Coping with Cancer

Dr. Lisa Bialy, PsyDdrbialy@yahoo.com

415-948-8823 Survivors’ Day 2008

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

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References

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