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=== Coping === |
=== Coping === |
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Psychological and behavioral responses by individuals to diagnosis and treatment of cancer are of primary interest in the field. These responses constitute what can be referred to as one's coping response to a health threat and is closely associated with individuals' illness perceptions. |
Psychological and behavioral responses by individuals to diagnosis and treatment of cancer in an effort to manage the substantial stress and threat to health are of primary interest in the field of psycho-oncology. These responses constitute what can be referred to as one's coping response to a health threat and is closely associated with individuals' illness perceptions. |
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Approach |
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Revision as of 22:14, 21 November 2018
Psycho-Oncology
Introduction
Psycho-oncology is an interdisciplinary field at the intersection of physical, psychological, social, and behavioral aspects of the cancer experience. Also known as Psychiatric Oncology or Psychosocial Oncology, researchers and practitioners in the field are concerned with aspects of individuals' experience with cancer beyond traditional medical treatments, and across the disease trajectory, including at diagnosis, during treatment, transitioning to and throughout survivorship, and approaching the end-of-life. Founded by Jimmie Holland in 1997 via the incorporation of a psychiatric service within the Memorial Sloan Kettering Cancer Center in New York, the field has expanded drastically in the years since and is now recognized as an integral component of quality cancer care.[1]Cancer centers in major academic medical centers across the country now uniformly incorporate a psycho-oncology service into their clinical care, and provide infrastructure to support research efforts to advance knowledge in the field.
Psycho-oncology broadly deals with the psychological reactions to the experience of cancer, the behavioral component of coping with cancer as well as health behavior change including preventative medicine, as well as social factors that are associated with diagnosis with and treatment of cancer, including communication with providers and loved ones and social support. In addition, research into the influence of psychosocial factors on biological disease-related processes is an important component. Much research takes as biopsychosocial approach to account for the interplay between biological, psychological, and social factors in coping with cancer.
Psychological
Diagnosis and treatment of cancer is known to influence psychological well-being to a significant degree. Rates of distress are elevated for most individuals who have been diagnosed with cancer when compared to population norms[2][3]Chief among psychological reactions to cancer are mood and anxiety-related concerns. Elevated rates of depression and anxiety in response to a cancer diagnosis is often attributable to uncertainty regarding mortality and well as going through arduous treatments and concerns related to functional interference and body-image or other self-concept related distress. Understanding how individuals react psychologically to cancer is important to support their overall well-being and maximize quality of life during treatment and beyond.
While the prevalence of psychological disturbance in reaction to cancer is relatively high when compared to population norms, many individuals report fairly stable psychological well-being through the cancer trajectory and some even report improved psychological well-being.
Depression and Anxiety
Primary psychological areas of concern within the field of psycho-oncology are adjustment and mood disorders in response to life threatening disease and functionally impairing treatment, in addition to anxiety in the face of uncertain disease outcomes.
Coping
Psychological and behavioral responses by individuals to diagnosis and treatment of cancer in an effort to manage the substantial stress and threat to health are of primary interest in the field of psycho-oncology. These responses constitute what can be referred to as one's coping response to a health threat and is closely associated with individuals' illness perceptions.
Approach
Avoidance
Emotional Approach
Positive Psychological Reactions
benefit finding
Meaning Making
as part of interventions for individuals who do not naturally or spontaneously engage in these processes
illness perceptions/representations
Behavioral
Health Promoting Behaviors/preventative medicine
Smoking Cessation, skin protection, screening (e.g., melanoma, breast cancer, lung cancer)
physical activity (e.g., fatigue, inflammation associations)
Treatment Adherence
Adherence to medical treatment is of crucial importance to managing cancer effectively and is a topic that largely falls under the purview of psycho-oncology for the cognitive-behavioral causes for lack of treatment adherence. A number of factors can contribute to lack of treatment adherence including toxic side effects, misinformation or lack of understanding of treatment regimen, lack of communication with medical providers, and lack of medical support (e.g., treatment self-management). Treatment adherence has become an increasingly important topic of study in psycho-oncology due to the increasing popularity of oral antineoplastics.[4] Individuals on oral chemotherapy must manage sometimes complex treatment regimens at home, on their own, and be able to communication effectively with treatment providers to manage toxic side effects that may influence ability or willingness to take the prescribed drug without the assistance of nursing as in traditional intravenous chemotherapy.
Social
Social Support and Isolation
During a stressful experience such as cancer diagnosis, social connections can provide valuable emotional and practical support. Research in the broader field of Health Psychology has revealed significant influences of social support on the psychological well-being of individuals as well as associations with disease processes, particularly in cardiovascular disease[5]. Patients undergoing treatment for cancer often rely on a social support network of varying size, including spouses, children, friends and other family, to support them through difficult treatments and functional impairment. These types of social support refer to instrumental social support and are related to task-based support. Additionally, the emotional toll that cancer diagnosis can take on a person necessitates a degree of emotional support from the support network. Both instrumental and emotional social support have been shown in research to improve quality of life in patients being treated for cancer[6].
On the other hand, a diagnosis of cancer can be significantly socially isolating for individuals. Life changes including functional impairment may separate people from their friends and family, and a shift from "healthy" to "ill" in terms of self-identity can lead to a sense of social isolation as well. Research has shown that social isolation and perceptions of loneliness have significant negative impact on physical and psychological quality of life in individuals with cancer[7].
Communication with Medical Providers
Family and loved ones (dyadic coping, communication)
Biological
Stress Pathways to Disease
Antoni review
Lutgendorf Review
Psychosocial Treatment Models
Adaptations of CBT, ACT, other effective interventions
Multiple evidence based treatments for mood and anxiety disorders in the general population have been adapted to deal with stressors directly related to cancer.
Mindfulness
Mindfulness is a burgeoning area of interest as a common element across multiple modalities in mental health treatment[8], having shown effectiveness in ameliorating depressive symptoms and anxiety. Particular to cancer, mindfulness has been applied to general stress reduction through mindfulness-based stress reduction (MBSR)[9][10], with evidence growing for not only decreased levels of cancer-related distress in response to mindfulness-baed treatments, but impact on biomarkers of disease and enhanced survival
Technology-Assisted Interventions
Online social support
mobile symptom tracking for medication adherence and communication with providers
Overall Impact on Standard Oncology Care
Intradisciplinary Research and Clinical Care
Routine Distress Screening
Palliative Care
 | This is a user sandbox of Jmacdonald7. You can use it for testing or practicing edits. This is not the sandbox where you should draft your assigned article for a dashboard.wikiedu.org course. To find the right sandbox for your assignment, visit your Dashboard course page and follow the Sandbox Draft link for your assigned article in the My Articles section. |
- ^ Holland, J. C., & Bultz, B. D. (2007). The NCCN guideline for distress management: a case for making distress the sixth vital sign. Journal of the National Comprehensive Cancer Network, 5(1), 3-7.
- ^ Zabora J, BrintzenhofeSzoc K, Curbow B, et al. The prevalence of psychological distress by cancer site. Psycho-Oncol. 2001;10:19-28.
- ^ Carlson LE, Angen M, Cullem J, et al. High levels of untreated distress and fatigue in cancer patients. Br J Cancer. 2004;90:2297-2304.
- ^ Greer, J. A., Amoyal, N., Nisotel, L., Fishbein, J. N., MacDonald, J., Stagl, J., ... & Pirl, W. F. (2016). A systematic review of adherence to oral antineoplastic therapies. The oncologist, 21(3), 354-376.
- ^ Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S., & Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart, 102(13), 1009-1016.
- ^ Nausheen, B., Gidron, Y., Peveler, R., & Moss-Morris, R. (2009). Social support and cancer progression: a systematic review. Journal of psychosomatic research, 67(5), 403-415.
- ^ Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science, 10(2), 227-237.
- ^ Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of consulting and clinical psychology, 78(2), 169.
- ^ Ledesma, D., & Kumano, H. (2009). Mindfulness‐based stress reduction and cancer: a meta‐analysis. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 18(6), 571-579.
- ^ Rush, S. E., & Sharma, M. (2017). Mindfulness-based stress reduction as a stress management intervention for cancer care: a systematic review. Journal of evidence-based complementary & alternative medicine, 22(2), 348-360.