PSYCHOSOCIAL ISSUES AND CANCER

1. 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

2. PI occur with every cancer-related experience: • Prediagnosis • Diagnosis • Treatment • Recovery • Long-term survivorship • Death • Caregiving

3. Overview of 4 Psychosocial Concerns • Fatigue • Intimacy • Anxiety • Work

4. 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

5. Causes of fatigue... • Dehydration • Deconditioning • Changes in sleep patterns and nutrition • Grief • Depression • Anxiety and worry • Pain • Daily life

6. Fatigue affects: everything • intimacy • work • relationships • self esteem • coping • appetite

7. 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. Clinical syndrome of treatment-related fatigue 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.

8. “Feel weak”, “heavy” Trouble concentrating Loss of interest Sleep disturbances Non-refreshing sleep Sick or unwell after activities requiring effort “Struggle to do anything” Sad, frustrated, irritable b/c of fatigue Difficulty with task completion Memory problems Specific fatigue symptoms: 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.

9. Prevention and Treatment • Balance rest and physical activity • Adequate nutrition and hydration • Monitor use of sedating medications • Cognitive-behavioral interventions • Treat comorbid conditions • Improve quality and quantity of sleep • Psychostimulants or wake-promoting medication

10. 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

11. 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.

12. Human sexual response: • Desire • Excitement • Orgasm • Resolution Dysfunction generally occurs in: desire, excitement, orgasm

13. 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.

14. Interventions - continued • Review current medications for sexual side effects • Cognitive-behavioral therapy for anxiety, depression, body image, interpersonal and intrapersonal concerns • Couple therapy • Hormone replacement

15. ANXIETY occurs as: Reactive Anticipatory Phobia Panic Pre-existing Post-traumatic Substance-induced

16. Causes of anxiety: • Medical - substances, needles, procedures • Psychological - loss of control • Lack of social support or fearing loss of support - “loner”, relocation, rejection, abandonment by significant other • Financial - insurance, work, disability • Family - patient as caregiver, parent, etc. • Pre-existing conditions - chronic illnesses

17. Symptoms of anxiety: • Heightened sensitivity - environment, pain • Distractible, irritable • Restlessness, fidgeting, unable to relax • Sweating or chilling, sighing, fatigue • Disrupted sleep or appetite, GI distress • Worrying, intrusive thoughts, apprehension, delayed decisions • Distorted thinking

18. Interventions: • Cognitive-behavioral treatment • Improve social support options • Medications • Education

19. 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

20. 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.

21. THANK YOU Contact information: Amy Johnson, Ph.D. Psychologist/ Health Service Provider Tennessee Oncology ajohnson@tnonc.com