Psychosocial Effects of Cancer 271spectrum), has been linked to increased risk for skin cancer
(melanomas and nonmelanomas). In addition to being car-
cinogenic, UVB is an immunosuppressor, potentially leading
to DNA damage. UVA radiation, which is between 320 and
400 nanometers of the solar spectrum, because it was thought
to be noncarcinogenic, is the basis for commercial tanning
salon sun lamps. Recent studies, however, demonstrate that
individuals who use suntanning beds had a 39% higher risk
of melanoma (Westerdahl, Olsson, & Ingvar, 1994). In addi-
tion, sunscreen lotions that block UVB, but not UVA, may
also be linked to increased melanoma rates.
Socioeconomic Status
Research that cuts across many varying populations around
the world provides the following conclusions: (a) depending
on the speci“c cancer site, in general, a direct and inverse
relationship exists between socioeconomic status (SES) and
cancer incidence; and (b) across cancer sites, the relationship
between SES and cancer survivalis positive, that is, as SES
decreases, so does the rate of cancer survival (Balfour &
Kaplan, 1998). It is likely that SES impacts on cancer inci-
dence and survival rates by in”uencing various lifestyle
activities, health behaviors, and access to health care, rather
than on any endogenous pathways (e.g., immune system)
themselves.
Personality
A cancer-prone personality, Type C, has been described by
Morris and Greer (1980) as being characterized by behavior
that is appeasing, unassertive, unexpressive of negative emo-
tions (particularly anger), and socially compliant. Although
some research suggests that such a set of personality charac-
teristics is frequently observed among cancer patients, there
is no clear evidence that this, or any other, personality type
has a causal role in cancer (Watson & Greer, 1998).
Summary
Only a small percentage of cancers are known to have a ge-
netic etiology. Certain lifestyle activities, such as smoking,
drinking alcohol, diet, and exposure to the sun, places an
individual at substantial risk for developing cancer and thus
underscores the major role that psychosocial and behavioral
factors serve in the etiopathogenesis of cancer. More impor-
tantly, the causal role that such behaviors play suggests many
cancers might be preventable.
Research that has focused on a causal link between a par-
ticular personality type and cancer, similar to the association
identi“ed between Type A personality characteristics and
heart disease (see chapter by O•Callahan, Andrews, and
Krantz in this volume), has not been fruitful. Speci“cally, a
Type C personality has not been proven to be premorbidly
predictive of cancer incidence.PSYCHOSOCIAL EFFECTS OF CANCERConsiderable medical progress has been made in treating this
set of diseases. Many forms are curable and there is a sus-
tained decline in the overall death rate from cancer when you
focus on the impact on the totalpopulation (Murphy, Morris,
& Lange, 1997). Because of improvements in medical sci-
ence, more people are living with cancer than ever before.
Although the extensive medical needs of such patients may
be well attended to, psychosocial and emotional needs are
often overlooked (Houts, Yasko, Kahn, Schelzel, & Marconi,
1986). Almost every aspect of a person•s life can be affected,
as cancer engenders many stressors and can lead to a signi“-
cantly compromised quality of life. Even for people who
historically have coped well with major negative life
events, cancer and its treatment greatly increases the stressful
nature of even routine daily tasks. Weisman and Worden
(1976...1977) refer to this situation for cancer patients as an
•existential plight,Ž where a person•s very existence may be
endangered. Recognizably, not every individual diagnosed
with cancer will experience a plethora of problems, but most
patients do report signi“cant dif “culties.Prevalence of Psychiatric DisordersEstimates of the prevalence of psychological dif“culties
range between 23% and 66% across cancer populations
(Telch & Telch, 1985). In a study of 215 cancer patients with
mixed diagnoses (Massie & Holland, 1987), 53% of the can-
cer patients evaluated were found to be adjusting normally
to stress; however, nearly half (47%) had clinically apparent
psychiatric disorders. Over two thirds (68%) had reactive
anxiety and depression (adjustment disorders with depressed
or anxious mood), 13% had major depression, 8% had an or-
ganic mental disorder, 7% had personality disorders, and 4%
had anxiety disorders. In addition, of the psychiatric disor-
ders observed in this population, 90% were reactions to or
manifestations of the disease or treatment itself.
The prevalence of psychiatric disorders is especially high
in patients experiencing pain as a result of cancer and its treat-
ment. In the Psychosocial Collaborative Oncology Group
study (Derogatis, Morrow, & Fetting, 1983), 39% of those
who received a diagnosis of a psychiatric disorder were