psychological responses to a cancer diagnosis [16-40]

7/25/2019 Psychological Responses to a Cancer Diagnosis [16-40]

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Hello.I'm Dr. Barbara Andersen, professor ofpsychology at Ohio State Universityand a member ofthe Cancer Control Program atthe Ohio State University ComprehensiveCancer Center, James Cancer Hospital, andSolove Research Institute.Previous videos in this modulepresented the various methods andtechnologies used to diagnose cancer.I am now going to tell you aboutsome of the behavioral effects,including stress and emotional distress,changes in behaviors, andimmune responses that may comealong with a cancer diagnosis.In the United States, at least onein four cancer patients experiencestress at a clinical level and clinicallevels of anxiety after their diagnosis.If it's left untreated, this stresscan lead to poor mental health,

quality of life, andeven additional physical symptoms.Research that I andothers have done over the last decade,however, shows that psychologicalinterventions can help patients copewith the stress of cancer andimprove their quality of life.So in this video,I'll cover three major areas.A patient's reaction to a cancerdiagnosis, and the model that we've usedto capture this complicated phenomenon,

ways to help patients cope withthe stress of diagnosis and treatment,and how healthcare professionalscan provide psychosocial care tothe newly diagnosed cancer patient.So being diagnosed withcancer can be life changing.For many it's a frightening andstressful experience.The challenges may begin withthe words you have cancer.Others can come during treatment, andstill others may arise as time passes.

We now know that stress influencesour mind, our body, and our behavior.For example, stress can worsen physicalsymptoms such as pain or fatigue.Psychological changes caninclude feelings of tension oranxiety, more worries,or having a sad mood.Behavioral changes can include eatingan unhealthy diet, failing to exercise,


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or having low motivation forone's daily activities.There's also evidence, though,that stress levels can weakenimmune responses andinfluence treatment outcomes.Here's an example of how stress mightlower immune responses in cancer patients,which can effect the immune system'sability to fight the cancer.The data shown in this scatter platsuggests that a negative relationshipexists between patients' stress levels andthe death orlysis of cancer fighting immune cellscalled natural killer cells or NK cells.On the x-axis,you can see the level of cancer stressgoing from low to high,with higher numbers meaning more stress.The y-axis shows the levelof NK cell killing,or lysis,where high numbers mean more killing.

So we obtained this databy using blood samplesobtained from breast cancer patients.They had been diagnosed,had their surgery, andwere awaiting the start of chemotherapy.The data show that forthese patients with higher stress,their natural killer cell killing was low.Conversely, those individuals with lowstress had higher levels of NK cell lysis.This was a very robust relationship, andwe observed this same effect with other

NK assays and with T-cell assays.So, experiencing a cancer diagnosis andundergoing treatment can producea cascade of negative effects.This is common for many, butcertain individuals are at higher risk forcontinuing persistent stress.They include the unemployed orthose having limited financialresources, the poor,people with limited education,people who are alone, people witha psychiatric history of anxiety or

depression for example, andpeople with advanced or recurrent cancer.Fortunately, there are ways tohelp patients reduce stress andimprove their quality oflife after diagnosis.I'll describe threecommon coping strategies,all ones with empirical supportnot only for cancer patients and


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patients with other kinds of illnesses,but they're strategies we could all use.They are relaxation,social support, and exercise.So, how does a personwho's stressed just relax?[LAUGH] We recommend a particularway to help your body relax,and that's called progressive musclerelaxation, or PMR for short.PMR is regularly used in the treatmentof anxiety disorders, butit is an effective complimentarytreatment for many physical disorders.Cancer patients have used it to controlnausea, vomiting, reduce pain andother symptoms.The aim of relaxation is tolower your body's tension, andlower the wear and tear of stress.When your body's physically relaxed, itbecomes easier to control your thoughts,change your emotions, and reduce symptomsof stress, such as difficulty sleeping.

And the physiologic effectsof relaxation are clear.It decreases heart rate, andblood pressure, and breathing rate.It lowers muscle tension.It alters mood, and improves your abilityto concentrate on what's important.And subjectively, one feels calmer andrelaxed, as if you've had a brief nap.For those interested in trying PMR,you can listen to an audiotrack online at our website.Another aid in coping well is coping

with the aid of social support.Close relationships ease stress byproviding guidance, advice, and support.Support from friends, family, andother persons can convey feelings andthoughts that we're valued and cared for.It provides a sense of satisfactionwith life and an all-round,better physical and mental health.With something as significantas a cancer diagnosis,social support can be a tremendousresource for breaking through the stress.

Without support,stress can linger and worsen, soduring this time of need, patientsneed help from family and friends.The help can come in the formof helping with tasks,such as transportation to an appointment,caring for one's children while away,or taking care of the heavywork around the home.


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Social support can also be emotional.Someone to talk to, someone to helpyou problem solve a difficulty, orsimply having someone to sit with you orgive you a hug.Not everyone has a close friend orfamily member, however.Even so, it's important to not bealone when going through cancer.During difficult times, patients canbe encouraged to seek out new supportrelationships orbring more distant ones closer in.Counseling with a mental healthprofessional, or the clergy, ora specialized support group forcancer patients can also help.Despite the commonality of cancer,social support can be difficult forpeople in communities where there'sa stigma to being diagnosed with cancer.Stigma can prevent early detection,delay individuals in seeking a diagnosis,and prevent patients from asking for

support, or those individuals whootherwise might offer support don't.If that's the case in your community,think about ways you might crossthe stigma barriers and reach out to help.A third stress relieveris perhaps the easiest.That is physical activity.Just get out of the chair and move.Receiving and recovering fromcancer treatment can take months.It can take a toll on patients' diet andactivity patterns.

Curbing these effects is criticalto help patients recover andto improve their quality of life.Many people might have had a regularroutine of exercise, walking,riding a bike, running,before their cancer diagnosis.With the doctor's permission,we encourage many people,even those patients in treatment,to maintain some level of activity,even if for only 15 minutes a day.Research has found that regular

physical activity lowers stress,improves mood and cognition, along withhaving great cardiovascular benefits.In fact, we can think ofcancer as a teachable moment,an opportunity to encourage patientsto make healthy lifestyle choices.So let's summarize.It's important to identify and addressthe stresses of the cancer diagnosis.


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The psychological, behavioral, andbiologic effects of stress can linger andworsen symptoms and lengthen recovery.Patients, though,can be helped to reduce stressby using strategies such asthose I talked about here.Progressive muscle relaxation,social support, andencouraging physical activity andhealthy eating.Now I'll turn to what healthcare professionals can doto help meet the psychologicalneeds of the newly diagnosed.First, be aware of the current nationaland international guidelines forthe screening and treatment of mentalhealth concerns among cancer patients.The guidelines published by the AmericanSociety for Clinical Oncology, forexample, recommend evaluatingall cancer patientsat the time of their diagnosis and

periodically thereafter.An easy way to screen patients forsymptoms of depression is touse the Patient Healthcare Questionnaire,or the PHQ-9.For symptoms of anxiety,use the Generalized Anxiety DisorderQuestionnaire, or the GAD-7.Both are shown here.What's great about these measures, isthey're very widely used in primary careand they've been translatedto over 75 languages,

probably more tomorrow,including Chinese, Spanish, French,German, Italian, Russian, Portuguese,and Arabic, to mention just a few.Patients with no ormild symptoms can be referedto readily available resourcesat their institution orin the community, such as those thatmight be provided at your hospital.Those with moderate symptomsare recommended for low intensityinterventions, such as group-based

treatments, such as cognitive behavioraltherapy, bio-behavioral interventions, orstructured physical activity programs.Those with moderate to severe orsevere symptoms are recommended formore intense therapies,usually delivered individually orface to face therapies such ascognitive behavior therapy.Guidelines have also been


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developed by organizations such asthe Breast Health Global Initiativeto assisthealthcare professionals in low andmiddle income countries, andin regions with limited resourcesto provide supportive care.Their recommendations have four tiers,starting at a basic levelof resource allocation andincrementally adding services as resourcesbecome available in the country.At the basic level, these recommendationsinclude educating health professionalsabout the psychosocial considerations likethe ones we are talking about here today.Community education is also important forreducing stigma and burden.Then, educating patients about treatmentrelated toxicities and side effects,such as fatigue, problems with cognition,infertility, sexuality and others.And lastly, educating patients andfamilies about the topics such as those

presented here, stress, relaxation,social support, and offering peersupport by trained volunteers.In the United States, national groups,such as the American College of SurgeonsCommission on Cancer, have mandatedthat by 2016 all cancer clinics mustprovide psycho-social screening andservices to cancer patients andalso document the efficacy of doing so.Here at Ohio State, we're participating inan effort to provide the best empiricallysupported treatment to patients in

this country and around the world.So, how can we do that?Well, we train mental healthprofessionals to provide those services.Several times a year we conduct FromCancer to Health training institutes formental health professionalsin the deliveryof evidence basedbio-behavioral interventions.They were developed here.The intervention that we use is based onthe conceptual model that incorporates

psychological, social, behavioral,and biologic effects of stress.The intervention uses cognitive andbehavioral techniques toreverse the negative emotional,behavioral, and physical responses tocancer that we've just talked about.The key components we teach professionalsare how to conceptualize anduse stress reduction strategies,


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assertive communication andproblem-solving, how to help patientsgarner social support from their friendsand family, health behavior changefocused on eating a healthy diet,engaging in physical activity, andreducing negative health behaviors,such as smoking, or heavy alcohol abuse.And very importantly, strategies to helppatients maintain their positive changes.So the key to providing effectivepsycho-social support to patients is touse evidence based methods.This is the central tenet ofmodern health care delivery.If you are a mental health professionalwho works with cancer patients andwould like to learn more about ourintervention or our training institutes,please visit our website orfollow us on Twitter.Thanks so much.

psychological responses to a cancer diagnosis [16-40]

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