anxiety and depression after breast cancer ruth h. steinman, md clinical assistant professor...
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Anxiety and Depression After Breast Cancer
Ruth H. Steinman, MDClinical Assistant Professor Department of PsychiatryPerelman School of MedicineUniversity of Pennsylvania
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Anxiety and Depression After Breast Cancer…
Is Common!Peaks at times which can be confusing
to you and those around youLessens over time but sudden
re-experience is common with triggerIs characterized by multiple, often
conflicting emotions
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Survivors of Breast Cancer Live With Uncertainty
The psychological and spiritual effects of pre-existing disease and its treatment
The worry about long term effects The possibility of cancer recurrence
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Emotional Responses to Uncertainty
Obsessive Worry and Fear
Anger/Disgust Apprehension Hurt Demeaned Guilty/Ashamed Hopeless/helpless
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Triggers of Emotional Distress
Tests/scansWaiting for results Appointments with oncology teamBirthdaysAnniversariesHolidaysHearing of other’s recurrence or deathFeeling pain or fatigue/developing cough
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What are we afraid of?
Pain, fatigue, nausea, vomiting, hair loss and long term effects of resuming treatment
Physical deterioration/body image Inability to care for family Family’s responses Being a burden/dependent on others Helplessness Threat to financial stability
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What is Obsessive Worry?
“This is unbearable…I feel damaged/inadequate…Why do I have to feel this way…This is unfair…I can’t cope with this”
Negative spiral in which the longer you are in it, the deeper it gets and the more energy it carries
Can feel like a trance It can feel compelling, like the path of least
resistance and takes a deliberate effort to shift gears and get out of this spiral
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Who is at risk for a psychiatric disorder?
Those with history of mood or anxiety disorder
Those who have experienced recurrenceThose with a disease free interval of less
than 24 months
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What is an Anxiety Disorder?
Generalized Anxiety DisorderAdjustment Disorder with AnxietyPost Traumatic Stress DisorderPanic Disorder
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What is a Depressive Disorder?
Dysthymic DisorderMajor DepressionAdjustment Disorder with Depressed
Mood
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How many people experience this?
Prevalence psychiatric disorders following diagnosis is 14-38%
Approximately 25% develop psychiatric disorder throughout course of illness
Clinically significant psychological distress at recurrence is > 40%
Prevalence of breast cancer is 2 ½ million
(NCI SEER Cancer Statistical Review of data from 2006 released 4/09)
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“Under Toad Days”…
Elizabeth McKinley, MD
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What type of “coper” are you?
Confrontative Coping Distancing Self-Control Seeking Social
Support Accepting
Responsibility Escape-Avoidance
Planful Problem Solving
Positive Re-appraisal
(Folkman and Lazarus)
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Strategies for managing uncertainty
Education Find safe place to share fears and distress Pace life to avoid being overwhelmed Treat pain and other persistent treatment
related side effects to avoid demoralization Set short term goals Work on developing non-cancer identity
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Friendship
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Spirituality
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More Strategies…
Reinforce past adaptive strategies for coping under stress and uncertainty
Support from family, community, health care providers: other’s optimism can engender hope
Writing
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Taking care of yourself can enhance your sense of control
Diet/NutritionExerciseMeditation/Mind-body interventionsEnergy Therapies: Qi Gong; ReikiRelaxation techniques
BreathingMuscle relaxationGuided imagery
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What is Hope?
Belief that a positive outcome lies ahead.
We can learn to see that a positive outcome can exist even if what we originally hoped for is not likely to happen.
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Take comfort in knowing…
Others have survived this treatment, this side effect, this waiting, this uncertainty about the future…I can too!
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Where Can I Find Professional Help?
American Psychosocial Oncology Society (APOS) Helpline:1-866-APOS-4-HELPwww.apos-society.org/survivors/helpline
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Bibliography
McKinley ED, Under Toad Days: Surviving the Uncertainty of Cancer Recurrence, Annals of Internal Medicine,2000;133(6):479-480.
Folkman S, Lazarus, RS. Coping as a Mediator of Emotion. J of Personality and Social Psych; 1988;
Okamura M, Yamawaki, S, et al. Psychiatric Disorders following First Breast Cancer Recurrence: Prevalence, Associated Factors and Relationship to Quality of Life. Japanese Journal of Clinical Oncology. 2005;35(6):302-309.
DiGianni LM, Garber JE, and Winer EP. Complementary and Alternative Medicine Use Among Women with Breast Cancer. Journal of Clinical Oncology. 2002;20(185)34s-38s.
Wonghongkul T, Moore, SM, et al. The Influence of Uncertainty in Illness, Stress Appraisal, and Hope on Coping in Survivors of Breast Cancer. Cancer Nursing. 2000;23(6):422-429.
Nelson, JP. Struggling to Gain Meaning: Living with the Uncertainty of Breast Cancer. Advances in Nursing Science. 1996;18(3):59-76.
Greenlee RT, Murray T, et al. Cancer Statistics. CA Cancer J Clin. 2000;50:7-33.