Psychiatric News – March 16, 2012/Joan Arehart-Treichel
The most important thing that psychiatrists can do for cancer patients is to help them change their approach from “I am dying of cancer” to “I am living with cancer”.
In the past 10 years some very impressive views were introduced on psychological health and cancer.
In a speech he made, the head of Psychiatry in the Memorial Sloan-Kettering Cancer Centre, Dr David Kissane, stated that new research has disproven the claim put forward by former research, that “stress can cause cancer”. One of the prominent research studies was carried out in Denmark. Using the detailed national data bank of Denmark, the researchers investigated by matching the control group, whether women who have lost a child are more prone to cancer. They could establish no link. Dr Kissane stated that therefore the claim that stress leads to cancer, could be regarded as a myth.
In an interview with Psychiatric News, Dr Luigi Grassi, who is the Head of Psychiatry at the Ferrara University in Italy and the Head of the International Psycho-Oncology Society, stated that generalized emotional distress, maladjusted coping mechanisms, and psychiatric disorders like anxiety and depression are often found in cancer patients, that these complaints can be seen in 25-30% of these patients.
Dr. David Spiegel however reported in an interview, that depression not only reduces cancer patients’ quality of life but also reduces the probability of these patients staying alive, just as in patients with heart conditions. Dr. Spiegel, who is Assistant Head of Psychiatry at the Stanford University, is also a Psycho-oncologist.
On the other hand, effective treatment of depression in cancer patients improves their chances of staying alive. A study which Dr. Spiegel and his colleagues published in the Clinical Oncology Journal on 10 December 2010 showed that a reduction in depressive symptoms in patients with metastatic breast cancer increases their life expectancy.
Dr. Grassi stated that studies over the past 10 years have shown, that various psychotherapy methods (for example supportive-expressive therapy, meaning-centred therapy, equilibrium therapy, cognitive existential therapy and cognitive behavioural therapy), reduce the fear of a recurrence of the cancer and can improve the patients’ quality of live.
According to Michael Antoni, Professor in Psychiatry at the Miami University, and his team, who published a paper in the Biological Psychiatry Journal last November, cognitive behavioural therapy (CBT) does not only lead to a reduction in negative feelings and cortisol levels, and an increase in positive feelings and interferon levels, it also stops the genes, that adversely effect the cancer process, from becoming active.
The Director of the psycho-oncology program at Michigan University, Dr. Michelle Riba, stated in an interview with Psychiatric New’s, that “Michael Antoni and his team have really carried out some very refined and ground-breaking research. Their existing study is very interesting. The number of cases in the study is small, therefore it will have to be verified by other studies, but it opens up new horizons for research on customized specific types of treatment that may be effective in reducing the injury and death rate in cancer.
In his interview Dr. Spiegel said: “We have to find out how psychotherapies act on cancer patients and which effects they have in common”. “There are still many important unanswered questions on the relationship between the psyche and cancer”, he adds.
Let’s say, some SSRI group antidepressants can reduce the destruction in the body caused by the breast cancer drug Tamoxifen. There is still a lot that we need to find out about the interaction of psychiatric drugs and cancer drugs. Interferon which is used in treating certain types of cancer, can even lead to suicide. It should be established how Interferon leads to depression and what we need to do in order to prevent depression caused by Interferon. Some patients who are undergoing chemotherapy and use androgens complain that their mind is not as clear as before. This impairment which some call “chemo brain” or “chemo fog”, is one of the subjects that needs to be studied in order to establish which parts of the brain are affected and lead this condition.
Dr. Kissane reported that “one of the major disadvantages of cancer treatment is the impact of this treatment on cognitive functions. In recent years efforts were made to improve cognitive rehabilitation therapies for individuals in whom the state referred to as “chemo brain” or “chemo fog” has occurred.
Dr. Fawzy Fawzy, Assistant Head of Psychiatry at the California University in Los Angeles, who previously conducted research on this subject, stated the following in an interview: “The most significant and unanswered question about the link between the psyche and cancer – which is also the most debated issue – is the question whether or not psychological approaches extend the life span of cancer patients. But if these approaches have a healing effect on the psychological state of the patient, even this should be sufficient”.
Whilst all these discussions continue, there are still many aspects of cancer in which psychiatrists can help cancer patients.
Dr. Spiegel suggests that, for example, cancer is assessed with regards to disorders that accompany cancer, like depression and anxiety which are common in cancer patients, and delirium and dementia which are less common.
Dr. Grassi states that when a cancer patient develops anxiety, depression or other psychological conditions, the psychiatrist should not only prescribe psychiatric drugs but should also place emphasize on psychotherapies.
And Dr. Riba remarked: “When people with a heavy smoking habit or alcohol habit develop head or neck cancer, they sometimes get blamed by their families. In such cases the psychiatrist can cooperate with the patient to help him overcome his feelings of guilt, and with the family to encourage them to be more understanding. It is really difficult to come to terms with an approaching end, but everyone needs to be healed”.
Dr. Randy Hillard, who is one of the psychiatrists at the Michigan County University, and who is fighting a gastric cancer, expressed his thoughts as follows: “As life expectancy in cancer patients is on the increase, it is no longer sufficient to think of death and the process of death in terms of the grief stages described by Elizabeth Kubler-Ross. When we think of existing effective treatments and new treatment methods that have appeared in the horizon, accompanied by the fact that the average life expectancy of cancer patients has risen, the process of death becomes a more complex cyclic structure. Therefore the most important thing that psychiatrists can do for cancer patients is to help them change their approach from “I am dying of cancer” to “I am living with cancer”.