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  • Print publication year: 2008
  • Online publication date: August 2009

21 - Support services



Whether the primary treatment approach to cognitive impairment in cancer is remediation/rehabilitation, pharmacotherapy, or a combination, one must not underestimate the importance of comprehensive support services throughout the illness continuum.

Cognitive deficits related to cancer may be primary, related to the disease entity itself, or may be secondary, related to the various methods used to treat the cancer. Such deficits may also be related to direct and indirect co-morbidities of the cancer and treatments. Among the most common co-morbidities are mood disturbances (e.g., depression, anxiety) and fatigue. Fatigue is the most widely reported deleterious symptom in adult cancer patients (Valentine & Meyers, 2001). Additionally, in childhood cancer survivors, fatigue and “aches and pains” are reported as most problematic relative to other symptoms (Zebrack & Chesler, 2002). In this chapter, we will consider cognitive deficits, mood disturbances or emotional distress, and fatigue as highly inter-related symptoms of cancer and will discuss support services that may apply to one or more of these conditions in isolation or in combination.

Support has many definitions, but is generally understood as strengthening the patient's and family's resources by providing emotional, informational, and practical assistance as needed, and by appropriately fostering a sense of hope or optimism. Here, we refer to a wide range of strategies designed to improve emotional and social adjustment and functioning, increase coping, assist with decision-making, and minimize distress.

Allen, DH, Tepper, S, Carter, Ket al. (2003). Use of Beck Depression Inventory II: evaluating quality of life symptoms in glioma patients [Abstract] Society for Neuro-Oncology Eighth Annual Meeting, 13–16 November, 2003. Keystone, Colorado. Neurooncology 5: 329.
Angelino, AF, Treisman, GJ (2001). Major depression and demoralization in cancer patients: diagnostic and treatment considerations. Support Care Cancer 9(5): 344–349.
Armstrong, FD, Blumberg, MJet al. (1999). Neurobehavioral issues in childhood cancer. School Psychol Rev 28: 194–203.
Baider, L, Denour, AK (1999). Psychological distress and cancer couples: a leveling effect. New Trends Exp Clin Psychiatry 15: 197–203.
Bernstein, BJ, Grasso, T (2001). Prevalence of complementary and alternative medicine use in cancer patients. Oncology (Huntington) 15(10): 1267–1272; discussion 1272–1278, 1283.
Bertakis, KD, Roter, D, Putnam, SM (1991). The relationship of physician medical interview style to patient satisfaction. J Fam Pract 32(2): 175–81.
Blanchard, CG, Albrecht, TL, Ruckdeschel, JC (1997). The crisis of cancer: psychological impact on family caregivers. Oncology 11: 189–194.
Blueglass, K (1991). Care of the cancer patient's family. In Watson, M (ed.) Cancer Patient Care: Psychosocial Treatment Methods (pp. 159–189) Cambridge: British Psychological Society and Cambridge University Press.
Bonner, MJ, Hardy, KKet al. (2006). Development and validation of the parent experience of illness (PECI) questionnaire. J Pediatr Psychol 31: 310–321.
Boudioni, M, Mossman, Jet al. (2000). An evaluation of a cancer counselling service. Eur J Cancer Care 9: 212–220.
Boulton, M, Boudioni, Met al. (2001). “Dividing the desolation”: clients views on the benefits of a cancer counselling service. Psychooncology 10: 124–136.
Braden, CJ, Mishel, MHet al. (1998). Self-help intervention project: women receiving breast cancer treatment. Cancer Pract 6(2): 87–98.
Bradley, CH, Bednarek, HL (2002). Employment patterns of long-term cancer survivors. Psychooncology 11: 188–198.
Brown, RT, Madan-Swain, Aet al. (2003). Posttraumatic stress symptoms in adolescent survivors of childhood cancer and their mothers. J Trauma Stress 16: 309–318.
Butler, RW, Mulhern, RK (2005). Neurocognitive interventions for children and adolescents surviving cancer. J Pediatr Psychol 30(1): 65–78.
Campbell, H, Phaneuf, Met al. (2004). Cancer peer support programs – do they work? Patient Educ Counsel 55: 3–15.
Carlson, , Angen, M, Cullum, Jet al. (2004). High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90(12): 2297–2304.
Carter, PA, Chang, BL (2000). Sleep and depression in cancer caregivers. Cancer Nurs 23: 410–415.
Cassileth, BR, Lusk, EJet al. (1985). A psychological analysis of cancer patients and their next-of-kin. Cancer 55: 72–76.
Cheville, A (2001). Rehabilitation of patients with advanced cancer. Rehabilitation in the New Millennium. Cancer 92 [4 Suppl.]: 1039–1048.
Chirikos, TN, Russell-Jacobs, Aet al. (2002). Functional impairment and the economic consequences of female breast cancer. Women Health 36(1): 1–20.
Cliff, AM, McDonagh, RP (2000). Psychosocial morbidity in prostate cancer II; a comparison of patients and partners. Br J Urol Int 86: 834–839.
Clinical Practice Guidelines in Oncology. Version 1.205 Available at: Accessed 11 April, 2008.
Compas, BE, Worsham, NLet al. (1994). When mom or dad has cancer: markers of psychological distress in cancer patients, spouses, and children. Health Psychol 13: 507–515.
Covinsky, KE (1994). The impact of serious illness on patients' families. SUPPORT investigators study to understand prognoses and preferences for outcomes and risks of treatment. J Am Med Assoc 272(23): 1839–1844.
Deasy-Spinetta, P, Spinetta, JJ (1980). The child with cancer in school: teacher's appraisal. Am J Pediatr Hematol Oncol 2: 89.
DeLisa, JA (2001). A history of cancer rehabilitation. Cancer Rehabilitation in the New Millennium. Cancer 92 [4 Suppl.]: 970–974.
Devine, EC, Westlake, SK (1995). The effects of psychoeducational care provided to adults with cancer: meta-analysis of 116 studies. Oncol Nurs Forum 22(9): 1369–1381.
Ell, KO, Mantell, JE, Hamovitch, MB, Nishomoto, RH (1989). Social support, sense of control, and coping among patients with breast, lung, or colorectal cancer. J Psychosocial Oncol 7: 63–89.
Ernst, E, Cassileth, BR (1998). The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer 83(4): 777–782.
Frank, NC, Brown, RTet al. (2001). Predictors of affective responses of mothers and fathers of children with cancer. Psychooncology 10: 293–304.
Gabanelli, P (2005). A rehabilitative approach to the patient with brain cancer. Neurol Sci 26: S51–S52.
Gagnon, B, Low, G, Schreier, G (2005). Methylphenidate hydrochloride improves cognitive function in patients with advanced cancer and hypoactive delirium: a prospective clinical study. J Psychiatry Neurosci 30(2): 100–107.
Garrard, P, Farnham, C, Thompson, AJ, Playford, ED (2004). Rehabilitation of the cancer patient: experience in a neurological unit. Neurorehabil Neural Repair 18(2): 76–79.
Given, CW, Stommel, Met al. (1993). The influence of cancer patients' symptoms and functional states on patients' depression and family caregivers' reaction and depression. Health Psychol 12: 277–285.
Given, C, Given, Bet al. (2004). Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy. J Clin Oncol 22(3): 507–516.
Hall, IM, Cope, DN (1995). The benefit of rehabilitation in traumatic brain injury: a literature review. J Head Trauma Rehabil 10: 1–13.
Holmes, AM, Deb, P (2003). The effect of chronic illness on the psychological health of family members. J Mental Health Policy Econ 6(1): 13–22.
Johnson, J (1982). The effect of a patient education course on persons with a chronic illness. Cancer Nurs 5(2): 117–123.
Johnson, J (1988). Cancer: a family disruption. Recent Results Cancer Res 108: 306–310.
Kazak, AE, Barakat, LPet al. (1997). Posttraumatic stress, family functioning, and social support in survivors of childhood leukemia and their mothers and fathers. J Consult Clin Psychol 65: 120–129.
Kazak, AE, Alderfer, Met al. (2004). Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in families of adolescent childhood cancer survivors. J Pediatr Psychol 29: 211–219.
Kirshblum, S, O'Dell, Met al. (2001). Rehabilitation of persons with central nervous system tumors. Cancer Suppl 92(4): 1029–1038.
Klemm, P, Bunnell, Det al. (2003). Online cancer support groups: a review of the research literature. Computers Infomatics Nursing 21(3): 136–142.
Langeveld, NE, Stam, Het al. (2002). Quality of life in young adult survivors of childhood cancer. Support Care Cancer 10(8): 579–600.
Leigh, LD, Miles, MA (2002). Educational issues for children with cancer. In Pizzo, PA, Poplack, DG (eds.) Principles and Practice of Pediatric Oncology (pp. 1463–1476). Philadelphia, PA: Lippincott Williams & Wilkins.
Maddrey, AM, Bergeron, JA, Lombardo, ER (2005). Neuropsychological performance and quality of life of 10 year survivors of childhood medulloblastoma. J Neurooncol 72(3): 245–253.
Maguire, P (1999). Improving communication with cancer patients. Eur J Cancer 35: 1415–1422.
Marciniak, C, Sliwa, Jet al. (2001). Functional outcomes of persons with brain tumors after inpatient rehabilitation. Arch Phys Med Rehabil 82: 457–463.
Matthews, B, Baker, F, Spillers, RL (2004). Oncology professionals and patient requests for cancer support services. Support Care Cancer 12(10): 731–738.
Meyer, TJ, Mark, MM (1995). Effects of psychosocial interventions with adult cancer patients: a meta-analysis of randomized experiments. Health Psychol 14(2): 101–108.
Meyers, CA (2000). Neurocognitive dysfunction in cancer patients. Oncology 14(1): 75–85.
NCCN Standards of Care for Distress Management, DIS-3. Version 1.205 Available at: Accessed 9 April, 2008.
Nijboer, C, Triemstra, Met al. (1999). Determinate of caregiving experiences and mental health of partners of cancer patients. Cancer 86: 577–588.
Nijboer, C, Gtriemstra, Met al. (2000). Patterns of caregiver experiences among partners of cancer patients. Gerontologist 40: 738–746.
Northouse, LL (1988). Social support in patients' and husbands' adjustment to breast cancer. Nurs Res 37: 91–95.
Northouse, LLet al. (2000). Couples' patterns of adjustment to colon cancer. Soc Sci Med 50: 271–284.
Oberst, MT, Thomas, SEet al. (1989). Caregiving demands and appraisal of stress among family caregivers. Cancer Nurs 12: 209–215.
O'Dell, M, Barr, Ket al. (1998). Functional outcome of inpatient rehabilitation in persons with brain tumors. Arch Phys Med Rehabil 79: 1530–1534.
Rehse, B, Pukrop, R (2003). Effects of psychosocial interventions on quality of life in adult cancer patients: meta analysis of 37 published controlled outcome studies. Patient Educ Counsel 50: 179–186.
Ressler, IB, Cash, Jet al. (2003). Continued parental attendance at a clinic for adult survivors of childhood cancer. J Pediatr Hematol Oncol 25: 868–873.
Rosenbaum, E, Gautier, Het al. (2004). Cancer supportive care, improving the quality of life for cancer patients. A program evaluation report. Support Care Cancer 12: 298–301.
Rozans, M, Dreisbach, A, Lertora, JJ, Kahn, MJ (2002). Palliative uses of methylphenidate in patients with cancer: a review. J Clin Oncol 20(1): 335–339.
Sanson-Fisher, R, Girgis, A, Boyes, Aet al. (2000). The unmet supportive care needs of patients with cancer. Supportive Care Review Group. Cancer 88(1): 226–237.
Sheard, T, Maguire, P (1996). The effect of psychological interventions on anxiety and depression in oncology; results of two meta-analyses. Paper presented at Third World Congress of Psycho-Oncology. New York.
Sheard, T, Maguire, P (1999). The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br J Cancer 80(11): 1770–1780.
Sherer, M, Meyers, CA, Bergloff, P (1997). Efficacy of postacute brain injury rehabilitation for patients with primary malignant brain tumors. Cancer 80(2): 250–257.
Short, PF, Vasey, JJ, Tunceli, K (2005). Employment pathways in a large cohort of adult cancer survivors. Cancer 103(6): 1292–1301.
Sierpina, V, Sierpina, Met al. (2005). Complementary and integrative approaches to dementia. South Med J 98(6): 636–645.
Sloper, P (2000). Predictors of distress in parents of children with cancer: a prospective study. J Pediatr Psychol 25: 79–92.
Speca, M, Carlson, Let al. (2000). A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosomatic Med 62: 613–622.
Spelten, ER, Verbeek, JH, Uitterhoeve, ALet al. (2003). Cancer, fatigue and the return of patients to work – a prospective cohort study. Eur J Cancer 39(11): 1562–1567.
Spiegel, D, Bloom, JRet al. (1981). Group support for patients with metastatic cancer. A randomized outcome study. Arch Gen Psychiatry 38(5): 527–533.
Stewart, JL, Mishel, MH (2000). Uncertainty in childhood illness: a synthesis of the parent and child literature. Sch Inq Nurs Pract 14: 299–319.
Sutherland, JE, Sutherland, SJ, Hoehns, JD (2003). Achieving the best outcome in treatment of depression. J Fam Prac 52(3): 201–209.
Svavarsdottir, EK (2005). Caring for a child with cancer: a longitudinal perspective. J Adv Nurs 50: 153–161.
Valentine, AD, Meyers, CA (2001). Cognitive and mood disturbance as causes and symptoms of fatigue in cancer patients. Cancer Supplement 92(6): 1694–1698.
Dongen-Melman, JEWM, Pruyn, JFAet al. (1995). Late psychosocial consequences for parents of children who survived cancer. J Pediatr Psychol 20: 567–586.
Dongen-Melman, JEWM, Zuuren, FJet al. (1998). Experiences of parents of childhood cancer survivors: a qualitative analysis. Patient Educ Couns 34: 185–200.
Weis, J (2003). Support groups for cancer patients. Support Care Cancer 11: 763–768.
Welch, AS, Wadsworth, MEet al. (1996). Adjustment of children and adolescents to parental cancer. Parents' and children's perspectives. Cancer 77: 1409–1418.
Ybema, JF, Kuijer, RGet al. (2001). Depression and perceptions of inequity among couples facing cancer. J Psychosocial Oncol 27: 3–13.
Zebrack, BJ, Chesler, MA (2002). Quality of life in childhood cancer survivors. Psychooncology 11(2): 132–141.