View
215
Download
1
Category
Tags:
Preview:
Citation preview
PSYCHOSOCIAL ISSUES AND CANCER
Amy Johnson, Ph.D.
Psychologist and Health Service Provider
Health Psychology and Behavioral Medicine Services
Tennessee Oncology
(April 23, 2009)
Funding provided by Tennessee Oncology
PI occur with every cancer-related experience:
Prediagnosis DiagnosisTreatmentRecoveryLong-term survivorshipDeathCaregiving
Overview of 4 Psychosocial Concerns
Fatigue
Intimacy
Anxiety
Work
Treatment-related FATIGUE
Definition: Subjective? Objective? Clinical?
Incidence: Clinically, most common treatment-related side effect (research reports = 0-100%)
Causes: multiple and interacting Pre-existing conditions Treatment side effects Medication effects - analgesics, antiemetics
Causes of fatigue...
Dehydration Deconditioning Changes in sleep patterns and nutrition Grief Depression Anxiety and worry Pain Daily life
Fatigue affects: everything
intimacyworkrelationshipsself esteemcopingappetite
Clinical syndrome of treatment-related fatigue
During last month, 2 weeks of significantly decreased energy & increased need to rest
Fatigue which interferes with work, home chores, or relationships
Evidence that s/s due to cancer/therapy
S/s not primary consequence of co-morbid psychiatric disorder
At least 5 of 10 following s/s almost daily in same 2 weeks.
Andrykowski, M. (2009). Use of a Case Definition Approach to Identify Off-Treatment Fatigue in Cancer Survivors. Presented at American Psychosocial Oncology Society, Charlotte, NC.
Specific fatigue symptoms:
“Feel weak”, “heavy”Trouble concentratingLoss of interestSleep disturbancesNon-refreshing sleepSick or unwell after
activities requiring effort
“Struggle to do anything”
Sad, frustrated, irritable b/c of fatigue
Difficulty with task completion
Memory problems
Andrykowski, M. (2009). Use of a Case Definition Approach to Identify Off-Treatment Fatigue in Cancer Survivors. Presented at American Psychosocial Oncology Society, Charlotte, NC.
Prevention and Treatment
Balance rest and physical activityAdequate nutrition and hydrationMonitor use of sedating medicationsCognitive-behavioral interventionsTreat comorbid conditionsImprove quality and quantity of sleepPsychostimulants or wake-promoting
medication
INTIMACY and CANCER
Treatment-related sexual dysfunction &/or infertility occurs in up to 100% of survivors depending on site of cancer
Dysfunction caused by: interventions of surgery, chemotherapy, radiation, and hormonal treatments: absence of/injury to organs, nerve or vascular disruption, decreased hormonal levels, pain, disrupted body image, fatigue
Olweny, Tuttner, and Rofe concluded that “cancer survivors enjoy a quality of life similar to their neighbors’ in all but one aspect of daily life: sexual functioning”. Their study found that premature menopause was the most common difficulty for females and “performance dysfunction” was the most common problem for males who had been treated for cancer.
Olweny, C., Tuttner, C., Rofe, P. (1993). Long-term effects of cancer treatment and consequences of cure: Cancer survivors enjoy quality of life similar to their neighbors. European Journal of Cancer and Clinical Oncology , 29A:826-830.
Human sexual response:
DesireExcitementOrgasmResolution
Dysfunction generally occurs in:
desire, excitement, orgasm
Interventions:
Education about human sexual response and consequences of cancer treatment, as well as expected recovery
Education about options for treatment of sexual dysfunction - sexual aids/devices, artificial internal and external lubricants, implants, positioning, ED meds, pain and fatigue management.
Interventions - continued
Review current medications for sexual side effects
Cognitive-behavioral therapy for anxiety, depression, body image, interpersonal and intrapersonal concerns
Couple therapyHormone replacement
ANXIETY occurs as:
ReactiveAnticipatoryPhobiaPanicPre-existingPost-traumaticSubstance-induced
Causes of anxiety:
Medical - substances, needles, proceduresPsychological - loss of control Lack of social support or fearing loss of
support - “loner”, relocation, rejection, abandonment by significant other
Financial - insurance, work, disabilityFamily - patient as caregiver, parent, etc.Pre-existing conditions - chronic illnesses
Symptoms of anxiety:
Heightened sensitivity - environment, painDistractible, irritableRestlessness, fidgeting, unable to relaxSweating or chilling, sighing, fatigueDisrupted sleep or appetite, GI distressWorrying, intrusive thoughts,
apprehension, delayed decisionsDistorted thinking
Interventions:
Cognitive-behavioral treatment
Improve social support options
Medications
Education
4 Groups Who Need Psychosocial Assistance:
Patients with history of adverse events or unresolved personal concerns but who have been coping with life
Patients with pre-existing psychopathology
Patients who develop psychological treatment-related side effects: phobias, anticipatory N/V, fatigue, depression, anxiety, etc.
Family members/caregivers
When a referral is needed:
Refer when patient or family exhibits a behavior that interferes with the delivery of quality care or safety in the clinic or hospital
Refer for signs/symptoms of psychopathology, or significant stress in patient or family caregivers which interferes with the caregiver’s ability to provide support
Refer if patient develops side effects, symptoms, or behaviors that will affect quality of life during long-term survivorship.
THANK YOU
Contact information:Amy Johnson, Ph.D.
Psychologist/ Health Service ProviderTennessee Oncologyajohnson@tnonc.com
Recommended