PSYCHO-ONCOLOGY

Definition
Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells in the
body. Normally, cells in the body go through a regulated process of growth, division, and death. However,
in cancer, this orderly process is disrupted, leading to the formation of a mass or lump of tissue called a
tumour.
Cancer is the second leading cause of death in developed countries and the third leading cause of death in
developing countries.
Oncology is a branch of medicine that deals with the study, treatment, diagnosis, and prevention of cancer.
A medical professional who practices oncology is an oncologist. It includes:
 Medical oncology (the use of chemotherapy, immunotherapy, hormone therapy, and other drugs to
treat cancer),
 Radiation oncology (the use of radiation therapy to treat cancer)
 Surgical oncology (the use of surgery and other procedures to treat cancer)
Psycho-oncology defined as the study of psychological, behavioral, and psychosocial factors involved in the
risk, detection, course, treatment, and outcome (in terms of survival) of cancer. The field examines
responses to cancer on the part of patients, families, and caregivers at all stages of the disease.
Psycho-oncology is a specialized field of study and practice that focuses on the psychological, social, and
emotional aspects of cancer. It involves the intersection of oncology (the branch of medicine dealing with
the prevention, diagnosis, and treatment of cancer) and psychology. Psycho-oncologists work with
individuals affected by cancer, including patients, their families, and caregivers, to address the psychological
and emotional challenges associated with the disease.

Behavioural & Psychological Factors in Cancer risk

Cancer is the second leading cause of death in developed countries and the third leading cause of death in
developing countries. It is estimated that there will be more than 12 million new cancer cases in 2007
worldwide, and by 2050, the global burden is expected to grow to 27 million new cancer cases. Although
there have been considerable improvements in early detection and treatment of cancer; preventing the
disease by targeting modifiable factors such as tobacco use, diet, and inactivity has received considerable
attention.
1. TOBACCO AND CANCER
Each year over 185,000 Americans die of cancer caused by tobacco smoking. Smoking is responsible for
approximately 40% of all cancer deaths among men, and 26% of cancer deaths among women. Lung
cancer alone now causes approximately 140,000 smoking-attributable deaths annually in the United
States. Cigarette smoking accounts for 89% of all lung cancer mortalities, and also contributes
significantly to mortality rates for oral cancer, and cancers of the oesophagus, larynx, bladder, stomach,
pancreas, kidney, and cervix. In addition to cancer, smoking contributes significantly to coronary heart
disease, chronic obstructive pulmonary disease, cardiovascular disease, stroke, and ulcer disease.
Smoking cessation is associated with decreased mortality and morbidity from cancer and other diseases.
There is a growing body of evidence that smoking following cancer diagnosis has a negative impact on
cancer treatment efficacy, treatment related complications and side effects, cancer recurrence and second
malignancies, and overall survival. With advances in cancer treatments, the number of cancer survivors
is significantly increasing, emphasizing the importance of improving health outcomes and quality of life
within this high-risk population.
Treatment of Tobacco Use and Dependence
  Pharmacotherapy
 Nicotine Replacement Therapy
 Bupropion SR
 Varenicline
 Second-Line agents
 Combination pharmacotherapies
 Social/behavioral treatments.
 Brief interventions

2. DIET AND CANCER

The role of diet, however, in the development of cancer is complex. In recent years, it has become
increasingly clear that cancer is not a single disease, but an expression of multiple alterations in the
normal process of cell growth and death. Therefore, it is important to analyze which foods affect cancer
risk and how they interact with the chain of cellular events that lead to carcinogenesis and cancer. Most
foods contain a variety of components, making it difficult to identify which components, individually or
in combination, affect cell function.
Because of the complexity of both carcinogenesis and dietary intake, the true relationship between
diet and cancer is difficult to determine. Lung cancer is both the most common cause of cancer death and
the most commonly occurring cancer worldwide. The most established dietary risk factor for lung cancer
is arsenic in drinking water. β-Carotene supplements are also associated with increased risk for lung
cancer, particularly among smokers. Stomach cancer is the second most common cause of cancer death.
It is the fourth most common cancer worldwide. Salt and salt-preserved foods have the strongest
association with increased risk for stomach cancer. The most significant dietary-related risk factor is
exposure to aflatoxins. Multiple studies have shown convincing evidence that red meat (e.g., beef, veal,
pork, and lamb) and processed meats increase risk for colorectal cancer. Liver cancer, the second most
common cause of cancer death is influenced by, Hepatitis B (HBV) and C (HCV) viruses being the
primary risk factors. There is significant evidence that consuming high levels of alcohol is a risk factor
for both pre- and postmenopausal breast cancer. Esophageal cancer is strongly related to weight status
and lifestyle behaviors, including tobacco use, alcohol consumption, and diet.
3. EXCERSICE AND CANCER
The role of physical activity (PA; defined as any bodily movement produced by skeletal muscles that
results in energy expenditure) or exercise (defined as PA that is planned, structured, repetitive, and
directed to the improvement or maintenance of physical fitness) in preventing cancer has been examined
in numerous epidemiological studies and several reviews of the literature. To obtain a comprehensive
view of Physical activity, there are various types of PA that should be considered: for example,
occupational, leisure, transportation, and household activities.
4. SUN EXPOSURE AND CANCER RISK
Sunlight, critical to human health, provides light and warmth and aids the body in the formation of
vitamin D. Yet too much may be lethal. Excessive exposure to the sun invites the most common cancer
of all: skin cancer, melanoma, and non-melanoma. There is a great deal of evidence that ultraviolet (UV)
exposure has both positive and negative effects. A systematic review of the literature identified risk from
sun exposure for melanoma skin cancer, cancer of the lip, basal cell carcinoma (BCC) of the skin, and
squamous cell carcinoma (SCC) of the skin but potential protection for other cancers such as prostate,
non-Hodgkin’s lymphoma, breast, and colon cancer. Although sun protection messages are important to
prevent diseases associated with UV exposure, some sun exposure is probably essential to avoid diseases
of vitamin D deficiency.
Sun exposure plays a complex role in causing melanoma skin cancer and its precursor lesions. Lifetime
sun exposure is difficult to measure; most people cannot recall episodes of sunburn or amount of sun
exposure reliably. The use of sunscreens that block UVB but not UVA may be associated with an
increase in melanoma rates.
Nonmelanoma skin cancers occur primarily at sun exposed body sites such as the head, neck, and arms,
in people who are sensitive to the sun, and possibly among those who have a reduced capacity to repair
DNA damage. Conversely, light pigmentation and sun exposure may decrease risk of colon, breast,
prostate, and ovarian cancer at higher latitudes if the hypothesized association between sun exposure and
vitamin D3 in relation to carcinogenesis is correct.
5. SOCIOECONOMIC STATUS AND PSYCHO-ONCOLOGY
The social hazards referenced are the resource-based and prestige-based characteristics of individuals
and the places they live, which comprise “socioeconomic status” (SES). These “social hazards” can be
found at all points along the cancer care continuum beginning with the etiology of cancer, screening and
early detection, diagnosis and treatment, survivorship, and mortality. Even though cancer outcomes have
improved in the past two decades, those individuals with lower SES have not improved as quickly as
those with higher SES. Moreover, the impact of SES on health is much broader than cancer. SES affects
the chances of contracting both acute and chronic illnesses. In general, poorer people have a higher risk
of getting most acute and chronic health conditions.
Generally, SES is defined as “a broad concept that refers to the placement of persons, families,
households, and census tracts or other aggregates with respect to the capacity to create or consume goods
that are valued in our society.” This definition of SES underscores (1) the various elements of SES—
education, wealth, income, education, occupation; (2) the dynamic nature of SES over the lifespan; and
(3) the levels of analysis at which SES can be measured—individual, family, household, neighbourhood,
and so on.
Cancer incidence refers to the number of newly diagnosed cases and is often expressed as the
absolute number of new cases in a given year. Cancer incidence is related to SES both directly and
inversely. The incidence of some types of cancer, such as lung and stomach, increases with decreasing
SES. The incidence of other types of cancer, such as breast and prostate, generally increases with
increasing SES. In addition, socioeconomic gradients for cancer incidence differ between nations, and
the availability and quality of data are variable. At a global level, the incidence of some cancers is more
prevalent among low-resource, or developing, countries while high-resource, or developed/
industrialized, nations have higher rates of other cancers. Discrepancies in cancer incidence between
nations are often explained by differences in access to preventive healthcare services and differential
patterns of behavioral risk, such as smoking. Although differences in cancer incidence between low- and
high-resource countries are not true socioeconomic disparities, they reflect systematic differences
between those areas of the world with high income and those with relatively low income.
6. PSYCHOSOCIAL FACTORS
Few studies in psychosocial cancer research discuss how psychosocial factors fi t into the context of
cancer causation in terms of initiation or promotion, latency, duration and timing, and pattern of
exposure. Researchers on psychosocial risk factors for cancer should refer to the guidelines for cancer
causation published by the International Agency for Research in Cancer (IARC) in Lyon, France, in the
worldwide eff ort to identify cancer-causing agents. Since , working groups convened by IARC
have assessed the degree of evidence for the carcinogenicity to humans of some biological,
physical, chemical, and occupational factors and have ranked risk factors for cancer according to the
degree of evidence for causality.
Researchers on psychosocial risk factors for cancer should refer to the guidelines for cancer causation
published by the International Agency for Research in Cancer (IARC) in Lyon, France, in the worldwide
eff ort to identify cancer-causing agents. Since 1969, working groups convened by IARC have assessed
the degree of evidence for the carcinogenicity to humans of some 800 biological, physical, chemical, and
occupational factors and have ranked risk factors for cancer according to the degree of evidence for
causality.
The three psychosocial factors that have been most rigorously studied in investigations of psychosocial
cancer risks are major life events or stress, depression or depressive mood, and personality or personality
traits.
 Numerous studies have investigated the association between major life events, stress in daily life or
work-related stress, and the risk for cancer. depression independently increases the risk for cancer, but
they emphasize the deleterious effect that depression can have on lifestyle.

7. SOCIAL ENVIRONMENT AND CANCER

Social environment has both structural and functional characteristics. Structural measures of the social
environment describe the existence of connections with network members. Three types of structural
measures have been evaluated: marital status, network size, and social integration. Functional measures
of the social environment tap the receipt of support resources or the perception that support resources are
available. The most common functions or kinds of support assessed are emotional support, instrumental
support, and informational support.
Social structure represents the presence of social network members, such as marital status, network size,
and social integration. One of the primary pathways by which social structure is expected to influence
health is by the provision of support functions, such as emotional and instrumental support. Both social
structure and support functions may influence the incidence and mortality from cancer as well as cancer
survival via cognitive, affective, and behavioral pathways.
The overall risk of cancer for divorced individuals was slightly less than that for married individuals.
Divorce was associated with an increased risk of lung cancer, pancreatic cancer, digestive tract cancers,
cervical cancer, and anal cancer.
It has been found stronger relations between the social environment and disease progression or cancer
survival than cancer incidence. First, people who have stronger social ties and more social support may
engage in better health behavior and may be more adherent to treatment recommendations. Second,
social ties and support may lead to earlier treatment-seeking in response to symptoms, which could result
in earlier detection of the disease.

Palliative and Terminal Care

In the course of cancer care, many transitions occur for patients, families, and the care teams. The
“transition” to palliative care is perceived to be one of the more difficult, but it need not be. Psycho-
oncologists are well positioned to support patient, family, and oncologist while they navigate changes in
goals of care throughout an illness course. Palliative care is an approach to the relief of suffering. It grew out
of, and includes, hospice care for the terminally ill. Suffering from cancer is substantial. Suffering can have
physical, psychological, social, and spiritual components
The term “palliate” originated with the Latin term pallium which means “cloak” or “cover.” While at
one time the term palliative care was used as a pejorative for “covering up” the real problem; it is now a
superlative; “covering up” the suffering and letting the patient experience the best quality of life possible.
The field of palliative care encompasses a wide range of therapeutic interventions that aim to prevent and
relieve suffering caused by the multiple issues that patients, families, and caregivers face at any stage during
an acute or chronic life-threatening illness. In providing whole-person care to relieve suffering, palliative
care attends to all domains of the human experience of illness that may be involved: physical, psychological,
social, and spiritual. Quality of life rather than quantity of life is most often the chief aim of those engaged
in the delivery of palliative care.
Palliative care can be delivered at primary (generalist), secondary (specialist), or tertiary (academic)
levels. At the primary level, all physicians, nurses, and other health professionals need basic skills in
relieving suffering. In this sense, the palliative care skills one would expect of every medical, radiation,
surgical, or paediatric oncologist qualify as primary palliative care. One might expect oncology
professionals to even have exemplary skills in this area. Secondary levels refer to specialist physicians and
services. Palliative Medicine is the term coined to denote the physician subspecialty concerned with the
relief of suffering within the larger interdisciplinary model of palliative care.
 Palliative treatments are not adjuncts or complementary to “conventional” cancer care, but are an
essential part of good cancer care. In fact, when oncologists integrate palliative care in their practice, the role
of the palliative care specialist is only to help with the difficult cases. When considered carefully, no care
provider would suggest waiting to introduce measures for alleviating suffering and improving quality of life
until either all attempts at cure have been exhausted or the patient and family plead for such efforts to stop.