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

PI occur with every cancer-related experience:

Prediagnosis DiagnosisTreatmentRecoveryLong-term survivorshipDeathCaregiving

Overview of 4 Psychosocial Concerns

Fatigue

Intimacy

Anxiety

Work

Treatment-related FATIGUE

Definition: Subjective? Objective? Clinical?

Incidence: Clinically, most common treatment-related side effect (research reports = 0-100%)

Causes: multiple and interacting Pre-existing conditions Treatment side effects Medication effects - analgesics, antiemetics

Causes of fatigue...

Dehydration Deconditioning Changes in sleep patterns and nutrition Grief Depression Anxiety and worry Pain Daily life

Fatigue affects: everything

intimacyworkrelationshipsself esteemcopingappetite

Clinical syndrome of treatment-related fatigue

During last month, 2 weeks of significantly decreased energy & increased need to rest

Fatigue which interferes with work, home chores, or relationships

Evidence that s/s due to cancer/therapy

S/s not primary consequence of co-morbid psychiatric disorder

At 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.

Specific fatigue symptoms:

“Feel weak”, “heavy”Trouble concentratingLoss of interestSleep disturbancesNon-refreshing sleepSick or unwell after

activities requiring effort

“Struggle to do anything”

Sad, frustrated, irritable b/c of fatigue

Difficulty with task completion

Memory 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.

Prevention and Treatment

Balance rest and physical activityAdequate nutrition and hydrationMonitor use of sedating medicationsCognitive-behavioral interventionsTreat comorbid conditionsImprove quality and quantity of sleepPsychostimulants or wake-promoting

medication

INTIMACY and CANCER

Treatment-related sexual dysfunction &/or infertility occurs in up to 100% of survivors depending on site of cancer

Dysfunction 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

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.

Human sexual response:

DesireExcitementOrgasmResolution

Dysfunction generally occurs in:

desire, excitement, orgasm

Interventions:

Education about human sexual response and consequences of cancer treatment, as well as expected recovery

Education about options for treatment of sexual dysfunction - sexual aids/devices, artificial internal and external lubricants, implants, positioning, ED meds, pain and fatigue management.

Interventions - continued

Review current medications for sexual side effects

Cognitive-behavioral therapy for anxiety, depression, body image, interpersonal and intrapersonal concerns

Couple therapyHormone replacement

ANXIETY occurs as:

ReactiveAnticipatoryPhobiaPanicPre-existingPost-traumaticSubstance-induced

Causes of anxiety:

Medical - substances, needles, proceduresPsychological - loss of control Lack of social support or fearing loss of

support - “loner”, relocation, rejection, abandonment by significant other

Financial - insurance, work, disabilityFamily - patient as caregiver, parent, etc.Pre-existing conditions - chronic illnesses

Symptoms of anxiety:

Heightened sensitivity - environment, painDistractible, irritableRestlessness, fidgeting, unable to relaxSweating or chilling, sighing, fatigueDisrupted sleep or appetite, GI distressWorrying, intrusive thoughts,

apprehension, delayed decisionsDistorted thinking

Interventions:

Cognitive-behavioral treatment

Improve social support options

Medications

Education

4 Groups Who Need Psychosocial Assistance:

Patients with history of adverse events or unresolved personal concerns but who have been coping with life

Patients with pre-existing psychopathology

Patients who develop psychological treatment-related side effects: phobias, anticipatory N/V, fatigue, depression, anxiety, etc.

Family members/caregivers

When a referral is needed:

Refer when patient or family exhibits a behavior that interferes with the delivery of quality care or safety in the clinic or hospital

Refer for signs/symptoms of psychopathology, or significant stress in patient or family caregivers which interferes with the caregiver’s ability to provide support

Refer if patient develops side effects, symptoms, or behaviors that will affect quality of life during long-term survivorship.

THANK YOU

Contact information:Amy Johnson, Ph.D.

Psychologist/ Health Service ProviderTennessee Oncologyajohnson@tnonc.com