The psychological dimension in cancer treatment

Abstract

A cardinal principle of medical ethics, primum non nocere, is examined in relation to current cancer treatments. In randomised, clinical trials of such treatments, the quality of life of patients has been largely ignored. The few systematic psychological studies reported so far indicate the likelihood of considerable psychosocial morbidity associated with radical surgery and prolonging combined chemotherapy. Detailed measures of psychosocial adjustment should be included in all future clinical trials of cancer therapy in order: (i) to identify those patients who require psychological help and (ii) to enable clinicians to base their decisions regarding cancer therapy not only on the probability of prolonging or, in some cases, saving life, but also on an accurate knowledge of the quality of that life.

KIE: Although quality of life for patients is considered a crucial concern of medical ethics, it is an aspect that is largely ignored in cancer therapy and research. A survey of the literature on psychological sequelae associated with various cancer treatments indicates a high degree of psychosocial morbidity. A recommendation is made that future clinical trials include appropriate psychological measures in order to give some indication of the quality of life of patients, and to help determine which patients might benefit from counseling. Assessments of the quality of life will enhance treatment by allowing clinicians to make decisions based on broader information than just the probability of prolonging or saving lives.