A cancer diagnosis can be a profoundly stressful experience, bringing many challenges that can generate uncertainty, fear, and emotional distress. Coping with the stressors of cancer requires substantial psychological and physiological adaptation and can take a toll on cancer patients’ quality of life and well-being. Moreover, this stress may also promote cellular and molecular changes that exacerbate physical symptoms, facilitate tumor growth, and contribute to adverse long-term health outcomes. In this context, randomized controlled trials have tested stress management interventions to improve psychological and physiological adaptation, quality of life, and clinical health outcomes.
As per a study published in the Annual Review of Psychology, receiving a cancer diagnosis can be a devastating experience for patients, as it often involves uncertainty, fear, and emotional distress. Patients must navigate new information and make important treatment decisions while also dealing with significant disruptions to their daily lives and the social and occupational roles that define their identity.
Additionally, a cancer diagnosis can bring salient awareness of mortality and vulnerability, exacerbating adverse emotional reactions. Cancer treatment can vary significantly across different types and stages of the disease. Common targeted treatments include surgery to remove a tumor and radiation to ablate DNA in cancer cells. Systemic therapies targeting cancer cells throughout the body include chemotherapy, hormone therapy, and immunotherapy. However, these treatments can create short- and long-term side effects and toxicities that can significantly impact a patient’s quality of life.
Cancer treatments can be classified into different categories based on their intention. Primary treatment is the first or foremost treatment used to eliminate or reduce cancer. At the same time, adjuvant therapy is an additional treatment given after primary treatment to eliminate any remaining cancer cells. Neoadjuvant therapy occurs before initial treatment and facilitates the primary treatment or makes it more effective. Palliative treatment aims to improve quality of life and reduce the physical burden of cancer by relieving treatment side effects or symptoms related to cancer itself.
However, an individual’s response to cancer treatment can be highly variable. Side effects and toxicities such as pain, nausea, fatigue, and neuropathy can significantly reduce a patient’s capacity to adhere to therapy and therefore hurt the quality of life and psychosocial adjustment. Cancer treatment and related disabilities can also hurt an individual’s finances, further compromising the quality of life. Financial toxicity, highly prevalent among individuals with cancer, reduces the tolerability of cancer treatments and can result in material consequences like reduced income, increased debt, depletion of savings, and bankruptcy.
Advances in cancer prevention, screening, and treatment have led to a significant increase in the number of individuals who live beyond a cancer diagnosis and the completion of curative-intent treatment. However, these effects may persist long-term in some individuals or emerge for the first time months or years later. Common symptoms individuals experience after cancer treatment include pain, fatigue, impairments in physical functioning, sexual and urinary/bowel dysfunction, cognitive impairment, and sleep disturbance.
Treatment for incurable advanced or metastatic cancer is often not circumscribed to a final period and does not include a post-treatment completion phase as with curative-intent treatment. Patients with advanced disease experience a high degree of uncertainty and anxiety tied to multiple repeated diagnostic procedures. Care teams must continuously evaluate how their cancer is responding to treatment and whether their treatment plan needs to be changed. As a result, patients may experience significant treatment-related burnout and cumulative effects of cancer treatment on symptomatic side effects and toxicities, which underlines the importance of patient-centered care.
The article highlights various cognitive-behavioral therapy (CBT)-based SMIs that have been shown to improve psychological adaptation and have beneficial effects on physiological adaptation (neuroendocrine and immune system variables) in cancer patients. The studies demonstrating these effects have been limited to trials enrolling nonmetastatic cancer patients, including breast cancer and malignant melanoma patients, at the early stages of the disease.
One study demonstrating the effects of SMIs on immune indices was an RCT showing that stage 1-2 malignant melanoma patients assigned to a 6-week group CBT-based SMI (coping skills training, relaxation) improved psychological adaptation (negative mood) at six weeks and cellular immune functioning (NKCC) at six months. The article suggests that further research is needed to determine whether SMIs can promote recovery or preserve immune functioning as patients undergo adjuvant therapies.
Overall, the article highlights the importance of studying the effects of SMIs on both psychological and physiological adaptation in cancer patients and survivors and the challenges associated with conducting such studies. According to recent research, there is growing evidence for the effectiveness of psychological interventions, specifically cognitive behavioral therapy (CBT)-based interventions, in improving psychological and physiological adaptation and clinical health outcomes in cancer patients.
However, it remains unclear which subgroups of patients are most likely to benefit from these interventions and at what point in the cancer continuum they should be implemented. The peri-surgical period may be a good time for intervention, and embedding SMIs into adjuvant therapy settings could benefit patients. Future research should focus on identifying biomedical, sociodemographic, and psychosocial factors that predict optimal SMI effects and using patient-reported outcomes and biomarker assessments for precision oncology care.
