PSIHO-ONCOLOGIE

Pacienţii cu tumori maligne - intervenţie psihologică

 Patients with malignancies - psychological intervention

First published: 24 aprilie 2015

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/OnHe.31.2.2015.4270

Abstract

Data from the literature reveals that a person with cancer may be exposed to a wide range of physical, emotional, psychological, social and practical issues. Throughout the oncological treatment, patients might develop various difficulties requiring specific psychosocial interventions. Depending on the case, emotional distress screening stage and assessing mental health of the patient is necessary (pre-existing psychiatric conditions diagnosis is needed before the diagnosis and psychological problems can result from the impact of diagnosis and treatment modalities). Based on these results it is important to offer specific psychosocial interventions aimed to reduce the emotional issues associated to the disease and to improve the quality of life of the patients in different stages of the disease (recent diagnosis, treatment, remission, recurrence, terminal phase) or of the caregivers. Psychosocial interventions help to be structured and guided depending on what the literature says, but tailored to each patient, sustained by the supported intervention and by a continuous and carefully built therapeutic relationship.  The term used in the literature and the right one is the psychosocial intervention, but because I refer strictly to psychological intervention strategies, I will use only the term psychological intervention.

Keywords
psychosocial intervention, psychiatric conditions, diagnosis, treatment

Rezumat

Datele din literatură indică faptul că o persoană cu cancer poate fi expusă la o gamă largă de probleme fizice, emoţionale, psihologice, sociale şi practice. De-a lungul tratamentului oncologic, pacienţii ar putea dezvolta diverse dificultăţi ce necesită intervenţii de specialitate specifice. În funcţie de caz, etapa de screening a suferinţei şi evaluarea sănătăţii mintale sunt necesare pacientului (diagnosticul problemelor psihiatrice preexistente este necesar înainte să apară probleme psihologice ce pot rezulta din impactul diagnosticului cu cancer şi modalităţile de tratament). Bazat pe aceste rezultate este important să fie oferite intervenţii psihosociale specifice menite să reducă problemele emoţionale asociate bolii şi pentru a îmbunătăţi calitatea vieţii pacienţilor în diferite stadii ale bolii (diagnostic recent, tratament, remitere, recurenţă, fază terminală) sau a persoanelor care îi îngrijesc. Intervenţiile psihosociale ajută să fie structurate şi ghidate în funcţie de ceea ce spune literatura de specialitate, dar adaptate la fiecare pacient, sprijinit de intervenţia susţinută şi printr-o continuă şi atent construită relaţie terapeutică. Termenul folosit în literatura de specialitate şi cel corect este „intervenţia psihosocială”, şi pentru că mă refer strict la strategii de intervenţie psihologică, voi folosi doar termenul intervenţia psihologică.

National Center for Health Statistics (2006) shows that cancer is one of the leading causes of death worldwide and for the next decade is predicted an over 50% increase in cancer related illnesses. More than that, it is believed that two thirds of the adult patients diagnosed with cancer may be surviving more than 5 years. If we have a look at the prevalence of emotional and psychiatric problems, these show to be over 50%: 1/3 of these people suffer from an adjustment disorder, 10-15% suffer from major depression and 10% of delirium, and regarding hospitalized patients, the incidence of depression is around 25-45% (Holland and Alici, 2010, and Massie 2004).

Data from Romania show also that the level of distress of cancer patients, as measured by the prevalence of moderate and severe depression, is high (Degi, 2013).

Also, other studies conducted on the population of Romania (Degi, 2013, Degi, 2009) show that hospitalized patients experience high levels of distress: 47.5% experience high levels of clinical depression, 46.7% suffer from an anxiety disorder and 28.1% report a very low quality of life.

A person with cancer may be exposed to a wide range of physical, emotional, psychological, social and practical issues. A psychologist, in this case, should provide counseling or therapy, as appropriate, for the emotional and psychological problems and facilitate the patient’s access to other specialized people to solve physical or practical problems (doctors and social workers).

Psychosocial needs and emotional reactions of the patients could be different depending on the stage of the treatment which influences the interventions during this period of time.

The therapeutic relationship and the continuous supportive intervention must become the key elements to be taken into account during the intervention with the patient.

1. The psychological interventions
for people newly diagnosed with cancer

The main goals of psychological intervention after a person was diagnosed with cancer refer to: a psychological screening achievement, creating an overall picture, building and maintaining a good therapeutic relationship to facilitate the provision of emotional support, emotional reactions normalization, awareness therapeutic options; psychological preparation for the first option of intervention (eg. pre-operative psychological preparation); assessment of depressive symptoms and/or other types of pathologies that may occur.

2. The psychological interventions
to cancer patients in active treatment phase

As patients move to the treatment phase itself, the main role of psychological intervention is to help the patient cope with treatment side effects; to actively acquire coping skills, to strengthen social support network and learn problem solving techniques and centering on the unsolved psychological problems, depending on each case. In the active phase of treatment, and after that, many cancer patients experience different symptoms, from nausea and vomiting to fatigue, weakness, depression, anxiety.

Studies in the literature (Redd, Montgomery & Duhamel, 2001) hold a series of cognitive and behavioral interventions:

1. contingency management

2.cognitive distraction/attentional

3. hypnosis/imagery

4. systematic desensitization

5. directed imagery

6. training of relaxation

7. cognitive restructuring

8. modeling with proven efficiency to reduce the adverse effects caused by treatment, such as nausea and vomiting, anxiety and distress, pain.

For nausea and vomiting, psychological intervention helps to have as objective the focus on preventive control of these side effects of the treatment - through relaxation and hypnosis (before and after chemotherapy), or through distraction using video games, especially for children.

For anxiety and distress it is recommended the use of behavioral interventions packs; for children - distraction, modeling, relaxation, contingency management, cognitive restructuring - these are proved to be effective in controlling the anxiety associated with invasive medical procedures. It seems that, for children, involving the imaginary hypnosis represents the fundamental component. The hypnosis and imaging methods have an important role in the management of pain, particularly for children (Henderson, 1997). For adults, hypnosis has highlighted, in particular, to be effective for controlling the symptoms of pain, nausea and fatigue after surgery performed in the case of patients with breast cancer (Montgomery et al., 2007).

3. The psychological interventions
to patients with disease
recurrence/terminal stage

Regarding the patients with disease recurrence or those in a terminal stage, psychological intervention has as objective offering them management strategies for the pain and the stress, maintaining the quality of life.

The pain management, for patients with final stage cancer, requires a multidimensional intervention/interdisciplinary (the pain control is imposed primarily in medical terms).

For the pain management there are a number of cognitive and behavioral procedures and packages interventions, whose effectiveness is proven, both in children and in adults - hypnosis, guided imagery relaxation and distraction by restructuring cognitive and mindfulness techniques (Keefe, Abernethy & Campbell, 2005, Lesma & Kumano, 2008). To maintain or improve the quality of life for patients in an advanced stage of disease, it is needed a specialized multidisciplinary team to involve.

The psychological problems which are faced by the patients in this phase are numerous, so they could benefit by physically, mentally, spiritually and cognitive interventions (important components of the quality of life) (Harding & Higginson, 2003).

An important element is to maintain the social connection - relationship with husband/wife, children, friends - where the psychological intervention is to facilitate communication and support perceived by the patient.

The main areas that help maintaining a good quality of life despite disease progression are: physical, mental, cognitive and spiritual (Rummans, Bostwick & Clark, 2000).

4. The psychological interventions
to patients in partial/complete remission

For the patients in partial/complete remission the psychological interventions have as a general objective the preventing emotional relapses, psychological intervention for fear of relapse of the disease, strengthening adaptive coping mechanisms, social adjustment, social reintegration, continuation the process of self-care.

The researches show that for people in complete remission, the following areas relating to post-cancer adaptation are identified as persistent concerns: late physical effects of medical treatment, cure or uncertain remission, couple problems, privacy, redefinition of obstacles and challenges, encouraging the search for support groups, fear of relapse intervention, factors related to employment discrimination (Henderson, 1997).
 

5. The psychological interventions addressed to carers/cancer patient’s family

Not just people passing through the stages of cancer treatment experience distress and crisis periods associated with the disease, but also caregivers/caretakers, considered sometimes secondary patients.

The interventions addressed to the caregivers, mainly to reduce the level of distress and effective adjustment to the situation, include psychosocial, supportive, cognitive behavioral ones and strategies for solving problems.

The sessions of counseling or group therapy allow expression of emotional distress, which may play a role in reducing the symptoms of emotional venting and learning through modeling of certain adaptive coping strategies for emotional, social and informational support (Spiegel D, Classen C, 2000).

In conclusion, with an increased incidence of neoplastic problems and prevalence of physical, social, practical and psychological issues, it is imposed that psychological intervention, psychosocial interventions to become an integrated part for an efficient care of an oncological patient.

As we can see, the goals and objectives of psychological intervention help to be designed and adapted to the crisis situation, to the patient and to the specific issues during the treatment stage.  

Bibliografie

1. Degi C.L. (2013) In search of the sixth vital sign: cancer care in Romania. Suport Care Cancer;  21:1273-1280.
2. Degi C. (2009) Non disclosure of cancer diagnosis: an examination of personal, medical and psychosocial factors. Support Care Cancer 17 (8):1101-1107.
3. Harding, R.,  Higginson, I.J. (2003) What is the best way to help caregivers in cancer and palliative care? A systematic literature review of interventions and their effectiveness, Palliative MedicinE, 17, 63-74.
4. Henderson, P.A. (1997). Psychosocial adjustment of adult cancer survivors: Their needs and counselor interventions. Journal of Counseling and Development, 75, 188-194.
5. Holland, J. C. and Alici Y. (2010) Management of distress in cancer patients. Review.  The Journal of supportive Oncology, vol.8. Number 1.
6. Ledesma D., Kumano H (2008) Mindfulness-based stress reduction and cancer: a meta-analysis, Psycho-Oncology, Volume 18, Issue 6, pages 571–579.
7. Kazak, A.E., Simms, S., Barakat, L., Hobbie, W., (1999). Surviving Cancer Competently Intervention Program (SCCIP): A cognitive-behavavioral and Family Therapy for Adolescent Survivor of Childhood Cancer and their Families. Family Process; 38, 175-191.
8. Keefe, F.J., Abernethy, A.P., Campbell, L.C. (2005) Psychological approaches to understanding and treating disease-related pain. Annual Review of Psychology, 56, 601-630.
9. Massie M. J (2004) Prevalence of depression in patients with cancer. J. Natl. Cancer Inst Monogr 3;2; 57-71.
10. Montgomery, G., Bovbjerg, D., Schnur, J., David, D., Goldfarb, A., Welty, C., Schechter, C., Graff-Yivin, J., Tatrow, K., Price, D., & Silverstein, J. (2007). A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of National Cancer Institute, 99, 1304-1312.
11. Redd, W.H., Montgomery, G.H., DuHamel, K.N. (2001). Behavioral Intervention for Cancer Treatment Side Effects. Journal of the National Cancer Institute, 93, 810-823.
12. Rummans, T.A., Bostwick, J.M., Clark, M.M (2000). Maintaining quality of life at the end of life. Mayo Clinic Proceedings,  75, 1305-1310.
13. Spiegel D, Classen C. Group Therapy for Cancer Patients: A Research-Based Handbook of Psychosocial Care. New York: Basic Books; 2000.
14. http://www.cdc.gov/nchs/

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