Life stress and disease-free interval
In a case control study, Ramirez et al. (1989) examined the relationship between life
stress and relapse in operable breast cancer. The life events and difficulties occurring
during the disease-free interval were recorded in 50 women who had developed their first
recurrence of breast cancer and 50 women who were in remission. The two subject
groups were matched for the main physical and pathological factors believed to be
associated with prognosis and for the socio-demographic variables believed to be related
to life events and difficulties. The results showed that life events rated as severe were
related to first recurrence of breast cancer. However, the study was cross-sectional in
nature, which has implications for determining causality.
FOCUS ON RESEARCH 14.2: PUTTING THEORY INTO
PRACTICE – TREATING CANCER SYMPTOMS
A randomized controlled trial to examine the effects of adjuvant psychological
therapy on the psychological sequelae of cancer (Greer et al. 1992).
Research has examined the psychological consequences of having cancer. This study
examined changes in cancer patients’ psychological state as a result of adjuvant psycho-
logical therapy (APT). The study used a random controlled trial design in order to
compare changes in measures of quality of life in patients receiving APT with those
receiving no therapy.
Background
Evidence suggests that a substantial minority of cancer patients show psychological
ill-health, particularly in terms of depression and anxiety. As a result, a number of psycho-
therapeutic procedures have been developed to improve cancer patients’ emotional well-
being. However, evaluating the effectiveness of such procedures raises several ethical and
methodological problems, and these are addressed by Greer et al. (1992). These are:
(1) the ethical considerations of having a control group (can patients suffering from
psychological distress not be given therapy?); (2) the specificity of any psychological
intervention (terms such as counselling and psychotherapy are vague and any procedure
being evaluated should be clarified); and (3) the outcome measures chosen (many
measures of psychological state include items that are not appropriate for cancer
patients, such as weight loss and fatigue, which may change as a result of the cancer not
the individuals’ psychological state). The authors of this study aimed to examine the
effects of APT on the psychological state of cancer patients in the light of these problems.
Methodology
Subjects A total of 174 patients attending the Royal Marsden Hospital in the UK were
recruited for the study using the following criteria: (1) any form of cancer except cerebral
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