Cancer

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Cancer

• Cancer is a disease of cells where cell
  reproduction is uncontrolled
• Caused by a change in cell DNA
• Uncontrolled cell reproduction leads to the
  development of a tumor or neoplasm
• Immature cells so dont perform normal function

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Tumor Types

• Malignant Tumor
• Cells more immature, dysfunctional
• More likely to spread to other areas of the body
  (metastasis)
• Metastasis
• Spread of cancer cells through blood/lymphatic
  system and abdominal cavity
• (ie primary site to secondary sites)
• Non-Malignant Tumor
• Benign cancer
• less likely to spread to other areas of the body

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4 Broad Categories of Cancers

• Carcinomas
• Occur in tissue lining internal/external surfaces
  of organs (including the skin)
• Account for 85-90 of cancers
• Lymphomas
• Occur in lymphatic system
• (e.g., lymph nodes, lymph vessels, spleen)

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4 Broad Categories of Cancers

• Sarcomas
• Arise in connective tissue
• (e.g., muscle, bone, fat)
• Leukaemias
• Present in blood-forming tissues (e.g., bone
  marrow)
• Essentially involve the production of large
  numbers of immature white blood cells
  (leucocytes) of one form or another

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Most common sites for women

• Incidence
• Breasts, colon/rectum, lung, uterus, ovary,
  lymphomas
• Death
• Lung, breast, colon/rectum, pancreas, ovary,
  uterus

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Most common sites for men

• Incidence
• Prostate, lung, colon/rectum, bladder, lymphomas,
  oral
• Death
• Lung, prostate, colon/rectum, pancreas,
  lymphomas, leukaemias

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5 year survival percentages for men and women
with cancers
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Immune Surveillance Theory and Cofactors in Cancer
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Causes of Cancer

• It has been suggested that 75 to 80 of cancers
  are caused by modifiable lifestyle factors!
• Causes random mutations and environmental agents

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Risk Factors

• Genetics
• Some breast cancers are very strongly influenced
  by genes
• Viruses
• Human Papilloma Virus (disease which leads to
  suppression of immune function)
• Radiation
• UV light (sun), X-rays, nuclear

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Lifestyle Risk Factors

• Tar in cigarettes
• Accounts for 70-80 of lung cancers and 30 of
  all cancer deaths
• Diet
• Fat
• Carcinogens (natural or additives)
• Methods of food preparation (charring, smoking)
• Alcohol (heavy drinkers 2x risk)
• Sexual behavior
• Kaposis sarcoma, non-Hodgkins lymphoma

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Psychological Risk Factors

• Stress
• Data not consistent
• Stress may impact on the progression of cancer
  (impaired immune function)
• Suppression of Emotion
• Denial, anger
• Greer Morris (1978)

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Psychological Risk Factors

• Personality
• Eysenck Grossarth-Maticek
• Type I Cancer-prone personality
• Type II CHD-prone personality
• Type III Mixed-type (with psychopathic
  tendencies)
• Type IV Healthy autonomous type

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Psychological Risk Factors

• Cancer-Prone Personality
• Emotionally non-autonomous (ie dependent on
  someone else)
• Represses emotions
• Does not express anger or anxiety
• Unable to cope with stress
• (helplessness, hopelessness, depression)
• Passive and inhibited

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Cancer-Prone Personality (emotionally
non-autonomous)
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Psychological Risk Factors

• Cancer-Prone Personality
• Numerous articles from 3 longitudinal studies
• Type I individuals have a particularly high risk
  of dying of cancer relative to the other 3 types
• This effect of personality is considerable larger
  than the effect of smoking

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Psychological Reactions to Cancer

• Psychopathology?
• Reaction depends on a number of factors
• Overall, a maximum of 20-49 will qualify for a
  formal diagnosis of a psychological disorder
  (depression, anxiety, PTSD)
• Adjustment disorder the development of
  emotional and behavioral symptoms following a
  major life stressor

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Psychological Reactions to Cancer

• The most common responses are
• Anxiety (symptoms, treatment, prognosis)
• Depressive symptoms
• Sadness, crying, guilt, hopelessness/helplessness,
  etc
• Most people experience these at some time
• Feelings of loss of control
• Positive outcomes are not dependent on
  individuals behavior

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Psychological Reactions to Cancer

• The most common responses are
• Cognitive (poor concentration, memory and
  judgment)
• Sexual dysfunction
• Affects 90 of individuals with cancer
• Caused by distress, symptoms, pain, body image,
  preoccupation with cancer
• Denial
• useful initial reaction, potentially injurious
  later

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Predictors of Depression/Distress

• Pain (the major predictor of depression/distress)
• Lancee et al. (1994)
• Social support and quality of life
• Godding et al. (1995)
• Quality of life the stronger predictor
• Personal control
• Hofwartner et al. (1992)
• More optimistic, lifestyle changes, seek social
  support

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Positive Psychology

• Search for Meaning
• Taylor (1983)
• Psychosocial transition
• Cordeeva et al (2001)
• Research that has focused solely on detection
  of distress and its correlate may paint an
  incomplete and potentially misleading picture of
  adjustment to cancer

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Treatment for Cancer

• Physical/medical interventions
• Surgery - remove cancer
• Radiotherapy / Chemotherapy - shrink, slow
  cancer, prolong life
• Electricity - sarcostic cancers

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Treatment for Cancer

• The role of psychology
• Prevention
• Adjunct to medical treatment
• Recovery/Relapse

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The potential role of psychology in cancer
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Prevention of Cancer

• Psychological interventions
• To modify risk behaviors (eg smoking)
• To improve general functioning and minimize
  adverse psychological reactions
• To promote preventative methods

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Prevention of Cancer

• Primary Prevention
• Control environmental carcinogens
• Remove asbestos from schools
• Move all Australian children to Canada or just
  introduce hat-wearing policy in schools, Slip
  Slop Slap!?!
• Ban on workplace smoking (bars and cafes)
• Anti-pollution laws

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Treatment for Cancer

• Secondary Prevention
• Early detection (reduce spread)
• Reliable, acceptable, accessible screening
• Education (self screening)

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Early warning signs of cancer?

• A change in bowel or bladder habits
• A sore that does not heal
• Unusual discharge or bleeding from genital,
  urinary, or digestive tract.
• A thickening or lump is breast or elsewhere.
• Indigestion or difficulty swallowing
• An obvious change in wart or mole
• A persistent cough or hoarseness.
• American Cancer Society

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Treatment for Cancer

• Psychological interventions
• Aim to improve general functioning and minimize
  adverse psychological reactions

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Treatment for Cancer

• Psychological interventions
• For adverse reactions
• Support, counseling, and support groups
• Stress management and coping strategies
• Cognitive restructuring (promote hopefulness)
• For noxious procedures
• (procedural/sensory information, relaxation,
  imagery, systematic desensitization, distraction,
  modeling, cognitive restructuring)
• Pain management
• (CBT, hypnosis)

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Term Paper 2 - Practice Exercise

• Decisions in the management of pain and anxiety
  in hospitals
• Imagine you are a Health Psychologist working at
  a large hospital. The CEO of the hospital asks
  you if you can reduce patients level of pain and
  anxiety during their hospital stay.
• There are a number of different approaches that
  might be taken to treatment and different goals
  that might be adopted. Briefly, as the
  psychologist, what goals and methods would you
  consider. What goal might you ultimately
  recommend to the CEO and why?

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Term Paper 2

• Decisions in the treatment of a mildly overweight
  client.
• Imagine you are a Health Psychologist who is
  consulted by a 35 year-old client who is mildly
  overweight. She is 56 (167.6cms) tall and
  weighs 11 stone 6 lbs (74 kgs)BMI 26.34.
  Since adolescence she has had an extensive
  history of repeated, unsuccessful dieting, and
  has sought assistance from you to lose weight.
  She is embarrassed about her weight and her
  husband says she is fat, and makes her run up and
  down the stairs in their house for 10 minutes
  each day. She believes losing weight will
  improve the quality of her relationship with her
  husband and make her happier. She tells you her
  weight goal is 60 kgs (132 lbs).
• There are a number of different approaches that
  might be taken to treatment and different goals
  that might be adopted. Briefly, as the
  psychologist, what goals and methods would you
  consider. What goal might you ultimately
  recommend to the client and why?

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Term Paper 2

• Decisions in the treatment of a mildly overweight
  client.
• Maximum Length 1000 words
• Due Date Monday, November 15
• References
• Sarafino, E. P. (2003). Health psychology
  Biopsychosocial interactions. (Chapter 8, pp.
  236-265). Wiley New York.
• Rosen, J. C., Orason, P., Reiter, J. (1995).
  Cognitive behavior therapy for negative body
  image in women. Behavior Therapy, 26, 25-42.