Psychological Impact of Advanced Cancer
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1 Psychological Impact of Advanced Cancer Anne Crook Counsellor / Psychotherapist Psycho-oncology The Christie NHS Foundation Trust
2 Impact of cancer and treatment
3 Living with the challenges Physical Uncertainty Social Loss of control Finding meaning Future
4 This is not who I am
5 Challenges for Men Sense of self as a man Sexual self Masculinity and role Less willing to share feelings? Expectations of coping Often no previous health contact Talking about Cancer?
6 Pete It s very frustrating. I m not looking for something to make me feel better - they can t do that. I just want them to listen to me. It s easier not to say anything.
7 Impact on relationships 76% Erectile Dysfunction Both patient and partner report distress Marital dissatisfaction increased over time Couper et al 2006
8 Distress Continuum
9 Psychological adjustment Depression and anxiety predict poorer psych outcomes Coping that involves interpersonal awareness and expression of emotions linked to better adjustment Sense of helplessness correlates with low selfesteem and depression Bloch et al (2007)
10 Screen for distress early Would you describe yourself as a worrier? Have you ever struggled with depression? How have you coped with challenges in the past? Do you have someone you can talk to? What stops you? What gets in the way?
11 When does normal become abnormal?
12 Psychological Disorders 21% depression 10% anxiety disorders 19% adjustment disorder Prevalence in Oncology / Haematology, Mitchell et al (2011)
13 Depression and anxiety % prevalence across treatments Sam Watts et al. BMJ Open 2014;4:e by British Medical Journal Publishing Group
14 What is Depression? Low / Depressed mood most of the day on most days Loss of interest or enjoyment in previously enjoyable activities Increasing irritability Easily moved to tears Recurrent thoughts of death Suicidal thoughts Men often present with irritability/ anger issues
15 Case Study - Tom 67yrs, married, two sons, three grandchildren Fatigue, bone pain Irritable and withdrawn What s the point? HADS: Dep=14, Anx=11 Declined anti-depressants
16 Tom - Depression Depression increase routine and activity Planned and began train set Rehearsed what he wanted to say Unfinished business
17 What is Anxiety? Prominent tension, worry and feelings of apprehension about every-day events and problems. Physical symptoms may be present including: Palpitations / increased heart rate / tight chest Sweating, Trembling, Muscle tension Difficulty breathing, choking Nausea, dizziness, tingling Avoidance, Checking
18 Anxiety = Overestimate threat Underestimate resources
19 Unhelpful coping strategies Avoidance / Withdrawal short-term relief / gain, long-term pain Excessive worry trying to make the uncertain certain Rumination negative thinking about the past
20 Helpful coping strategies Physical Exercise Relaxation / Breathing / Visualisation Mindfulness in the present moment Doing something more interesting
21 Mindfulness Resources (App)
22 Helpful coping strategies 2 Set realistic plans and goals Problem solving What steps do I need to take? Talk to someone / Write it out Finding your new normal Counselling / CBT Soothing self-talk Thoughts aren t facts It s just my alarm going off I ve coped before so I can cope again
23 Looking after ourselves
24 References Watts S et al (2014) Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open 2014;4 Bloch S et al (2007) Psychological adjustment of men with prostate cancer: a review of the literature. BioPsychoSocial Medicine Cooper JW et al (2006) The psychosocial impact of prostate cancer on patients and their partners. Medical J of Aus De Sousa A et al (2012) Psychological Aspects of Prostate Cancer: a clinical review. Prostate Cancer Diseases Michele Angelo Petrone pictures
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