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Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003.

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Cover of Holland-Frei Cancer Medicine

Holland-Frei Cancer Medicine. 6th edition.

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Historical Perspective

, MD and , PhD.

The stigma that cancer equals death, which has been attached to the disease for centuries, led to the long-respected dictum that doctors should not tell patients that they had cancer. To do so was considered cruel and would take away patients' hope (Table 70-1). For centuries, indeed, there was no treatment, and both doctors and patients had a fatalistic attitude as they awaited the inevitable outcome. The advent of anesthesia and antisepsis, however, led to possible surgical removal of some tumors. Near the end of the nineteenth century, and early in the twentieth century, it became important to counter the public's fatalistic attitudes, since surgical cure was possible but only if the cancer was detected in an early stage. The American Cancer Society was formed in 1913 to teach the warning symptoms of cancer to the public and to reduce their immobilizing fears. As radiation and surgery were combined to treat cancer, more cures were effected. The establishment of the National Cancer Institute in 1937 reflected new enthusiasm, seeking a cause and cure of cancer. The addition of chemotherapy to the combined modalities resulted in the cure of several childhood tumors. This led to an increase in interest in the medical outcome of long-term survivors of cancer and provided the first opportunities for exploring patients' psychological responses to being cured of cancer.

Table 70-1. Historical Attitudes About Cancer and Development of Psycho-Oncology.

Table 70-1

Historical Attitudes About Cancer and Development of Psycho-Oncology.

By the early 1970s, as survival improved further and patients became more willing to reveal that they had had cancer, the diagnosis of cancer began to be more frequently disclosed to patients as well as to family. At about the same time, increased concern appeared for more humane care of patients at the end of life, with the development of the hospice movement and greater interest in pain management and palliative care. Greater openness in revealing the diagnosis, increased concern for the dying, and enhanced concern about quality of life and the rights of patients led to more attention to the supportive and psychological aspects of care. Evidence for the link of environmental exposures to cancer, particularly cigarette smoking, gave new impetus to examining the role of psychological and behavioral factors in cancer prevention.

Around this same period, psychosomatic medicine developed within the field of psychiatry, leading to a powerful movement that sought to identify psychological factors as the major cause of several chronic diseases, particularly asthma, peptic ulcer, rheumatoid arthritis, and cancer. Coupled with the long stigma attached to mental illness, patients with cancer often were told that psychologically they had “caused their own cancer.” Beliefs such as this led to “blaming the victim” societal attitudes, which made coping with cancer even harder. Patients were, and are, often reluctant to ask for counseling because they fear this second stigma.5

By 1980, the stage was set for greater interest in the psychological problems of patients with cancer. Valid tools to assess these variables were few, however. Early investigators were forced to develop new test instruments or to modify those originally developed to assess patients with frank psychiatric disorders. Investigators with knowledge of research methods in both cancer and social science were few. Nevertheless, a small group of investigators around the world, largely in the United States and the United Kingdom, began to identify themselves as psycho-oncologists or psychosocial oncologists, and they began to study prevalence of psychiatric comorbidity in cancer and to address key psychosocial questions.

This brief history underscores the relative youth of this oncologic subspecialty, which began in the mid 1970s. It also points up the degree to which historical attitudes toward cancer contributed to the late development of psycho-oncology, and still contributes to negative patient attitudes today.

By agreement with the publisher, this book is accessible by the search feature, but cannot be browsed.

Copyright © 2003, BC Decker Inc.
Bookshelf ID: NBK12903

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