title: Group psychological therapy for cancer patients: a point of view, and discussion of the hierarchy of options.
abstract: OBJECTIVE
  We present here a point of view about the logical role of group psychological therapies in the care of cancer patients, and propose a comprehensive, four-stage program that could be implemented at any large cancer treatment center.
  
  
  METHODS
  Our proposals rest on a review of the literature, and on our own experience with various kinds of psychological help for cancer patients, some of which is described.
  
  
  RESULTS
  It is clear that group psychological therapies improve the quality of life of many participating cancer patients, and there is preliminary evidence that it may prolong life in some cases. We describe five main kinds of adjuvant psychological therapy, arranging them on a hierarchy of increasingly active participation by the recipient, and noting the status of evidence for their efficacy. They are: providing information, emotional support, behavioral training in coping skills, psychotherapy (of various kinds), and more speculatively, spiritual/existential therapy.
  
  
  CONCLUSIONS
  We propose that it is time to consider psychological therapy as an adjuvant in cancer management, analogous to adjuvant chemotherapy. The main indication for advocating group psychological therapy to patients should, we argue, be an expert assessment that the patient is likely to benefit, and should not (as is usual at present) be restricted to either 1) those patients with overt psychopathology, or 2) those few who specifically request it.
authors.affiliation: Ontario Cancer Institute/Princess Margaret Hospital, Toronto, Canada.
authors.forename: A J
authors.initials: AJ
authors.lastname: Cunningham
authors.forename: C V
authors.initials: CV
authors.lastname: Edmonds
mesh_terms: D000223:Adaptation, Psychological; D005086:Existentialism; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D016730:Program Development; D011615:Psychotherapy, Group / Q000145:classification* / Q000379:methods / Q000458:organization & administration; D011788:Quality of Life; D012657:Self-Help Groups; D012944:Social Support; D016896:Treatment Outcome; D016312:Treatment Refusal