Psychosocial Effects of Cancer 275more severe the structural and functional loss, the slower the
recovery, the more prolonged the isolation, the lower the self-
esteem, and the more pronounced the postoperative depres-
sion (Krouse, Krouse, & Fabian, 1989).
Chemotherapy
Along with physical side effects, such as nausea, diarrhea,
fatigue, cognitive changes or anorexia, chemotherapy treat-
ments can result in time lost from work, family disruption,
and depressed mood. The end of treatment also signi“es a
loss for the patient because of the decreased medical surveil-
lance and the loss of support and communication with the
medical personnel (Hart, McQuellon, & Barrett, 1994).
Approximately 45% of adult cancer patients experience nau-
sea, vomiting, or both in the 24 hours preceding their
chemotherapy (Burish & Carey, 1986). Anticipatory nausea
and vomiting is a psychological consequence resulting from
an associative learning process (i.e., classical conditioning)
within the context of the chemotherapy treatment. These
symptoms are often embarrassing for patients and can lead to
discontinuation of treatment, resulting in more detrimental
conditions (Carey & Burish, 1988). After treatment, these
symptoms can persist and may actually generalize to other
situations (Andrykowski, Redd, & Hat“eld, 1985).
Radiation Therapy
Similar to patients experiencing chemotherapy, patients• re-
ceiving radiotherapy may become anxious. Some reports in-
dicate that the waiting room experience triggers anticipatory
anxiety. Women also fear recurrence after treatment because
of the decreased medical attention from the radiotherapy
staff (Greenberg, 1998). Radiation often arouses associa-
tions in individuals with an atomic bomb, nuclear accidents,
radiation sickness, and ionizing radiation in the atmosphere.
Patients can also experience claustrophobia, fear that the
machine will not release the appropriate amount of radia-
tion, and fear of burns to the skin. Greenberg (1998) found
that 26% of a sample of oncology patients undergoing radi-
ation treatment experienced signi“cant apprehension and
anticipation due to the fear that radiation may damage their
bodies. The acute physical side effects of radiotherapy de-
pend on the site, dose, and volume of treatment. However,
anticipatory or conditioned nausea is prevalent in 60% of
cases (Greenberg, 1998). Dry skin, desquamation, and dark-
ening as a result of the treatment, may cause body image
concerns in patients. Other side effects impacting the
patients• quality of life include fatigue, sore throat, anorexia,
and diarrhea.
Bone Marrow TransplantationBone marrow transplantation (BMT) is a physically and
emotionally taxing procedure for both the patient and family.
Patients undergoing a BMT are often treated for an extended
time at a major medical center, which for many, may be a dis-
tance from home. This often creates monetary and trans-
portation problems. Waiting for a donor, fearing relapse, the
threat of infection in the isolated rooms, as well as the threat
of death can also produce anxiety (Wochna, 1997). Neu-
rocognitive symptoms are likely to appear during hospitaliza-
tion, resulting in hallucinations or delirium. Even after
discharge, the uncertainty of recurrence, the absence of med-
ical care, and the pressure to engage in self-care behaviors to
protect against infections can be distressing. Patients may
be physically compromised by fatigue and weakness that
may persist for 6 to 12 months post-BMT (Patenaude, 1990).
This results in functional limitations impeding the patient•s
quality of life.SummaryThe psychosocial sequella of cancer can be devastating.
Whereas not all oncology patients go on to experience clini-
cally signi“cant levels of psychopathology, estimates of gen-
eral prevalence suggest that individuals with cancer are likely
to undergo higher rates of psychological distress than the
general population. Such psychological reactions include
depression, anxiety, suicide, delirium, body image problems,
and sexual dysfunctions.
Although the research generally documents an increased
cancer-related risk for psychological distress, estimates of
incidence and prevalence often vary signi“cantly from study
to study. In large part this variability is due to the method-
ological variations characteristic of these investigations.
More speci“cally, these studies use different measures of dis-
tress, vary in their sample selection process, and employ
varying diagnostic criteria. Future research should attempt to
develop consensual methodologies to better estimate preva-
lence rates of emotional distress and psychopathology among
oncology populations.
In addition to the general emotional distress that oncology
patients may experience, cancer treatment itself can engender
additional problems. Cancer patients often describe the
treatment as worse than the disease. For example, a com-
mon problem experienced by cancer patients undergoing
chemotherapy is anticipatorynausea and vomiting, whereby
the nausea is classically conditioned to the antineoplastic
protocol, leading to patients experiencing such problems
prior to the next chemotherapy appointment.