Coping after a Cancer Diagnosis Sept 2014 Webinar

Welcome to Fight Colorectal Cancer’s Webinar Session:

Coping After a Cancer Diagnosis – What does this mean and how?

Make Sure You Know the Latest News About CRC Research and Treatment visit fightcrc.org

Our webinar will begin shortly.

Today’s Webinar:1. Today’s Speaker: Dr. Kristin Kilbourn, Ph.D., M.P.H.

2. Archived Webinars: FightColorectalCancer.org/Webinars

3. AFTER THE WEBINAR: expect an email with links to the material. Also a survey on how we did, receive a Blue Star pin when completed

4. Ask a question in the panel on the RIGHT SIDE of your screen

5. Follow along via Twitter – use the hashtag #CRCWebinar

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Guide

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DisclaimerThe information and services provided by Fight Colorectal Cancer are for general informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnoses, or treatment.

If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the nearest emergency room.

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Speaker

Dr. Kristin Kilbourn, Ph.D., M.P.H.

Kristin is an assistant professor in the Department of Psychology at the University of Colorado Denver.  She is a member of the University of Colorado Cancer Center and also holds an adjunct faculty position in the Division of Internal Medicine.

The Psychosocial Aspects of Cancer Survivorship

Kristin Kilbourn, Ph.D. MPHClinical Health Psychologist

Associate ProfessorDepartment of Psychology

University of Colorado Denver

OverviewThe psychosocial aspects of living as a colon

cancer survivor

Recognizing the signs and symptoms of distressDepressionAnxiety

Ways to improve or maintain good emotional well-being

Illness as a Major Life Stressor

Illness can lead to:Uncertainty about the futureMultiple losses

Independence & controlFunctional lossFinancial loss

Changes in one’s role within the family

Adjustment Across the Course of Illness

Diagnosis• Life Disruption• Decisions• Facing Mortality• Loss

Treatment• QoL• Social isolation• Stigma• Side-effects

Re-entry• Uncertainty• Hypervigilance• Distress• Adjustment• Economic stress

Screening• Fear• Anticipatory

anxiety

The Study of Cancer Survivors

“Not that you live, but how you live.” 13.7 million cancer survivors Increase over next 20 years

Increasing number of childhood cancer survivors Aging population and progress in cancer treatments

Unique Issues Following Treatment

Post-treatment represents a new phase of adjustment Loss of safety net of active medical treatment and

support Resume former roles in and outside the home Lingering physical and psychosocial symptoms

Stages of early survivorship Long term follow-up and on-going monitoring Uncertainty and fear of recurrence Redefining one’s sense of self

Often expectations of how an individual believes they will feel after treatment does not match how they feel

What about the family? Everyone is impacted by illness

RelationshipsFamily-rolesFinancial issuesFuture plans and dreams

Illness places high levels of stress on the “family” unit

How do you know if you are experiencing

significant levels of distress?

Symptoms of Depression Mood symptoms:

Sadness Anger/Irritability Hopelessness

Somatic Symptoms: Problems with sleep Change in appetite Low energy/fatigue

Cognitive symptoms: Problems with concentration and memory

Decreased interest in previously enjoyed activities Feelings of Worthlessness Feeling that life is not worth living/Suicidal thoughts

Symptoms of Anxiety

Excessive worry and anxiety Restlessness or feeling on edgeEasily fatiguedConcentration and memory problemsIrritabilityMuscle tensionSleep disturbancePanic attacks

(racing heart, difficulty breathing, sweaty, chest pain discomfort, feeling detached from self, trembling/shaking, feeling of choking, dizzy, nausea, fear of losing control, going crazy or dying)

How do you know when to seek help and support?

The symptoms are interfering with your daily life

Your quality of life has decreased because of these symptoms

Your family and friends have noticed that something has changed

You are not experiencing joy in your life

You have thoughts that life is not worth living and you would be better off dead

Psychosocial Interventions

Psychotherapy Interventions Cognitive-Behavioral Therapy Existential Therapy Supportive Therapy

Mind-Body Interventions Relaxation interventions Yoga, meditation etc. Spiritual interventions

Support Groups Peer led vs. professional led

Psychotropic Medications Antidepressants Medication for anxiety

Strategies for maintaining good emotional and

physical health

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Stress management techniques

Effective communication

Adaptive coping strategies

Use of your social support system

Practicing healthy behaviors

Identify your basic needs and developing and utilizing a self-care plan

Stress ManagementThe chronic stress can lead to a number of

problems in various domains:Emotional, Cognitive, Behavioral, Physical, Social

Cognitive-behavioral techniques -identify distorted thoughts and change them to more accurate thoughts

Relaxation exercises and pleasurable activities can help to decrease/manage stressDeep Breathing, Progressive Muscle Relaxation,

Imagery, Yoga /Tai ChiWalking, Yoga/Tai Chi and other forms of ExercisePrayer/MeditationDifferent Hobbies / Artistic Endeavors

Communication

Communication problems are very common in families dealing with serious medical issues

It can include communication with your loved-one, other family, friends, co-workers, the medical team etc.

Strategies and skills: Set aside time to talk Make an outline or list of what you want to ask/say Use assertive communication (“I” statements) Utilize good listening skills and reflect what you’ve

heard Don’t jump to conclusions or make assumptions- just

ask

Adaptive CopingThere are multiple ways to cope with

stressful situations

Importance of matching the stressor type with the appropriate coping strategy

Coping Skills Training

Matching the Situation and Stressor

Situation

Controllable

Uncontrollable

Coping Response

Problem-Focused•Problem solving•Decision making•Seeking information•Goal setting

Emotion-Focused•Venting/talking to others•Reframing the situation•Journaling•Exercise/relaxation•Meditation/spiritual practices•Pleasurable activities

Stressor Is:

Coping Strategy:

Controllable

Problem-Focused

Uncontrollable

Emotion-Focused

Active(adaptive)

Information SeekingGoal SettingDecision MakingConflict ResolutionRequesting helpFocused activities

Reappraisal of situationReframing thoughtsExercise, MassageMeditation, relaxationMindfulness exercisesExpressing emotions: journaling, poetry, art, talking with othersAccept Negative Emotions: (softening)

Passive(maladaptive)

Behavioral AvoidanceCognitive Avoidance: denial not thinking about it

Smoke, Eat, Drink AlcoholNot Caring For Yourself: don’t take medication miss appointment non-adherenceStuffing Feelings

Coping SkillsThose who handle stress have:

Have a variety of coping techniques available to them (“more tools in the toolbox”)

Can match the stressor to the coping response

Awareness of your common coping style(s) is importantDo you tend to be more analytical or more

emotional in times of stress?

Social Support Do you know how to ask for support? Do you know who to ask for support? Match your support needs to the person(s) who can

meet your needs: Emotional Support Informational support Tangible Support

Consider ways to increase your social support network Support groups Professional therapy or counseling Try new hobbies or activities where you will meet others with similar interests (classes, clubs

etc.) Quality is more important than quantity

Health BehaviorsPoor health behaviors

increase the risk for recurrence or the development/exacerbation of other health problems

impact psychosocial well-being

Weight/Body Mass Index

Cancer treatment can lead to weight gain/changes in body composition

Even modest wt. loss can lead to significant health benefits

Physical activity –

1/3 of survivors have not participating in physical activity over the past 30 days.

Step-counters and fit bits can be useful to increase activity

Sleep – most Americans do not get enough sleep

Alcohol

General Recommendations- 2 drinks per day for men, 1 drink per day for women

No level of alcohol considered safe for some survivors

Smoking (15% survivors smoke)- includes tobacco and marijuana

Practicing Good Self-CareWhat does this mean?

Putting your self-care first

Maintaining good health behaviors (diet, exercise, sleep)

Sticking to your medical regimen

Engaging in pleasurable activities

Finding balance in your life

Thriving• Ask questions

• What can I do to maintain and/or improve my health and well-being

• Where can I find the support that I need• Develop a plan that addresses physical,

emotional, social and spiritual needs• Seek out help when needed• Now is the time to make positive changes in

your life• Adopt healthy behaviors• Practice adaptive coping skills• Reprioritize what is really important in your life

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“The bend in the road is not the end of the road unless you refuse to take the turn”

-anonymous

Thank You

Kristin.Kilbourn@UCDenver.edu

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