Oncology social workers often ask researchers to guide them to the best evidence available that supports the type of services they provide. Occasionally, the Research column in The Navigator introduces its readership to a particularly significant article. A newly published article by Carlson, Toivonen and Subnis (2019) is such an article. It provides a great summary of research on the scope of psychological distress/stress in patients with cancer and survivors, as well as various evidence-based stress management interventions.

The first part of the article begins with an overview of research on the scope of psychosocial distress and stress in patients with cancer and survivors and the potential negative consequences of untreated symptoms. It points to a wide body of research on the negative consequences of untreated distress, including some studies on the physiological impact of distress on the cancer itself. These negative consequences include fatigue and insomnia, reduced physical activity and increased insensitivity to pain. While more work needs to be done to establish a direct linkage, the article cites studies that suggest distress may even influence the emergence, progression and metastasis of cancer itself. Additional troubling psychosocial consequences of distress among cancer patients include emotional disturbances, depression and cognitive impairment that can result from depletion of coping resources required to deal with multiple stressors encountered during the cancer-care trajectory. The authors conclude that a compounding of stress and reduced available coping resources can result in emotional disturbances, depression and cognitive dysfunction, and set the stage for lowered capacity to work, employment and relationship issues, social isolation and reduced overall quality of life.

The second part of the article reviews the research on evidence-based interventions to treat these symptoms, beginning with a summary of published clinical practice guidelines. Included are detailed reviews of the specific integrative interventions with the largest empirical support. Oncology social workers will likely be most interested in reviewing the evidence base of CBT and Mindfulness, which many oncology social workers incorporate into their practice. Other therapies with some evidence base include yoga, music therapy and massage.

Like all good research articles, this article concludes with a discussion of methodological issues in the research and suggestions for future research. This will be important for those of you who are researchers. For practitioners, we recommend the article as an excellent, up-to-date review of the evidence base that underlies the practice of psychosocial oncology. Overall, this is a highly informative, timely publication that effectively addresses the need to recognize the value and utility to cancer patients of psychosocial distress/stress management interventions.

Reference

Carlson, L., Toivonen, K., & Subnis, U. (2019). Integrative approaches to stress management. The Cancer Journal, 25, 329-336.

Other articles authored by Carlson

Carlson, L.E., Zelinski, E.L., Toivonen, K.I., Sundstrom, L., Jobin, C.T., Damaskos, P., & Zebrack, B. (2019). Prevalence of psychosocial distress in cancer patients across 55 North American cancer centers. Journal of Psychosocial Oncology, 37(1), 5-21.

Carlson, L.E., Beattie, T.L., Giese‐Davis, J., Faris, P., Tamagawa, R., Fick, L.J., Degelman, E. & Speca, M. (2015). Mindfulness‐based cancer recovery and supportive‐expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer, 121(3), 476-484.

Garland, S.N., Tamagawa, R., Todd, S.C., Speca, M., & Carlson, L.E. (2013). Increased mindfulness is related to improved stress and mood following participation in a mindfulness-based stress reduction program in individuals with cancer. Integrative Cancer Therapies, 12(1), 31-40.

Mackenzie, M.J., Carlson, L.E., Munoz, M., & Speca, M. (2007). A qualitative study of self‐perceived effects of mindfulness‐based stress reduction (MBSR) in a psychosocial oncology setting. Stress and Health: Journal of the International Society for the Investigation of Stress, 23(1), 59-69