Introduction

Over the past 20 years, increasing attention has been given to the psychiatric aspects of comorbid disorders and psychosocial problems of cancer. The field has evolved to the point that it is a recognized subspecialty of oncology and consultation liaison psychiatry. (1„) Psycho-oncology addresses the two major psychiatric and psychological dimensions of cancer:

1. the psychiatric comorbid disorders and psychological responses of patients at all stages of illness and their families and, the psychological stresses on health professionals delivering their care;

2. the psychological, behavioural, and social factors that influence cancer risk, detection, and survival.

A vigorous research effort is being conducted in both areas.

This chapter focuses on the first dimension, relating to the clinical care of patients and families which, in the broadest sense, deals with their quality of life. Many clinical trials of new cancer treatments include a quantitative assessment of the patient's quality of life along with survival, as part of the outcome variables. These issues are particularly important in palliative and end-of-life care when quality of life becomes the paramount focus of care. There are also issues that arise in which psychiatric, ethical, religious, and spiritual issues overlap and careful psychiatric assessment is required to assure proper diagnosis. This chapter provides a brief overview of the most frequently observed psychiatric disorders and their management.

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