Cancer and Psycho-oncology

Question 1

What are the risk factors for distress?

Answer 1

Demographic: Living alone, female, younger age, young kids, low social support, low SES, poor marital functioning, psychiatric history, substance use.
Medical: More side effects, chronic pain and fatigue, functional impairment.

Question 2

When should we screen?

Answer 2

Treatment milestones: at dx, commencing and completing tx, anniversaries, checkups, recurrence, advanced dx, palliation.

Question 3

What is the 6th vital sign of oncology?

Answer 3

Distress
35-40% of people will experience distress
Brain cancer highest distress
Cancer elicits more distress than any other diagnosis regardless of prognosis

Question 4

What can psychologists in oncology settings do?

Answer 4

Educate on the need for screening of distress and provide advice about screening tools.

Question 5

What should be assessed?

Answer 5

Presenting problem
Pt's perspective of cancer, including illness perceptions (primary appraisal - threat, secondary appraisal - control, perceptions of cause and possible illness duration)
Current coping strategies
Biopsychosocial functioning
Biopsychosocial history
Goals for tx

Question 6

What are the recommended screening tools?

Answer 6

• Illness Perception Q’aire (appraisal measure)
• Mental Adjustment to Cancer SF (coping)
• Medical Outcomes Study SF (QoL)
• Distress measure e.g. DASS

Question 7

What is Lazarus and Folkman’s (1984) model?

Answer 7

• Primary appraisal - level of threat e.g. Am I in danger?
  (Challenge, Threat, Harm-Loss)
• Secondary appraisal - Can I control or alter this e.g. Is there a way to overcome the threat or improve prospects?
• Coping process - the individual’s efforts to manage the internal and external demands
• Decision made whether situation has been resolved (cancer does not need to go for this to be the case).

Question 8

What purpose does coping serve?

Answer 8

• Problem focused coping addresses the problem
• Emotion focused coping regulates emotions
• Benefit finding helps find meaning

Question 9

How can assessment be an intervention?

Answer 9

Psychoeducation
Normalise
Validate
Challenge illness perceptions and coping responses
Building alliance and hope
Client’s first opportunity to talk about things they don’t wish to share with family members e.g. existential concerns

Question 10

What is the structure of CBT for cancer?

Answer 10

6-10 sessions of 90mins
3 components: psychoed, cognitive procedures, behavioural procedures
Better outcomes if offered earlier e.g. during medical treatment

Question 11

What is the psychoeducation component of CBT for cancer?

Answer 11

Psychoed
Normalising
Formulation - how current cognitive and behavioural responses maintain problem
Identify targets for intervention

Question 12

What are the key interventions in cognitive components of treatment?

Answer 12

Cognitive restructuring
Distraction
Problem-solving
Behavioural experiments
Communication training
Coping skills training

Question 13

What are the key interventions in behavioural components of treatment?

Answer 13

Behaviour activation
Exposure
Guided imagery/relaxation
Goal setting

Question 14

What are the social factors to consider?

Answer 14

• Separation from family esp. if child or adolescent, leading to anxiety
• reduced ability to perform ADLs leading to change in social role and more dependent relationship (potentially affecting separation/individuation)
• financial stressors, leading to relationship strain
• social isolation if rural
• not working - reduced interaction from colleagues
• communication issues - family members wish client would ‘leave it behind’, not understand cancer survivor identity
• carer may have vicarious trauma
• difficulties/fears about forming new relationships - disclosure about physical and emotional problems, intimacy problems

Question 15

What are the biological factors to consider?

Answer 15

These depend on type, site, stage and grade of cancer.
Long periods of treatment, uncertainty, possible return of cancer.
Stoma/lymphoedema
Side effects of treatment include:
- nausea and vomiting
- libido and sexual functioning
- depressive-like symptoms e.g. fatigue, appetite, insomnia
- pain
- fertility
- scarring/disfigurement
- fecal and urinary incontinence and bowel problems
- nutritional deficiencies
- swallowing difficulties
- respiratory symptoms
- poor general health and disability
- comorbid medical conditions
- cognitive changes

Question 16

What are the psychological factors to consider

Answer 16

20% develop depression or anxiety
Negative affect - anger, guilt, self-blame, PTSD
High rates of suicidal ideation
Changes in self concept, body image, libido and sexual functioning
Loss of perceived control and self-efficacy
Illness perceptions - threat, control, perceptions of cause and duration
Cancer patient/survivor label
Body as fallible or ‘unsafe’
Existential issues/search for meaning
Possible PTG