Coping with Cancer

1. Coping with Cancer Dr. Lisa Bialy, PsyD drbialy@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 “D’s” • 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; 18:191ﾐ210[Medline]2.Maunsell 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; 33:561ﾐ5694.Forsen A: Psychosocial stress as a risk for breast cancer. Psychother Psychosom 1991; 55:175-185[Medline]5.Derogatis LR, Abeloff MD, MelisartosN: Psychological coping mechanism and survival time in metastatic breast cancer. JAMA 1979; 242:1504ﾐ15086.Greer S, Morris J, Pettingage KW: Psychological response to breast cancer: effect on outcome. Lancet 1979; 2:785ﾐ787[Medline]7.Greer S: Psychological response to cancer and survival. Psychol Med 1991; 21:43ﾐ49[Medline]8.Spiegel D, Kato P: Psychosocial influences on cancer incidence and progression. Harvard Review of Psychiatry 1996; May/June, pp 10ﾐ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ﾐ42510.Spiegel D, Bloom JR, Kraemer HC, et al: Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989; 2:888ﾐ901[Medline]11.Richardson JL, Shelton DR, Kasilo M, et al: The effect of compliance with treatment on survival among patients with hematological malignancies. J Clin Oncol 1990; 8:356ﾐ364[Abstract]12.Fawzy FI, Fawzy NW, Hyun CS, et al: Malignantmelanoma: effects of an early structured psychiatric intervention, coping, and effective state on recurrence and survival, 6 years later. Arch Gen Psychiatry 1993; 50:681ﾐ689[Abstract]13.Straker M: A review of short-term psychotherapy. Diseases of the Nervous System 1977; 38:813ﾐ816[Medline]14.Caplan G: Principles of Preventative

33. References • Psychiatry. New York, Basic Books, 196415.Lindemann E: Symptomatology and managementof acute grief. Am J Psychiatry 1944; 101:141ﾐ148[FreeﾊFullﾊText]16.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ﾐ11817.Straker N, Wyszynski A: Denial in the cancer patient: a common sense approach. Internal Medicine for the Specialist 1986; 7(3):150ﾐ15518.Leshan L, Leshan E: Psychotherapyand the patient with a limited lifespan. Psychiatry 1961; 24:318ﾐ323[Medline]19.Wise TN, Berlin RM: Burnout: stresses in consultation. Psychosomatics 1981; 22:744ﾐ751[Abstract/FreeﾊFullﾊText]20.Holland J: Psychological management of cancer patients and their families. Practical Psychology 1977; October, pp 14ﾐ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; 18:541ﾐ560[Medline]23.Deutsch F: Euthanasia: a clinical study. Psychoanal Q 1933; 347ﾐ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ﾐ606