Psychological consequences of cancer
Emotional responses
Up to 20 per cent of cancer patients may show severe depression, grief, lack of control,
personality change, anger and anxiety. Pinder et al. (1993) examined the emotional
responses of women with operable breast cancer and reported that these can differ
widely from little disruption of mood to clinical states of depression and anxiety. The
emotional state of breast cancer sufferers appears to be unrelated to the type of surgery
they have (Kiebert et al. 1991), whether or not they have radiotherapy (Hughson et al.
1987) and is only effected by chemotherapy in the medium term (Hughson et al. 1986).
However, persistent deterioration in mood does seem to be related to previous psychiatric
history (Dean 1987), lack of social support (Bloom 1983), age, and lack of an intimate
relationship (Pinder et al. 1993). Pinder et al. (1993) also reported that in sufferers with
advanced cancer, psychological morbidity was related to functional status (how well
the patient functioned physically) and suggested that lowered functional status was
associated with higher levels of depression, which was also related to lower social class.
However, lowered mood is not the only emotional consequence of cancer. Women with
breast cancer often report changes in their sense of femininity, attractiveness and body
image. This has been shown to be greater in women who have radical mastectomies
rather than lumpectomies (e.g. Moyer 1997) and to occur across a range of ethnic
groups (e.g. Petronis et al. 2003).Cognitive responses
Research has also examined cognitive responses to cancer and suggests that a ‘fighting
spirit’ is negatively correlated with anxiety and depression whilst ‘fatalism’, ‘helplessness’
and ‘anxious preoccupation’ is related to lowered mood (Watson et al. 1991). Taylor
(1983) examined the cognitive adaptation of 78 women with breast cancer. She reported
that these women responded to their cancer in three ways. First, they made a search for
meaning, whereby the cancer patients attempted to understand why they had developed
cancer. Meanings that were reported included stress, hereditary factors, ingested
carcinogens such as birth control pills, environmental carcinogens such as chemical
waste, diet, and a blow to the breast. Second, they also attempted to gain a sense of
mastery by believing that they could control their cancer and any relapses. Such
attempts at control included meditation, positive thinking, and a belief that the original
cause is no longer in effect. Third, the women began a process of self-enhancement. This
involved social comparison, whereby the women tended to analyse their condition in
terms of others they knew. Taylor argued that they showed ‘downward comparison’,
which involved comparing themselves to others worse off, thus improving their
beliefs about their own situation. According to Taylor’s theory of cognitive adaptation,
the combination of meaning, mastery and self-enhancement creates illusions which are
a central component of attempts to cope. This theory is discussed in more detail in
Chapter 3.342 HEALTH PSYCHOLOGY