Handbook of Psychology

278 Psychosocial Oncology

cancer prognosis as opposed to a poor prognosis (Dunkel-
Schetter, 1984). Despite the strong importance of social sup-
port in the lives of breast cancer patients, approximately 33%
of them do not feel they have adequate social support (Peters-
Golden, 1982). In studies with breast cancer patients, social
support has been found to be related to psychological, social,
and physical bene“ts (Moyer & Salovey, 1996; Royak-
Schaler, 1991; Stanton & Snider, 1993). Speci“cally, com-
munication and shared decision making with the person•s
spouse enhance adjustment to mastectomy, including the sex-
ual relationship (Royak-Schaler, 1991; Wortman & Dunkel-
Schetter, 1979).
The physical bene“ts of social support have been noted in
the research literature as well. These bene“ts have even been
identi“ed at the cellular level in a sample of breast cancer
patients. For example, patients• perceptions of the quality of
emotional support provided by signi“cant others were the
most important predictors of natural killer cell activity, an
immunological defense against neoplastic cells (Moyer &
Salovey, 1996). Studies with adult cancer patients suggest
that those who are unmarried have a decreased overall sur-
vival because they seek help later and at a more advanced dis-
ease stage. In addition, they have a higher likelihood of being
untreated for cancer. After adjustment for both factors, there
remains a poorer treatment response by unmarried individu-
als (Anderson, 1994). Therefore, it appears that social support
can act as a moderator in the relationship between stress and
health outcomes in cancer patients (Helgelson et al., 1998).

Summary

Although cancer can be a potentially devastating experience,
research has identi“ed various coping variables to be signi-
“cantly associated with positive psychological adaptation.
Such factors include a “ghting spirit or optimism and ef fec-
tive problem-solving ability. Conversely, avoidance and
denial have been found to be correlated with poor psycho-
logical outcome, although the “ndings regarding denial are
somewhat equivocal. In addition, research has focused on the
manner in which a person seeks cancer-related information
and its relationship to distress. Of great signi“cance are the
“ndings that link various coping reactions to improved health
and disease outcome.
Social support has also been a major focus of research
with speci“c regard to its role as a buffer of the negative ef-
fects of the cancer experience, both in terms of psychologi-
cal adaptation, as well as actual health outcome. The latter
has included studies focusing on overall treatment response,
as well as on the cellular level regarding immunological
variables.

Thus far, this overview of the “eld of psychosocial oncol-

ogy has focused on the etiological role that various lifestyle

activities play regarding cancer development, as well as the

psychosocial impact of cancer and its treatment. The follow-

ing section focuses on the next logical step: psychosocial

interventions that address this negative impact.

PSYCHOSOCIAL INTERVENTIONS

FOR CANCER PATIENTS

Given the previous description of the literature documenting

the negative psychosocial consequences of cancer, the impor-

tance of developing effective interventions to improve the

quality of life of cancer patients appears obvious. In fact,

Redd (1995) suggests that an important factor responsible in

part for the birth of psychosocial oncology as a “eld was the

publishing of certain studies that underscored the successful

use of behavioral procedures to control the anticipatory side

effects of cancer chemotherapy, such as nausea and vomiting

(e.g., Morrow & Morrell, 1982). Moreover, during the past

two decades, a suf“ciently large number of intervention stud-

ies have been conducted engendering a number of qualitative

and quantitative review articles (e.g., Andersen, 1992; Dreher,

1997; Fawzy, Fawzy, Arndt, & Pasnau, 1995; Meyer & Mark,

1995; Trijsburg, van Knippenberg, & Rijpma, 1992). The

general conclusion that the majority of these reviews reached

underscores the ef“cacy of a wide variety of psychosocial in-

terventions geared to improve the quality of life of adult can-

cer patients. For example, Meyer and Mark (1995) conducted

a meta-analysis of 62 treatment-control comparisons and

found the bene“cial and signi“cant effect sizeds were .24 for

emotional adjustment measures, .19 for functional adjustment

measures, .26 for measures of treatment- and disease-related

symptoms, and .28 for compound and global measures.

However, similar to a qualitative literature review regarding

earlier published studies (Watson, 1983), signi“cant differ-

ences among varying types of treatment approaches (e.g.,

behavioral versus supportive group therapy) were not found.

Because a comprehensive review of the treatment out-

come literature for cancer patients is beyond the scope of this

chapter, the reader is directed to the listed review articles.

However, in this section, we present a brief overview of this

literature to illustrate the type and variety of interventions

investigated.

Educational Interventions

The goal of educational interventions is to reduce cancer

patients• distress and improve their sense of control that may