ncreasingly, medical personnel recognize that patients with lifethreatening disease, at every stage of the disease and at every stage of treatment, experience some degree of emotional distress* and that emotional distress negatively affects health and recovery.* It has been demonstrated that immune functioning is enhanced by perception of a degree of control over noxious stimuli3,4 and by expression of emotions, even negative emotions. 5,6 These are good reasons to include counseling in treatment plans, but perhaps the most important reason is that psychological intervention can improve the patient's quality of life during a stressful time.7
Each phase of breast cancer treatment has unique emotional features. This article presents recommendations for timing and methodology of psychological assessment' and intervention at each stage of breast cancer.* Assessment issues, along with suggested interventions, are summarized in Table 1.
Diagnosis
At our center, patients meet with the psychologist on the day they are diagnosed. Psychological evaluation is presented as a routine part of the clinical workup for breast cancer. This approach helps avoid any stigma women might feel about the referral itself.
The first step of any good assessment is to listen to patients' subjective experiences. These might be elicited by probing questions, such as "What did the doctor tell you?' and "Did you expect your diagnosis?' It is also useful to ask patients whether they have friends or family members who have had breast cancer and what the outcomes were.
If patients are distressed or anxious, specific concerns should be addressed first and formal assessment deferred. Typically, the most prominent concerns are survival and fear of treatment side effects. Women are reassured when given information that most women survive breast cancer and that psychosocial support is available to them and their families. A referral to Reach to Recovery, an American Cancer Society program that