Elsevier

European Journal of Cancer

Volume 35, Issue 11, October 1999, Pages 1554-1558
European Journal of Cancer

Original Paper
Psycho-oncology: where have we been? Where are we going?

https://doi.org/10.1016/S0959-8049(99)00190-2Get rights and content

Abstract

This article reviews the development of the subspeciality of psycho-oncology and its contributions to patient care, encouraging more attention to and research into the care of the total patient: the physical, psychological, social and spiritual aspects of care. The result is enhanced quality of life as the patient is studied in the domains of living that are important, extending across the continuum of care from diagnosis to palliative care. In addition, cancer prevention and early detection depends largely on changing attitudes and behaviours that put people at greater risk. This is an important area of research for psycho-oncologists. In the past two decades, research has contributed to our understanding of the psychological responses that accompany a cancer diagnosis. Oncologists better recognise psychological distress and psychiatric disorders such as anxiety, depression and delirium (in hospitalised patients) as frequent comorbid disorders. The development of valid assessment tools for the patients' self-report has been important. Increasingly, outcome measures in controlled trials of new therapies include quality of life, and no longer look at survival alone. The future will continue to bring new challenges to psycho-oncology as patients face new challenges in treatment. A major aim of the next century will be to bring this integrated approach to all patients in an affordable manner.

Introduction

Over the past 20 years, psycho-oncology has developed as one of the subspecialities of oncology. This area deals with the two psychological dimensions of cancer: the patients', families' and staff's emotional reactions to cancer and its treatment (psychosocial); and the psychological and behavioural factors that influence cancer risk and survival (psychobiological) [1].

This has occurred as interest in the ‘human side’ of patients with cancer has increased. The dimensions dealing with the psychological, social, and spiritual were neglected for many years in most countries around the world. The focus was almost totally on the physical aspects of care. Patients' psychosocial problems were usually not addressed in their care. Suffering from unrecognised anxiety and depression was common: confusional states, common with opioid management of pain and vital organ failure, were often not diagnosed and were, therefore, untreated.

Through the activities of a few teams devoted to the psychosocial area around the world, psycho-oncology has become a recognised area of oncology and oncologic research [2]. It is called both psycho-oncology and psychosocial oncology, depending on preference. In Europe, the term psychosocial has been more widely used. However, the area—the ‘human’ side of cancer—is the essence of its concerns.

Section snippets

Historical perspective: where have we come from?

The word cancer was equated with death for centuries because there was no treatment for it until surgical removal became possible after the introduction of anaesthesia in the last half of the nineteenth century (Table 1). The disease was so frightening that the diagnosis was withheld from the patient. It was considered cruel to reveal it, so only the family was given the facts. This has been called the ‘conspiracy of silence’ which left the patient feeling isolated and alone. The result was a

The future challenges: Where are we going?

The new millennium provides a superb opportunity to review our experience and to look forward to directing the field in the most useful way. In terms of clinical services, the traditional focus of psycho-oncology has been at the time of diagnosis and while receiving active treatment. It is important to extend our focus: to survivors, palliative care; and to the ‘worried well’: people who are healthy but recognise that they have a high risk of developing cancer by virtue of genetic risk,

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