Cancer

1. 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 don’t perform normal function

2. 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

3. 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)

4. 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

5. Most common sites for women Incidence • Breasts, colon/rectum, lung, uterus, ovary, lymphomas Death • Lung, breast, colon/rectum, pancreas, ovary, uterus

6. Most common sites for men Incidence • Prostate, lung, colon/rectum, bladder, lymphomas, oral Death • Lung, prostate, colon/rectum, pancreas, lymphomas, leukaemias

8. 5 year survival percentages for men and women with cancers

9. Immune Surveillance Theory and Cofactors in Cancer

10. 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

11. 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

12. 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 • Kaposi’s sarcoma, non-Hodgkin’s lymphoma

13. 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)

14. 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

15. 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

16. Withdrawal of/separation from love object Stress Increased cortisol production Impaired immune functioning CARCINOGENIC CELLS ARE NOT DETECTED AND DESTROYED Cancer-Prone Personality (emotionally non-autonomous)

17. 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

18. 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

19. 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 individual’s behavior

20. 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

21. 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

22. 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”

23. Treatment for Cancer • Physical/medical interventions • Surgery - remove cancer • Radiotherapy / Chemotherapy - shrink, slow cancer, prolong life • Electricity - sarcostic cancers

24. Treatment for Cancer • The role of psychology • Prevention • Adjunct to medical treatment • Recovery/Relapse

25. The potential role of psychology in cancer

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

27. 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

28. Treatment for Cancer Secondary Prevention • Early detection (reduce spread) • Reliable, acceptable, accessible screening • Education (self screening)

29. 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

30. Treatment for Cancer • Psychological interventions • Aim to improve general functioning and minimize adverse psychological reactions

31. 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)

32. 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?

33. 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 5’6” (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?

34. 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.