Cancer and stress: counselling the cancer patient

In addition to the commonly accepted aetiological agents of cancer, such as chemical carcinogens, oncogenic viruses, hereditary factors, irradiation, and chronic trauma, multiple psychological factors are also important. Among these are psychological depression, impaired emotional outlets, and perceived lack of closeness to parents. The effect of addressing these factors in addition to standard medical factors in addition to standard medical management is an important question to be answered. A pilot study is in progress, in which patients with medically advanced malignant disease are being counselled in addition to receiving appropriate medical treatment. Standard mental health processes of counselling are employed in a combination of individual and group counselling sessions. From 1974 through 1978, a total of 193 patients with medically advanced malignant disease have received counselling in addition to their medical treatment. The three most frequent diagnoses are breast cancer (71), bowel cancer (28), and lung cancer (24). These are also the three most common diagnoses in the United States. In this study we have observed median survival times of 38.5 months in advanced breast cancer, 22.5 months in advanced bowel cancer, and 14.5 months in advanced lung cancer. These survival times are considerably longer than expected median survival times reported in the literature. Our primary concern in using this approach was that the counselling be helpful and not detrimental to the duration of life, quality of life, and quality of death of the individual. Preliminary results indicate that counselling can be helpful and can also be detrimental, depending upon the dynamics of the relationships among the counsellor, the patients, the medical team and the family. This is a preliminary study, and many major questions remain unanswered.