Psychosocial Aspects of Breast and Cervical Cancer Diagnoses

Emily Lane, MSW, LCSWSIU School of Medicine

A little about me…

Objectives

At the end of this webinar, you should be able to…

◦ Identify possible psychosocial stressors associated with breast and cervical cancer diagnoses.

◦ Recognize symptoms of psychological distress in newly diagnosed patients.

◦ Utilize supportive interventions with the hopes of decreasing the level of acute distress in patients with breast or cervical cancers.

◦ Educate patients on avenues of assistance and coordinate appropriate referrals to alleviate some of the psychosocial distress that they are experiencing.

What are psychosocial stressors?

◦ Social conditions that can affect our mental health.

◦ Example: financial concerns can lead to feelings of inadequacy or depression OR major depression could lead to missed days of work and subsequent financial concerns

Common psychosocial stressors for persons with cancer

Psychological Distress

Interpersonal

Physical

Financial

Financial ◦ Unable to work due to appointments or treatment◦ Uninsured/underinsured◦ Out-of-pocket costs for medications

Physical◦ Side-effects from chemotherapy, surgery, radiation and/or

hormone treatments◦ Difficulty with activities of daily living◦ Transportation◦ Navigation of the healthcare system

Interpersonal◦ Difficulty communicating with loved ones because of

high levels of distress◦ Little support from family and friends◦ Too many people counting on the person with cancer◦ Changes in libido and sexuality can lead to difficulties in

marriage

Cervical Cancer Specific

Significant pain from internal radiation which can lead to difficulty having sex afterward. This can lead to marital strain.

Guilt/Shame of HPV infection or stigma

Fertility concerns – early menopause

Cervical cancer is 10x more prevalent in women who are victims of domestic violence than in general population

Breast Cancer Specific

Body image issues may result from physical changes to the breast from surgery, radiation

Femininity/Sexuality issues can lead to marital strain

Lymphedema – can be a financial burden due to the supplies needed to manage the condition

The emotional toll of these stressors

◦Depression◦Anxiety◦Anger◦Guilt◦Difficulty sleeping◦Existential questions◦Difficulty concentrating◦Distress over treatment choices

What is psychological distress?

The National Cancer Institute defines psychological distress as “an unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with the ability to cope with cancer treatment. It extends along a continuum, from common normal feelings of vulnerability, sadness, and fears, to problems that are disabling, such as true depression, anxiety, panic, and feeling isolated or in a spiritual crisis”

Use of a distress screener can help you find out what your patients are dealing with both

physically and emotionally.

http://www.nccn.org/patients/resources/life_with_cancer/pdf/nccn_distress_thermometer.pdf

We know the problemHow do we help?

Validation and Communication

Validation

Empathic Statements ◦Reflection◦Statements of understanding◦Ask patients how they feel

Mirroring Active ListeningBeing able to just sit with a patient and their

emotionsNormalizing emotions

Why is empathy important?

Building block of rapport◦Adds to patient’s subjective experience of a safe

place to express him or herself

Facilitates hope

Improves patient compliance and satisfaction

Communication

Provide education as to what the next step is regarding treatment and/or follow-up.

Ask patients if it would help them if you made the follow-up appointments for them.

Ask them if they have any immediate concerns, such as support at home, transportation, insurance coverage and/or other financial issues.

Provide information regarding resources in the community.

A word about survivorship…

Resources

Illinois Breast and Cervical Cancer ProgramAmerican Cancer Society

◦ Patient navigators to assist with financial concerns and other needs

◦ Wig Salon◦ Look Good, Feel Better◦ Road to Recovery◦ Co-Pay Assistance

Community Action Agencies◦ Sangamon County Resource Center

Local Support Groups

Helpful websites

www.needymeds.comwww.getcoveredillinois.govwww.cancer.orgwww.nccn.org/patients/resources/life_with_cancer/www.livestrong.orgwww.cancercare.org

Final ThoughtsEach person is unique, and their response to a

cancer diagnosis will be just as unique.

Ask your patients about how they are coping, what they are feeling and what they need… don’t assume to know.

Encourage them to share their feelings with their loved ones or with a oncology social worker, counselor or psychologist.

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Special thanks to Katherine Howerter, MSW, LCSW and Patricia Fank, Psy.D. for their contributions and

guidance.