Coping with Cancer

1
Coping with Cancer

• Dr. Lisa Bialy, PsyD
• drbialy_at_yahoo.com
• 415-948-8823
• Survivors Day 2008

2
This is your brain on cancer.
3
Fight or Flight Response/Survival

• Normal response to survival situation.
• Overuse causes damage.
• Lowered immune functioning, higher burnout, more
  stress.

4
The 6 Feared Ds

• 1) Discomfort
• 2) Dependency
• 3) Disfigurement
• 4) Disability
• 5) Disruption
• 6) Disengagement
• 7) Death
• (Holland et al, 2001)

5
Doing the Right Thing

• Treatment choices.
• Personality changes
• Is this making me sicker?

6
You are already coping
7
Understanding Coping Styles

• Distancing/Denial
• Accepting
• Escape-Avoidance
• Problem Solving
• Confronting
• Self-controlling
• Seeking social support

8
Substance Abuse

• Avoidant response
• Exacerbated by illness
• Loss of control
• Fear of pain, tx, outcomes
• Interferes with tx

9
Coping Skills and QOL

• Thought stopping
• Affect regulation
• Exercise, diet
• Relaxation
• Emotion expression
• Humor
• Distraction
• Information

10
4 Phases of Treatment

• Diagnosis
• Active Treatment
• Follow-Up
• Future and Possible Recurrance

11
Myths about Depression/Anxiety

• All patients with cancer are depressed/anxious
  and need help.
• Patients with cancer manage well and very few
  need help coping.
• Talking about depression/anxiety makes matters
  worse.

12
Prevalence of Depression

• About 47 cancer patients experience depression
  at some point during their illness (Derogatis et
  al, 1983).
• Of these, most fit criteria for Adjustment
  Disorder, smaller number for Major Depressive
  Disorder.
• 90 of above secondary to disease or tx.

13
Why do people get depressed?

• Physical compromises.
• Life changing event.
• Stress of decision making.
• Fear of future.
• Pain, loss of freedom, changes in lifestyle.
• Medication Interactions.
• Thoughts of death.

14
Treatment for Depression/Anxiety

• Psychotherapy
• Social Support
• Medication
• Psycho-education and coping skills

15
How does psychotherapy work?

• Normalizes negative feelings.
• Facilitates communication.
• Supports fears and hopes.
• Reinforces existing coping skills.
• Develops new coping skills.
• Focuses on Quality of Life
• Individual, Couples, or Families

16
What is meaningful helps.

• Support and love from family and friends.
• Finding personal meaning, creating rituals.
• Hobbies, activities, beliefs, reflection.

17
Grief Work

• Normal response to loss, whether from death of a
  beloved, loss, or injury.
• Usually proportionate to disruption caused by
  loss.
• Loss is normal part of life for everyone.

18
Stages of Grief

• Denial/Shock
• Anger
• Bargaining
• Depression/Sadness
• Acceptance
• (On Death and Dying Kubler Ross)

19
Recognizing Grief

• Insomnia
• Appetite changes
• Aimlessness
• Hopelessness
• Excessive guilt
• Psychomotor retardation

20
Specific Psychosocial Interventions

• Targeted Approaches/Solutions

21
Relaxation Training

• Breathing
• Meditation
• Hypnosis
• Music
• Exercise
• Guided Imagery

22
Sleep Disturbance

• 48 prescribed medications for cancer patients
  are hypnotics (sleep aids).
• 44 psychotropics sleep aids.

23
Sexual Dysfunction

• Medication side effects
• Treatment side effects
• Depression
• Fear of intimacy
• Couples Therapy

24
Communication with Medical Professionals

• List of questions and concerns.
• Education
• Collaboration/ coordination of care by point
  person.

25
Caregiver Burnout

• Empathic effort takes its toll
• Express negative or exhausting feelings
• Self-care essential
• Support for caregivers
• Re-focus on what is important in own lives

26
Group Interventions

• Benefits social support, communication skills,
  coping responses, and immune functioning.
• Feedback from other patients and caregivers.
• Mixed diagnosis/prognosis?

27
Case Presentation

• Multi-method Interdisciplinary
• Treatment of Cancer

28
Couple Dealing with Cancer

• 40 y/o male, w/kids, engaged to be married
• Recently diagnosed with Colon cancer
• Tx- surgery, 6 rounds of chemo, possible
  radiation

29
Woman with Breast Cancer

• 55 y/o married Chinese American woman, w/ 2 kids.
• Communication struggles w/ family and doctors.
• Cultural Considerations.

30
Palliative Care

• 70 y/o Type A male with metastatic cancer.
• Wife, 2 kids and 3 grandchildren.
• End of life decisions.
• Meaning making.
• Saying goodbye.

31
Summary

• Advances in cancer dx and tx promising but
  treatment decisions increasingly complex.
• Coping responses inherent.
• Depression and anxiety common.
• Social support essential.
• Self-care facilitates caregiving.

32
References

• 1.Jensen AB Psychological factors in breast
  cancer and their possible impact upon prognosis.
  Cancer Treat Rev 1991 18191?210Medline2.Maunse
  ll E, Jacques B, Duschene L Social support and
  survival among women with breast cancer.
  Presented at the Annual Psycho-Oncology Meeting,
  Memorial Sloan-Kettering Cancer Center, New York,
  NY, October 19933.Dean C, Surtees PG Do
  psychological factors predict survival in breast
  cancer? Journal of Psychosocial Research 1989
  33561?5694.Forsen A Psychosocial stress as a
  risk for breast cancer. Psychother Psychosom
  1991 55175-185Medline5.Derogatis LR, Abeloff
  MD, Melisartos N Psychological coping mechanism
  and survival time in metastatic breast cancer.
  JAMA 1979 2421504?15086.Greer S, Morris J,
  Pettingage KW Psychological response to breast
  cancer effect on outcome. Lancet 1979
  2785?787Medline7.Greer S Psychological
  response to cancer and survival. Psychol Med
  1991 2143?49Medline8.Spiegel D, Kato P
  Psychosocial influences on cancer incidence and
  progression. Harvard Review of Psychiatry 1996
  May/June, pp 10?269.Hill D, Kelleher K, Shamaker
  SA Psychosocial interventions in adult patients
  with coronary heart disease and cancer a
  literature review. Gen Hosp Psychiatry 1992
  14(6, suppl)285?42510.Spiegel D, Bloom JR,
  Kraemer HC, et al Effect of psychosocial
  treatment on survival of patients with metastatic
  breast cancer. Lancet 1989 2888?901Medline11.R
  ichardson JL, Shelton DR, Kasilo M, et al The
  effect of compliance with treatment on survival
  among patients with hematological malignancies. J
  Clin Oncol 1990 8356?364Abstract12.Fawzy FI,
  Fawzy NW, Hyun CS, et al Malignant melanoma
  effects of an early structured psychiatric
  intervention, coping, and effective state on
  recurrence and survival, 6 years later. Arch Gen
  Psychiatry 1993 50681?689Abstract13.Straker
  M A review of short-term psychotherapy. Diseases
  of the Nervous System 1977 38813?816Medline14.
  Caplan G Principles of Preventative

33
References

• Psychiatry. New York, Basic Books,
  196415.Lindemann E Symptomatology and management
  of acute grief. Am J Psychiatry 1944
  101141?148Free?Full?Text16.Schmale A
  Principles of psychosocial oncology, in Clinical
  Oncology For Medical Students and Physicians A
  Multidisciplinary Approach, 4th edition.
  Rochester, NY, University of Rochester School of
  Medicine and Dentistry/American Cancer Society,
  1974, pp 109?11817.Straker N, Wyszynski A Denial
  in the cancer patient a common sense approach.
  Internal Medicine for the Specialist 1986
  7(3)150?15518.Leshan L, Leshan E Psychotherapy
  and the patient with a limited lifespan.
  Psychiatry 1961 24318?323Medline19.Wise TN,
  Berlin RM Burnout stresses in consultation.
  Psychosomatics 1981 22744?751Abstract/Free?Full
  ?Text20.Holland J Psychological management of
  cancer patients and their families. Practical
  Psychology 1977 October, pp 14?2021.Kohut H The
  Analysis of the Self. New York, International
  Universities Press, 197122.Norton J Treatment of
  a dying patient. Psychoanal Study Child 1963
  18541?560Medline23.Deutsch F Euthanasia a
  clinical study. Psychoanal Q 1933
  347?36824.Eissler K The Psychiatrist and the
  Dying Patient. New York, International
  Universities Press, 195525.Cassem NH The dying
  patient, in Massachusetts General Hospital
  Handbook of General Hospital Psychiatry, edited
  by Hackett T, Cassem N. St Louis, MO, CV Mosby,
  1978, pp 579?606