Psychological support of skin cancer patients

Abstract

SummaryThe diagnosis of skin cancer imposes a great stress on our patients. Ultraviolet (UV) radiation-induced skin cancers are on the rise and frequently occur in younger patients and unexposed sites despite improved protective behaviour. Environmental factors and lifestyle habits have changed greatly in the last century and in addition to UV radiation exposure, psychosocial stressors and physical inactivity may play a role in the rising tumour incidence. With environmental stressors such as UV radiation they share the capacity to change the stress reaction. So far research into the interaction between stress, cancer and psychosocial intervention has generated some interesting results with respect to improvement of quality of life and the function of the hypothalamic-pituitary-adrenal axis, the sympathetic axis and natural killer cells. These results hint at a suppressive effect of chronic stress on cellular immunity and the importance of a sufficient length and intensity of any psychosocial intervention for it to be effective. Nevertheless, the evidence remains inconclusive and does not take into account the findings of current psychoneuroimmunological research. This research has demonstrated the importance of a third stress axis along which neurotrophins and neuropeptides are effective. Along this axis, regulatory mechanisms may contribute to suppress tumoricidal immune responses. This may be instrumental in the establishment of an immune response that promotes tumour progression and holds important implications for integrated therapeutic strategies. However, research into the psychoneuroimmunological benefits of psychosocial intervention is largely missing, and future interdisciplinary research is warranted for understanding and further promoting improved quality of life and psychological as well as physical well-being after psychosocial intervention.Recent studies point to the steadily rising incidence of skin cancers and the pressure rises to identify explanatory models in addition to ultraviolet (UV) radiation exposure and other environmental stressors. Among them, psychosocial stress may play a hitherto underestimated role as several studies suggest that the immune response can be modified by stress and plays a role in the association between coping with a cancer diagnosis, i.e. mental stress, and long-term survival.

Deaths and major biographical events: a study of all cancer deaths in Germany from 1995 to 2009

“…Coming back to the mechanisms presented in the discussion, we found evidence of negative influences such as increased distress to be present before Christmas surpassing possible positive aspects of this holiday, which might in turn advance tumour progressive effects of the HPA2 7 or growth factors 8. Nevertheless, we cannot attribute a certain cause (immunological, social) underlying these changes.…”

“…As the number of deaths peaks several days before Christmas when considerable staff shortages are not to be expected the distress hypothesis seems indeed to be more plausible, while the key role of the HPA was emphasised by previous studies 2 7. In consequence, the process of growing distress might start even earlier and just cumulate few days before Christmas.…”

“…Previous studies found an escalation of distress and depressive symptoms before death in patients with cancer 1 2. A study by Allen-Mersh et al 3 gives evidence of an impaired survival in patients showing depressive symptoms.…”

“…Male and female patients with cancer perceive disease-related distress differently 5 6. An increased distress-induced activity of the hypothalamic-pituitary axis (HPA) leads to a reduced natural killer cell activity and thus tumour control 2 7. In head and neck cancer poorer psychosocial functioning (including depressive symptoms, perceived stress, anxiety and social support) was associated with a greater expression of vascular endothelial growth factor (VEGF), which itself triggers tumour growth by inducing angiogenesis 8.…”

Prevention initiative for dermatological malignancies: where do we stand?

“…Stratigos et al 13 summarized the history of the Euromelanoma campaign, present its organizational structure and discuss the results of the campaign in individual countries and on a European scale. The data discussed by Peters 14 suggest that there is a close connection between psychosocial status and disease outcome in skin cancer patients. The author suggests that early identification of patients in distress and their prompt enrolment in studies investigating effective psychosocial ⁄psychoeducative interventions and their effect on neuroendocrine-immune parameters represent an approach to improve both life quality and disease prognosis in a controlled setting.…”