Psychooncology - The state of its development in 2006

Abstract

Background and Objectives: Psychooncology research and practice has grown exponentially in recent years. We review the evidence-based accomplishments of psychooncology in key areas that inform clinical practice. Methods: We reviewed the following computerized databases: PubMed, Embase, Cochrane, Ovid Medline and Psychinfo for studies on predetermined areas of interest representing the continuum of current psychooncology, focusing on meta-analyses and controlled studies. Results: Cancer related psychological distress occurs in one third of patients. Psychological factors are of importance in cancer prevention such as the relationship of smoking to depression. The association between personality styles and cancer vulnerability is not strong, but social support is a well-established prognostic factor. Existential distress may manifest as demoralization; meaning and dignity-based therapies have been designed to assuage existential angst in the cancer setting. Psychotherapy is efficacious in ameliorating cancer related distress, anxiety and depression, with newer models focusing on meaning and adaptive coping. Although there is not a strong evidence-base for the impact of psychooncology on survival, psychological factors clearly impact on adherence to cancer treatment. Most survivors do well overall, but concerns relate to the long term impact of specific treatments or special populations including children. Neurocognitive effects of chemotherapy have recently been associated with carriers of Alzheimer precursor genes. Doctor-patient communication is of increasing clinical interest alongside concern that physician burnout is increasing. Conclusions: Evidence-based research informs psychooncology's clinical practice and service provision in 2006.