Konstantina Kontopoulou, Ph.D. Candidate, School of Economics and Political Sciences, Aristotle University of Thessaloniki
Ένας από τους πλέον υποτιμημένους τομείς της σωματικής και ψυχικής υγείας είναι η ψυχοκοινωνική ογκολογία. Καταδεικνύοντας την έννοια της άρρηκτης σχέσης μεταξύ του νου και του σώματος, θέτει επίσης νέα ερωτήματα για τις πολιτικές υγείας που σχετίζονται με τη θεραπεία και την πρόληψη του καρκίνου. Η παρούσα βιβλιογραφική επισκόπηση στοχεύει στη γεφύρωση του χάσματος μεταξύ ψυχοκοινωνικής ογκολογίας και ιατρικού ιστορικού. Πρωταρχικός στόχος του δοκιμίου είναι η παροχή και προώθηση έρευνας που περιέχει συμπεράσματα, όσον αφορά στη σχέση μεταξύ κινδύνου καρκίνου και ψυχοκοινωνικής ευημερίας.
One of the most underappreciated areas of physical and mental health is psycho-social oncology. Demonstrating the concept of an unbreakable relationship between the mind and the body, it also poses new questions for health policies related to cancer treatment and prevention. This bibliographical overview aims to bridge the gap between psycho-social oncology and medical history. Its primary goal is to provide and promote research that contains conclusions about the relationship between cancer risk and psycho-social well-being.
Psycho-social oncology as a branch of oncology
Psycho-social oncology is a branch of oncology that studies the connections between psycho-social sciences and cancer biology. Its history clearly demonstrates that a wide range of biological and psychological information has to be investigated further in order to better understand how stress and body function coexist and react. There is currently insufficient data to substantiate this link (Dalton et al., 2002). Historical evidence, on the other hand, has intriguing implications for future research. Understanding whether there is a link between these two features would also be an essential step in preventative medicine. Kash, Mago, and Kunkel (2005) emphasize the importance of cancer care.
Increasing attention is being paid to the emotional and psycho-social needs of cancer patients. As a result, there now are millions of cancer survivors in the United States. There has been a realization that cancer survivors have distinct psychosocial needs. As cancer survivors live longer, reduction of psychological distress has been recognized as being an important part of having an improved quality of life. There have been numerous changes in the field of psychosocial oncology since it first began 25 years ago. (2005, p. 211)
The historical context
Hippocrates recognized the psychosomatic component of medicine, which emphasized the contemporary holistic perspective. According to Kleisiaris (2014), the influence of Hippocrates and his observations on all current and later philosophers provides a considerable push to the psychosomatic notion of medicine and will contribute to its consolidation for many generations. Hippocrates’ opinions were shared by Galinus. Rigatos (2000)A significant amount of research appears to have determined the first exceptional conclusions regarding the connection between human biology and psychology in the latter years and during the 18th, 19th, and 20th centuries. Guy notes that there is some sort of link between cancer growth and ladies with sad personalities (Guy, 1759).
Almost a century later, Snow (1893) analyzes 250 cancer patients. One hundred and fifty of them had recently lost at least one member of their family, and 32 of the remaining had experienced major career challenges before developing cancer. (Snow, 1893) William Parker (1885) investigates 397 cases of females with breast cancer and their pre-cancer psychosocial factors. The women had been through grief for various reasons. Moving forward to the twentieth century, Evans (1926) studied 100 cancer patients and discovered that they had lost some key emotional attachments prior to the onset of their neo-plasmatic sickness. This could have been a death or a sentimental loss. He also emphasized that he noticed the inability of the patients to break out. They had accumulated energy that could not be exposed.
Scholtz and Pfeiffer (1923) seem to have noticed a wide range of neurotic manifestations before the appearance of pancreatic cancer in patients. Dalton supports the assumption that psychosocial factors such as melancholy, generalized anxiety and limited social support have been linked to cancer risk (Dalton et al, 2002).
Some data on the biology behind
For decades, the single involvement of genes and certain lifestyle choices has been the primary risk factor for cancer development. More studies in following years gave evidence on the hypothesis that some biological mechanisms are tied to our organism’s biology. Chronic stress has been demonstrated to impair tumor suppressor and anti-angiogenic functions. Continuous activation of the sympathetic nervous system during chronic stress was found to be associated with the p53 gene, which is a tumor suppressor gene (Hassan et al., 2013).
The effect of persistent stress destabilizes p53’s function as a tumor suppressor and anti-agiogenic factor. With the exception of the p53 “deactivating” suspicion, it has been demonstrated that Catecholamines enhance tumor growth in murine prostate cancer models by phosphorylating and inactivating the pro-apoptotic molecule Bcl-2-associated death promoter, which is normally associated with regulated cell death, apoptosis. (2013) (Hassan et al.).Taking everything into account, it appears that unfavorable psycho-social elements before to human cancer and after the initial diagnosis contribute to certain mechanisms that play a role in both the genesis and progression of neoplasmatic disease.
The Self in Loss and the Social Circle
Although studies have shown that cancer patients do not meet the diagnostic criteria for any particular psychopathological disorder (Massie & Holland, 1989; Derogatis, 1983), patients experience various emotional difficulties in their attempt to cope with the disease (Bisson, 2002). In 1983, Derogatis showed that anxiety disorders were noticed in 20–25 percent of the patients. This study was later affirmed by Zabora (2001) and Stark (2002). Recent research has shown that anxiety-related symptomatology has been associated with a poorer survival rate in cancer patients. (Hamer, 2009; Chida and Hamer, 2008).
Generalized anxiety disorder should also be examined in cancer patients or in patients who experienced anxiety disorders before the beginning of the disease. It is shown that pro-inflammatory cytokines, which induce sickness behavior with symptoms overlapping those of clinical depression, are validated biomarkers of increased inflammation in patients with cancer. (Sotelo et al., 2014, p. 23) Rigatos also explains that the difficulty of socialization is evident after the diagnosis.
Some avoid communicating with the cancer patient due to their fear of cancer; others react with a sympathetic attitude or even feel sorry for the patient. Some others might even treat them with hostility, like they face death themselves. (2001, 182) The significance of research regarding depression in cancer patients Is evident however it remains an under-recognized comorbidity with serious consequences for patient suffering and their quality of life especially after the diagnosis. What should be also taken into account is that depression in cancer patients is distinct from depression in healthy people. It has different symptomatology and a biological aetiology which is different from the other cases of depression and might be caused by surgery, chemotherapy and the activation of pro-inflammatory cytokines with an effect on tryptophan and the triggering of TRYCATs. (Smith, 2015).
Therefore, the flexibility of ideas and the adaptation of applied methods to the personality and the desires of the patients are of crucial importance for social, mental and medical scientists who work with them.
Taking past scientific evidence into account, it appears that emphasis could be placed in childhood loss or trauma. Through government initiatives, social workers and psychologists could maintain contact with local organizations in every city to ensure those in need of psychological assistance will be able to have them. Hospitals could provide social and psychological care to both patients and staff. This would also mean a much more energetic role in the field of environmental and social medicine.
Remaining social after the diagnosis seems a major challenge. Reasonably however, the wider circle of friends and family has been shown to play an important role in terms of coping and psychological support (Wdowik et al., 1997; Riegel and Carlson, 2002; Bayliss et al., 2003; Jerant et al., 2005); therefore, any intervention strategy or technique for those who already suffer could also place importance on the role of family and maybe a new friend circle focused on the hospital patients. Small groups of patients could participate in small psycho-therapeutic interventions inside or outside the hospital setting. Interventions like the ones mentioned above, may also provide a sense of supportive atmosphere and mutual understanding. Furthermore, social circles may contribute to a sense of self-affirmation in terms of existence.
The role of Art
Regarding the treatment of mental frustration during cancer therapy, this is also an extremely difficult task for all mental and medical staff. Frank and Cook (1986) linked music therapy to relaxation, to treat physical pain in cancer patients, or to episodes of cytostatic drugs. Eldri Steen, a nurse in an oncology hospital in Oslo, used musical compositions in cancer patients who suffered from pain, to reduce the stress-relieving effects of drugs (Steen,1990). Art therapies employing a variety of methodologies assist cancer patients in dealing with typical issues such as negative feelings and thoughts, stress disorders, chronic hyperactivity, troublesome behavioral patterns, attention deficiency, and memory deficit. (Heather & Stuckey, 2010). One of the most effective ways for cancer patients to convey their emotions is through the use of different colors.(Darley, 2008).
The process of creating art allows the patient to communicate his or her thoughts as well as generate ideas. (Camic, 2004) It seems that art has a positive effect in cancer and this could be an implication for further applications in public hospitals through volunteering or art activities created by social workers and psychologists. (Libman, 2015) However, it is characteristically referred to in a study concerning the different therapies, art therapy is an important place, but some patients are too reluctant to participate in visual curative activity. (Nainis et al., 2008)
Gardening and Plantation
One of the unexplored regions of health psychology and clinical social work is the effect of gardening on cancer patients and cancer prevention. Simple, affordable, aesthetically interesting for everyone, it gives an implication for a new model of application in the hospital setting. Recent study on community gardening has shown that the population who was involved in the activity of plantation developed a different lifestyle, eating healthier while feeling less anxious and stress. The study proposed gardening as a preventive medicine’s tool of cancer risk and anxiety disorders.(2023) Governments raise awareness on the relation of gardening and cancer as well.
The National Garden Scheme in the UK discusses the power of gardening for people living with cancer (2022). Despite its limited data, gardening can become a new space of research both in terms of prevention and in terms of assisting the strictly medical therapeutic parts such as chemotherapy or surgery. It also opens the way for new qualitative and quantitative research in the hospital setting.
Providing ideas for further research, thought, applications and experimentation, space for gardens in all local hospitals could be a first tool for further research.
Conclusion: towards a more personalized model
In conclusion, the link between cancer risk and negative psycho-social factors is not fully clear. However, the existing evidence from two centuries implies the demand for a more in-depth and qualitative research on the topic. Only through more individualized research in the field of psycho-social oncology will preventive oncology be able to infer clear answers on the role of social and psychological frustration in the development of cancer. Social medicine, social work, psychiatry, and preventive oncology should focus on the field in a much more dedicated way in order for more statistical or empirical data to come to the surface.
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