Working With Cancer Patients: Expanding Your Practice
by Richard M. Suinn, Ph.D., ABPPFN1
Cancer Today One of every three persons and three of every four families can expect to be afflicted with cancer (American Cancer Society, 1988; Bonica, 1980). The following are ways counselors can help patients.
Help in Diagnosis: Counselors can help to separate normal from maladaptive emotional reactions (Fawzy, Pasnau, Wolcott, & Ellsworth, 1983):
Psychological Treatment and Cancer. Examples of interventions counselors can provide are:
In what is considered one of the most comprehensive and well-documented outcome studies, Gordon Freidenbergs, Diller, et al. (1980) determined that counseling increased return to vocational work, reduced negative affect, and increased reality perspective.
Finally, social support networks appear associated with adjustment to cancer, reduced distress, more vigor, and possibly recovery (Taylor, Falke, Shoptaw & Lichtman, 1986).
Some psychological interventions have increased survival rates. Spiegel, Bloom, Kraemer, and Gottheil (1989) offered group therapy to breast cancer patients for one year, and followed the patients over 10 years. Survival for the intervention group averaged 36.3 months compared with 18.9 months for the control. Fawzy, Fawzy, and Hyun also reported 91.8% of their treated group as surviving after 5 years compared to 67.5% of the control.
Interventions to prevent such side effects aim at the conditioned learning or anxiety components (Carey & Burish, 1988). Burish, Snyder and Jenkins (1991) provided education, relaxation, and guided imagery before the patient's first chemotherapy session. Other typical interventions have used relaxation, initiating other responses to overcome nausea and act as new conditioned responses, desensitization, guided imagery, and hypnosis (see reviews by Andrykowski, 1990; Carnrike & Carey, 1990; Morrow & Dobkin, 1988). These interventions can be provided in very brief sessions; Burish, Snyder and Jenkins's procedure was one session of 90 minutes.
Pain management methods. Moderate to severe pain is experienced by about 40% of adults in intermediate stages of cancer, and 60-90 % in advanced stages (Jay, Elliott, & Varni, 1986). Bone marrow aspirations and lumbar punctures are routine but highly painful diagnostic procedures.
Counselors can provide pain management through biofeedback, hypnosis. cognitive/behavioral therapy, support groups, and education (Jay, Elliott, & Varni, 1986). Hypnosis has been among the more often used procedure, aimed at distraction through pleasant imagery, creation of anesthesia, induction of amnesia for the pain experience, or time distortion (Hilgard & LeBaron, 1982; Jay, Elliott, & Varni, 1986). Spiegel and Bloom (1983) used 5-10 minutes of hypnosis during weekly support groups for breast cancer patients to "filter the hurt out of the pain" (p. 335), by imagining competing sensations as cold numbness or warm tingling. Jay, Eilliott, Woody & Siegel (1991) designed a cognitive behavioral package (CBTP) involving film models, reinforcement, breathing, imagery for distraction, and behavioral rehearsal, for children undergoing painful medical procedures for cancer.
Spiegel's procedure is available from him through the Psychosocial Treatment Laboratory, Stanford University School of Medicine (Classen, Diamond, Soleman, Fobair, Spira, & Spiegel, 1993). Fawzy's patient manual, from the UCLA School of Medicine (Fawzy & Fawzy, 1994) details the training in coping strategies using cancer scenarios, and stress management techniques.
Jay and Elliot's (1984) cognitive behavioral package is described in detail, available from Susan Jay in Los Angeles.
Gordon et al. (1980), at Mt. Sinai Medical Center, New York, produced treatment manuals for their intervention which involved education, counseling aimed at feelings and actions, and environmental consultation. Other structured interventions include the PREP package by Burish, Snyder & Jenkins for anticipatory nausea/vomiting, and the Omega Project for coping skills and communications released as a Practitioner's Manual (Sobel & Worden, 1982).
Finally, the counselor interested in offering services to cancer patients should attend to the following practice principles (Andersen, 1992):
Psychologists are an important resource for cancer patients; I would urge counselors to expand their services to this area of primary health care!
Dick Suinn Dept. of Psychology Colorado State Univ Ft. Collins, CO 80523 FAX (970) 491-1032 Ph. (970) 491-1351
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