Management of Patients with Oncology Disorder

The physical impacts of oncology disorders influence the mental well-being of patients. Based on the relationship between mental well-being and immunity, this paper explores existing research on integrating psychotherapeutic interventions in managing patients with oncology disorders. It seeks to determine whether psychotherapy improves care outcomes for oncology patients.

Oncology disorders affect how the body’s systems function. Various aspects of oncology disorders have a severe impact on the mental wellness of the patient and the people around them. One of the significant symptoms of oncology disorders, regardless of their severity, is chronic pain. A systematic review by ishakIshak et al. (2018) found that there existed a neurobiological link between experiencing physical pain and emotional distress. People diagnosed with cancers have reduced social functioning and risk of social isolation (Coughlin, 2019). Isolation is a known risk factor for anxiety, severe depression, fear, drug abuse, and the development of suicidal thoughts.

Relieving adverse mental outcomes helps manage oncologic pain and improve the patient’s patient’s quality of life. Pharmacological therapy is one of the primary methods used in the management of cognitive outcomes in patients with oncology disorders. Pharmacological treatments such as the use of antidepressants (ADs) provide a safe and effective method of managing severe major depression in cancer patients (Grassi et al., 2018). However, there exist concerns over the side effects of majorly used ADs, the risk of drug interactions with cancer medications, and patient pharmacological experiences.

Psychotherapeutic interventions are being adopted for the management of cancer-related mental disorders to improve cancer outcomes for patients. Molecular, cellular, and clinical studies have linked psychological stress factors to immune suppression with an impact on the management of cancer (Antoni & Dhabhar, 2019). Psychotherapy is a non-pharmacological approach that has been applied in the management of mental distress and depression in patients with oncology disorders. It involves talking with the patients to help them overcome their psychological distress. Psychotherapeutic methods include cognitive behavioral therapy (CBT), interpersonal therapy, and supportive therapy (Primeau, 2018). Based on the application of psychotherapy in the management of depression and other mental illnesses, it is arguable that psychotherapy can be applied in the management of patients with oncology disorders with notable outcomes.

Methods

A database search was carried out in PubMed specifically for relevant randomized controlled trials (RCTs). Focus was paid to RCTs on the application of any form of psychotherapy in patients with various severity levels of cancer. A methodology review was conducted to ensure the quality of the articles included. Four clinical trials were selected based on the primary outcome of the intervention.

Results

One study applied meaning-centered group psychotherapy for patients. A second one applied Managing Cancer and Living Meaningfully (CALM) individual psychotherapy for patients. The RCT utilized physical and psychosocial training as an intervention, and the fourth study used Mindfulness-Based Cognitive Therapy. Each of the RCTs reviewed demonstrated that when applied as an intervention, psychotherapy improved the quality of life for the patients, improved their emotional and spiritual well-being, and improved the ability of patients to cope with cancer. There was a notable reduction in anxiety and depression among all of the participants in the reviewed RCTs.

Discussion

Combining physical exercises and psychosocial training in children living with cancer improved bone mineral density. In addition, their health-related quality of life (HrQoL) also improved with time (Braam et al., 2018). Individual Meaning-Centered PsychoMeaning-Centered, when applied as an intervention for psychological and existential distress in patients with advanced cancer, showed significant positive outcomes when compared to other forms of care (Breitbart et al., 2018). The application Managing Cancer and Living Meaningfully (CALM) showed superior outcomes over regular care approaches in the management of depressive symptoms in patients with advanced cancer (Mehnert et al., 2020). The randomized controlled trial study by Park et al. (2020) focused on applying mindfulness-based cognitive behavioral therapy (CBT). It showed that CBT could help manage psychological, physical, and spiritual distress in patients with nonmetastatic breast cancer.

The use of various psychotherapeutic approaches has a significant impact on depression and mental distress symptoms in patients living with oncology disorders. Psychotherapeutic interventions have proved to have longer-lasting effects on the management of cancer-related mental illnesses, as the positive outcomes of the interventions could be maintained long after the intervention was completed. Although this review finds various types of psychotherapy to be suitable for managing the psychological consequences of cancer, more studies should be included in the review to draw an informed conclusion.

Conclusion

Psychotherapy does not present any harmful side effects as compared to pharmacotherapy. Psychotherapy as an intervention in managing patients with oncology disorders has been proven to be an effective method of managing cancer-related mental health issues with an impact on reducing oncologic pain. Therefore, psychotherapy can be adopted as an essential management strategy to alleviate symptoms in a patient with oncology disorder. However, since psychotherapy can be objective and subjective, it is necessary to tailor it objectively or subjectively to the patient’s needs.

References

Antoni, M. H., & Dhabhar, F. S. (2019). The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer, 125(9), 1417–1431. https://doi.org/10.1002/CNCR.31943

Braam, K. I., van Dijk-Lokkart, E. M., Kaspers, G. J. L., Takken, T., Huisman, J., Buffart, L. M., Bierings, M. B., Merks, J. H. M., van den Heuvel-Eibrink, M. M., Veening, M. A., & van Dulmen-Den Broeder, E. (2018). Effects of a combined physical and psychosocial training for children with cancer: A randomized controlled trial. BMC Cancer, 18(1), 1–12. https://doi.org/10.1186/S12885-018-5181-0/TABLES/4

Breitbart, W., Pessin, H., Rosenfeld, B., Applebaum, A. J., Lichtenthal, W. G., Li, Y., Saracino, R. M., Marziliano, A. M., Masterson, M., Tobias, K., & Fenn, N. (2018). Individual Meaning-Centered PsychotheMeaning-Centeredatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer. Cancer, 124(15), 3231. https://doi.org/10.1002/CNCR.31539

Coughlin, S. S. (2019). Social determinants of breast cancer risk, stage, and survival. Breast Cancer Research and Treatment 2019 177:3, 177(3), 537–548. https://doi.org/10.1007/S10549-019-05340-7

Grassi, L., Nanni, M. G., Rodin, G., Li, M., & Caruso, R. (2018). The use of antidepressants in oncology: a review and practical tips for oncologists. Annals of Oncology, 29(1), 101–111. https://doi.org/10.1093/ANNONC/MDX526

Ishak, W. W., Wen, R. Y., Naghdechi, L., Vanle, B., Dang, J., Knosp, M., Dascal, J., Marcia, L., Gohar, Y., Eskander, L., Yadegar, J., Hanna, S., Sadek, A., Aguilar-Hernandez, L., Danovitch, I., & Louy, C. (2018). Pain and Depression: A Systematic Review. Harvard Review of Psychiatry, 26(6), 352–363. https://doi.org/10.1097/HRP.0000000000000198

Mehnert, A., Koranyi, S., Philipp, R., Scheffold, K., Kriston, L., Lehmann-Laue, A., Engelmann, D., Vehling, S., Eisenecker, C., Oechsle, K., Schulz-Kindermann, F., Rodin, G., & Härter, M. (2020). Efficacy of the Managing Cancer and Living Meaningfully (CALM) individual psychotherapy for patients with advanced cancer: A single-blind randomized controlled trial. Psycho-Oncology, 29(11), 1895–1904. https://doi.org/10.1002/PON.5521

Park, S., Sato, Y., Takita, Y., Tamura, N., Ninomiya, A., Kosugi, T., Sado, M., Nakagawa, A., Takahashi, M., Hayashida, T., & Fujisawa, D. (2020). Mindfulness-Based Cognitive Therapy for Psychological Distress, Fear of Cancer Recurrence, Fatigue, Spiritual Well-Being, and Quality of Life in Patients With Breast Cancer—A Randomized Controlled Trial. Journal of Pain and Symptom Management, 60(2), 381–389. https://doi.org/10.1016/j.jpainsymman.2020.02.017

Primeau, B. A. (2018, August 17). Psychotherapy and Cancer. https://www.cancertherapyadvisor.com/home/tools/fact-sheets/psychotherapy-and-cancer/

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