Coping with Cancer
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Transcript of Coping with Cancer
This is your brain on cancer.
Fight or Flight Response/Survival
• Normal response to survival situation.
• Overuse causes damage.
• Lowered immune functioning, higher burnout, more stress.
The 6 Feared “D’s”
• 1) Discomfort• 2) Dependency • 3) Disfigurement• 4) Disability• 5) Disruption• 6) Disengagement• 7) Death (Holland et al, 2001)
Doing the Right Thing…
• Treatment choices.
• Personality changes
• Is this making me sicker?
You are already coping…
Understanding Coping Styles
• Distancing/Denial• Accepting• Escape-Avoidance• Problem Solving• Confronting• Self-controlling• Seeking social support
Substance Abuse
• Avoidant response• Exacerbated by
illness • Loss of control• Fear of pain, tx,
outcomes• Interferes with tx
Coping Skills and QOL
• Thought stopping• Affect regulation• Exercise, diet• Relaxation• Emotion expression• Humor• Distraction• Information
4 Phases of Treatment
• Diagnosis
• Active Treatment
• Follow-Up
• Future and Possible Recurrance
Myths about Depression/Anxiety
• All patients with cancer are depressed/anxious and need help.
• Patients with cancer manage well and very few need help coping.
• Talking about depression/anxiety makes matters worse.
Prevalence of Depression
• About 47% cancer patients experience depression at some point during their illness (Derogatis et al, 1983).
• Of these, most fit criteria for Adjustment Disorder, smaller number for Major Depressive Disorder.
• 90% of above secondary to disease or tx.
Why do people get depressed?
• Physical compromises.• Life changing event.• Stress of decision
making.• Fear of future.• Pain, loss of freedom,
changes in lifestyle.• Medication Interactions.• Thoughts of death.
Treatment for Depression/Anxiety
• Psychotherapy• Social Support• Medication • Psycho-education
and coping skills
How does psychotherapy work?
• Normalizes negative feelings.• Facilitates communication.• Supports fears and hopes.• Reinforces existing coping skills.• Develops new coping skills.• Focuses on Quality of Life
Individual, Couples, or Families
What is meaningful helps.
• Support and love from family and friends.
• Finding personal meaning, creating rituals.
• Hobbies, activities, beliefs, reflection.
Grief Work
• Normal response to loss, whether from death of a beloved, loss, or injury.
• Usually proportionate to disruption caused by loss.
• Loss is normal part of life for everyone.
Stages of Grief
• Denial/Shock
• Anger
• Bargaining
• Depression/Sadness
• Acceptance
(“On Death and Dying” Kubler Ross)
Recognizing Grief
• Insomnia• Appetite changes• Aimlessness• Hopelessness• Excessive guilt• Psychomotor
retardation
Specific Psychosocial Interventions
Targeted Approaches/Solutions
Relaxation Training
• Breathing• Meditation• Hypnosis• Music• Exercise• Guided Imagery
Sleep Disturbance
• 48% prescribed medications for cancer patients are hypnotics (sleep aids).
• 44% psychotropics sleep aids.
Sexual Dysfunction
• Medication side effects
• Treatment side effects
• Depression • Fear of intimacy• Couples Therapy
Communication with Medical Professionals
• List of questions and concerns.
• Education • Collaboration/
coordination of care by point person.
Caregiver Burnout
• Empathic effort takes its toll
• Express negative or exhausting feelings
• Self-care essential• Support for caregivers• Re-focus on what is
important in own lives
Group Interventions
• Benefits social support, communication skills, coping responses, and immune functioning.
• Feedback from other patients and caregivers.
• Mixed diagnosis/prognosis?
Case Presentation
Multi-method Interdisciplinary
Treatment of Cancer
Couple Dealing with Cancer
• 40 y/o male, w/kids, engaged to be married
• Recently diagnosed with Colon cancer
• Tx- surgery, 6 rounds of chemo, possible radiation
Woman with Breast Cancer
• 55 y/o married Chinese American woman, w/ 2 kids.
• Communication struggles w/ family and doctors.
• Cultural Considerations.
Palliative Care
• 70 y/o “Type A” male with metastatic cancer.
• Wife, 2 kids and 3 grandchildren.
• End of life decisions.• Meaning making.• Saying goodbye.
Summary
• Advances in cancer dx and tx promising but treatment decisions increasingly complex.
• Coping responses inherent.• Depression and anxiety common.• Social support essential.• Self-care facilitates caregiving.
References
• 1.Jensen AB: Psychological factors in breast cancer and their possible impact upon prognosis. Cancer Treat Rev 1991; 18:191 ミ 210[Medline]2.Maunsell E, Jacques B, Duschene L: Social support and survival among women with breast cancer. Presented at the Annual Psycho-Oncology Meeting, Memorial Sloan-Kettering Cancer Center, New York, NY, October 19933.Dean C, Surtees PG: Do psychological factors predict survival in breast cancer? Journal of Psychosocial Research 1989; 33:561 ミ 5694.Forsen A: Psychosocial stress as a risk for breast cancer. Psychother Psychosom 1991; 55:175-185[Medline]
5.Derogatis LR, Abeloff MD, Melisartos N: Psychological coping mechanism and survival time in metastatic breast cancer. JAMA 1979; 242:1504 ミ 15086.Greer S, Morris J, Pettingage KW: Psychological response to breast cancer: effect on outcome. Lancet 1979; 2:785 ミ 787[Medline]7.Greer S: Psychological response to cancer and survival. Psychol Med 1991; 21:43 ミ 49[Medline]8.Spiegel D, Kato P: Psychosocial influences on cancer incidence and progression. Harvard Review of Psychiatry 1996; May/June, pp 10 ミ269.Hill D, Kelleher K, Shamaker SA: Psychosocial interventions in adult patients with coronary heart disease and cancer: a literature review. Gen Hosp Psychiatry 1992; 14(6, suppl):285 ミ 42510.Spiegel D, Bloom JR, Kraemer HC, et al: Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989; 2:888 ミ 901[Medline]11.Richardson JL, Shelton DR, Kasilo M, et al: The effect of compliance with treatment on survival among patients with hematological malignancies. J Clin Oncol
1990; 8:356 ミ 364[Abstract]12.Fawzy FI, Fawzy NW, Hyun CS, et al: Malignant melanoma: effects of an early structured psychiatric intervention, coping, and effective state on recurrence and survival, 6 years later. Arch Gen Psychiatry 1993; 50:681 ミ 689[Abstract]13.Straker M: A review of short-term psychotherapy. Diseases of the Nervous System 1977; 38:813 ミ 816[Medline]14.Caplan G: Principles of Preventative
References
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