AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Psycho-Oncology

By:
Prof.(Dr.) Rita Kumar
Professor
Amity Institute of Psychology and Allied Sciences,
AUUP, Noida
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

SYLLABUS
L T P/S SW/FW TOTAL CREDIT UNITS
2 0 0 2 3

Course Objectives:
On completion of this course a student will be able to:
• Understand and assess the mental health of a cancer-
affected person
• Analyze the likely benefit of Psycho-therapy and / or
Psychological Counseling for Cancer Patients
• Be able to offer psycho-oncology counselling services in
diverse clinical setting
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

1 Module I Introduction to Psycho-Oncology 20%

 Introduction to the Meaning & Concept

2 Module II Introduction to Cancer 20%

 Cancer as a disease
 Cancer Biology

3 Module III Psychological Impact on Cancer Patient & Caregiver 20%

 Impact & Assessment on individuals and families

4 Module IV Theory & Application 20%
 Theory & Application of Psycho-Oncology
5 Module V Treatment & Rehabilitation 20%
 Onco-genetic Counselling -Skills & Issues
 Palliative Counseling – Skills & Issues
 Pediatric Counseling
 Support & Rehabilitation Counseling
 Primary, Secondary & Tertiary
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Student Learning Outcomes:

• Defining basic principles and terminologies in
Psycho-oncology.
• Identifying the psychological impact on Cancer
• Various Skills & Issues in Counselling.
Continuous Assessment/Internal Assessment
End Term
Component Project
Examination
(Drop Home Class Attendance
down) Assignment Presentatio
n

Weightage 10%
(%) 10% 5% 5% 70%
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Assignments For
• Continuous Assessment/Internal Assessment
1. Home Assignment
2. Project
3. Presentation of Researches on the Topics
from Syllabus/ Case Presentation
Self Work:
Review of Researches/ Visit to Oncology
wards of Hospitals
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Prevalence of Cancer
• According to WHO, 2018 report on Cancer
Death, it is 9.6 million death worldwide and 70%
of this population cancer death in Low middle
Income Countries.
• According to Two Meta-analysis study of
A.Mehnert,T.J.Hartung.,etc & Meta-analysis
study of Ali Taguizadeh, Leila Pourali explored
the prevalence fact of psychological distress
60% in cancer patient of age group of 18 to
75year
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• The World Health Organization (WHO) has reported that India

had estimated 1.16 million new cancer cases in 2018, which
indicated that one out of 10 Indian will develop cancer during
their lifetime and one out of 15 will die with the disease.
• The cancer was the second leading cause of death globally after
ischemic heart stroke in 2018 (WHO, 2020).
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• Evidence from the meta-analysis performed by Anna

Coughtrey, et.al, suggest the effectiveness and impact of
psychosocial interventions in children with cancer.
• Furthermore Isabelle Bragard,e.t.,al,(2016) studied that
mind– body interventions can decrease distress in Breast
Cancer patients.
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– According to IACR (2015), oral, lungs in males and cervix, breast

in females for over 50% of all cancer deaths in India.

• Research study of Lynch, J., Prihodova, L.,etc, (2018), aims to

review studies of mantra meditation to understand its potential value
in fostering positive mental health and alleviating negative affectivity
in non-clinical populations. Finding of these studies indicate that
mantra meditation interventions may have minimal to moderate
beneficial effects on mental health in general populations. Over 90%
of studies were considered to be of weak quality.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Research study of Amritanshu R.R. et al., (2017), indicate

that breast cancer survivors, doing yoga, have better
psychological profiles and are able to deal with demanding
situations better.
• Research of Rao R.M. et al., 2015, indicate a positive
correlation(<0.01) between depression
and stress during RT and CT and significant decrease in
depression scores in the yoga group as
compared to controls following surgery.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Need of Psycho-oncology
• There is sound evidence today that about 30% of all cancer patients
suffer from some form of mental disease (Mehnert et al. 2014; Mitchell
et al. 2011; Singer et al.2010; Vehling et al. 2012).
• The most prevalent diagnoses are depression, anxiety, and adjustment
disorders.
• These diagnoses are based on a thorough assessment of cancer
patients, using some kind of structured clinical interview for diagnosing
mental disorders. These measures relate to the current psychiatric
classification systems, i.e., DSM or ICD, which were primarily
developed for the assessment of (more or less) physically healthy
patients with psychological problems.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• The psychological symptoms of cancer patients, and other medical

patients, sometimes do not fit the usual descriptions and the criteria
of common mental disorders.
• Gurevich et al. (2002, p. 259) noticed, “the personal tragedy of
serious medical illness is not necessarily captured within the bounds
of psychiatric illness”
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Psycho-oncology, is a way to resolve this dilemma was to

introduce the concept of distress,
• Distress is an umbrela term, encompasses a wide range
of psychological problems, ranging from severe
psychopathological symptoms to mild forms of irritation.
 Distress AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• “a multifactorial unpleasant emotional experience of a psychological

(cognitive, behavioral, emotional), social, and/or spiritual nature that
may interfere with the ability to cope effectively with cancer, its
physical symptoms and its treatment.
• Distress extends along a continuum, ranging from common normal
feelings of vulnerability, sadness, and fears to problems that can
become disabling, such as depression, anxiety, panic, social isolation,
and existential and spiritual crisis” (see NCCN Guideline Distress
Management 2013).
• Distress can be measured by self-report, which is one methodological
advantage compared to the interviewer-based assessment of mental
disorders.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Medicine is a social science in its very bone

marrow. . . . No physiologist or practitioner ought ever to
forget that medicine unites in itself all knowledge of the
laws which apply to the body and the mind.

• —Rudolf Virchow (1821–1902), German pathologist

 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Given the overwhelming importance of psychological issues in cancer,

it is surprising that psycho-oncology began only in the mid-1970s. It
becomes understandable, however, when one recognizes that, in
Western countries, the centuries-old stigma attached to cancer
diminished in the late twentieth century only when patients began to be
told their diagnosis.
• This made it possible to openly explore and study patients’
psychological responses for the first time. However, it is crucial to
understand society’s attitudes toward cancer and toward mental
illness, because these attitudes still impact patients’ willingness to
accept counseling services.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• This Introduction explores the history of psycho-oncology,

with initial attention to the ways in which the long-standing
beliefs and stigma attached to cancer and mental illness
constituted major barriers to improving the optimal
psychosocial care of patients with cancer.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Introduction
• Psycho-oncology is an interdisciplinary field at the
intersection of
• physical,
• psychological,
• social, and
• behavioral aspects
• of the cancer experience for both patients and caregivers.
• Meta Psychological / Spiritual
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Researchers and practitioners in the field are concerned with

aspects of individuals' experience with cancer beyond medical
treatment, and across the cancer tajectory, including at
diagnosis, during treatment, transitioning to and throughout
survivorship, and approaching the end-of-life.
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• Founded by Jimmie Holland in 1977

• Via the incorporation of a psychiatric service within the Memorial
Sloan Kettering Cancer Center in New York,
• The field has expanded drastically since and is now universally
recognized as an integral component of quality cancer care.
• Cancer centers in major academic medical centers across the
country now uniformly incorporate a psycho-oncology service into
their clinical care, and provide infrastructure to support research
efforts to advance knowledge in the field.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Psycho-oncology deals with

• psychological reactions to the experience of cancer,
• the behavioral component of coping with cancer
• as well as health behavior change including preventative
medicine, and
• social factors that are associated with diagnosis and
treatment of cancer,
• including communication with care providers, loved ones
and social support.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• In addition, research related to the influence of

psychosocial factors on biological disease-related
processes has burgeoned over the past two
decades.
• Much research takes a biopsychosocial approach to
account for the interplay between biological,
psychological, and social factors in coping with
cancer.
• The integration of psycho-oncology into routine
oncologic care represents a major step forward in
terms of care for the whole patient.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Definition
• The psychological, social, behavioral, and ethical
aspects of Cancer.
• Psycho-oncology addresses the two major
psychological dimensions of cancer:
– Psychological reactions of patients with cancer
and their families and health care providers
– Psychological, social and behavioral factors that
contribute to cancer risk, detection and survival
• Slowly emerging as a subspecialty within oncology as well
as psychiatry and psychosomatic medicine
• Its is the study of psychological aspects of cancer along
the continuum from prevention to cure
Meyer et al, 2009
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

History of Psycho Oncology

• Galen, in the second century AD, thought that
melancholic women were predisposed to breast
cancer.
• This theme was taken up again in the eighteenth
century by Gendron (1701), who found that his
patients who suffered from depression and anxiety
were more subject to cancer.
• Guy (1759) added a little more detail by observing
that nervous and hysterical women developed
cancer after existential traumas and bereavements.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Cancer
After all, A Disease of Both
The Body
and
The Mind.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Understanding Self
• Who and what we are?
• We are combination of Material and Non material
components

Non Material
Material
Energy
Non Living
Consciousness
Body
Soul
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Origin Of Life and mind

Material Non Material

Non Living Energy
Body Consciousness
Soul

Life Mind
 Life System
AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Social System BMS & SSE

and Environment
M & SSE is
Body Mind the Region
of
Origin of
Emotions

BMS
Spirit
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Place of Emotions

Body

Mind

Soul
AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Psychology of Wellness
The mind and body are not discrete,
separate entities,
Physical health can affect emotional
well-being.
Emotional disturbances can affect
physical health
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

How Positive Emotions Build Physical Health: Perceived

Positive Social Connections Account for the Upward Spiral
Between Positive Emotions and Vagal Tone

• 1 Department of Psychology, University of North Carolina

at Chapel Hill;
• 2 Osher Center for Integrative Medicine, University of
California, San Francisco;
• 3 Duke Integrative Medicine, Duke Center for Living
Campus, Duke University
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• Group-1 Group -2
self-generated People in a
positive emotions waiting-list were
via loving-kindness considered as
meditation control group
Participants in the intervention group increased in positive
emotions relative to those in the control group, an effect
moderated by baseline vagal tone, a proxy index of physical
health. Increased positive emotions, in turn, produced
increases in vagal tone, an effect mediated by increased
perceptions of social connections
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Mental patterns create dis –eases in the body

• Every thought we think is creating our future
• Every one suffers from self hatred and guilt
• The bottom line for every one is “I’m not good
enough”
• It’s only a thought and a thought can be changed
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• We create every so called illness in the body by

– Resentment
– Criticism
– Gulit
– Anger
Releasing resentment or guilt will dissolve even cancer
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Every cell of our body is capable to think and

have a creative intelligence.
• If one holds negative emotion for somebody,
something or some event in life.
• Each time we think of that whole body relives the
emotional upheaval of that association.
• Each and every cell of the body start feeling the
same emotion or hatred.
• The body is not at ease
• This is the condition where the condition of
disease sets in.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

“You are not a drop in the

ocean, you are ocean in every
drop.”
Rumi
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Ultimate aim of every life is to attain

‘Happiness’

Dalai Lama and Denial Goleman

Destructive emotions
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

• Destructive Emotions are the hindrance in Happiness

and Peace

• Emotions that are harmful to oneself or others are

basically three poisons of our mind
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Three Basic Afflictions/ Poisons

• 1. Anger
• 2. Attachment
• 3. Ignorance
• Ignorance + Attachment
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Twenty Derivative Mental Afflictions

• Anger • Attachment Ignorance
  Avarice  Blind Faith
Wrath
 Inflated Self  Spiritual Sloth
 Resentment
Esteem  Forgetfulness
 Spite • Excitation  Lack of
 Envy/ • Concealment introspective
Jealousy of one’s own attentiveness
 Cruelty vices
 Dullness
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• Ignorance + Attachment
– Pretention
– Deception
– Shamelessness
– Inconsideration of others
– Unconscientiousness
– Distraction
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Freedom From Destructive emotions

• The belief, based on contemplative experiences, is that
destructive emotions are not embedded in the basic nature
of consciousness.

• Rather, they arise depending on circumstances and

various habits and tendencies that express themselves
from the outer core of consciousness.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Antidote for Negative Emotions

• Hatred--- Love and compassion

• Ignorance-- try to refine our understanding
of what needs to be
accomplished and what avoided
• Jealousy--- Rejoice in other’s qualities
• Pride ---- Try to appreciate others
achievements
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

True health and wellness is to be

found in having a positive attitude
toward life and a strong self that
refuses to be defeated by anything.

Dr. Daisaku Ikeda

 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Carol Ryff’s six Dimensions of

Well-being
1) Self-Acceptance
2) Personal Growth
3) Purpose in Life
4) Positive Relations With Others
5) Environmental Mastery
6) Autonomy
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Hygiene for Wellness

1. Hygiene of Emotions
Nurture Positive Emotions
– Forbearance
– Gratitude
– Forgive Every One
– Release the Past
– Joy and Happiness
– Compassion
– Pride
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

2. Hygiene of Mind
Consciously inculcate positive thinking

 Belief that every disguise inherit

blessings

 Be Hopeful in every situation of life

 Every problem of life inherits its solution one has

to explore it.
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

3. Hygiene of Cognition
 Think what to think

 Cognitive hygiene is the moment to

moment practice of positively managing
your thoughts

 This good habit results from the

understanding that your thoughts truly
matter
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• Integrate knowledge and information to reach out the

solution of a problem in such a way that it will bring
positive out come for every one involved.
Win - Win Situation
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4. Hygiene of Senesce
 AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

Research model for psychosocial & quality of life research in oncology

Independent variables Mediating variables Outcome variables

• Quality of life
Cancer and • Socio demography
(functional level)
its treatment • Personal attributes
physical
• Medical factors
psychological
• Social supports
social
• Other stressors
work
sexual
• Survival

Interventions
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Life goals, Purpose, Beliefs (global meaning)

Appraisal coping