Cancer Realities

By Heather Millar

A growing body of research suggests that talking things out, taking stock, and tapping into whatever spiritual tradition you prefer is good for terminally ill cancer patients. Not only do various kinds of psychotherapy and “life review” seem to reduce anxiety and depression in these patients; they may even help to relieve pain and other symptoms.

For instance, people in the late stages of cancer may benefit from “meaning-centered psychotherapy,” a new technique outlined in a recent study led by Dr. William S. Breitbart, a psychiatrist at Memorial Sloan-Kettering Cancer Center in Manhattan and a pioneer in an emerging field called “psycho-oncology.”

The technique, outlined by Breitbart and his team in the Journal of Clinical Oncology, involves talk sessions and contemplation exercises aimed at helping patients sustain and enhance their sense of meaning, purpose, and peace.

“During their final weeks or months of life, many of our patients suffer from feelings of despair, demoralization, and hopelessness, which in extreme cases can lead to a wish to end one’s life sooner,” Dr. Breitbart explains. “Our studies have shown that such distress often is related to an existential crisis people struggle with at the end of their lives, when questions emerge about mortality and the ultimate value of our existence.”

In this pilot study of 120 patients who had a prognosis of six months or less to live, people were randomly selected to either get massage therapy or seven, one-hour sessions of meaning-centered psychotherapy. With the help of a therapist, the psychotherapy group explored personal sources of meaning such as love, relationships, and work. They talked about universal themes such as hope, legacy, and the impermanence of life.

Those who got the psychotherapy not only reported that they noticed an improvement in their quality of life and sense of wellbeing, but they also felt less burdened by physical symptoms such as pain. The massage therapy group reported no significant improvement.

This latest study builds on work that Breitbart and colleagues have done using meaning-based therapy with groups of cancer patients. Individual therapy was thought to be more appropriate for the terminally ill. I can understand why: If you have Stage I cancer and someone in your support group is coping with the challenges of Stage IV disease, it’s difficult not to spiral into freak-out mode.

Breitbart is now conducting studies to discover if group therapy can also work with advanced-stage patients. In addition, the team is working to adapt the method for people who are not terminally ill, but are struggling with a decline in spiritual wellbeing.

This is still a very new area of research in palliative care, but several other studies suggest that grappling with cosmic issues at the end of life may be just as important as more explored measures such as pain management:

• A 2003 study by Breitbart showed that spiritual wellbeing offered some protection against end-of-life despair.

• A 2003 review of studies from 14 countries in the Journal of Advanced Nursing concluded that patients who have an enhanced sense of psychological and social wellbeing cope better with the process of terminal illness.

• A 2010 study in Japan reported that terminally ill patients who simply do a “short-term life review” experience increased well-being and decreased anxiety.

• A 2011 study suggests that “spiritual concerns,” such as feeling abandoned by God, or feeling a need for forgiveness seem to be linked to a poorer quality of life for terminally ill patients.

Literature reviews report that several components of psycho-social wellbeing emerge again and again:

• Self-awareness.

• Effectively coping with and adjusting to stress.

• Relationships and connectedness with others.

• A sense of faith (this might be a sense of spirituality, or adherence to a particular tradition).

• A sense of empowerment and confidence.

• Living with meaning and hope.

We’d all be better off if we cultivated those things, right? But it seems even more important at the end-of-life when New Year’s resolutions or hope for a “do-over” may not be enough.

Would you add anything to this list of psychological ideals? Are there coping strategies that have worked for you that you’d like to share?