Psychosocial issues in oncologic practice

Impressive gains in the survival of some patients with malignant diseases have primarily reflected the availability of multimodality programs for selected pediatric neoplasms and germ cell tumors and for subsets of patients with regional breast cancer, colorectal cancer, and small-cell lung cancer. Most patients with advanced solid tumors, however, will die of their disease. Sophisticated psychosocial investigations of patients with advanced cancer have targeted several areas in which clinicians can positively influence quality of life. Families often "cascade through an avalanche" of emotional upheavals as patients struggle with the sequelae of their illness. After a patient dies, clinicians should be familiar with some generally recognized patterns of behavior that are indicative of a normal mourning process. This knowledge may help clinicians be aware of situations that might necessitate intervention of other professionals, either medical or pastoral. Attention to psychosocial events is an integral part of a comprehensive oncologic program to facilitate patients and families to live in an atmosphere of peace and dignity.