Patient Perceptions of Psychosocial Intervention at the Time of New Diagnosis Breast Cancer

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Patient Perceptions of Psychosocial Intervention
at the Time of New Diagnosis Breast Cancer

• Joy Feliciano
• December 15, 2006

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Case scenario

• 28 year old female of Ashkenazi Jewish decent was
  seen in clinic to discuss further medical
  management for newly diagnosed bilateral
  multicentric breast cancer s/p bilateral
  mastectomy.
• She was tearful throughout the entire interview
  and repeatedly said, you must think Im crazy.
  She also reported poor appetite, difficulty
  sleeping, and erratic moods.

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• After medical treatment was discussed, the idea
  of seeing a counselor or psychologist was
  approached to help talk about adjusting to her
  diagnosis.
• Her initial response was, I dont need that,
  Im not crazy.

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Why this topic?

• In the United States, breast cancer is the most
  commonly diagnosed malignancy in women, affecting
  approximately 215,000 new women each year.¹
  
• Over the last two decades, breast cancer 5 year
  survival rates have improved from approximately
  75 to now, over 87.¹

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Why this topic?

• Still, over 40,000 women are expected to die from
  breast cancer this year.1
  
• The diagnosis of breast cancer and treatment of
  breast cancer is still associated with many side
  effects and effects on a patients health related
  quality of life.¹

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What can I gain from this as an Internist?

• Are barriers unique to cancer patients?
• We have our own perceptions and barriers.
• Holistic approach to the care of the patient

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What are the effects on Quality of Life

• Physical consequences and symptoms
• Sexual and interpersonal complications
• Emotional and psychosocial complications

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Why should we address quality of life?

• Improves communication
• Patient satisfaction
• Better patient care

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Physical complications

• Generalized aches and pains ²
• Fatigue
• Nausea
• Lymphedema
• Difficulty with bladder control 2
• Dyspareunia 2
• Hot flashes 2
• Early Menopause 2

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Sexual and Interpersonal complications

• Dyspareunia 2
• Unhappiness with appearance 2
• Difficulty in communicating with partner 3
• Dating Issues 3
• Chemotherapy induced menopause 2,3

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Emotional and Psychosocial Complications

• Tend to be more immediate as opposed to long
  term.
  
• Psychologic distress 4
• Anxiety in medical situations 4
• Worry about the future 4
• At risk patients appear to have longer duration
  of consequences 4
  

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Interventions for Emotional and Psychosocial
Complications

• Individual psychological support for cancer
  patients.
  
• Psychologist vs. trained nurse in multiple types
  of cancer found that individual psychological
  support is beneficial vs. control. 5
  
• Patients who participated were satisfied with the
  intervention and most reported they would
  recommend this to a friend. 5

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• Group psychotherapy or social support group vs.
  control in patients with primary, non-metastatic
  breast cancer.
  
• This study of 69 women found that social support
  groups were beneficial to women who had minimal
  support systems prior to study. 6
  

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• Early psychosocial intervention decreases
  distress at 12 months in women with early stage
  breast cancer compared to delayed psychosocial
  intervention. 7

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• Cognitive behavioral therapy meta-analysis in
  breast cancer patients
  
• Meta-analysis of 20 prospective randomized
  studies of CBR in cancer patients.
  
• Individually administered cognitive behavioral
  techniques appear to be beneficial in the
  management of distress and pain in breast cancer
  patients.8

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Possible barriers to pursuing psychosocial
intervention or support5

• Not interested in participating (40 of 202)
• No need for psychosocial interventions (25)
• Distance (11)
• Too ill (8)
• Time constraints (4)
• Previous negative experience with
  psychologists(1)

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Possible barriers contd7

• In the study of early vs. delayed
  interventions..
  
• Not interested (26 / 164)
• Having enough support (26/164)
• Distance / time (27 / 164)

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Goals of this Survey

• Identify women who are at risk of psychosocial
  distress or complications early on in their
  diagnosis.
  
• Identify patients perceptions of psychosocial
  interventions
  
• Identify barriers to pursuing psychosocial
  intervention or support

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My ultimate goal..

• Attempt to form an intervention to address
  patient barriers to pursuing psychosocial
  intervention or support.

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References

• 1.American Cancer Society Cancer Facts and
  Figures. Atlanta, GA, American Cancer Society,
  2005.
  
• 2.Avis, N., Crawford, S., Manuel, J. Quality of
  Life Among Younger Women With Breast Cancer.
  Journal of Clinical Oncology. 23 (15) May 20,
  2005
• 3.
• 4.Schag, E. et al. Characteristics of Women at
  Risk for Psychosocial Distress in the Year After
  Breast Cancer. Journal of Clinical Oncology.
  11(4) April 1993
• 5.Hellbom, M. et. Al. Individual Psychological
  Support for Cancer patients Utilisation and
  patient satisfaction. Patient Education and
  Counseling 34.
• 6.Vos, P. et. Al. Psychosocial Intervention for
  Women with Primary, Non-Metastatic Breast Cancer
  A Comparison between Participants and
  Non-Participants. Psychotherapy and
  Psychosomatics. 2004 73 276-285.
• 7.Vos, P. ets. Al. Effects of delayed
  psychosocial interventions versus early
  psychosocial interventions for women with early
  stage breast cancer. Patient Education and
  Counseling. 60 (2006) 212-219.
• 8.Tatrow, K. and Montgomery, G. Cognitive
  Behavioral Therapy Techniques for Distress and
  Pain in Breast Cancer Patients A Meta-Analysis.
  Journal of Behavioral Medicine. 29 (1) 2006.