CancerSupport:PsychosocialCareofCancer

OncologySocialWorker
DevelopedcancercounselingprogramatYaleUniversity
o Ptsusetonotknowdxandandtheydidn'ttalktoptsabouttx
Developedchildrencounselingprogram
Arkansas:hadtodoresearchandhadtopublish
WorkedwithMr.Rogers
o Thedayyouarenotjoyfulaboutwhatyoudo,isthedayyoushouldretire.
WorksforFoxChase:
o DevelopedcounselingprogramforladieswithbreastCAandhusbands

CAaffectsfamilyasmuchasitaffectspatientSpecificallythechildren
o 1.)Overviewofemotionalsequelae
o 2.)Needsofcancerpatientsandresourcesavailibletothem
o 3.)CommunicationwithCApatientsandfamilywhatquestionsareimportanttoaskwhentakinghx?

SeveralfactorsthatimpacthowapatientwillreactwithadxofCA:
o 1.)Theactualdiagnosis(BreastCA)isdifferentthanaptwhoisdxwithlungcancer,rectalcancer,etc.
becauseofmortality
o 2.)PtspriorframeofreferencetocancerDidtheyknowanyonewithcancer?Howdidtheydo?
o 3.)Presenceofanyotherpreexistingissue
CAisnottheonlythingtheseptsdealwith,itisjustsomethinginaddition
Whatelseisgoingoninthisptslife?
Intxasteamdualdxisextremelyimportanttoknow!
Ex:Chemothrewptintomenopausethroughherintobipolarepisode(manic)
Thiscreatedanewprophylacticguidelines:anyonethatisgoingthroughmenopausethat
hashxofmentalillnesswillbeplacedbackonpsychdrugs

Howdoesacancerptreacttocancerdx?
o Supportsystem
o Cancerdestroysptsfinanciallymayneverrecuperatefromthis!
o Ptspriorhistory/copingskills
Haveyouevergonethroughapriorcrisisinyourlife?
Howdidyoureact?Whatworkedforyou/didn'tworkforyou?
o Whatissuesarethefamilygoingthrough?
Isthefamilyintact?Havetherebeenmajorbumpsintheirroad?
o SleeppatternisVERYimportant!
Hyperemotional
Depression/manic
Bigissue=noncompliancewithmedications
o Everyexpensive!CanIaffordtomisswork,buypainmeds,tx,etc.

ExpectedEmotionalPhases:(StagesofDeathandDyingprofoundin1980)
o PtsdoNOTmovegraduallythroughthephasesptsebandflowmuchmorefluid
o Itisnotdifferentphasestheygothrough,butseparatepsychologicalchallengesateachstageofthe
Cancercrisis
Howwelookatitnow:
PreDiagnosisPhase
TreatmentPhase
SurvivorPhase/Terminal

WhichphasedoweseethemostanxietyanddepressionPostTreatment
612monthsaftertxhasfinished(60%ofherreferrals)

PrePhase:WorkupandDiagnosis:
MobilizedInformationalseekingmode
Lotsofsupport,hope,andTHEYAREINSHOCK(brainhasntacceptedthisyet)
DENIALISAPROTECTOR!Itisnotabadthinghere!
TreatmentPhase:
Atthispointrealityhassetinandtheemotionalnovicaneisgone
Whatisthebiggestchallengeforptandfamilyisthattheyhavelosttheirsenseofnormalcy
Changeoffamilyroles
o Weneedtoworkwithpt.heretogetthemmobilizedagain
ThisiswhenweseealotofthefeelingoflossofcontrolDepressionbeginstoensue
Thisiswhenitismostimportanttoinstill(redefining)asenseofhopefulness
HATESwordacceptance
Moreoftenhavetointroducedepressionorsleepaidshere;alsoaccupunture,diet,etc.
SurvivorPhase:
PeakofCrisis
VietnamSyndromethesamepeoplethatdidwellincombat,didn'tdosowellwhentheygot
homefoundthissamethingwithCApts
Realize,thereisnogoingbacktothenormal,lifeisNEVERthesame
Trytogetthemtorealizethattherecanbeanewnormal!
MostDifficultPart:patientisstillstruggling,butthefamilyhasmovedon
Nowtheyarefeelingisolatedintheirstruggleb/cnooneelseunderstands
TerminalPhase:
Weusuallyknowthisaheadoftimeatthispointitisimportanttotrytohelpthept.gainas
muchcontrolaspossibleTheystillgettowritethischapter!
Focusisonseeinghowtobuildsupportforfamily,especiallyoncethept.isgone

Communicatingwithpt:BEWHERETHEPTISAT,NOTWHEREYOUWANTTHEMTOBE!
o Iftheptisindenial,gowithitunlessitisimpedingtreatment
o Listenduringhxtakingandmakeeyecontact
o Reinforcetheirabilitytocopewiththis
o Rememberwhoyourpt.waspriortodiagnosis

katkinlcsw@yahoo.com

DanielleNotes:
1. Psychosocialaspectsofcancersupport
2. Pt.'sdon'tgetdiagnosedwithcancer,familiesdo
a. Notjustaboutthept.alsoaboutthefamily
2 Overviewofemotionalphasesthroughouttheexperience
a. Needsandresourcesavailableforacancerpt.
b. Importanttounderstandthatthereareseveralfactorsthatapt.experienceswheninitiallydiagnosedw/CA
i.
Lifewillchange,andsomeofthemmightnotdowell
ii.
Actuallydiagnosedgoesintohowtheyaregoingtoreact
1. DifferentCA'shavedifferentreactions,dependingontype&thestageofprogressionofthecancer
ii
Whetherthept.'shadsymptomsornot
1. Moredifficultwhenthept.hasn'thadanysymptoms,moreofasurprise
2. Ifthept.hassymptoms,cansometimesfeelasenseofreliefthattheyfinallyknowwhat'sgoingon
andcanfinallymoveontothetreatmentprocess
ii
Higherframeofreferencewithcancer
1. Havetheyknownanyoneelsewiththesamediagnosisandhowdidthatpersondowiththatcancer?
2. Ifthepersondidwell,pt.cantypicallyhaveapositiveframeofreference
3. Ifpersondidn'tdowell,pt.canhaveanegativeframeofreference&makept.feelmoreanxious
ii
Otherfactorsthatthept.isdealingwith
1. Performingascreeningtoassessifthereisanyotherpsychosocialissuesgoingon
2. Canestablishatreatmentplanthatthept.canbecompliantwith
3. Womenwhoareonchemotherapycaninducemenopausedependingontheage
a. Bipolarisaphysiologicalillness,andinducingmenopauseandchangeinhormones
wouldexacerbatethebipolardisorder
b. Developaprotocolthatapt.withbipolarinremissionneedstogobackonmedication
proactively
ii
Qualityoftheirsupportsystem
1 Pt.candobetterduringchemotherapywithagoodsupportsystem
2 Sometimesthebestsupportsystemistypicallyfromfriends
2 Emotionalsequelaeofcancertreatment,cancercrisis
a Pt.'sfeelingresentfulwhentheyseept.'sonmedialookinghappyandfullytreated
b Pt.'sgotheirvariousphases
i
Denial,anger,sadnessbargaining,acceptance
b Havetosuccessfullynavigatethisstage
i
Knowthatpt.'sgothroughthesteppingstonethrougheachphase
ii
Actuallypt.'stypicallyexperiencethesephasesatdifferenttimesthroughacontinuum
iii
Goalistohelpthemnavigatethedeathchapterthebestwaythept.candeal
iv
Morediseasesstagesthatpt.'sgothrough,&ateachdiseasestageit'sveryfluidintermshowthept.'sfeel
b Thesurvivorshipphaseisthepeakofthecrisis
i
Typicallygetpsychologicalhelp69monthsaftertreatmentisdone
b Pt.'saremostmobileattheinitialdiagnosticphase
i
Pt.'sareinshockanddenial
ii
Becausethey'reinshockthattheyareabletodoeverythingthattheycando
2 Howtocommunicatewithaterminalpt.

Howweasproviderstakecareofourselvesinthisfield