Objective-To determine the effect of adjuvant psychological therapy on the quality of life of patients with cancer.

The ability of rectal digital examination to recognize significant stages of local extent and lymph node involvement in adenocarcinoma of the lower two‐thirds of the rectum was investigated. Seventy patients with a palpable rectal cancer were examined by 2 or 3 out of a panel of 10 clinicians including 2 consultants and 8 registrars. A defined protocol was used and the results were recorded on a proforma. Clinical findings were compared with the results of pathological examination of the resected specimen or the final surgical assessment when the growth was not removed. In 38 patients computed tomography of the primary growth was performed and the results were also compared to the pathological findings. Four groups of cases with different degrees of extent of spread were recognized by digital examination in 67–83 per cent by consultants and in 44–78 per cent by registrars. Computed tomography correctly identified growths with extensive local spread in 89 per cent of cases, but was no more reliable than digital examination in the assessment of other degrees of spread or of lymph node involvement. Based on the results, a clinical staging system is proposed, comprising four stages of local extent as follows—stage 1: confined to rectum; stage 2: confined to rectum or slight extrarectal spread; stage 3: moderate or extensive extrarectal spread; stage 4: involvement of other organs or unresectability. Two stages of lymph node involvement are also proposed: namely, node negative and node positive. Each stage corresponds to different survival and local recurrence rates after surgery. Combined with other factors, such as level and size of tumour, histological grade and the general state of the patient, the clinical staging system may facilitate the choice of treatment. It might extend the use of major sphincter‐saving procedures, indentify many patients suitable for local treatment and define those with a considerable risk of local recurrence where combined surgery and radiotherapy might be considered.

Patients attending the Royal Marsden Hospital with newly diagnosed cancers or first recurrence were screened for psychological morbidity. A total of 174 patients who met the inclusion criteria were randomly allocated to either adjuvant psychological therapy, a brief, cognitive—behavioural treatment specially designed for cancer patients, or a routine care control. This paper reports the results of the study one year after the baseline assessment. A total of 134 patients completed questionnaires at one year. Patients who received therapy showed significantly less psychological distress measured on the Psychological Adjustment to Illness Scale. There was a tendency for patients in the therapy group to show more change on measures of helplessness and anxiety. Using the criteria for psychological morbidity employed at the time of entry into the study, at one year only 19% of therapy patients were still in the clinical range for anxiety compared with 44% of the control patients; 11% of therapy patients were in the clinical range for depression compared with 18% of the control patients. This study demonstrates that a brief psychological intervention can produce improvement in psychological functioning which persists up to 10 months after the end of the intervention; in particular, the number of patients who would still meet criteria for ‘caseness’ is reduced. These findings justify further investigation of the efficacy of adjuvant psychological therapy in cancer patients.