Sally Singer Horwatt, Ph.D.

Clinical Psychologist

Cancer 

June 3, 1999 

This article is one of a series of radio spots prepared by Sally Singer Horwatt, Ph.D. for 
WAGE 1200 AM RADIO

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Psychological progress and medicine are two streams which are flowing together in the war on cancer.  Here are some basic facts taken from the June, 1999 edition of the APA Monitor: Cancer is the second most common cause of death in the United States behind heart disease. Ultimately, it is estimated that one of every four Americans will die of cancer. Several "silent" cancers, such as cervical, colorectal, ovarian and breat can be stopped when caught early.  You know, small is good.  Think Small.  Think mammogram. 
 
At the same time, more than 8 million Americans have survived cancer for at least five years.  Chances of recovery have risen from one out of two in the early 1980's, to three out of five today.  In its annual report, the American Cancer Society said that the incidence of cancer fell a steady 2.2% a year between 1992 and 1996.  Much of that is attributable to the large number of men who have stopped smoking - their death rates have been dropping more rapidly than those of women who have been slower to quit.  The lung cancer rates of women are still rising. 
 
As expectation of survival has increased, so has the need for psychosocial support.  For example, in the area of pediatrics, psychologists have committed attention and resources to helping children cope with learning disabilities caused by anti-cancer drugs, and with social adjustment problems caused by disfigurement or loss of school time. 
 
Another contribution is the recognition that the nausea and vomiting related to chemotherapy were often conditioned reflexes which could be treated behaviorally.  One of the ways to diminish these problems is to expose patients to all the sights, sounds and smells of cancer treatment before they receive any treatment. This tends to desensitize them and prevent conditioning from taking root. 
 
Because so much of health care, even cancer care, is now done on an outpatient basis.  Families have become the primary health care providers.  They are being aided in coping with the stress of a loved one's cancer by making them active partners in the treatment. Research is continuing on several fronts: First, psychologists are replicating the 1989 report by Stanford University's David Spiegel, M.D., that women who had metastatic breast cancer lived an average of 18 months longer if they participated in group therapy than if they didn't.  New studies, larger and better designed are not only researching survival rates, but are searching for the mechanisms by which group psychotherapy promotes survival.  They are finding that women who are motivated and participate actively in group psychotherapy live two times as long as predicted by oncologists based on their medical records.  Those who were most motivated live more than three times longer than predicted by oncologists. 
 
Two mechanisms suspected of accounting for improved survival is the effect of the environment on immune and endocrine function.  Prelimary results indicate that immune function in women who attend group therapy is more active than in women who don't participate.  The boost in immune function may not be enough, in and of itself, to fight cancer, but might be just enough so that the women can tolerate the full course of cancer therapy. 
 
Researchers caution, however, that the leap across the biobehavioral boundary should be made with great caution and immense humility.  Robert Ader, Father of the Field of PsychoNeuroimmunology, PNI for short, fears that the way some people are using the term -claiming that every type of treatment and relaxation technique is PNIC, is trashing the field and turning it into a fad. 
 
Of course, there are many psychological and medical phenomena for which we have not defined the exact mechanisms of cure, but it doesn't mean that effectiveness of treatment is not real.  What is beyond doubt, is that group psychotherapy that includes cancer education and social support, has been demonstrated to improve quality of life including overall mood, interactions with family and overall energy level.  That is critical for people who may be dying. 
 
In particular, psychologists are studying two of the most common side effects facing cancer survivors - post traumatic stress disorder (PTSD) and fatigue.  Psychologist, Dr. Anne Kazak, Director of psychosocial services in the division of oncology at The Children's Hospital in Philadelphia has designed a program, funded by the National Cancer Institute, to help families of survivors identify and change beliefs that could lead to negative consequences.  For example, parents are taught to manage their fear that their child may have a relapse by 1) accepting the uncontrollable (My child must return to the clinic for checkups); 2) focusing on the controllable (By going to the clinic for checkups we are making sure my child is as healthy as possible; and 3) using the positive (My child is in remission). They are also telling survivors what to expect.  For example, breast cancer survivors tend to cope well, but there are issues that tend to come up.  For example, a subset of women are fatigued long after their chemotherapy treatment ends.  Often this makes them anxious because they fear their disease is coming back.  When they are educated about what is normal and about what can be done to feel good about coping, and responding to others, their quality of life improves. 
 
By the way, how small is the head of a pin?  Not too small for a mammogram to find! 

More radio spots:

CANCER
OSTRACISM
ROAD RAGE
VIOLENCE
LOVE
WAGE 1200 AM
 

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