Cunningham's discovery won't stop the debate about psychological interventions' impact on patients' life spans. Scientists still don't even know how cancer develops. "For years we've been puzzling around the labs trying to figure out what regulates cancer," says Cunningham, noting that the endocrine or immune systems may play a role. "Not much is known yet."
Enduring Treatment
What is known is that psychologists can teach patients how to manage their treatment more effectively.
"Patients get caught up in the physical aspects of their illness," says Sandra B. Haber, Ph.D., a psychologist in private practice in New York City. "That's understandable. But in dwelling on the medical possibilities and diagnostic procedures, patients tend to minimize the role of their feelings and the role that psychology can play."
Haber helps her patients cope with the emotions cancer elicits, which may include terror, depression, or even relief for patients who have been told their malaise was all in their heads. But, Haber insists, it's the other issues she tackles that are even more crucial for cancer patients.
For instance, Haber also helps her patients weigh decisions that can be a matter of life or death. She teaches them how to talk more effectively with doctors and get the information they need. She'll even set up "buddy groups" that take on everyday chores patients are too weak to manage.
Psychologists can also help patients comply with their treatment regimens, teaching them techniques for managing side effects that may not only affect their quality of life but can actually interfere with their treatment. After all, chemotherapy can't work if a patient can't keep the drugs down. To help patients control nausea and other side effects, Haber teaches patients self-hypnosis and other techniques designed to help them relax.
Pain management is especially important. "The experience of pain is very subjective," says Haber. "If you break your leg, it's always going to be painful. But if you're panic-stricken about going to the hospital, that exacerbates the pain."
Take Patrick Riordan, for example. Riordan, special assistant to the president of the University of South Florida in Tampa, discovered he had lung cancer in 1998. As he prepared for chemotherapy, a psychologist at the university's H. Lee Moffitt Cancer Center taught him how to use guided imagery to control discomfort. The psychologist quizzed Riordan about places dear to him, then created a tape that allowed Riordan to take a guided trip into a nearby park all in his mind.
The cassette became invaluable when Riordan's radiation therapy burned his esophagus. In agony; Riordan was barely able to eat or even swallow. "I could close my eyes and go to this beautiful park with lots of palms, cypresses and alligators," says Riordan, who took the trip so often he could soon go there without the tape's help. "I'd just think about the fact that there was a great chain of ecology that had created that environment over eons, that I was part of it, and that I didn't need to be so focused on my present discomfort."
Today Riordan, 54, is in remission. And he's back to putting hot sauce on his pizzas.
Helping Families
Patients aren't the only ones who can benefit from psychologists' help. In fact, researcher Laurel L. Northouse, Ph.D., R.N., a professor at the University of Michigan's School of Nursing in Ann Arbor, has discovered that family members are often more distressed than actual patients.
In one study, for example, Northouse discovered that spouses of colon cancer patients were more upset than the patients. Northouse also found that husbands of breast cancer patients experience just as much distress as their spouses and have an even harder time coping with their work and family obligations. Yet family members are often overlooked, says Northouse.
And their distress can take a toll on patients, warns psychologist Mary Jo Kupst, Ph.D., a professor of pediatrics at the Medical College of Wisconsin in Milwaukee. In research that followed children for a decade after their cancer diagnoses, Kupst found that the best predictor of how well the children fared was how well their parents adjusted to their children's illness.
Pediatric oncology wards have done a good job of meeting the needs of what are sometimes called "secondary" patients, says Kupst. Psychologists can help parents manage stress and help siblings overcome fear and feelings of isolation. Some psychologists actually encourage family members to become active participants in patients' care.
Using a technique pioneered by William H. Redd, Ph.D., now associate director of the Ruttenberg Cancer Institute at Mount Sinai/New York University Medical Center, psychologists teach worried parents or spouses how to soothe their family members through hypnosis, relaxation or even something as simple as a video game. According to Redd, doing so helps channel relatives' anxiety and makes them feel useful.
Kupst used the technique with a 4-year-old patient who was terrified at the prospect of spinal taps and other painful procedures being used to treat his leukemia. Kupst taught his mother to teach her son deep breathing, using bubble blowing and party favors to encourage him to really exhale.
"Coaching him gave her a sense of control in a situation in which you don't have a lot of control," says Kupst. "And the boy really enjoyed the party favors, especially blowing them at nurses."
To learn more about how psychology can help improve cancer care, visit the American Psychological Association at www.apa.org.
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