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Beyond psychiatric classification in oncology: Psychosocial dimensions in cancer and implications for care

Au-delà de la classification psychiatrique en oncologie: aspects psychosociaux du cancer et répercussions pour les soins

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Psycho-Oncologie

Abstract

Although the field of psychological reactions of patients in response to cancer and cancer treatment has been the object of intense psycho-oncology research, the DSM and ICD nosological systems fail to give proper space to this area. Both the ICD and DSM rubrics Psychological Factors affecting a Medical Condition fail to fully describe the several psychosocial implications of cancer. The development of Diagnostic Criteria for Psychosomatic Research (DCPR) is in line with the psychosomatic and biopsychosocial tradition and has given a new impulse to this area by translating psychosocial variables into operational tools for psychosocial variables with prognostic and therapeutic implications in medically ill patients. The application of the DCPR has been shown to be useful in a more precise identification of several psychological conditions affecting cancer patients. The DCPR dimensions of health anxiety, demoralization and alexithymia have been recognized in oncology, with a low overlap with a formal DSM psychiatric diagnosis; the DCPR dimensions dealing with the patients’ ways of perceiving, experiencing, evaluating, and responding to their health status (abnormal illness behaviour) have also been demonstrated, while more data are needed with regard to the complex area of somatization and somatic symptom presentation of distress in cancer patients, for which the DCPR clusters of somatization (functional somatic symptoms secondary to psychiatric disorders, persistent somatization, conversion symptoms, and anniversary reaction) can be of help. More research and the possible refinement of DCPR clustering dimensions are needed in order to understand the several and multiform psychosocial responses of cancer patients across the trajectory of the disease.

Résumé

Bien que le champ des réactions psychologiques des patients en réponse au cancer et au traitement du cancer ait fait l’objet de recherches intensives en matière de psychooncologie, les systèmes nosologiques DSM et ICD n’accordent pas suffisamment d’importance à ce domaine. Les rubriques concernant les facteurs psychologiques des systèmes ICD et DSM affectant un état pathologique ne décrivent pas dans leur intégralité les nombreuses conséquences psychosociales du cancer. Le développement de critères diagnostiques pour la recherche psychosomatique (DCPR) s’aligne sur la tradition psychosomatique et biopsychosociale et a permis de donner un nouvel élan à ce domaine en transposant des variables psychosociales à des outils opérationnels pour les variables psychosociales ayant des implications pronostiques et thérapeutiques chez des patients malades. L’application des DCPR a démontré leur utilité pour l’indentification plus précise de plusieurs conditions psychologiques affectant les patients atteints d’un cancer. Les dimensions des DCPR concernant l’anxiété, la démoralisation et l’alexithymie liées à la santé ont été reconnues en oncologie, avec une faible coïncidence avec un diagnostic DSM psychiatrique formel. Les dimensions des DCPR relatives à la manière dont les patients perçoivent, ressentent, évaluent et réagissent à leur état de santé (comportement anormal lié à la maladie) ont également été prouvées. Cependant, il sera nécessaire de fournir davantage de données concernant les zones complexes de somatisation et de symptômes somatiques signalant de l’anxiété chez les patients atteints d’un cancer, pour lesquels les groupes de somatisation des DCPR (symptômes somatiques fonctionnels secondaires pour les troubles psychiatriques, somatisation persistante, symptômes de conversion et les réactions anniversaires) peuvent être utiles. Des recherches supplémentaires et un éventuel affinement des dimensions de regroupement des DCPR sont nécessaires afin de comprendre les réactions psychosociales, nombreuses et complexes, des patients atteints d’un cancer tout au long de l’évolution de la maladie.

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  1. Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy

    L. Grassi & M. G. Nanni

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  1. L. Grassi
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Grassi, L., Nanni, M.G. Beyond psychiatric classification in oncology: Psychosocial dimensions in cancer and implications for care. Psycho Oncologie 7, 235–242 (2013). https://doi.org/10.1007/s11839-013-0436-4

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  • DOI: https://doi.org/10.1007/s11839-013-0436-4

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