Psycho-oncology is a rather new, specialised area of liaison psychiatry, which began developing in the late 1970s in the USA and the UK. The hospice movement began with the opening of St Christopher's Hospice by Cicely Saunders in South London in 1967. Elisabeth Kübler-Ross published her seminal text On Death and Dying in 1969, and it is only since the early 1970s that cancer diagnoses have been routinely shared with patients in the USA and the UK.

Although psychoanalysts and European psychosomaticists have been alert to the importance of psychological factors in cancer for much of the 20th century, it is only since the late 1970s that scientific research, in the narrower sense, has addressed these questions.

The psycho-oncology literature covers normal psychological reactions to cancers and cancer treatments, as well as addressing psychiatric disorders among people with cancer. Some research has tended to conflate stress, personality traits, coping styles, distress, mood states and affective disorders. In this chapter an effort is made to unpick these strands as an aid to evidence-based clinical practice.

The first half of the chapter organises some key research findings around seven important questions in psycho-oncology. The second half of the chapter is devoted to three clinical skills relevant to liaison psychiatrists supporting patients with cancer and their carers.

Question 1: Do stress, coping style, personality traits or psychiatric disorders cause cancer, or alter its prognosis?

In an influential case–control study, Ramirez et al (1989) counted stressful life events occurring between the diagnosis of breast cancer and first recurrence of the disease. The control group were age-matched women without recurrence. There was an excess of threatening life events reported among women with recurrence, supporting the view that psychological stress affects cancer prognosis. However, this finding was not replicated in the same centre (Graham et al, 2002), and prospective studies, free of recall bias, do not confirm any effect of stressful events on cancer incidence, progression or mortality (Fox, 1998).