The emotional stress of living with a diagnosis of cancer and its treatment, fear of recurrence, and the distress imposed by living with the day-to-day physical problems described above can create new or worsen preexisting psychological distress for people living with cancer, their families, and other informal caregivers. Physical and psychological impairments can also lead to substantial social problems, such as the inability to work or fulfill other normative social roles.
Although the majority of cancer patients and their families have normal psychological functioning (Kornblith, 1998), distressed psychological states are common in individuals with cancer. The prevalence of psychological distress varies by type of cancer, time since diagnosis, degree of physical and role impairment, amount of pain, prognosis, and other variables. In one U.S. comprehensive cancer center’s study of nearly 4,500 patients aged 19 and older, the prevalence of significant psychological distress ranged from 29 to 43 percent for patients with the 14 most common types of cancer7 (Zabora et al., 2001). These rates are consistent with those found in subsequent studies of diverse populations with cancer that have reported high rates of psychological symptoms meeting criteria for such clinical diagnoses as depression, adjustment disorders, and anxiety (Spiegel and Giese-Davis, 2003; Carlsen et al., 2005; Hegel et al., 2006). Studies have also documented the presence of symptoms meeting the criteria for post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSS) in adults and children with cancer, as well as in the parents of children diagnosed with the illness (Kangas et al., 2002; Bruce, 2006). Indeed, experiencing a life-threatening medical illness or observing it in another to whom one is close can be a qualifying event for PTSD according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (APA, 2000).
Even patients who do not develop clinical syndromes may experience worries, fears, and other forms of psychological stress that cause them significant distress. Chronic illness can bring about guilt, feelings of loss of control, anger, sadness, confusion, and fear (Charmaz, 2000; Stanton et al., 2001). Anxiety, mood disturbance, fear of recurrence, concerns about body