1. Presented by Lynn Barwick, LCSW Presented by Xochitl Gaxiola, MSW in Spanish

2. Stress in patients and families well documented  Recognized psychosocial dimensions of cancer  Desire to improve psychosocial care  National Comprehensive Cancer Network:  Develop standards of care in 2008  Reduce stigma of psychological problems  Recommended use of term “distress” (National Comprehensive Cancer Network. Distress Management Guidelines, 2008)

3. “You have Cancer”  Disbelief, shock and panic  Anger and hostility  Fears based on risk of mortality  Feeling out of control and vulnerable  Losses  Learning language of cancer  Treatment decisions (Social Work in Oncology, 2001)

4.  Physical side effects  Body image changes  Changes in roles  Disruption of work, home, family  Increased dependence  Loss of dreams  Emotional  Insurance and Finances

5.  Type of cancer, stage, prognosis  Degree of disability  Intensity of treatment  Age and stage in life cycle  Past experience with cancer  Current life circumstances  Degree of social support  Coping skills (Social Work in Oncology, 2001)

6.  Struggle to comprehend – Why me?  Continuum from denial to acceptance  Vacillation between hope and despair  Sense of personal failure  Bad things do happen to good people

7.  Making sense of life and death  Creating a new normal  Changing priorities  Greater sensitivity towards others  Increased closeness in relationships  Awareness of life’s gifts  Spiritual quest  A negative, life-altering experience (McMillen, 1999)

8. Children need to know:  Name of disease  Part of body being treated  They did not cause the cancer  They will be loved and cared for  It is unlikely that other parent will get cancer  It is unlikely that they will get cancer  Routines will be maintained as much as possible

9. Adolescents  Interruption or delay of individuation from parents  May need to take on more responsibilities  Need relief from responsibilities  Need to be thanked  Need time to be with peers and maintain activities  Reassurance that it is okay to have fun As a Family we can Cope (When a Parent has Cancer, Wendy Harpham, MD, 1997)

10. --Caregiver Needs--  Physical assistance  Support Groups  Cancer education  Respite care  Financial assistance  Counseling

12. Identify patients with psychosocial needs Facilitate communication Collaboration with health care team Maintain cultural sensitivity Help patients and families feel more in control (Social Work in Oncology, 2001)

13. Psychosocial Needs & Services  Information about illness, treatments, services available  Assistance coping with emotions regarding illness  Help in managing illness related symptoms  Counseling for changing behavior or mood issues  Educational material and resources  Help in managing disruptions in work, school, family  Financial assistance with community resources (Cancer Care for the Whole Patient, 200 8)

14. INTERVENTIONS FOR DEPRESSION AND ANXIETY  Referral to social worker for assessment  Mood Disorders or Suicidality  Decision-making capacity  Safety concerns  Counseling by social worker  COPE D Study – PHQ-9  Short term counseling to help with issues  Referral to psychiatrist or therapist  Psychotropic medications  Support groups

15. Compassion Fatigue We work in a high-loss, high-stress environment Recognizing signs fatigue, headaches, sleep difficulties, GI disturbances, irritability Grieving losses Renewing oneself Finding balance Cancer Caregiving Rounds Learning to maintain personal boundaries

16. References Harpham, Wendy (1997). When a parent has cancer: A guide to caring for your children. New York: Harper Collins. Institute of Medicine (IOM). 2008. Cancer care for the whole patient: Meeting psychosocial health needs. Nancy Adler and Ann E.K. Page, eds. Washington, DC: The National Academies Press. Lauria, Marie, et al. (2001). Social work in oncology: Supporting survivors, families, and caregivers. Georgia: American Cancer Society. McMillen, J.C. (1999). Better for it: How people benefit from adversity. Social Work, 44(5), 455-468). National Comprehensive Cancer Network (1999). Practice guidelines for the management of psychosocial distress. Oncology, 13(5A), 113-147.

18. Look for Peaceful environments

19. Any questions, comments or discussion?