Cancer Patients in Assessment: Insights from a Bibliometric Analysis of the Journal 

Psycho-Oncology 

        According to recent American Cancer Society estimates, the burden of cancer incidence and morbidity continues to escalate at alarming rates (Siegel et al., 2024; Sung et al., 2021), encompassing both physical and psychological impairment. In the assessment enterprise, clients frequently present with copious health problems and a sizeable minority of these examinees struggle with serious medical conditions, such as cancer (see Bell et al., 1953). But what unique aspects does a cancer diagnosis play in psychological evaluation protocols? Perhaps, this is most applicable to the use of Inkblot measures, such as the SIS-Series and the Rorschach where somatization is a key clinical element, as reflected in the research literature (Cassell & Dubey, 1996; Georgoff, 1991; Marchioro et al., 2005; Mukherjee et al., 2023; Schon & Bard, 1958; Signorelli, 2015; Tofani & Vaz, 2007; Venturini & Pheulpin, 2021). Hence, what are the most prominent mental health issues and challenges in the lives of cancer patients? Secondly, to what extent does the psychological examiner consider the examinee’s cancer diagnosis as a potential critical factor in the clinical productivity evident through psychological and projective testing? 

        The field of Psycho-Oncology constitutes a specialty area within healthcare psychology (Kissane, 2022). Yet, there is scant research regarding the nature of the intellectual structure and extant scholarship reflecting this area of study. One approach to gaining an understanding on the breadth and scope of the extensive body of scientific knowledge that spans Psych-Oncology is the use of bibliometric analysis. To this end, I conducted a bibliometric analysis of contemporary studies indexed in the journal Psycho-Oncology from 2018 to 2024, which determined the most prominent topics of research attention published in this top-tier journal. Based on the analysis, I identified the core mental health issues that permeate the life of cancer patients. These central, most salient, issues should be at the forefront of clinical concern and attention of the examining psychologist during the psychological assessment of cancer patients. 

Method: 

        Bibliometric analysis offers a methodology in determining a systematic, quantitative description of the investigatory trends and scholarly research activity of a select field (Krippendorff, 2004). Bibliographic research has been well regarded in both the field of psychology (e.g., Piotrowski, 2020) and health care (Holden et al., 2020; Kokol et al., 2020). The current study sought to obtain a content analysis of studies represented in the journal Psych-Oncology over the past 7 years (2018-2024); an online review identified 1,677 references for this time span. Of these, 119 were editorials, erratum, corrections, and commentaries which were deleted from further consideration. Hence, the total dataset for the current analysis entailed 1,558 studies. The objective was to determine the main focus of each reference from the perspective of the study’s investigator(s). Based on these parameters, all studies were reviewed by the author and each reference was coded with a sole descriptor that best represented the main focus of study. A frequency tally, across individual subject categories, was maintained and then summed for each topic. 

Findings: 

        A caveat is in order: Only those psychological topics that are highly salient to the lives of cancer patients are presented in Table 1. Not surprisingly, psychological distress was the most prominent area of investigatory attention in Psycho-Oncology (see Mehnert et al., 2018; Mitchell et al., 2011; Wolyniec et al., 2022), representing almost 4% of the current analysis (i.e., 63 of 1,558 studies). Undoubtedly, this reflects the historically high prevalence of mental health concerns and psychiatric disorders evident in cancer patient populations (Derogatis et al., 1983; Holland & Rowland, 1989). Several topical areas each accounted for 3% of the examined dataset, i.e., quality of life, depression, and fear of cancer recurrence. This is consistent with the prior analyses of published scholarship in cancer research (e.g., Kissane, 2022; Shrestha et al., 2019).  

        In terms of cancer-related psychopathology, research on depression effects was much more prevalent than the study of anxiety conditions (Nikendei et al., 2018; Priede et al., 2022), although the focus on mental health evaluation of cancer patients is a central concern of health care providers (see Table 1). Measurement and assessment issues (39 studies) appear to be quite prominent in the journal Psycho-Oncology, and the current analysis identified 44 individual measures/scales that were the major focus of study. The most prominent measures were the Fear of Cancer Recurrence Inventory (Fardell et al., 2018; Luigjes-Huizer et al., 2022), the PROMIS series, the Distress Thermometer, and the Patient Health Questionnaire-9. Perhaps this reflects methodological challenges in the field, with unresolved validation of construct and evaluation procedures that define an emerging discipline (e.g., Piotrowski & Watt, 2025). The bottom-half of Table 1 lists topics with 1-2% of the dataset of 1,558 studies. 

Table 1. Rank Order of Major Topical Areas of Research 

Cancer Patients in Assessment: 63 

Note: Total dataset (n=1,558). 

        In addition, several salient topics represented just below 1% of the articles in the analysis i.e., investigatory areas dealing with existential issues, adolescent psychosocial development and genetic testing/heredity. These should be considered additional clinical factors that may be a significant feature in the psychological evaluation of the cancer patient. 

        Overall, the findings of this analysis seem to confirm that contemporary research in the area of Psych-Oncology spans a broad range of salient topics central to the mental health and psychological dynamics of cancer patients, issues frequently encountered in the assessment enterprise (Langford et al., 2020). Clinicians need to be cognizant of these issues and their potential significance to projective testing protocols. Further research is needed to determine critical aspects of not only the mental health status of cancer patients, but also the significance of these factors and their impact on clinical data revealed via psychological and projective assessment, including the examinees’ reference to pain concerns (see Piotrowski, 2020; Piotrowski & Lubin, 1990). 

References: 

Bell, A., et al. (1953). The use of projective techniques in the investigation of emotional aspects of general medical disorders. Journal of Projective Techniques, 17, 51-60. 

Cassell, W.A., & Dubey, B.L. (1996). The use of the Rorschach and Somatic Inkblot Series in releasing somatisized grief. Journal of Projective Psychology & Mental Health, 3(1), 3-32.  

Derogatis, L.R., et al. (1983). The prevalence of psychiatric disorders among cancer patients. Journal of the American Medical Association, 249, 751-757. 

Fardell, J.E., et al. (2018). Exploring the screening capacity of the Fear of Cancer Recurrence Inventory-Short Form for clinical levels of fear of cancer recurrence. Psycho-Oncology, 27(2), 492-499. 

Georgoff, P.B. (1991). The Rorschach with hospice cancer patients and surviving cancer patients. Journal of Personality Assessment, 56(2), 218-226.  

Holden, R.J., et al. (2020). Patient ergonomics: 10-year mapping review of patient-centered human factors. Applied Ergonomics, 82, 1-15. 

Holland, J.C. (2018). Psycho-Oncology: Overview, obstacles, and opportunities. Psycho-Oncology, 27, 1364-1376. 

Holland, J.C., & Rowland, J.H. (Eds.). (1989). Handbook of psycho-oncology. Oxford University Press. 

Kissane, D.W. (2022). The flourishing scholarship of psychological oncology viewed across 30 years through the lens of this journal. Psycho-Oncology, 31, 559-561. 

Kokol, P., et al. (2020). Application of bibliometrics in medicine: A historical bibliometrics analysis. Health Information & Libraries Journal, 38, 125-138. 

Krippendorff, K. (2004). Content analysis: An introduction to its methodology (2nd ed.). Sage. 

Langford, D.J., et al. (2020). Association of personality profiles with coping adjustment to cancer among patients undergoing chemotherapy. Psycho-Oncology, 29(6), 1060-1067. 

Luigjes-Huizer, Y.L., et al. (2022). What is the prevalence of fear of cancer recurrence in cancer survivors and patients? A systematic review. Psycho-Oncology, 31, 879-892. 

Marchioro, G., et al. (2005). The Rorschach Inkblot Test as an instrument for evaluating quality of life in breast-cancer victims. Rorschachiana, 27(1), 119-138. 

Mehnert, A., et al. (2018). One in 2 cancer patients is significantly distressed? Prevalence and indicators of distress. PsychoOncology, 27(1), 75-82. 

Mitchell, A.J., et al. (2011). Screening for distress and depression in cancer settings. Psycho-Oncology, 20, 572-584. 

Mukherjee, A., et al. (2023). Comparison of SIS-I and BDI-II for assessing depression in recurrent breast cancer patients. Journal of Projective Psychology & Mental Health, 30(2), 85-89. 

Nikendei, C., et al. (2018). Depression profile in cancer patients and patients without a chronic somatic disease. Psycho-Oncology, 27(1), 83-90. 

Piotrowski, C. (2020).  Pain assessment: Most prominent measures/tests in the research literature. Journal of Projective Psychology & Mental Health, 27(1), 21-31. 

Piotrowski, C., & Lubin, B. (1990). Assessment practices of health psychologists: Survey of APA Division 38 clinicians. Professional Psychology: Research & Practice, 21(2), 99-106. 

Piotrowski, C., & Watt, J.D. (2025). Applied Ergonomics: Contemporary research trends and under-studied areas of scholarly investigation. North American Journal of Psychology, 27(1), 430-438. 

Priede, A., et al. (2022). Cognitive variables associated with depressive and anxiety symptoms in patients with cancer. PsychoOncology, 31, 798-805. 

Schon, M., & Bard, M. (1958). The effect of hypophysectomy on personality in women with metastatic breast cancer as revealed by the Rorschach test. Journal of Projective Techniques, 22, 440-445. 

Shrestha, A., et al. (2019). Quality of life versus length of life considerations in cancer patients: A systematic literature review. Psycho-Oncology, 28(7), 1367-1380. 

Signorelli, S.C. (2015). Cancer and the Rorschach from an existential perspective. Existential Analysis, 26(1), 70-85. 

Sung, H., et al. (2021), Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209-249. 

Tofani, A., & Vaz, C.E. (2007). Prostate cancer, feelings of impotence and failures before Cards IV and V of the Rorschach. RevistaInteramericana de Psicologia, 41(2), 197-204. 

Venturini, E., & Pheulpin, M.C. (2021). Psychic treatment of constraint in cancerous pathology: Contribution to the study of movement responses in the Rorschach test. Psychologie Clinique et Projective, 30(2), 129-156. 

Wolyniec, K., et al. (2022). Psychological distress, understanding of cancer and illness uncertainty in patients with cancer of unknown primary. Psycho-Oncology, 31, 1869-1876. 

Chris Piotrowski 

PhD, Senior Editor 

University of West Florida, USA 

Email: piotrowskichris@hotmail.com