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Psychosocial Aspects of Breast and Cervical Cancer Diagnoses

Psychosocial Aspects of Breast and Cervical Cancer Diagnoses. Emily Lane, MSW, LCSW SIU School of Medicine. A little about me…. At the end of this webinar, you should be able to… Identify possible psychosocial stressors associated with breast and cervical cancer diagnoses.

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Psychosocial Aspects of Breast and Cervical Cancer Diagnoses

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  1. Psychosocial Aspects of Breast and Cervical Cancer Diagnoses Emily Lane, MSW, LCSW SIU School of Medicine

  2. A little about me…

  3. At the end of this webinar, you should be able to… • Identify possible psychosocial stressors associated with breast and cervical cancer diagnoses. • Recognize symptoms of psychological distress in newly diagnosed patients. • Utilize supportive interventions with the hopes of decreasing the level of acute distress in patients with breast or cervical cancers. • Educate patients on avenues of assistance and coordinate appropriate referrals to alleviate some of the psychosocial distress that they are experiencing. Objectives

  4. What are psychosocial stressors? • Social conditions that can affect our mental health. • Example: financial concerns can lead to feelings of inadequacy or depression OR major depression could lead to missed days of work and subsequent financial concerns

  5. Common psychosocial stressors for persons with cancer

  6. Financial • Unable to work due to appointments or treatment • Uninsured/underinsured • Out-of-pocket costs for medications • Physical • Side-effects from chemotherapy, surgery, radiation and/or hormone treatments • Difficulty with activities of daily living • Transportation • Navigation of the healthcare system

  7. Interpersonal • Difficulty communicating with loved ones because of high levels of distress • Little support from family and friends • Too many people counting on the person with cancer • Changes in libido and sexuality can lead to difficulties in marriage

  8. Significant pain from internal radiation which can lead to difficulty having sex afterward. This can lead to marital strain. • Guilt/Shame of HPV infection or stigma • Fertility concerns – early menopause • Cervical cancer is 10x more prevalent in women who are victims of domestic violence than in general population Cervical Cancer Specific

  9. Body image issues may result from physical changes to the breast from surgery, radiation • Femininity/Sexuality issues can lead to marital strain • Lymphedema – can be a financial burden due to the supplies needed to manage the condition Breast Cancer Specific

  10. Depression • Anxiety • Anger • Guilt • Difficulty sleeping • Existential questions • Difficulty concentrating • Distress over treatment choices The emotional toll of these stressors

  11. What is psychological distress?

  12. The National Cancer Institute defines psychological distress as “an unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with the ability to cope with cancer treatment. It extends along a continuum, from common normal feelings of vulnerability, sadness, and fears, to problems that are disabling, such as true depression, anxiety, panic, and feeling isolated or in a spiritual crisis”

  13. Use of a distress screener can help you find out what your patients are dealing with both physically and emotionally. http://www.nccn.org/patients/resources/life_with_cancer/pdf/nccn_distress_thermometer.pdf

  14. We know the problem How do we help?

  15. Validation and Communication

  16. Empathic Statements • Reflection • Statements of understanding • Ask patients how they feel • Mirroring • Active Listening • Being able to just sit with a patient and their emotions • Normalizing emotions Validation

  17. Building block of rapport • Adds to patient’s subjective experience of a safe place to express him or herself • Facilitates hope • Improves patient compliance and satisfaction Why is empathy important?

  18. Provide education as to what the next step is regarding treatment and/or follow-up. • Ask patients if it would help them if you made the follow-up appointments for them. • Ask them if they have any immediate concerns, such as support at home, transportation, insurance coverage and/or other financial issues. • Provide information regarding resources in the community. Communication

  19. A word about survivorship…

  20. Illinois Breast and Cervical Cancer Program • American Cancer Society • Patient navigators to assist with financial concerns and other needs • Wig Salon • Look Good, Feel Better • Road to Recovery • Co-Pay Assistance • Community Action Agencies • Sangamon County Resource Center • Local Support Groups Resources

  21. www.needymeds.com • www.getcoveredillinois.gov • www.cancer.org • www.nccn.org/patients/resources/life_with_cancer/ • www.livestrong.org • www.cancercare.org Helpful websites

  22. Each person is unique, and their response to a cancer diagnosis will be just as unique. • Ask your patients about how they are coping, what they are feeling and what they need… don’t assume to know. • Encourage them to share their feelings with their loved ones or with a oncology social worker, counselor or psychologist. Final Thoughts

  23. American Cancer Society. (2013). What is Breast Cancer? Retrieved from: http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf. • Arm, J., Crowe, L.C., Morgan, H., Murrells, T., Oakley, C., Palmer, N., Ream, E., Young, A., &Richardson, A. (2009). Patients’ supportive care needs beyond the end of cancer treatment: A prospective, longitudinal study. Journal of Clinical Oncology, 27(36): 6172-6179. • Brintzenhofe-Szoc, K.M., Levin, T.T., Li,Y., Kissane, D.W., & Zabora, J.R. (2009). Mixed anxiety/depression symptoms in a large cancer cohort: prevalence by cancer type. Psychosomatics, 50:383–391. • Camu, J.N. (2013). Mirroring: A calculated therapeutic technique or just conversation? Understanding how and why a shiny reflective surface might heal. Retrieved November 25, 2013 from www.fuelforemtionalhealth.com. • Carpenter, K.M., Fowler, J.M., Maxwell, G.L., & Anderson, B.L. (2010). Direct and buffering effects of social support among gynecologic cancer survivors. Annuls of Behavioral Medicine, 39: 79-90. • Cesario, S.K., McFarlane, J., Angeles, N., Gilroy, H., & Maddoux, J. (2014). Linking cancer and intimate partner violence. Clinical Journal of Oncology Nursing, 18(1): 65-79. References

  24. Drolet, M., Brisson, M., Maunsell, E., Franco, E., Coutlee, F., Ferenczy, A., Fisher, W., & Mansi, J. (2012). The psychosocial impact of an abnormal cervical smear result. Psycho-Oncology, 21:1071-1081. • Eskelinen, M. & Ollonen, P. (2011). Assessment of general anxiety in patients with breast disease and breast cancer using the Spielberger STAI self evaluation test: a prospective case–control study in Finland. Anticancer Research, 31:1801–1806. • Fobair, P., Stweart, S. L., Chang, S., D’Onofrio, C., Banks, P.J., & Bloom, J.R. (2006). Body image and sexual problems in young women with breast cancer. Psychooncology, 15 (7): 579-94. • Gerdes, K. E., Segal, E. A., (2009). A social work model of empathy. Advances in Social Work, 10(2), 114-127 • Institute of Medicine. (2007). Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: The National Academies Press. • Meyer, T.J. & Mark, M.M. (1995). Effects of psychosocial interventions with adult cancer patients: a meta-analysis of randomized experiments. Health Psychology, 14:101-8. • Neukrug, E., Bayne, H., Dean-Nganga, L., Pusateri, C. (2013). Creative and novel approaches to empathy: A neo-Rogerian perspective. Journal of Mental Health Counseling, 35(1), 29-42.

  25. Ollonen, P., Lehtonen, J., & Eskelinen, M. (2005). Anxiety, depression, and the history of psychiatric symptoms in patients with breast disease: a prospective case–control study in Kuopio, Finland. Anticancer Research, 25:2527–2533. • Rashid, A. (2011). Anxiety in Cancer Patients. In Duffy, J.D. & Valentine, A.D.(Eds.), MD Anderson manual of psychosocial oncology (pp. 271-288). New York: McGraw-Hill Companies, Inc. • Reiss, H., Kelley, J. M., Bailey, R. W., Dunn, E. J., Phillips, M. (2012). Empathy training for resident physicians: A randomized controlled trial of a neuroscience-informed curriculum. Journal of General Internal Medicine, 27(10), 1280-1286. • Spandler, H., Stickley, T. (2011). No hope without compassion: the importance of compassion in recover-focused mental health services. Journal of Mental Health, 20(6), 555-566. • Valentine, A.D. (2011). Mood Disorders. In Duffy, J.D. & Valentine, A.D. (Eds.), MD Anderson manual of psychosocial oncology (pp. 271-288). New York: McGraw-Hill Companies, Inc.

  26. Special thanks to Katherine Howerter, MSW, LCSW and Patricia Fank, Psy.D. for their contributions and guidance.

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