PSYCHOSOCIAL ISSUES AND CANCER

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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
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PI occur with every cancer-related experience

• Prediagnosis
• Diagnosis
• Treatment
• Recovery
• Long-term survivorship
• Death
• Caregiving

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Overview of 4 Psychosocial Concerns

• Fatigue
• Intimacy
• Anxiety
• Work

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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

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Causes of fatigue...

• Dehydration
• Deconditioning
• Changes in sleep patterns and nutrition
• Grief
• Depression
• Anxiety and worry
• Pain
• Daily life

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Fatigue affects everything

• intimacy
• work
• relationships
• self esteem
• coping
• appetite

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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.
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Specific fatigue symptoms

• Feel weak, heavy
• Trouble concentrating
• Loss of interest
• Sleep disturbances
• Non-refreshing sleep
• Sick 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.
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Prevention and Treatment

• Balance rest and physical activity
• Adequate nutrition and hydration
• Monitor use of sedating medications
• Cognitive-behavioral interventions
• Treat comorbid conditions
• Improve quality and quantity of sleep
• Psychostimulants or wake-promoting medication

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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

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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 , 29A826-830.
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Human sexual response

• Desire
• Excitement
• Orgasm
• Resolution

Dysfunction generally occurs in desire,
excitement, orgasm
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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.

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Interventions - continued

• Review current medications for sexual side
  effects
• Cognitive-behavioral therapy for anxiety,
  depression, body image, interpersonal and
  intrapersonal concerns
• Couple therapy
• Hormone replacement

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ANXIETY occurs as

• Reactive
• Anticipatory
• Phobia
• Panic
• Pre-existing
• Post-traumatic
• Substance-induced

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Causes of anxiety

• Medical - substances, needles, procedures
• Psychological - loss of control
• Lack of social support or fearing loss of support
  - loner, relocation, rejection, abandonment by
  significant other
• Financial - insurance, work, disability
• Family - patient as caregiver, parent, etc.
• Pre-existing conditions - chronic illnesses

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Symptoms of anxiety

• Heightened sensitivity - environment, pain
• Distractible, irritable
• Restlessness, fidgeting, unable to relax
• Sweating or chilling, sighing, fatigue
• Disrupted sleep or appetite, GI distress
• Worrying, intrusive thoughts, apprehension,
  delayed decisions
• Distorted thinking

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Interventions

• Cognitive-behavioral treatment
• Improve social support options
• Medications
• Education

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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

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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 caregivers
  ability to provide support
• Refer if patient develops side effects, symptoms,
  or behaviors that will affect quality of life
  during long-term survivorship.

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THANK YOU

• Contact information
• Amy Johnson, Ph.D.
• Psychologist/ Health Service Provider
• Tennessee Oncology
• ajohnson_at_tnonc.com