Lecture 24 Health Flashcards
prevalence of cancer
1 in 2 Australian men and women will be diagnosed with cancer by the age of 85
145,000 new cases of cancer will be diagnosed in 2019
cancer is a leading cause of death in Australia (a total of ~ 50,000 deaths from cancer in 2019) => death rates continue to fall, with a sharper decline for males.
By 2030, the GLOBAL cancer burden is expected to nearly double, growing to 21.4 million cases and 13.2 million deaths.
11.8 million cancer survivors in australia
Angelina effect
Women diagnosed with breast cancer and tested for BRCA ½ gene mutations: 2007 = 70%, 2013 = 95%
Australia 2004 -2014: risk-reducing mastectomy (RRM) procedures nearly DOUBLED in 10 years
Genetic testing for breast cancer
Around a quarter of women undergoing testing report:
- high levels of anxiety & intrusive thoughts about the potential consequences of testing
- ‘constant/frequent’ worrying about their risk of getting cancer
- many partners report same or higher anxiety levels (as their partners testing positive for the gene)
Elevated levels of distress even among women WITHOUT the mutation (10%) and their partners (13%)
• over half (51%) of non-carriers still choose bilateral mastectomy (vs. 86% of BRCA1/2 mutation carriers).
Treatment decision-making
1961: 2% of oncologists usually or always told the cancer diagnosis
1976: 98% usually or always told the cancer diagnosis
1989: 85% of oncology patients given more than 1 treatment option
2001: 99% given more than 1 treatment option
key features: tailoring communication, ensuring understanding, facilitating involvement, avoiding coercions
INTERVENTIONS/STRATEGIES
Clinicians: communication skills training
Patients/family:
-coaching patients/family members to ask questions
-psycho-educational resources
-question prompt sheets
-decision aids
treatments
Surgery: high levels of pre-operative anxiety
Radiotherapy: often perceived more frightening than surgery
-depression/anxiety tends to increases at the end of
treatment, when side effects are experienced
Chemotherapy: most feared treatment
-anticipatory nausea and vomiting
Hormonal therapy: long term ‘insurance
Adequate preparation and post-treatment support is critical:
- patient and staff attitudes to side effects/pain
- education (procedural AND sensory information)
- anxiety management;
- managing side-effects;
- continuity of care (nurse care coordinators)
- peer support
importance of family carers
- related to patient biologically, legally, or emotionally
- ‘invisible backbone of healthcare system’
• provide unpaid care for adult cancer patients
Healthcare
-Attend consultations (~ 60-85%; e.g. info. and emotional support, patient advocacy)
-Involved in treatment decision-making
-Arrange and attend tests/treatments
-Provide home-based medical care (e.g. wound care, medication, supervision)
Practical
-Personal hygiene
-Cooking / cleaning / transport
-Financial assistance
-Emotional support
• Recent shift in healthcare delivery from inpatient => outpatient => home-based care
• May have a considerable impact on the dynamics + outcomes of consultations/care!
=> a need to shift healthcare to “patient and family centred care
Complementary & Alternative Medicine (CAM)
Alternative therapies
• When a therapy is used INSTEAD OF conventional health approach
• Often be promoted as a ‘cure’ without evidence => 4 in 10 Americans believe alternative therapies can cure cancer!
• May be biologically active, potentially harmful and extremely costly
Complementary therapies
• The use of a non-mainstream approach ALONG WITH conventional medicine
• Used to help alleviate treatment side effects, enhance wellbeing, contribute to overall care
• If proven safe and effective, may be integrated into mainstream care
prevalence of CAM
Cancer: average 65% (range 50-80%) Diabetes: average 46% (range 17-73%) HIV: average 60% Rheumatoid arthritis: range 28-90% General population: 40%
Between the end of treatment and 5-year survival
For the majority, psychological wellbeing returns to normal
For some, cessation of treatment leads to heightened anxiety
Fear of cancer recurrence (FCR) => the greatest concern/unmet need!
- often higher in CARERS than in patients/survivors
This time period is often more difficult and (emotionally)
more painful than the active treatment phase
psychological morbidity:
- German national study of psychiatric disorders in cancer care
- 27% lifetime anxiety, 24% mood disorder, 23% substance use
End-of-life issues
Uncertainty / fear of the process of dying
Fear of pain and suffering, anticipatory grief
Decision-making: advanced directives
Carer: feelings of inadequacy
Practical issues
survivorship issues
A common assumption that survivors will return “back to normal” once their health returned post-treatment
Continuing existential tension of the survivor => ‘compulsory philosophers’
Identity disruption => finding a “new normal”
The body becomes a ‘house of suspicion’
Positive outcomes: post-traumatic growth
mental health is the only direct impairment associated with being a cancer survivor
psychological care during survivorship
Normalising and validating the experience
Tailoring care to the needs of the survivor and their family
SURVIVORSHIP CARE PLANS : to address poorly coordinated follow-up care = formal, written documents that provide details of a person’s:
• cancer diagnosis and treatment
• potential late/long-term effects arising from the cancer and its treatment
• plans for medical follow up
• recommended management of current medical/psychosocial/practical issues;
• advice and coaching regarding healthy lifestyle
• discussion of potential future issues and a plan for management
the pressure to be positive
Cancer patients often feel pressure to keep a “positive
attitude/fighting spirit” at ALL times:
• Unrealistic => feelings of sadness, fear, anxiety post-cancer diagnosis are normal
• Adds to the patient’s emotional burden
Rigorous scientific studies show NO correlation between positive thinking & cancer SURVIVAL
A positive attitude is a useful coping strategy/technique which CAN improve QUALITY of LIFE
