The psychosocial factors in the initiation and promotion of cancer

Page 339
Black blue
HIV AND CANCER
339
The prevalence of cancer
In 1991, it was reported that there were 6 million new cases of cancer in the world
every year, and that one-tenth of all deaths in the world are caused by cancer. In 1989,
it was reported that cancers are the second leading cause of death in the UK and
accounted for 24 per cent of all deaths in England and Wales in 1984 (Smith and
Jacobson 1989). The main causes of cancer mortality among men in England and Wales
are lung cancer (36 per cent), colorectal cancer (11 per cent), prostate cancer (9 per
cent); and among women are breast cancer (20 per cent), lung cancer (15 per cent),
colorectal cancer (14 per cent), ovarian cancer (6 per cent), cervical cancer (3 per cent).
While the overall number of cancer deaths do not appear to be rising, the incidence of
lung cancer deaths in women has risen over the past few years.
The role of psychology in cancer
A role for psychology in cancer was first suggested by Galen in  200–300, who argued
for an association between melancholia and cancer, and also by Gedman in 1701, who
suggested that cancer might be related to life disasters. Eighty-five per cent of cancers
are thought to be potentially avoidable. Psychology therefore plays a role in terms,
attitudes and beliefs about cancer and predicting behaviours, such as smoking, diet and
screening which are implicated in its initiation (details of these behaviours can be found
in Chapters 2, 5, 6, 7, 8 and 9). In addition, sufferers of cancer report psychological
consequences, which have implications for their quality of life. The role of psychology in
cancer is also illustrated by the following observations:
I Cancer cells are present in most people but not everybody gets cancer; in addition
although research suggests a link between smoking and lung cancer, not all heavy
smokers get lung cancer. Perhaps psychology is involved in the susceptibility to
cancer.
I All those who have cancer do not always show progression towards death at the same
rate. Perhaps psychology has a role to play in the progression of cancer.
I Not all cancer sufferers die of cancer. Perhaps psychology has a role to play in
longevity.
The potential role of psychology in understanding cancer is shown in Figure 14.2.
The role of psychology in cancer will now be examined in terms of (1) the initiation
and promotion of cancer; (2) the psychological consequences of cancer; (3) dealing with
the symptoms of cancer; and (4) longevity and promoting a disease-free interval.
The psychosocial factors in the initiation and promotion
of cancer
1 Behavioural factors. Behavioural factors have been shown to play a role in the
initiation and promotion of cancer. Smith and Jacobson (1989) reported that 30 per
cent of cancers are related to tobacco use, 35 per cent are related to diet, 7 per cent
Page 339
Black blue
Page 340
Black blue
340 HEALTH PSYCHOLOGY
Fig. 14-2 The potential role of psychology in cancer
are due to reproductive and sexual behaviour and 3 per cent are due to alcohol. These
behaviours can be predicted by examining individual health beliefs (see Chapters 2, 5,
6 and 9).
2 Stress. Stress has also been shown to have a role to play in cancer. Laudenslager et al.
(1983) reported a study that involved exposing cancer-prone mice to stress (shaking
the cage). They found that if this stressor could be controlled there was a decrease
in the rate of tumour development. However, if the stressor was perceived as
uncontrollable this resulted in an increase in the development. This suggests a role for
stress in the initiation of cancer. However, Sklar and Anisman (1981) argued that an
increase in stress increased the promotion of cancer not its initiation (see Chapter 11
for a discussion of the relationship between stress and illness).
3 Life events. It has also been suggested that life events play a role in cancer (see
Chapter 10 for a discussion of life events). A study by Jacobs and Charles (1980)
examined the differences in life events between families who had a cancer victim and
families who did not. They reported that in families who had a cancer victim there
were higher numbers who had moved house, higher numbers who had changed some
form of their behaviour, higher numbers who had had a change in health status
other than the cancer person, and higher numbers of divorces indicating that life
events may well be a factor contributing to the onset of cancer. However, the results
from a meta-analysis by Petticrew et al. (1999) do not support this suggestion. They
identified 29 studies, from 1966 to 1997, which met their inclusion criteria (adult
women with breast cancer, group of cancer-free controls, measure of stressful life
events) and concluded that although several individual studies report a relationship
between life events and breast cancer, when methodological problems are taken into
account and when the data across the different studies is merged ‘the research shows
no good evidence of a relationship between stressful life events and breast cancer’.
Page 340
Black blue
Page 341
Black blue
HIV AND CANCER
341
4 Control. Control also seems to play a role in the initiation and promotion of cancer
and it has been argued that control over stressors and control over environmental
factors may be related to an increase in the onset of cancer (see Chapter 11 for a
discussion of control and the stress–illness link).
5 Coping styles. Coping styles are also important. If an individual is subjected to
stress, then the methods they use to cope with this stress may well be related to
the onset of cancer. For example, maladaptive, disengagement coping strategies, such
as smoking and alcohol, may have a relationship with an increase in cancer (see
Chapters 3 and 11 for a discussion of coping).
6 Depression. Bieliauskas (1980) highlighted a relationship between depression and
cancer and suggests that chronic mild depression, but not clinical depression may
be related to cancer.
7 Personality. Over the past few years there has been some interest in the relationship
between personality and cancer. Temoshok and Fox (1984) argued that individuals
who develop cancer have a ‘type C personality’. A type C personality is described as
passive, appeasing, helpless, other focused and unexpressive of emotion. Eysenck
(1990) described ‘a cancer-prone personality’, and suggests that this is characteristic
of individuals who react to stress with helplessness and hopelessness, and individuals
who repress emotional reactions to life events. An early study by Kissen (1966) supported this relationship between personality and cancer and reported that heavy
smokers who develop lung cancer have a poorly developed outlet for their emotions,
perhaps suggesting type C personality. In 1987, Shaffer et al. carried out a prospective
study to examine the predictive capacity of personality and its relationship to developing cancer in medical students over 30 years. At follow-up they described the type of
individual who was more likely to develop cancer as having impaired self-awareness,
being self-sacrificing, self-blaming and not being emotionally expressive. The results
from this study suggest that those individuals who had this type of personality were
16 times more likely to develop cancer than those individuals who did not. However,
the relationship between cancer and personality is not a straightforward one. It has
been argued that the different personality types predicted to relate to illness are not
distinct from each other and also that people with cancer do not consistently differ
from either healthy people or people with heart disease in the predicted direction
(Amelang and Schmidt-Rathjens 1996).
8 Hardiness. Kobasa et al. (1982) described a coping style called ‘hardiness’, which
has three components: control, commitment and challenge. Low control suggests a
tendency to show feelings of helplessness in the face of stress. Commitment is defined
as the opposite of alienation: individuals high in commitment find meaning in
their work, values and personal relationships. Individuals high in challenge regard
potentially stressful events as a challenge to be met with expected success. Hardiness
may be protective in developing cancer.
Page 341
Black blue