Psychotherapy for cancer patients with advanced disease

Abstract

Advanced cancer represents not only a medical but an existential crisis. Beyond diagnosable psychiatric disorders – anxiety, depression, adjustment disorders – many patients experience a form of distress that is diagnostically more elusive: existential suffering, demoralization, and the loss of meaning and dignity. Modern oncological treatments have in many cases substantially extended life expectancy even in the palliative stage, giving rise to new clinical realities that have yet to be adequately addressed by psychotherapy. This article describes the theoretical and empirical framework of evidence-based psychotherapeutic approaches for patients with advanced cancer, with a focus on the CALM approach (Managing Cancer And Living Meaningfully): a manualized, meaning-oriented brief therapy derived from empirical and clinical evidence and grounded in multiple therapeutic traditions. Randomized controlled trials demonstrate its efficacy with respect to depressive symptoms, psychological well-being, and preparation for end of life. A detailed example from psycho-oncological practice outlines the psychotherapeutic work with CALM.