1. Coping with Cancer Dr. Lisa Bialy, PsyD drbialy@yahoo.com 415-948-8823 Survivors’ Day 2008

2. This is your brain on cancer.

3. Fight or Flight Response/Survival Normal response to survival situation. Overuse causes damage. Lowered immune functioning, higher burnout, more stress.

4. The 6 Feared “D’s” 1) Discomfort 2) Dependency 3) Disfigurement 4) Disability 5) Disruption 6) Disengagement 7) Death (Holland et al, 2001)

5. Doing the Right Thing… Treatment choices. Personality changes Is this making me sicker?

6. You are already coping…

7. Understanding Coping Styles Distancing/Denial Accepting Escape-Avoidance Problem Solving Confronting Self-controlling Seeking social support

8. Substance Abuse Avoidant response Exacerbated by illness Loss of control Fear of pain, tx, outcomes Interferes with tx

9. Coping Skills and QOL Thought stopping Affect regulation Exercise, diet Relaxation Emotion expression Humor Distraction Information

10. 4 Phases of Treatment Diagnosis Active Treatment Follow-Up Future and Possible Recurrance

11. Myths about Depression/Anxiety All patients with cancer are depressed/anxious and need help. Patients with cancer manage well and very few need help coping. Talking about depression/anxiety makes matters worse.

12. Prevalence of Depression About 47% cancer patients experience depression at some point during their illness (Derogatis et al, 1983). Of these, most fit criteria for Adjustment Disorder, smaller number for Major Depressive Disorder. 90% of above secondary to disease or tx.

13. Why do people get depressed? Physical compromises. Life changing event. Stress of decision making. Fear of future. Pain, loss of freedom, changes in lifestyle. Medication Interactions. Thoughts of death.

14. Treatment for Depression/Anxiety Psychotherapy Social Support Medication Psycho-education and coping skills

15. How does psychotherapy work? Normalizes negative feelings. Facilitates communication. Supports fears and hopes. Reinforces existing coping skills. Develops new coping skills. Focuses on Quality of Life Individual, Couples, or Families

16. What is meaningful helps. Support and love from family and friends. Finding personal meaning, creating rituals. Hobbies, activities, beliefs, reflection.

17. Grief Work Normal response to loss, whether from death of a beloved, loss, or injury. Usually proportionate to disruption caused by loss. Loss is normal part of life for everyone.

18. Stages of Grief Denial/Shock Anger Bargaining Depression/Sadness Acceptance (“On Death and Dying” Kubler Ross)

19. Recognizing Grief Insomnia Appetite changes Aimlessness Hopelessness Excessive guilt Psychomotor retardation

20. Specific Psychosocial Interventions Targeted Approaches/Solutions

21. Relaxation Training Breathing Meditation Hypnosis Music Exercise Guided Imagery

22. Sleep Disturbance 48% prescribed medications for cancer patients are hypnotics (sleep aids). 44% psychotropics sleep aids.

23. Sexual Dysfunction Medication side effects Treatment side effects Depression Fear of intimacy Couples Therapy

24. Communication with Medical Professionals List of questions and concerns. Education Collaboration/ coordination of care by point person.

25. Caregiver Burnout Empathic effort takes its toll Express negative or exhausting feelings Self-care essential Support for caregivers Re-focus on what is important in own lives

26. Group Interventions Benefits social support, communication skills, coping responses, and immune functioning. Feedback from other patients and caregivers. Mixed diagnosis/prognosis?

27. Case Presentation Multi-method Interdisciplinary Treatment of Cancer

28. Couple Dealing with Cancer 40 y/o male, w/kids, engaged to be married Recently diagnosed with Colon cancer Tx- surgery, 6 rounds of chemo, possible radiation

29. Woman with Breast Cancer 55 y/o married Chinese American woman, w/ 2 kids. Communication struggles w/ family and doctors. Cultural Considerations.

30. Palliative Care 70 y/o “Type A” male with metastatic cancer. Wife, 2 kids and 3 grandchildren. End of life decisions. Meaning making. Saying goodbye.

31. Summary Advances in cancer dx and tx promising but treatment decisions increasingly complex. Coping responses inherent. Depression and anxiety common. Social support essential. Self-care facilitates caregiving.

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