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PSYCHOSOCIAL ISSUES AND CANCER Amy Johnson, Ph.D. Psychologist and Health Service Provider Health Psychology and Behavioral Medicine Services Tennessee.

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Presentation on theme: "PSYCHOSOCIAL ISSUES AND CANCER Amy Johnson, Ph.D. Psychologist and Health Service Provider Health Psychology and Behavioral Medicine Services Tennessee."— Presentation transcript:

1 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

2 PI occur with every cancer-related experience: zPrediagnosis zDiagnosis zTreatment zRecovery zLong-term survivorship zDeath zCaregiving

3 Overview of 4 Psychosocial Concerns zFatigue zIntimacy zAnxiety zWork

4 Treatment-related FATIGUE zDefinition: Subjective? Objective? Clinical? zIncidence: Clinically, most common treatment-related side effect (research reports = 0-100%) zCauses: multiple and interacting yPre-existing conditions yTreatment side effects yMedication effects - analgesics, antiemetics

5 Causes of fatigue... yDehydration yDeconditioning yChanges in sleep patterns and nutrition yGrief yDepression yAnxiety and worry yPain yDaily life

6 Fatigue affects: everything zintimacy zwork zrelationships zself esteem zcoping zappetite

7 Clinical syndrome of treatment-related fatigue zDuring last month, 2 weeks of significantly decreased energy & increased need to rest zFatigue which interferes with work, home chores, or relationships zEvidence that s/s due to cancer/therapy zS/s not primary consequence of co- morbid psychiatric disorder zAt 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.

8 Specific fatigue symptoms: zFeel weak, heavy zTrouble concentrating zLoss of interest zSleep disturbances zNon-refreshing sleep zSick or unwell after activities requiring effort zStruggle to do anything zSad, frustrated, irritable b/c of fatigue zDifficulty with task completion zMemory 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.

9 Prevention and Treatment zBalance rest and physical activity zAdequate nutrition and hydration zMonitor use of sedating medications zCognitive-behavioral interventions zTreat comorbid conditions zImprove quality and quantity of sleep zPsychostimulants or wake-promoting medication

10 INTIMACY and CANCER zTreatment-related sexual dysfunction &/or infertility occurs in up to 100% of survivors depending on site of cancer zDysfunction 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

11 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, 29A:826-830.

12 Human sexual response: zDesire zExcitement zOrgasm zResolution Dysfunction generally occurs in: desire, excitement, orgasm

13 Interventions: zEducation about human sexual response and consequences of cancer treatment, as well as expected recovery zEducation about options for treatment of sexual dysfunction - sexual aids/devices, artificial internal and external lubricants, implants, positioning, ED meds, pain and fatigue management.

14 Interventions - continued zReview current medications for sexual side effects zCognitive-behavioral therapy for anxiety, depression, body image, interpersonal and intrapersonal concerns zCouple therapy zHormone replacement

15 ANXIETY occurs as: Reactive Anticipatory Phobia Panic Pre-existing Post-traumatic Substance-induced

16 Causes of anxiety: zMedical - substances, needles, procedures zPsychological - loss of control zLack of social support or fearing loss of support - loner, relocation, rejection, abandonment by significant other zFinancial - insurance, work, disability zFamily - patient as caregiver, parent, etc. zPre-existing conditions - chronic illnesses

17 Symptoms of anxiety: zHeightened sensitivity - environment, pain zDistractible, irritable zRestlessness, fidgeting, unable to relax zSweating or chilling, sighing, fatigue zDisrupted sleep or appetite, GI distress zWorrying, intrusive thoughts, apprehension, delayed decisions zDistorted thinking

18 Interventions: zCognitive-behavioral treatment zImprove social support options zMedications zEducation

19 4 Groups Who Need Psychosocial Assistance: zPatients with history of adverse events or unresolved personal concerns but who have been coping with life zPatients with pre-existing psychopathology zPatients who develop psychological treatment- related side effects: phobias, anticipatory N/V, fatigue, depression, anxiety, etc. zFamily members/caregivers

20 When a referral is needed: zRefer when patient or family exhibits a behavior that interferes with the delivery of quality care or safety in the clinic or hospital zRefer for signs/symptoms of psychopathology, or significant stress in patient or family caregivers which interferes with the caregivers ability to provide support zRefer if patient develops side effects, symptoms, or behaviors that will affect quality of life during long-term survivorship.

21 THANK YOU Contact information: Amy Johnson, Ph.D. Psychologist/ Health Service Provider Tennessee Oncology ajohnson@tnonc.com


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