Collaboration could mitigate cancer risk

The American Cancer Society predicts that 1.6 million new cases of cancer will be diagnosed in 2015 and close to 600,000 cancer-related deaths will occur. While genetics plays a role in the development of cancer, some controllable factors could also lead to this disease. Psychological intervention before diagnosis could prevent unnecessary suffering and early death from cancer.

Research has shown that stress which causes inflammation, obesity, tobacco use, excessive alcohol consumption and over-exposure to the sun are just a few controllable causes, potentially leading to the development of cancer. Sherry L. Pagoto, Ph.D., associate professor of medicine in the division of preventive and behavioral medicine at the University of Massachusetts Medical School and co-founder of the UMass Center for Health and Social Media, focuses her work on the relationship between tanning and skin cancer, an often overlooked issue, which can be an addictive behavior.

“Excessive tanning is a characteristic of body dysmorphic disorder (BDD),” she said. “The person is trying to hide perceived imperfections. The problem is rooted in a psychological process, while the behavior itself is more associated with cancer risk.” She added that some individuals with seasonal affective disorder are also at risk for skin cancer as they seek to manage their moods with light therapy.

Working together with and educating dermatologists, psychologists could help change behaviors, according to Pagoto. She suggests that screeners for BDD and seasonal affective disorder that ask detailed questions about underlying reasons for the behavior be administered to patients with persistent patterns of tanning during dermatological visits.

“We could create a team approach. Psychologists often work in helping patients cope with cancer, but prevention is another matter. When you treat the psychological disorder, the behavior goes away and reduces the skin cancer risk,” she said. “If psychologists published in dermatology journals, the dermatologists would see what we are doing.”

During his work with the National Cancer Institute, Paul K. J. Han, M.D., MA, MPH, director of the Center for Outcomes Research and Evaluation and specialist in palliative medicine at Maine Medical Center, examined national survey data that measured the behavioral and psychological underpinnings of decision-making in relation to health screening and prevention. The data suggested that people avoid decision-making when confronted with ambiguity. He explained that “ambiguity aversion” provoked cognitive or affective behavioral responses to prevention recommendations.

Cognitive responses lead a patient to believe he is at increased risk of harm, while the affective dimension makes the patient more anxious and vulnerable, according to Han. “Avoidance of decision-making is part of the affective dimension,” he said.

As an example, Han pointed to the controversy over prostate screenings and mammograms. Differing opinions on the validity and necessity of these screenings complicate the decision to undergo the tests, he reported. “Aversion deprives the patient of a potentially positive intervention. The key is to help people deliberate appropriately. A psychologist could help the patient do the hard work of deliberating and supporting emotions. He or she could help guide the patient to make whatever decision is right and feels right for that person,” said Han.

In the past, physicians made all the medical decisions, Han pointed out. “We are now putting more responsibility on the patients, but don’t yet know how to deal with helping the patient learn. Psychologists could have a role in that.”

Ellen A. Dornelas, Ph.D., director, Quality of Life Programs at the Hartford HealthCare Cancer Institute, Hartford Hospital, suggested that psychologists should regularly be assessing patients for alcohol, tobacco, poor nutrition and exercise habits. “But some psychologists are not comfortable intervening. They should know that these factors exist and interact with presenting mental health concerns,” she said. “A psychologist shouldn’t wait for the patient to present a problem. It should be part of the first assessment. They should at least assess and note that the behavior is problematic.”

Dornelas believes that oncologists would appreciate collaboration with psychologists, although most have a limited resource pool. “As psychologists, we need to be better ambassadors in terms of reaching out. There are a lot of areas in which psychologists could contribute. We could develop policies, interventions and programs that require doctoral level training psychologists have,” she said. “Right now, we’re focused only at the individual level so we compete against other clinicians. As long as we work one-on-one with patients, we may continue to be underutilized. We could be well utilized at the health care system level.”