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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
health problems, limited financial and other material resources, and inadequate social support—are associated with increased morbidity and mortality and decreased functional status. These effects have been documented both for health generally (House et al., 1988; Kiecolt-Glaser et al., 2002) and for a variety of individual health conditions and illnesses, including heart disease (Hemingway and Marmot, 1999), HIV/AIDS (Leserman et al., 2002), pregnancy (Wills and Fegan, 2001; ACOG Committee on Health Care for Underserved Women, 2006), and cancer (Kroenke et al., 2006; Antoni and Lutgendorf, 2007).
Psychosocial stressors are theorized to affect health adversely in a number of ways. First, emotional distress and mental illness can themselves be the source of suffering, diminished health, and poorer functioning through their symptoms and their adverse effects on role performance. Second, psychosocial problems can adversely affect patients’ abilities to cope with and manage their illness by limiting their ability to access and receive appropriate health care resources; adhere to prescribed treatment regimens; and engage in behaviors necessary to manage illness and promote health, such as maintaining a healthy diet, exercising, and monitoring symptoms and adverse responses to treatment (Yarcheski et al., 2004; Kroenke et al., 2006). In multiple focus groups and interviews, patients with chronic illnesses such as diabetes, arthritis, heart disease, chronic obstructive lung disease, depression, and asthma have identified lack of family support, financial problems, lack of health insurance, problems with mobility, depression and other negative emotions, and stress as obstacles to dealing with their illness and health (Wdowik et al., 1997; Riegel and Carlson, 2002; Bayliss et al., 2003; Jerant et al., 2005). Moreover, a growing body of evidence is illuminating how the stress resulting from psychosocial problems can induce adverse effects within the body’s cardiovascular, immune, and endocrine systems (Segerstrom and Miller, 2004; Yarcheski et al., 2004; Uchino, 2006; Miller et al., 2007). Although evidence of adverse health outcomes from these effects is strongest for cardiovascular disease, emerging evidence from animal models and some human data suggest pathways through which these effects can influence the course of other illnesses (Antoni and Lutgendorf, 2007).
A wide range of psychosocial variables may affect the course of illness. For example, several studies have found that individual psychological traits such as optimism, mastery, and self-esteem (sometimes termed psychosocial resources) protect against stress (Segerstrom and Miller, 2004). This chapter details the health effects of three psychosocial factors—social support, financial and other material resources, and emotional and mental status—for which there is strong evidence on health effects, for which there are screening and assessment tools that can be used to detect problems, and for which psychosocial health services (described in Chapter 3) exist to address identified problems. Also presented is evidence of how problems in these areas