Psychological Aspects of Oncology Patient “Contributing Factors & Intervention” Elham Abd El-Kader Fayad Professor of Psychiatric & Mental Health Nursing 3/5/2006

For oncology client the following areas should be examend: Adjustment and quality of life. Symptoms control. Immune function. “Disease progression”

Adjustment & quality of life Psychosocial factors contributing to adverse outcomes: → Cancer can be emotionally jarring experience. → Accompanied by multiple challenges & disruptions.

Studies of quality of life & psychological adjustment focuses the attention on several questions Which patient are most vulnerable to psychological difficulties?

What challenges emerge for patient’s with different sites of disease at different phases of treatment? Disabilities? Tumor site? Choice of treatment & time since diagnosis? This plays an obvious role in shaping psychological responses to cancer.

Symptoms Control Nausea, vomiting, pain, fatigue & hot flashes are among the symptoms that have been targeted for adjective psychological interventions.

Interest in symptoms control helped set the stage for closer interdisciplinary collaboration in the clinic, introducing an alternative to the more traditional practice of referring medical symptoms to medical specialists & psychological problems to mental health specialists.

Immune Function & Disease Outcome Psychological factors contributing to disease progression.

Growing evidence suggests that social isolation, associated with all- cancer mortality after controlling for traditional risk factors. Social support may have differential effects on survival.

Psychological factors such as: stress, pessimism, or isolation affect the medical treatment.

Stress and psychological factors influence health behaviors contributing to poor diet, diminished appetite, disrupted sleep, limited exercise, increase cigarette smoking, and intensified substance abuse.

Associated Common Psychological Symptoms Certain psychological symptoms are common to clients diagnosed with cancer these include anger, depression, anxiety, helplessness, and hopelessness

Anger Clients with cancer diagnosis typically demonstrate behaviors that are indicative of anger.

These behaviors reflect feelings of helplessness and frustration about the illness and the effects the illness has on daily functioning.

Behaviors likely to be exhibited include demanding types of action, loud verbalization, slamming of items, and social withdrawal.

Depression Clients with cancer diagnosis typically demonstrate symptoms of depression related to disruption of daily functioning.

Signs associated with depression include feelings of helplessness/hopelessness, flat affect, poor eye contact, disrupted eating/sleeping patterns, absence of motivation and compliance, and decreased energy level.

Anxiety Oncology clients typically demonstrate feelings and behaviors of anxiety. This reflects feelings of real or imagined threat to body image.

Anxiety results in autonomic nervous system stimulation with increased heart rate, increased respirations, increased visual acuity, diaphoresis, shortness of breath, and restlessness.

Helplessness/Hopelessness Oncology clients demonstrate feelings of helplessness/hopelessness.

Helplessness relates to feelings of powerlessness associated with being unable to change what is happening, while hopelessness relates to feelings of despondency and loss of optimism.

This is reflected in feelings of loss of control (feeling that an event can be managed) and individuality and increased dependency on others.

Associated Psychiatric Symptoms Psychosis is the inability of a client to understand and know reality or cope with demands of daily living.

Psychotic symptoms that may be demonstrated in clients with selected medical illness diagnoses include evidence of delusions and hallucinations, thought process disruption, and difficulty in caring for oneself.

Assessment The nurse uses various resources to collect psychological, biological, and social data.

Subjective and objective symptoms, family/significant other reports, and diagnostic reports are considered in the assessment phase.

Psychological Assessment Elicits clients’ emotional reaction & coping abilities and support resources.

A stress appraisal should be done with identification of the source of stress, number of stressors, and duration of stressors.

Depression symptoms assessment should be completed with notation of time of initial symptoms, duration of symptoms, and physical appearance.

Identification of coping behaviors is part of the psychological assessment and includes assessment of adaptive and maladaptive behaviors that reflect a client’s ability to identify problems and analyze feelings

The assessment phase should also include identifying the emotional stage of the illness.

Clients often progressively move through stages of illness and interventions should be planned according to the emotional stage.

These Stages include Denial of the illness and associated limitations. Anger at loss of control and associated limitations. Bargaining, with a plea for another chance and a seeking of new answers/treatments.

Depression when grieving occurs due to loss or anticipated loss. Acceptance/adaptation when conflicts are resolved and the client participates in care.

Management In cancer illness: Client experiences feelings of helplessness & hopelessness. In addition, feelings of depression, anger, and hostility are experienced.

The client’s response will be affected by coping skills, developmental/lifespan level, spiritual, cultural, biological, and psychosocial factors.

Interventions for clients with cancer should include use of empathy and compassion; a focus on aspects of the client’s life that were positive, spirituality assessment and reinforcement; support of family and significant others; and allowing client dignity, client control, and use of pain management.