health psychology module on cancer

1. CANCER
Chapter 11
HEALTH PSYCHOLOGY Richard O. Straub | Sixth Edition

2. What Is
Cancer? (part
1)
• Set of diseases in which abnormal
body cells multiply and spread in
uncontrolled fashion, forming a
tumor
Cancer
• Benign
• Malignant
• In situ (Growing at site where
originated)
Tumor types
•
Metastasis

3. What Is
Cancer?
(part 2)
◦ Types of Cancer
◦ Carcinoma
◦ Cancer of the epithelial cells that line
the outer and inner surfaces of the
body (breast, prostate, lung, and skin
cancer)
◦ Sarcoma
◦
◦ Lymphoma
◦ Cancer of the body's lymph system;
includes Hodgkin's disease and non-
Hodgkin's lymphoma
◦ Leukemia
◦ Cancer of the blood and blood-
producing system

4. What Is Cancer? (part 3)
• Cancer Susceptibility and Demographic Aspects
• Many individual factors, such as gender, age, and
ethnicity affect susceptibility
◦ The older people become, the greater their chances of
developing and dying of cancer
◦ The prevalence of different cancers varies
by age group
◦ More men than women develop cancer over lifetime; more
women diagnosed before age 60

5. Estimated New Cancer Cases and
Deaths by Type and Gender, 2018

6. The Risk of Cancer Increases with
Age

7. What Is
Cancer?
(part 4)
◦ Variations in Cancer
Distributed by Race and
Ethnicity
◦ Among men, African
Americans have the highest
incidence rates for cancer in
the U.S. and are more likely
to die of cancer
◦ Among women, European
Americans have highest
incidence

8. What Is
Cancer?
(part 5)
◦ Variables that contribute to ethnic
disparities in chronic disease incidence
and mortality and cancer
◦ SES
◦ Knowledge about cancer and its
treatment
◦ Attitudes toward the disease
◦
◦ Less informative patterns of
provide-patient communication and
culturally competent health care
◦

9. Screening Tests
Shown to Reduce
Cancer Deaths
◦ Types of Screening Tests
◦ Colonoscopy, sigmoidoscopy, and
high-sensitivity fecal occult blood tests
(FOBTs)
◦ Low-dose helical computed
tomography (CT)
◦
◦ Pap test and human papillomavirus
(HPV) testing
◦ Breast MRI

10. Risk Factors for Cancer (part 1)
Although risk factors increase a person’s
chance of developing cancer, not every
person with those risk factors will develop
the disease
How many risk factors can you identify?

11. Risk Factors
for Cancer
(part 2)
◦ Carcinogen
◦ Cancer-causing agent
such as tobacco,
ultraviolet radiation,
or an environmental
toxin
◦ Tobacco Use
◦ Implicated in one of
every five U.S. deaths
◦ Lethal carcinogen
◦ Most tobacco-related
deaths result from
cancer
◦ Linked to cancers of
the mouth, pharynx,
larynx, esophagus,
pancreas, uterine
cervix, kidney, and
bladder
◦ Consideration of
immediate versus
future consequences
are important
determinants

12. Risk Factors
for Cancer
(part 3)
◦ Diet
◦ Foods Possibly Linked to Certain
Cancers
◦ Those that affect the cells that
line bodily tissues, including
those in the lungs, colon,
bladder, stomach, rectum, and,
to a lesser degree, the uterus,
prostate, breasts, and kidneys
◦ Foods That Appear to Cause
Certain Cancers
◦ Heterocyclic amines (HCAs)
and polycyclic aromatic
hydrocarbons (PAHs)

13. Risk Factors for
Cancer (part 4)
◦ AICR recommendations to reduce risk of
developing cancer; nutritional therapy for cancer
patients
◦
◦ Eating mostly plant-based foods
◦ Limiting intake of
◦ Limiting consumption of alcoholic beverages
◦ Reducing intake of oat-based, corn-based, wheat-
based, and rice-based breakfast cereals

14. Risk Factors for
Cancer (part 5)
◦ Alcohol Use
◦ Alcohol is known cause of cancer
◦ Heavy or regular drinking increases the risk of developing
cancers of the oral cavity, pharynx (throat), larynx (voice
box), esophagus, liver, breast, colon, and rectum
◦ Consumption linked to cirrhosis,
◦ Caution in drawing conclusions about alcohol and
immunocompetence

15. Risk Factors for Cancer (part 6)
◦ Physical Activity
◦ Sedentary lifestyle is risk factor for uterine, colorectal, and
breast cancer
◦ Regular physical activity may protect against different cancers
◦ Women’s Health Initiative Cohort Study
◦ Overweight and Obesity
◦ Obesity increases risk of cancers of endometrium, colon,
kidney, esophagus, pancreas, ovaries, and gall bladder
◦ NIH-AARP Diet and Health Study
◦ Exact causal mechanisms not known; possible mechanisms
include alterations in sex hormones, insulin, IGF–1

16. Risk
Factors for
Cancer
(part 6,
cont.)
• Across all forms of cancer, an
estimated 5% to 10% are caused by
inherited mutations of genes, with
breast, prostate, ovarian, and colorectal
cancers being most likely to arise from
family history
Family History
• Can interact with other risk factors to
increase individual risks
• Nurses’ Health Study found
relationship between daughters of
mothers with breast cancer and
mother’s age
• Vast majority (nearly 95%) are linked to
a combination of genetic and
nongenetic risk factors
Genetic Vulnerability

17. Risk Factors
for Cancer
(part 7)
◦ Environmental and Occupational
Hazards
◦ Toxic Chemicals
◦ No subfield of cancer has
identified as many new toxins
(asbestos, vinyl chloride, arsenic)
◦ Ultraviolet Radiation
◦
◦ High-frequency radiation, ionizing
radiation, and ultraviolet radiation
are proven carcinogens
◦ Ultraviolet B rays, which can
damage DNA, cause more than
90% of all skin cancers, including
melanoma

18. Risk Factors for Cancer (part 8)
Environmental and
Occupational Hazards
• Melanoma
• Potentially deadly form
of cancer that strikes
the melatonin-
containing cells of the
skin
• Early exposure, thinning
of ozone layer, tanning
Occupational Carcinogens
• Mostly affect lungs, skin,
bladder, and blood-
forming systems
• Asbestos, chromium and
compounds, benzene,
diesel exhaust, radon

19. Risk Factors
for Cancer
(part 9)
◦ Cancer and Infectious Disease
◦ An estimated 15% to 20% of new cancers
worldwide each year are attributable to
infection
◦ Higher in countries where certain
infections are more prevalent
◦ HPV, hepatitis B, and hepatitis C
viruses
◦ Helicobacter pylori (H. pylori) bacterial
infection

20. Your Health Assets—
What Is Your Risk of Developing Skin Cancer?
◦ Most experts agree that the following things affect a person’s risk of
melanoma
◦
◦ Light or fair physical features
◦
◦ Immunosuppressive medications
◦ Family history
◦ Which of these apply to you?

21. Risk Factors
for Cancer
(part 10)
◦ Stress and Immunocompetence
◦ Advances in
psychoneuroimmunology
(PNI) directly focus on
psychological risk (stress)
◦ Immunocompetence
◦ Immune surveillance theory
◦ Global immunosuppression
model
◦ Biphasic model

22. Risk Factors
for Cancer
(part 11) Research findings suggest that
childhood adversity may have an impact
on later life cancer development
Higher Epstein-Barr virus and CMV antibody titers
Childhood adversity associated with
greater emotional and physiological
sensitivity to stress
More pronounced
cortisol and
autonomic stress
response
Disrupted cellular
immune function
and immune system
dysregulation

23. Risk Factors
for Cancer
(part 12)
◦ Depression: Both Risk and Result
◦ Periodic and long-term clinical
depression common among cancer
patients (13% to 40%)
◦ Linked to higher risk of early
◦ Depression enhances mortality risks
in cancer patients
◦ Linked to depression of
neuroendocrine and
immunological functions in
hypothalamic-pituitary-adrenal
(HPA) axis
◦ Causes less likelihood to adhere
to recommended procedures and
treatments

24. Cancer Treatment (part 1)
◦ Early Diagnosis
◦ Early detection and treatment can
reduce treatment time overall and
perhaps prevent death
◦ Many people do not follow
recommended screening or
treatment schedules due to
perceptions of risk and feelings
of vulnerability
◦ Genetic screening useful in early
detection but may raise
psychosocial concerns

25. FIVE-YEAR RELATIVE SURVIVAL
RATES (%) BY STAGE AT DIAGNOSIS
All stages Local Regional Distant All stages Local Regional Distant
Breast
(female)
90% 99% 85% 27% Oral cavity &
pharynx
65% 84% 64% 39%
Colon &
rectum
65% 90% 71% 14% Ovary 47% 93% 73% 29%
Colon 64% 91% 72% 14% Pancreas 8% 32% 12% 3%
Rectum 67% 88% 70% 15% Prostate 99% >99% >99% 30%
Esophagus 19% 43% 23% 5% Stomach 31% 67% 31% 5%
Kidney 74% 93% 67% 12% Testis 95% 99% 96% 73%
Larynx 61% 77% 45% 34% Thyroid 98% >99% 98% 56%
Liver 18% 31% 11% 3% Urinary bladder 77% 70% 35% 5%
Lung &
bronchus
18% 56% 29% 5% Uterine cervix 67% 92% 57% 17%
Melanoma of
the skin
92% 99% 63% 20% Uterine corpus 81% 95% 69% 16%

26. PREVALENCE OF CANCER SCREENING
AMONG FIVE RACIAL AND ETHNIC GROUPS
Cancer Screening
European
American
African
American
Hispanic
American
Native
American
Asian/Pacific
Islander
Prostate test (protoscopy)
within the past five years
30.4% 28.2% 22.4% 27.6% California*:
24.3%; Hawaii*:
40.7%
Colorectal test 18.2% 20.3% 14.2% 12.3% California*:
2.6%; Hawaii*:
23.8%
Mammogram within the
past two years
73.7% 76.1% 63.5% Alaska*:93.5%
Hawaii*:80.7%
Cervical/uterine test within
the past three years
84.7% 91.1% 80.9% 90.5% Hawaii*: 84.2%

27. Cancer
Treatment
(part 2)
◦ Treatment Options
◦ Surgery
◦ Diagnostic surgery to
◦ Preventive surgery for
◦ Staging surgery to
determine the extent of
disease
◦ Curative surgery to remove
a tumor
◦ Restorative surgery to
reconstruct a person's
appearance
or the function of an organ
or body part

28. Cancer
Treatment
(part 2,
cont.)
◦ Treatment Options
◦ Chemotherapy
◦ Use of medicines to treat
cancer or enhance immune
system’s ability to selectively
target cancer cells
◦ Immunotherapy
◦ Chemotherapy with
medications used to
support or enhance
immune system's ability to
selectively target cancer
cells
◦ Radiation Therapy
◦ Using x-rays/gamma rays
to destroy malignant
tumors

29. Cancer
Treatment
(part 2,
cont.)
◦ Treatment Options
◦ Complementary and
Alternative Treatments
◦ Alternative therapies
generally unproven and not
scientifically tested; many
can be used safely as a
complement to standard
biomedical treatment
◦ Often help relieve
symptoms or side effects,
ease pain, and
improve patient’s overall
quality of life

30. Coping with Cancer
◦ Health Psychology and Coping
◦ Cancer surgery associated with higher levels of distress
and slower rates of emotional recovery than other
surgeries
◦ Side effects of chemotherapy and radiation may
include
◦ Educating cancer patients about what’s normal
following treatment and for improving the quality of
life may aid in recovery

31. Emotions,
Masculinity,
and
Ethnicity
(part 1)
◦ Emotions and Coping
◦ Emotion-focused coping and
◦ Optimistic disposition at diagnosis
is associated with active, engaged
coping style, and less psychological
distress over time
◦ Emotional intelligence
◦ Social and dispositional variables
and adjustment
◦ Social constraints and social support
absence inhibit active processing
and coping with cancer diagnosis

32. Emotions,
Masculinity,
and
Ethnicity
(part 2)
◦ Cancer-related Masculine Threat
(CMT)
◦ Involves common symptoms
associated with prostate cancer
treatment that threaten masculine
self-image
◦ High CMT scores related to
poorer prostate-related
functioning
◦ Male cancers and cancer patients
underrepresented in media/fewer
role models
◦ Fewer American men opt for
active surveillance (AS)

33. Emotions,
Masculinity,
and
Ethnicity
(part 3)
◦ Ethnicity and Coping
◦ African American breast cancer survivors
report more difficulties with physical
function and daily living activities
◦ Lower-SES African American and
Hispanic women more likely to perceive
benefits from breast cancer diagnosis than
European Americans

34. Emotions, Masculinity, and Ethnicity
(part 4)
◦ Post-Traumatic Growth (PTG)
◦ The idea that people can overcome challenges to
experience a more hardy state is relatively new in
health and disease research
◦ Positive psychological change experienced as the
result of struggle with a highly challenging life
circumstance
◦ Referred to as

35. Knowledge, Control, Social
Comparison,
and Social Support (part 1)
◦ Knowledge and Control
◦ Procedural information presented in narrative form is
effective
◦ Internet an important source of information; can
additionally provide social support and reduce loneliness in
breast cancer survivors
◦ Interventions aimed at self-presentation aid in management
of social relationships related to appearance changes

36. Knowledge,
Control,
Social
Comparison,
and Social
Support
(part 2)
◦ Social Comparison
◦ Social comparison with other
◦ Beneficial information
◦ Depends of how other
individual is perceived (upward
comparison versus downward
comparison)
◦ Depends on extent of
similarity felt to comparison
person (upward identification
versus upward contrast)

37. Knowledge, Control, Social Comparison,
and Social Support (part 3)
◦ Social Support
◦ Research findings note the protective value of social
relationships
◦ Unsupportive, negative behaviors that minimize,
force cheerfulness, or
◦ Intervention timing after diagnosis produces
different outcomes

38. Cognitive-Behavioral
Interventions (part 1)
In adults, focus on
stress/pain relief,
control of aversive
reactions to treatment,
enhancement of
emotional well-being
• Hypnosis, progressive muscle relaxation with
guided imagery, systematic desensitization,
biofeedback, cognitive distraction
• Mindfulness-based stress-reduction interventions
• Exercise
In children, focus on
increasing adherence
and reducing suffering

39. Cognitive-
Behavioral
Interventions
(part 2)
◦ Social Desensitization
◦ Effectively help patients
control side effects of
chemotherapy and other
cancer treatments
◦ Triggers state of relaxed
concentration
◦ Provides increased sense
of control and decreased
sense of helplessness
◦ May work through placebo
effect

40. Cognitive-
Behavioral
Interventions
(part 3)
• Active processing and expressing
emotions involved in cancer-
coping, linked in some patients to
lower stress levels and decreased
negative emotions and
physiological arousal
• Project Connect Online (PCO)
Emotional Disclosure
• Effectively helps patients control
side effects of chemotherapy and
other cancer treatments
Guided Imagery