and it can pose a barrier to health monitoring, illness management, and health promotion.

Depressed or anxious individuals have lower social functioning, more disability, and greater overall functional impairment than those without these conditions (Spitzer et al., 1995; Katon, 2003). Distressed emotional states also often generate additional somatic problems, such as sleep difficulties, fatigue, and pain (Spitzer et al., 1995; APA, 2000), which can confound the diagnosis and treatment of physical symptoms. Patients with major depression as compared with nondepressed persons also have higher rates of unhealthy behaviors such as smoking, a sedentary lifestyle, and overeating. Moreover, depression and other adverse psychological states thwart behavior change and adherence to treatment regimens by impairing cognition, weakening motivation, and decreasing coping abilities. Evidence emerging from the science of psychoneuroimmunology—the study of the interactions among behavior, the brain, and the body’s immune system—is beginning to show how psychosocial stressors interfere with the working of the body’s neuro-endocrine, immune, and other systems.

In sum, people diagnosed with cancer and their families must not only live with and manage the challenges and risks posed to their physical health, but also overcome psychosocial obstacles that can interfere with their health care and diminish their health and functioning. Unfortunately, the current medical system deploys its resources largely to address the former problems and often ignores the latter. As a result, patients’ psychosocial needs frequently remain unacknowledged and unaddressed in cancer care.

Cancer Care Is Often Incomplete

Many people living with cancer report that their psychosocial health care needs are not well addressed in their care. At the most fundamental level, throughout diagnosis, treatment, and post-treatment, patients report dissatisfaction with the amount and type of information they are given about their diagnosis, their prognosis, available treatments, and ways to manage their illness and health. Health care providers often fail to communicate this information effectively, in ways that are understandable to and enable action by patients (Epstein and Street, 2007). Moreover, individuals diagnosed with cancer often report that their care providers do not understand their psychosocial needs; do not consider psychosocial support an integral part of their care; are unaware of psychosocial health care resources; and fail to recognize, adequately treat, or offer referral for depression or other sequelae of stress due to the illness in patients and their families (President’s Cancer Panel, 2004; Maly et al., 2005; IOM, 2007). Twenty-eight percent of respondents to the National Survey of U.S. Households Affected by Cancer reported that they did not have a doctor who



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