Psychological concomitants of cancer: clinical aspects

Surveys have shown that cancer is probably the most commonly feared illness in our society. The lack of personal control over the current treatment methods and the uncertainty about outcome are two factors that set cancer apart from many other illnesses and influence greatly how patients, families, and physicians communicate. The psychological responses to cancer fall into four general categories: (1) sadness and hopelessness, (2) anxiety, (3) anger and/or guilt, and (4) a stance of avoidance or denial. These responses are modified by psychosocial factors such as premorbid psychological development, culture, the nature of emotional support, prior experience with illness, and the setting in which the cancer begins. In addition, factors such as age, sex, specific type of cancer and specific treatment, and the presence of delirium further modify the emotional response. Delirium is particularly common, often subtle, frequently unrecognized and may be a major cause of aberrant emotional reactions in the cancer patient.