Family and Caregiver Issues 283exciting area for future research and a possible means of ex-
plaining one pathway between behavioral factors and cancer-
related health outcome.
Prevention Issues
All of the interventions discussed so far are geared to impact
on health and mental health parameters aftera person is di-
agnosed with cancer. However, treatment strategies can also
affect behavioral risk factors, thus attempting to prevent
cancer to some extent. Some of the behavioral risk factors
mentioned earlier include smoking, alcohol, diet, and sun
exposure. Reviews of the relevant treatment literature bases
concerning some of these behaviors is contained in other
chapters of this volume, and therefore will not be repeated
here. With regard to sun exposure, some interventions have
led to increased knowledge of skin cancer and awareness of
protective measures; however, programs have had only lim-
ited success with increasing preventive behaviors in at-risk
groups (Cohen & Baum, 2001).
Prevention strategies are also important for individuals
considered at high risk due to genetic and familial factors.
For example, a positive family history of breast cancer is an
important risk factor for breast cancer in women (Slattery &
Kerber, 1993). As such, “rst-degree relatives of women with
breast cancer may also be at risk for psychological distress.
With this in mind, Kash, Holland, Osborne, and Miller
(1995) evaluated the ef“cacy of a group psychoeducational
intervention for women at high risk for breast cancer. Their
protocol included breast cancer education and risk communi-
cation, coping skills training, and group social support. As
compared to no-treatment control participants, patients
undergoing the group therapy program exhibited signi“cant
improvements in knowledge and risk comprehension and a
signi“cant decrease in perceived barriers to mammography.
More importantly, group therapy participants increased hav-
ing mammograms, clinical breast examinations, and breast
self-examinations during the year following treatment as
compared to the control subjects.
Schwartz et al. (1998) evaluated a brief PST intervention
as a means to reduce distress among women with a “rst-
degree relative recently diagnosed with breast cancer. Results
indicated that whereas patients in both the PST and an educa-
tional control group exhibited signi“cant decreases in
psychological distress, such differences did not differ as a
function of treatment condition. However, for participants in
the PST condition who were found to regularly practice the
PST techniques, differences in decreased cancer-speci“c
distress were signi“cantly greater as compared to control
participants and those PST subjects only infrequently using
the problem-solving skills.SummaryOverall, research has amply demonstrated that a variety of
psychosocial interventions are effective in reducing speci“c
cancer-related physical (e.g., pain, nausea, and vomiting) and
emotional (e.g., depression, anxiety) symptoms, as well as
enhancing the overall quality of life of cancer patients. Such
treatment programs include educational interventions, a wide
array of cognitive-behavioral interventions, and group psy-
chotherapy protocols. Using the telephone to increase acces-
sibility to such programs has also begun to show promise.
Among these various approaches, CBT interventions have
been more often the focus of empirical investigations, and
thus, have tended to emerge as the more effective and versa-
tile overall therapeutic model.
In addition to improving cancer patients• emotional well-
being, data suggests that psychosocial interventions can also
lead to improved survival by affecting the course of the can-
cer itself. One biological pathway that has been identi“ed as
a potential mechanism by which this can occur is the immune
system. However, additional studies have noted a lack of an
affect on survival rates as a function of participating in psy-
chosocial treatment. Moreover, the literature providing evi-
dence to support a link between behavioral variables and
health outcome as mediated by the immune system is only in
its infancy with regard to cancer. Therefore, substantial addi-
tional research is necessary before the nature of these rela-
tionships can be clearly elucidated.
Psychosocial interventions have also been developed
for at-risk groups (e.g., “rst-degree relative of women
with breast cancer) or people engaging in risky cancer-
engendering behaviors (e.g., excessive sun exposure) as a
means of reducing risk and preventing cancer.FAMILY AND CAREGIVER ISSUESIn addition to the effects on patients themselves, the experi-
ence of cancer and its treatment can change the lives of
family members, and in particular, the primary caregiver
(e.g., spouse). With shifts in health care economics, espe-
cially during the end of the twentieth century, more care and
recovery of cancer patients takes place at home, therefore,
having a potentially greater impact on the roles and responsi-
bilities of family members (Houts, Nezu, Nezu, & Bucher,
1996; Laizner, Yost, Barg, & McCorkle, 1993). This shift in