CA: A Cancer Journal for Clinicians, Vol 39, 305-310, Copyright
© 1989 by American Cancer Society
The Experience of Recurrent Cancer
J. William Worden PhD1
1 Assistant Professor of Psychology in the Department of Psychiatry at Harvard Medical School, Massachusetts General Hospital, in Boston, Massachusetts.
The following are the conclusions of the study and the implications for psychosocial intervention with recurrent patients:
1. Sickness factors such as symptoms, disability, and confinement are major, but not the only. contributors to distress. Concurrent problems also contribute to distress, and these should be the target for psychosocial interventions.
2. Highly distressed patients reported having fewer support systems available. Interventions that create an increased sense of support would be appropriate for this group.
3. Recurrence did not have an equal impact on all patients. Some found coping with the recurrence easier than coping with the exigencies of the first diagnosis. These patients were less open to psychological intervention, preferring to focus more on medical problems and less on family, social, and financial concerns.
4. Certain knowns helped recurrent patients cope—familiarity with the medical system, treatment methods, and side effects. Knowing the availability of support systems and how others are going to respond to one's cancer was helpful for most patients.
5. Existential concerns rose dramatically for most recurrent patients and presented a significant source of distress. Helping patients acknowledge and address these concerns should be an important part of any psychosocial intervention.
6. Elapsed time did not contribute significantly to emotional distress, although it did contribute to a cognitive appraisal of the overall situation.
7. The emotional impact of recurrence in and of itself did not predispose these patients to an early death.
