes
- Emotional adjustment
- Psychological adjustment among siblings and parents of pediatric cancer patients
Findings regarding long-term outcomes for social adjustment among pediatric cancer survivors are mixed:
- One study demonstrated that cancer survivors, compared to controls, show poorer functioning in love/sex relationships (cohabiting and non-cohabiting sexual relationships), friendships (relationships of at least 2 years with named individuals), and non-specific social contacts (social exchanges with strangers or acquaintances).
- Another study indicated that survivors and comparison peers were similar on a variety of outcomes, including family background, social self-concept, social competence, family relationships, friendships, and romantic relationships. Mothers reported that survivors engaged in fewer activities than comparison peers. The proportion of participants who lived with their parents, were dating, and expressed plans to marry or have children was similar between groups.
- In a Nordic sample of childhood acute myeloid leukemia, Wilms tumor and infratentorial astrocytoma survivors, no statistical differences were found between cancer survivors and comparison controls in terms of being recipients of social benefits, employment, or marital status. However, childhood cancer survivors were less likely of being parents.
Decreased likelihood of being parents may be due to sterility resulting from treatment or fears of transmitting genetic susceptibility to their offspring.
Summer camps exist to provide children and adolescents with cancer a respite from every day life and the chance to connect with other youths facing cancer and chronic illness. Several of these camps also offer the opportunity for patients' and survivors' parents and siblings to participate.
An empirical study of children's satisfaction with their experience at cancer camp noted that recreation opportunities, peer support, and respite from their lives at home contributed significantly to camper's positive experiences. A limited amount of research indicates that attending these camps may have beneficial effects on children with cancer and their families. For example, adolescents may feel more similar to camp peers than home peers, which may in turn lead to greater feelings of social acceptance, physical appearance, global self-worth, and fewer feelings of loneliness. Cancer camps have also led to improvements in affect among children with cancer that last beyond the camp experience itself.
- Benefit finding, the process of positive personal growth after a traumatic illness or other experience that makes the trauma seem like a blessing in disguise
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- Psychosocial oncology UK at www.psycho-oncology.info
- International Psycho-Oncology Society (IPOS)