The psychological dimension in cancer treatment.

A cardinal principle of medical ethics, primum non nocere, is examined in relation to current cancer treatments. In randomised, clinical trials of such treatments, the quality of life of patients has been largely ignored. The few systematic psychological studies reported so far indicate the likelihood of considerable psychosocial morbidity associated with radical surgery and prolonging combined chemotherapy. Detailed measures of psychosocial adjustment should be included in all future clinical trials of cancer therapy in order: (i) to identify those patients who require psychological help and (ii) to enable clinicians to base their decisions regarding cancer therapy not only on the probability of prolonging or, in some cases, saving life, but also on an accurate knowledge of the quality of that life.