1. Distress Assessment & Management Presented by: Barb Henry, APRN-BC, MSN Bjzh@aol.com Melvin S. Gale MD & Associates 2135 Dana Ave, Suite 410 Cincinnati, Ohio 45207-1327 (513) 241-1811 http://www.galemd.com

2. Next CTC-ONS Meeting Thursday, November 15 th Good Samaritan Hospital Conference Center at 6 p.m. Topic: Stigma, Anxiety, Depression, And Lung Cancer Presented by: Lisa Maggio, RN, PhDc, MSN, OCN, CTTS www.cincinnati.vc.ons.org

3. Objective Identify five components of distress assessment and four interventions for distress management using the 2012 NCCN Guidelines. Distress Thermometer & Problem List: Practical problems Family problems Emotional problems Physical problems Spiritual / religious concerns

4. NCCN, 2012

5. Use Distress thermometer as you would the pain scale- 0= no emotional distress, 10=severe emotional distress: severe depression/suicidal thoughts/no support Anyone who scores 4 or above on the Distress thermometer should be referred for psychiatric assessment, counseling and/or medications Levine, 2012

6. Therapeutic Fly Fishing Retreats for Breast Cancer Survivors: Emotional Distress Outcomes www.castingforrecovery.org https://www.facebook.com/#!/CastingForRecoveryOhio?fref=ts

7. N=44 participants from 5 states Henry & CFR, 2012

8. Ages of Participants Henry & CFR, 2012

9. Years Since Diagnosis Henry & CFR, 2012

10. Distress Thermometer Score Prior to the Retreat Henry & CFR, 2012

11. Distress Thermometer Score Two Weeks Post-Retreat Henry & CFR, 2012

13. Prevalence of Mental Health Issues in People with Cancer _____ percent (or more) of all people diagnosed with cancer have significant psychosocial distress_____ percent (or more) of all people diagnosed with cancer have significant psychosocial distress Less than 10% of these people actually are identified and referred for help.Less than 10% of these people actually are identified and referred for help. The suicide rate among cancer patients is ___ that among the general population.The suicide rate among cancer patients is ___ that among the general population. NCCN, 2010

14. Interventions to Manage Emotional Distress Refer patients/caregivers to the Cancer Support Community (a.k.a. Wellness Community): http://www.cancersupportcommunity.org http://www.cancersupportcommunity.org Refer patients/caregivers to Cancer Family Care http://www.cancerfamilycare.org http://www.cancerfamilycare.org

15. Interventions to Manage Emotional Distress Refer patients for spiritual/chaplain care as desired by the patient Provide education and support to patients & families, nurses are key! Use humor freely, listen, don’t give “pity” looks Talk to patients about other areas of their life, not just cancer; it’s about the person, not the disease

16. Common Psychiatric Medications Used in Oncology - Antidepressants SSRI’s- citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft) SNRI’s- desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor), atomoxetine, (Strattera), vilazodone (ViiBRYD) Others- mirtazapine (Remeron), nefazedone (Serzone), trazodone (Oleptro), buproprion (Wellbutrin) Epocratesonline.com, 2012

17. Common Psychiatric Medications Used in Oncology - Antidepressants Tricyclics- amitriptyline (Elavil), doxepin (Sinequan), nortriptyline (Pamelor), protriptylene (Vivactil), chlomipramine (Anafranil), imipramine (Tofranil), desipramine (Norpramin), trimipramine (Surmontil) MAOI’s- isocaboxazid (Marplan), phenezine (Nardil), seligiline (Emsam), tranylcypromine (Parnate) Epocratesonline.com, 2012

18. Common Psychiatric Medications Used in Oncology: Anti-Anxiety Medications Lorazepam (Ativan) Clonazepam (Klonopin) Alprazolam (Xanax) Diazepam (Valium) Oxazepam (Serax) Chlordiazepoxide (Librium) Buspirone (Buspar) (non-benzodiazepine anxiolytic) Epocratesonline.com, 2012

19. Common Psychiatric Medications Used in Oncology: Anti-Anxiety Medications Off label anxiety medications- Propranolol (Inderal) (beta blocker) Hydroxazine (Vistaril or Atarax) Diphenhydramine (Benadryl) Epocratesonline.com, 2012

20. Common Psychiatric Medications Used in Oncology: Sleep Aids Zolpidem (Ambien) Flurazepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Eszoplicone (Lunesta) Ramelteon (Rozeram) Zaleplon (Sonata) Estazolam (Prosom) Secobarbital (Seconal) Chloral Hydrate Off label sleep agents: any of the medications from the anti-anxiety and antidepressant slides, as well as low dose antipsychotic medications Epocratesonline.com, 2012

21. Less Common Psychiatric Medications Used in Oncology: Antipsychotics Atypicals/2 nd or 3 rd Generation- aripiprazole (Abilify), asenopine (Saphris), clozapine (Clozaril), iloperidine (Fanapt), lurasidone (Latuda), olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon) Epocratesonline.com, 2012

22. Less Common Psychiatric Medications Used in Oncology: Antipsychotics 1 st Generation- chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), loxapine (Loxitane), prochlorperazine (Compazine), thioridizine (Mellaril), thiothixene (Navane), trifluoperizine (Stelazine) Epocratesonline.com, 2012

23. Less Common Psychiatric Medications Used in Oncology Mood Stabilizers/Bipolar Drugs Valproic acid (Depakote), Carbemazepine (Tegretol), Lamotrigine (Lamictal), Lithium (Lithobid, Eskalith), Oxycarbemazepine (Trileptal), Gabapentin (Neurontin), Pregabalin (Lyrica) Epocratesonline.com, 2012

24. Less Common Psychiatric Medications Used in Oncology Stimulants & ADHD Medications Dextroamphetamine (Adderall, Dexadrine), Methylphenidate (Concerta, Desoxin, Ritalin, Metadate, Methylin), Methylphenidate transdermal (Daytrana), Dexmethylphenidate (Focalin), Guanfacine (Intuniv), Dexedrine (ProCentra), Lisdexamphetamine (Vyvanse), & Non-Stimulant s-Clonidine (Catapres, Kapvay), Atomoxine (Strattera) Epocratesonline.com, 2012

25. Sexual Dysfunction Medications & Resources for Cancer Survivors Erectile Dysfunction Medications & Devices Tadalafil (Cialis), Vardenifil (Levitra), Sildenifil (Viagra), Yohimbine (Yocon), Alprostadil urethral- injection, transurethral, (Muse, Edex, Caverject) SSRI’s that MAY cause sexual side effects Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft) Resources: http://www.columbus.vc.ons.org/file_depot/0-10000000/0- 10000/9206/folder/17505/2011%20Spring%20Conf%20Brixey.pdf Link to 2011 Molly Brixey presentation slides with more sexuality info/websites Epocratesonline.com, 2012

26. Sexual Dysfunction Medications Products of Vaginal Dryness Water based lubricants –KY jelly, Astroglide, Liquid Silk, Replens Hormones (unless ER+/PR+)-Vagifem (a vaginal pill to use daily x 2 weeks then twice/week), Estrogen creams, Premarin Vaginal Dilators-for vaginal stenosis, use 3- 4 times/week Kegal exercies to improve Kegal muscle strength Brixey, 2011

27. Want to learn more about assessment and management of psychosocial distress? Integrating Psychosocial Care Into Practice Web Course - 8.5 CEUs: $69-ONS members; & $100-non ONS members http://www.ons.org/CourseDetail.aspx?course_id=87 https://www.epocratesonline.comhttps://www.epocratesonline.com for psychiatric (and medical) medication photographs & patient education materials

29. Last but not least - don’t forget to manage your own distress!

30. My own Distress relief-ZUMBA! Join us for a FUN event to raise money for Mommy Has Breast Cancer! All proceeds will go towards helping local women undergoing breast cancer treatment. Register online TODAY at www.MommyHasBreastCancer.org or get advance tickets from your Zumba instructor! $10 Advance ticket. $15 At the door Lakota Family YMCA 6703 Yankee Rd, Middletown 45044 (513) 779-3917