Cancer, Psychosocial Dimensions of

Prevalence and Course

Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. Both cancer sites (e.g., breast, brain, lung) and cancer types (e.g., melanoma, sarcoma) vary with regard to etiology, course, mortality, and risk factors. In the United States, about 39% of women and 44% of men are estimated to have cancer at some point in their lives, and 20% of women and 24% of men are expected to die from cancer (National Cancer Institute, 2003). The incidence of cancer increases with age, with only a slight moderation among those over the age of 85. The course of cancer can be described as a process, starting with a phase of suspicious symptoms and followed by the definite diagnosis, treatment, and rehabilitation; in many cases by remission; and sometimes by recurrence and death.

Psychological Development in Cancer Patients

Most psychological studies have focused on immediate consequences of cancer for subjective well-being and other psychological variables. The diagnosis of cancer is very threatening because it is associated with fears of pain, disability, and death due to the disease and with fears of painful and debilitating treatment. Severe symptoms of psychological distress (anxiety, depression) are common at the time of diagnosis, recurrence, and the terminal phase of illness, when symptoms of pain and delirium also often occur (Holland, 1998). Due to progress in cancer therapy and associated increase in life expectancy of cancer patients, there is growing interest in the effects of cancer on individual development and in long-term effects of cancer on development in particular. Four groups of psychological consequences have been considered, namely, effects on psychological health, [Page 203]life outlook, developmental tasks and individual resources, and changes in priorities and life goals.

With regard to psychological adjustment, most cancer survivors (about 70% or higher) do well and do not differ from healthy controls in the prevalence of depression and anxiety, or report even fewer psychological symptoms. Cancer is more distressing for younger patients because it is more unexpected for that age range; they experience more disruptions in normative developmental tasks and have more to lose, whereas older patients have already lived most of their lives. In addition, the quality of psychological adjustment seems to vary according to the degree of cancer-based physical impairments, premorbid personality (e.g., optimism, emotional stability), and coping, although prospective studies are lacking.

Cancer survivors report reduced confidence regarding planning for or anticipating their futures (life outlook), reduced internal control over their lives, and higher overall vulnerability. For example, they often worry about whether cancer may reoccur or whether present physical or cognitive impairments due to cancer and/or therapy may be overcome (Holland, 1998).

Cancer may restrict available developmental options and resources to pursue one's age-typical goals. For example, studies on cancer in childhood have shown declines in cognitive and neuropsychological functioning as well as in academic achievement following brain cancer and/or central nervous system (CNS) irradiation, particularly at high doses and in younger children (Armstrong, Blumberg, & Toledano, 1999). In adolescence, issues of autonomy, peer relations, and identity are often complicated by increased dependency on parents, social isolation due to illness or treatment, and potential uncertainty of chronic or relapsing conditions (Stuber & Kazak, 1999). In young adulthood, lost opportunities for childbearing are an important stressor in women with breast and gynecological cancer (Siegel, Gluhoski, & Gorey, 1999).

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