by Dorreyya Mohungoo

A diagnosis of cancer is usually devastating for patients and their families. Often, the emotional and psychological effects are as daunting as the physical ones. A cancer diagnosis is likely to bring on changes to the individual?s relationships, aspirations and lifestyle as well as having to come to terms with an uncertain future. Not surprisingly, this is the kind of news that causes individuals to re-evaluate their lives and what is important to them. (Perry & Burgess, 2002).

General physical symptoms may have a critical impact on everyday life. Usually, the more advanced the disease, the greater the level of distress. This may be attributed to the increasing burden of the disease, including physical symptoms of increased pain, loss of appetite, breathing difficulties and weight loss. Other specific psychological challenges of cancer relate to the continued stress of treatments, the more immediate threat of death, being unable to carry out important activities that significantly contribute to well-being and concerns about life after death (Perry & Burgess, 2002). In addition, patients may be worried about the well-being of those they are leaving behind.

As such, facing a diagnosis of cancer is the prospect for change and the time for physical, psycholgical and social adaptation. Research in Health Psychology has revealed that individuals with cancer have an increased risk of experiencing shock, distress, lowered personal control, depression, anxiety, a loss in self-esteem and self-worth and collapsing into dependency. In fact, they are three times as likely to suffer from these psychological problems than the general population and twice as likely as other medical patients.

Estimates of the prevalence of long-term psychological distress in cancer patients range from 20 to 66 per cent (Parle et al. 1994). Clearly, these figures imply that there is an inherent aspect to cancer and its treatments that lead to the development of psychological distress. Such reactions may not only cause tremendous distress, but can also undermine medical efforts and hinder rehabilitation. While each patient will experience cancer differently, the psychological impact of the illness is revealed by changes in four areas: Thoughts: Unpleasant, negative thoughts that cannot be easily disregarded are likely to centre on events that have already happened or are likely to happen. For example ?Will I see my daughters grow up?? Behaviour: Behavioural changes may include avoidance of medical appointment, disturbed sleep, feeling irritable, eating less or more than usual and tearfulness as a reflection of underlying fear and anger.

The Body: Patients may also feel constantly panicky and experience bodily changes like breathlessness, nausea, sweating and dizziness. Feelings: Since cancer is a threatening disease, feelings of shock, disbelief, denial, anger, fear, guilt, depression, hopelessness and helplessness are also common.

Psychological interventions to help people cope: A growing body of research suggests that psychological interventions that alleviate anxiety, depression, anger, post traumatic stress and guilt and foster a fighting spirit can help individuals cope with cancer and remain in control over their thoughts, feelings and behaviour (Telch & Telch, 1986).

Patients are empowered and their feelings of competence and confidence are increased to help them manage their illness and deal with feelings of vulnerability and uncertainty. An optimistic, upbeat attitude is very important in fighting illness, including illnesses as serious as cancer and HIV (Taylor et al, 1992). Indeed, psychological interventions can improve quality of life and even survival time of patients with terminal cancer. In a study by Spiegel (1990), patients with metastic breast cancer participated in supportive group therapy sessions where they were allowed to express their feelings, openly discuss death and dying, offer comfort to each other and encouraged to live life fully. The therapy sessions also involved enhancing communication with members of the family and techniques to control pain, fatigue, tension and depression. A ten-year follow up of this study revealed that, compared with those who did not undergo therapy, the group-therapy patients lived twice as long.

Interventions to encourage prevention: Psychological interventions in the community psychology model aim at preventing cancer by enhancing detection health behaviour. Interventions include programs to help individuals quit smoking or getting women to perform breast self-examination (BSE). The main obstacle to BSE is that examination considerably raises the probability of an aversive consequence, that is, finding a lump. Logically, it would be better to take this risk than not, but the fact is that the fear of finding something unpleasant is a significant deterrent to performing the examination (Mahoney, 1977). The distress caused by perceptions of high risk, for example women with a family history of ovarian or breast cancer, can interfere with rational coping - an attitude that can calm nerves in the short run but lead to critical long-term consequences (Davison & Neale, 2001). Psychological treatment involving cancer risk counselling can reduce thought distortions such as the belief that ?Ignorance Is Bliss and not knowing will somehow prevent cancer from occurring?.

Health care, whether preventive or treatment-oriented, needs to embrace concern for psychological issues at all stages of the disease. In the words of Dr. Davis (2002), Professor of Health Psychology: ?Although physical recovery is of central concern, our purpose includes the effort to make people feel good about themselves, effective and able to face the future, no matter how bleak, with dignity?.