Psychological Aspects of Oncology Patient

“Contributing Factors & Intervention”

Elham Abd El-Kader Fayad

Professor of Psychiatric & Mental Health Nursing3/5/2006

For oncology client the following areas should be examend:

• Adjustment and quality of life.

• Symptoms control.

• Immune function.

“Disease progression”

Adjustment & quality of life

• Psychosocial factors contributing to adverse outcomes:

→ Cancer can be emotionally jarring experience.

→ Accompanied by multiple challenges & disruptions.

Studies of quality of life & psychological adjustment focuses the attention on several questions

• Which patient are most vulnerable to psychological difficulties?

• What challenges emerge for patient’s with different sites of disease at different phases of treatment?

• Disabilities? Tumor site? Choice of treatment & time since diagnosis?

• This plays an obvious role in shaping psychological responses to cancer.

Symptoms Control

• Nausea, vomiting, pain, fatigue & hot flashes are among the symptoms that have been targeted for adjective psychological interventions.

• Interest in symptoms control helped set the stage for closer interdisciplinary collaboration in the clinic, introducing an alternative to the more traditional practice of referring medical symptoms to medical specialists & psychological problems to mental health specialists.

Immune Function & Disease Outcome

• Psychological factors contributing to disease progression.

• Growing evidence suggests that social isolation, associated with all-cancer mortality after controlling for traditional risk factors.

• Social support may have differential effects on survival.

• Psychological factors such as: stress, pessimism, or isolation affect the medical treatment.

• Stress and psychological factors influence health behaviors contributing to poor diet, diminished appetite, disrupted sleep, limited exercise, increase cigarette smoking, and intensified substance abuse.

Associated Common Psychological Symptoms

• Certain psychological symptoms are common to clients diagnosed with cancer these include anger, depression, anxiety, helplessness, and hopelessness

Anger

• Clients with cancer diagnosis typically demonstrate behaviors that are indicative of anger.

• These behaviors reflect feelings of helplessness and frustration about the illness and the effects the illness has on daily functioning.

• Behaviors likely to be exhibited include demanding types of action, loud verbalization, slamming of items, and social withdrawal.

Depression

• Clients with cancer diagnosis typically demonstrate symptoms of depression related to disruption of daily functioning.

• Signs associated with depression include feelings of helplessness/hopelessness, flat affect, poor eye contact, disrupted eating/sleeping patterns, absence of motivation and compliance, and decreased energy level.

Anxiety

• Oncology clients typically demonstrate feelings and behaviors of anxiety.

• This reflects feelings of real or imagined threat to body image.

• Anxiety results in autonomic nervous system stimulation with increased heart rate, increased respirations, increased visual acuity, diaphoresis, shortness of breath, and restlessness.

Helplessness/Hopelessness

• Oncology clients demonstrate feelings of helplessness/hopelessness.

• Helplessness relates to feelings of powerlessness associated with being unable to change what is happening, while hopelessness relates to feelings of despondency and loss of optimism.

• This is reflected in feelings of loss of control (feeling that an event can be managed) and individuality and increased dependency on others.

Associated Psychiatric Symptoms

• Psychosis is the inability of a client to understand and know reality or cope with demands of daily living.

• Psychotic symptoms that may be demonstrated in clients with selected medical illness diagnoses include evidence of delusions and hallucinations, thought process disruption, and difficulty in caring for oneself.

Assessment

• The nurse uses various resources to collect psychological, biological, and social data.

• Subjective and objective symptoms, family/significant other reports, and diagnostic reports are considered in the assessment phase.

Psychological Assessment

• Elicits clients’ emotional reaction & coping abilities and support resources.

• A stress appraisal should be done with identification of the source of stress, number of stressors, and duration of stressors.

• Depression symptoms assessment should be completed with notation of time of initial symptoms, duration of symptoms, and physical appearance.

• Identification of coping behaviors is part of the psychological assessment and includes assessment of adaptive and maladaptive behaviors that reflect a client’s ability to identify problems and analyze feelings

• The assessment phase should also include identifying the emotional stage of the illness.

• Clients often progressively move through stages of illness and interventions should be planned according to the emotional stage.

These Stages include• Denial of the illness and associated

limitations.

• Anger at loss of control and associated limitations.

• Bargaining, with a plea for another chance and a seeking of new answers/treatments.

• Depression when grieving occurs due to loss or anticipated loss.

• Acceptance/adaptation when conflicts are resolved and the client participates in care.

Management

In cancer illness:• Client experiences feelings of

helplessness & hopelessness.

• In addition, feelings of depression, anger, and hostility are experienced.

• The client’s response will be affected by coping skills, developmental/lifespan level, spiritual, cultural, biological, and psychosocial factors.

• Interventions for clients with cancer should include use of empathy and compassion; a focus on aspects of the client’s life that were positive, spirituality assessment and reinforcement; support of family and significant others; and allowing client dignity, client control, and use of pain management.