PRESIDENT'S COLUMN

Cancer: a special look

By Richard M. Suinn, PhD
APA President

This very special issue of the Monitor highlights cancer. In reviewing how it took shape, it impresses me that the reports show the best integration of science and practice, as well as education and public interest--the watchword domains of APA.

Pay special attention to how each area has influenced, benefited from and contributed to the other areas. Our scientists have discovered new knowledge, practitioners have employed such knowledge in the community, the public has sought information from educators, educators have raised issues for scientists to investigate and the circle continues. Nowhere is the integration and synergy of our varied interests better summarized than in the content of this report.

More is needed. Yes, we do have a history, but more is needed as we rediscover our role in primary health care. I continue to call for the involvement of psychologists in cancer work. The American Cancer Society, which issues an informational volume about one-inch thick, advises that medication, psychotherapy or a combination can "improve the psychological condition (of anxiety, fear and depression) and also reduce the suffering of cancer patients, enhancing their qualify of life." The National Coalition for Cancer Survivorship, an advocacy group of survivors concerned with empowering individuals, has links to nursing and social work organizations.

However, neither group has formal arrangements with psychologists. I recently received several private requests for help in identifying psychologists able to provide services.

There is a need for a state-by-state procedure to identify licensed psychologists who have experience with cancer patients and their families. State psychological associations can serve an important role in reaching this goal. I encourage those of you with backgrounds in service with cancer patients to contact your state psychological association today. Identify yourself and work together with your state association to develop a referral service. I also encourage academic programs to organize collaborative training or research experiences to further this field.

Special areas to address

The minority population is in special jeopardy for cancer. For certain cancers, the incidence and mortality rate are higher for these culturally diverse groups than for whites. African-Americans are about 30 percent more likely to die of cancer than whites. Cervical cancer is more than two times higher among Vietnamese women, with Hispanic women being next highest. As indicated in an excellent review by Meyerowitz, et al, "Ethnicity and cancer outcomes: Behavioral and psychosocial considerations," Psychological Bulletin, (Vol. 123, p. 47_70) culturally sensitive approaches are needed. Psychologists can formulate appropriately framed messages to motivate participation in early screening. After detection, psychologists can aid in revising attitudes that discourage seeking treatment, such as passive acceptance of fate. Psychologists can offer consultation to agencies on removing barriers where such services are based upon one culture's model.

New areas also need to be addressed. Unlike other diseases, cancer is unique in the ambiguity created for the patient. For many illnesses, after diagnosis, a physician can predict the course of the disease, specify the treatment and indicate the chances of recovery. Cancer represents a challenge because medical knowledge is still unfolding. Patients, therefore, do not receive clear statements but are presented with options. Outcomes are in probabilities, and even probabilities may be more in terms of "improves your chances to 60-40, but we will even then be more certain after 10 years of remission."

What psychology can do

We need help from psychologists concerning medical decision-making. Perhaps a team of psychologists whose expertise is in cognitive psychology can look at how information is processed. Social psychologists can examine what social and environmental conditions influence personal decisions. Counseling and clinical psychology can explore what personality variables are involved. We need to understand and design approaches for patients that help them pursue the decision-making pathways that are appropriate for their individual situation, personal styles and values.

Cancer decisions cover a wide range. I recall a close friend who concluded, "I am ready to die," but also said, "and my family is ready to let me go." This simple statement summarized a complex decision, encompassing emotional and intellectual considerations, and personal and family participation. It meant that mortality was confronted and in a unique way.

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