Modifying Behaviors to Improve Outcomes
Many factors related to lifestyle that increase a person’s
risk of developing cancer can also increase risk of cancer
recurrence and reduce survival time (see Figure 4, p. 26).
In some cases they have also been shown to increase a
patient’s risk of cancer treatment toxicity. Thus, modifying
behaviors to eliminate or avoid these risk factors has the
potential to improve outcomes and quality of life for cancer
patients and survivors.
For example, research shows that quitting smoking can
reduce risk of radiation-induced toxicity, risk of death from
cancer, and risk for developing a second cancer ( 34). Even
in the face of this knowledge, one study found that 9 percent
of cancer survivors continue to smoke (200). Thus, more
research is needed to develop optimal strategies to provide
patients with cancer the best chance of quitting tobacco.
In addition, despite the knowledge that most cases of
melanoma are attributable to UV light from the sun,
sunlamps, tanning beds, and tanning booths (201), a recent
study found that 19. 5 percent of melanoma survivors report
having had a sunburn in the previous year and 1. 7 percent
report having used a tanning booth or bed (202). Thus, it
is clear that we need to develop more effective programs
educating melanoma survivors, and indeed everyone,
about the risks of UV exposure and to do more to address
skin cancer as a serious public health challenge.
Evidence is also emerging that regular aerobic exercise can
reduce recurrence and mortality in survivors of several
types of cancer including early breast, prostate, and
colorectal cancers (203). This evidence has largely come
from observational studies, but it was recently shown in
a small randomized exercise trial that patients with breast
cancer who participated in supervised exercise, either
aerobic or resistance, during chemotherapy tended to
have improved disease-free and overall survival compared
with those who did not have supervised exercise (204).
The results of ongoing larger studies should provide more
definitive answers about the role of exercise in improving
cancer outcome (205).
A psychoeducational intervention
comprising a psychoeducational
booklet and three individual
a psychologist effectively reduced stress and fear of
cancer recurrence among survivors of melanoma (194).
A psychosocial intervention called
Attention and Interpretation
Modification for Fear of Breast Cancer
Recurrence, which consisted of eight
personalized treatment sessions, reduced
health worries among survivors of breast cancer (195).
Treatment with the psychedelic drug
psilocybin led to clinically significant
reductions in depression and anxiety as well
as improved quality of life (198, 199).
eight group sessions led
by a psychiatrist, clinical
psychologist, or social worker, resulted in improved
spiritual well-being and quality of life as well as
reduced depression, hopelessness, desire for hastened
death, and physical symptom distress among
patients with advanced cancer (196).
A web-based cognitive rehabilitation
program called Insight, which uses
adaptive exercises to improve cognition
through speed and accuracy of information
processing, improved perceived cognitive
function and quality of life and reduced depression,
fatigue, and stress among adult cancer survivors
who reported having chemo brain (197).
Helping Patients with Cancer through
Health care practitioners working in the field of psycho-oncology, including psychiatrists, psychologists,
and nurses, are dedicated to addressing the behavioral, emotional, psychological, and social challenges
faced by patients with cancer. Examples of recent psycho-oncology clinical trials investigating new
approaches to helping patients with cancer follow:
continued from p. 85