Psychological Approaches to Cancer Care E-Book

Teresa L. Deshields

• Herausgeber: Hogrefe Publishing
• Kategorie: Geisteswissenschaft
• Serie: Advances in Psychotherapy - Evidence-Based Practice
• Sprache: Englisch
• Veröffentlichungsjahr: 2022

Seitenzahl: 181

Beschreibung

A comprehensive, evidence-based guide to the role of psychology in cancer care - Multidisciplinary authors provide a holistic overview - Details the key principles and models of cancer-related distress - Guides through assessment and treatment - Illustrated with case studies - Printable tools for clinical useMore about the book Psychosocial oncology is a health psychology specialty that focuses on the psychological, behavioral, emotional, and social challenges faced by patients with cancer and their loved ones. Cancer can cause significant distress, and psychosocial interventions are known to be effective for helping patients and families navigate the many issues that can arise at any stage of the cancer continuum. This volume provides psychologists, physicians, social workers, and other health care providers with practical and evidence-based guidance on the delivery of psychological interventions to patients with cancer. The multidisciplinary team of authors succinctly present the key principles, history, and theoretical models of cancer-related distress and explore clinical assessment and interventions in cancer care, in particular psychological and psychiatric treatments, multidisciplinary care management, and supportive interventions. Case vignettes provide clear insights into diagnostic processes and treatment planning, and printable handouts and screening tools are invaluable for practitioners.

Leseprobe

Advances in Psychotherapy – Evidence-Based Practice, Volume 46

Psychological Approaches to Cancer Care

Teresa L. Deshields

Jonathan L. Kaplan

Lauren Z. Rynar

Rush University Medical Center, Chicago, IL

About the Authors

Teresa L. Deshields, PhD, ABPP, is the Director of Supportive Oncology at Rush University Cancer Center and a professor in the Departments of Medicine, and Psychiatry and Behavioral Sciences at Rush University Medical Center in Chicago. She is a clinical health psychologist, and her clinical practice is devoted to treating cancer patients and their family members, throughout the cancer continuum. Her research is focused on issues related to symptom burden and quality of life in cancer patients and survivors.

Jonathan L. Kaplan, MD, is an assistant professor in the Departments of Psychiatry and Behavioral Sciences and Medicine at Rush University Medical Center. He is the psychiatrist for the Rush University Cancer Center and a consultation–liaison psychiatrist at Rush University Medical Center. He specializes in the psychiatric treatment of medically complex patients including patients with cancer. His research interests include psycho-oncology and collaborative care psychiatry.

Lauren Z. Rynar, PhD, is an assistant professor in the Department of Psychiatry and Behavioral Sciences and a clinician in the supportive oncology program at the Rush University Cancer Center. She specializes in the psychological care of cancer patients, survivors, and caregivers. Her research interests include quality of life, coping styles, cancer-related distress, and models of supportive care delivery among cancer patients.

Advances in Psychotherapy – Evidence-Based Practice

Series Editor

Danny Wedding, PhD, MPH, Professor Emeritus, University of Missouri–Saint Louis, MO

Associate Editors

Jonathan S. Comer, PhD, Professor of Psychology and Psychiatry, Director of Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami, FL

J. Kim Penberthy, PhD, ABPP, Professor of Psychiatry & Neurobehavioral Sciences, University of Virginia, Charlottesville, VA

Kenneth E. Freedland, PhD, Professor of Psychiatry and Psychology, Washington University School of Medicine, St. Louis, MO

Linda C. Sobell, PhD, ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a reader-friendly manner. Each book in the series is both a compact “how-to” reference on a particular disorder for use by professional clinicians in their daily work and an ideal educational resource for students as well as for practice-oriented continuing education.

The most important feature of the books is that they are practical and easy to use: All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls,” marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Continuing Education Credits

Psychologists and other healthcare providers may earn five continuing education credits for reading the books in the Advances in Psychotherapy series and taking a multiple-choice exam. This continuing education program is a partnership of Hogrefe Publishing and the National Register of Health Service Psychologists. Details are available at https://www.hogrefe.com/us/cenatreg

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

Library of Congress of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the Library of Congress Control Number 2022936270

Library and Archives Canada Cataloguing in Publication

Title: Psychological approaches to cancer care / Teresa L. Deshields, Jonathan L. Kaplan, Lauren Z. Rynar.

Names: Deshields, Teresa L., author. | Kaplan, Jonathan L., author. | Rynar, Lauren Z., author.

Series: Advances in psychotherapy--evidence-based practice ; v. 46.

Description: Series statement: Advances in psychotherapy--evidence-based practice ; volume 46 |

Includes bibliographical references and index.

Identifiers: Canadiana (print) 20220219532 | Canadiana (ebook) 20220219567 | ISBN 9780889375116

(softcover) | ISBN 9781616765118 (PDF) | ISBN 9781613345115 (EPUB)

Subjects: LCSH: Cancer—Psychological aspects. | LCSH: Cancer—Patients—Care. | LCSH: Cancer—Patients—

Mental health.

Classification: LCC RC262 .D47 2022 | DDC 616.99/40019—dc23

© 2023 by Hogrefe Publishing

www.hogrefe.com

The authors and publisher have made every effort to ensure that the information contained in this text is in accord with the current state of scientific knowledge, recommendations, and practice at the time of publication. In spite of this diligence, errors cannot be completely excluded. Also, due to changing regulations and continuing research, information may become outdated at any point. The authors and publisher disclaim any responsibility for any consequences which may follow from the use of information presented in this book.

Registered trademarks are not noted specifically as such in this publication. The use of descriptive names, registered names, and trademarks does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Cover image: © Evgeny Belenkov – iStock.com

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ISBN 978-0-88937-511-6 (print) • ISBN 978-1-61676-511-8 (PDF) • ISBN 978-1-61334-511-5 (EPUB)

https://doi.org/10.1027/00511-000

Citability: This EPUB includes page numbering between two vertical lines (Example: |1|) that corresponds to the page numbering of the print and PDF ebook versions of the title.

Contents

1 Description

1.1 Common Psychiatric Diagnoses in the Context of Cancer

1.1.1 Major Depression

1.1.2 Adjustment Disorder

1.1.3 Anxiety Disorders

1.2 Other Psychiatric/Psychological Issues

1.2.1 Severe Mental Illness and Cancer

1.2.2 Distress

1.2.3 Fear of Recurrence

1.3 Epidemiology

1.4 Course and Prognosis

1.4.1 Vulnerable Periods

1.4.2 Trajectories of Psychological Distress

1.4.3 Posttraumatic Growth

1.4.4 Survivorship

1.5 Differential Diagnosis

1.6 Comorbidities

1.7 Diagnostic Procedures and Documentation

1.7.1 Distress Screening

1.7.2 Symptom Assessment

1.7.3 Depression Assessment

1.7.4 Anxiety Assessment

1.7.5 Quality of Life (QoL)

2 Theories and Models

2.1 Biopsychosocial Model of Cancer

2.2 Models of Cancer-Related Distress

2.2.1 Cancer-Related Distress as an Adjustment Disorder

2.2.2 Self-Regulatory Model of Illness Behavior

2.2.3 Stressful Life Events and the Impact of Coping Style on Cancer-Related Distress

3 Diagnosis and Treatment Indications

3.1 Distress in Cancer

3.2 Adjustment Disorders

3.3 Major Depressive Disorder

3.4 Anxiety Disorders

3.4.1 Generalized Anxiety Disorder (GAD)

3.4.2 Panic Disorder

3.4.3 Specific Phobias

3.5 Trauma-Related Disorders

3.5.1 Acute Stress Disorder

3.5.2 Posttraumatic Stress Disorder

3.6 Cognitive Dysfunction Secondary to Cancer Treatment

3.7 Substance Use Disorders (SUD)

3.8 Vulnerable Populations

4 Treatment

4.1 Methods of Treatment

4.1.1 Psychotherapy

4.1.2 Groups and Other Approaches

4.1.3 Medications

4.1.4 Future Directions

4.2 Effectiveness of Treatments

4.2.1 Psychosocial Interventions

4.2.2 Psychotropic Medications

4.3 Challenges in Delivering Treatment

4.3.1 Access Concerns for Treatment

4.3.2 Presence of Family/Caretakers

4.3.3 High Burden of Disease

4.3.4 The Therapist’s Personal Experience With Cancer

4.3.5 Burnout/Compassion Fatigue

4.3.6 End-of-Life Care

4.4 Multicultural Issues

4.4.1 Diversity Issues

4.4.2 Religious Beliefs and Decision-Making About Treatment

5 Case Vignettes

5.1 Case Vignette 1: Ms. R.

5.2 Case Vignette 2: Mr. J.

6 Further Reading

7 References

8 Appendix: Tools and Resources

Peer Commentaries

|1|1Description

Many people think of cancer as a single disease, with multiple possible sites of impact. In truth, cancer is a family of disorders with varying degrees of severity, prognosis, life disruption, impact on appearance, etc. There are other common misunderstandings, or myths, about cancer and its treatment. These are reviewed in Appendix 1. Treatment can be acute and time-limited, or it can be chronic and lifelong. The length of survivorship after a cancer diagnosis is widely variable, including some patients who will live with the disease and some who will be cured. Of course, the impact of cancer on any individual’s mental health and quality of life is also greatly variable. There is also growing recognition of the impact of a cancer diagnosis on the family caregivers of the person with the diagnosis.

While cancer remains the second leading cause of death in the US, the death rate associated with cancer dropped every year between 1999 and 2019 (Centers for Disease Control and Prevention (CDC), 2021). This is generally attributed to decreases in cigarette smoking, increased utilization of cancer screening tests, and advances in cancer treatment. As death rates have dropped, there are increasing numbers of cancer survivors and longer periods of survivorship.

Psycho-oncology is a subspecialty in oncology, focused on the psychosocial impact of cancer on patients at all stages of the disease, on their families, as well as on individuals determined to be at increased risk for cancer. Psychosocial care in oncology is most typically provided by psychologists, social workers, nurses, and physicians, but it can also be provided by chaplains, patient navigators, and counselors (Deshields et al., 2013). For the psychosocial clinician, it can be difficult to learn the “language” of cancer care. Basic cancer terms are defined in Appendix 2.

While psycho-oncology clinicians often address psychiatric disorders, they also have occasion to provide care for those suffering from cancer with subclinical coping difficulties. Some appropriate targets for intervention may not rise to the level of a disorder, such as questions about how to communicate about the cancer diagnosis at work or with children, or dealing with hair loss, or concerns about sexuality after cancer treatment. We provide strategies that can be used in the context of clinical disorders or the context of coping challenges. Some clinicians may be working in settings where there is no concern about billing, but in those settings where billing is a concern, health and behavior codes may be appropriate for patients without a psychiatric diagnosis. Some patients may be willing to self-pay for psychosocial services.

|2|1.1 Common Psychiatric Diagnoses in the Context of Cancer

1.1.1 Major Depression

The prevalence of major depression in the oncology population is estimated to range up to 24% (Krebber et al., 2014). There can be overlap among the vegetative symptoms of depression (change in appetite, weight gain or loss, anergia, and change in sleep whether insomnia or excessive sleep) and symptoms of cancer or side effects of treatment. There can also be overlap among the cognitive/emotional symptoms of depression (feelings of guilt, concentration difficulties, thoughts of death) and reactions to cancer or to cancer treatment. Because anhedonia is one of the diagnostic criteria for depression and is not a side effect of cancer treatment, it may help the clinician to distinguish major depression from a general reaction to cancer.

1.1.2 Adjustment Disorder

Adjustment Disorder may be present in up to 19% of patients in this population (van Beek et al., 2019). Adjustment Disorder is most commonly further defined by “with depression,” “with anxiety,” or “with mixed anxiety and depression.” While Adjustment Disorder may be hard to distinguish from distress (described below), the diagnosis requires impairment in functioning.

1.1.3 Anxiety Disorders

The prevalence of anxiety disorders in patients with cancer is estimated to be around 11% (Mehnert et al., 2014). Several types of anxiety disorders are more likely to be problematic in the cancer setting.

Generalized Anxiety Disorder (GAD)

GAD is characterized by persistent and pervasive worry. There is much to worry about in the cancer setting, including upcoming scans, the efficacy of treatment, the possibility of recurrence or progression of the disease, and the probability of death. Learning how to manage anxiety/worry is an important skill for those diagnosed with cancer and is addressed later.

Obsessive-Compulsive Disorder

In the cancer setting, obsessive concern about exposure to germs can become an issue, particularly for immunocompromised patients. Compulsive self-examination for the presence or progression of tumors can lead to irritation of relevant parts of the body, and the resulting swelling or tenderness can increase anxiety.

|3|Phobia

Some phobias are particularly problematic in the cancer setting. A needle phobia can be very disruptive, especially for patients who require chemotherapy infusions, but it is also an issue because of the volume of routine blood draws required over the course of cancer care. Claustrophobia can be an issue during scans (particularly MRIs), but it can also be an issue if patients feel trapped by medical devices (during chemotherapy or radiation therapy) or in a hospital room.

1.2 Other Psychiatric/Psychological Issues

1.2.1 Severe Mental Illness and Cancer

Anyone can develop cancer, including those with pre-existing severe mental illness. Some literature suggests that this population is more vulnerable to worse cancer outcomes because of disparities in cancer screening and decreased likelihood of receiving appropriate cancer treatment (Grassi & Riba, 2020). Individuals with a psychiatric diagnosis are also screened for cancer less frequently than the general population (Solmi et al., 2020). Those with a psychiatric history are less likely to receive guideline-concordant cancer treatment and to receive timely treatment, resulting in worse medical outcomes (Kisely et al., 2013). Furthermore, cancer diagnosis and treatment have been associated with exacerbation of pre-existing psychiatric conditions (Hill et al., 2011).

1.2.2 Distress

Distress management has been advocated in cancer settings for many years but has been widely prevalent since 2015 when it became an accreditation standard for the American College of Surgeons Commission on Cancer (CoC; 2015). Distress is broadly defined by the National Comprehensive Cancer Network (NCCN) as a “multifactorial, unpleasant experience of a psychological, social, spiritual, and/or physical nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment” (NCCN, 2021, p. DIS-1). The prevalence of distress in cancer patients varies by type and stage of cancer, time since diagnosis, and sex, and ranges between 20% and 52% of cancer patients (Mehnert et al., 2018). Higher distress has been associated with increased utilization of medical resources, longer hospital stays, and poorer quality of life (QoL) (Götze et al., 2014; Nipp et al., 2017).

1.2.3 Fear of Recurrence

Fear of Cancer Recurrence (FCR) is defined as “fear, worry, or concern relating to the possibility that cancer will come back or progress” (Lebel et al., 2016, p. 3266). FCR is of clinical concern when the following characteristics |4|are present: (1) high levels of preoccupation; (2) high levels of worry; (3) hypervigilance for symptoms/sensations suggesting recurrence; and (4) persistent worry, fear, or anxiety (Mutsaers et al., 2020). FCR is an issue in up to 87% of cancer survivors, and can be associated with psychological difficulties (Simard et al., 2013).

1.3 Epidemiology

The incidence of cancer is higher in men than women and slightly higher in whites than in other ethnicities (US Cancer Statistics Working Group, 2020). The incidence rate for all cancers combined for men in the US is 494.8 per 100,000, for women 419.3 per 100,000 (American Cancer Society [ACS], 2019). Cancer incidence increases with age, but the risk is also increased with smoking history, excessive body weight, alcohol consumption, and family history of cancer (ACS, 2019). As noted previously, from 1999 to 2019, the death rate from cancer decreased by 27%, reflecting improved treatment, reduced rates of smoking, and better cancer screening (CDC, 2021).

Psychosocial factors have also been associated with cancer and with adjustment to cancer. While death rates for cancer have been dropping overall, socioeconomic disparities in survival have grown over this same period (Siegel et al., 2019). Furthermore, the LGBTQ population is at greater risk for poor cancer outcomes (Quinn et al., 2015). Finally, patients with pre-existing mental illness have a poorer cancer-specific prognosis and survival rate (Kisely et al., 2013).

1.4 Course and Prognosis

Certain individuals are at greater risk than the general population for experiencing psychological distress in association with a cancer diagnosis. Not surprisingly, those with a history of a psychiatric disorder, substance use disorder (SUD), attempted suicide, trauma, or abuse are vulnerable to increased emotional difficulties in the context of cancer (NCCN, 2021). A variety of social issues also make psychological distress more likely in general, including family conflict, inadequate social support, financial difficulties, and lack of stable housing. Patients with certain types of cancer, including head and neck cancer and pancreatic cancer, are at greater risk for depression (Rohde et al., 2018). In cancer patients, younger age is associated with greater distress (Sansom-Daly & Wakefield, 2013). Furthermore, in cancer patients, symptom burden is negatively correlated with QoL (Deshields et al., 2014).

1.4.1 Vulnerable Periods

While the medical workup around a cancer diagnosis can be complicated and distressing, the course of treatment can be extended over months or years, with |5|the latter more common in metastatic (stage 4) disease. Some patients never “finish” their treatment, and their cancer experience may be more comparable to other chronic illnesses, such as diabetes (more continuous) or asthma (more episodic). Certain timepoints across the cancer trajectory have been associated with increased risk of psychological difficulties (NCCN, 2021). Risk is highest at the time of cancer diagnosis (including the period of medical workup), disease progression or recurrence, upon anticipation of a new treatment, during hospitalization, and around the end-of-life. Interestingly, the conclusion of treatment can be a time of increased vulnerability to distress (NCCN, 2021). Some patients have acute episodes of anxiety in anticipation of surveillance imaging, a phenomenon labeled “scan-xiety” (Bauml et al., 2016).

1.4.2 Trajectories of Psychological Distress

Some researchers have examined the trajectories of distress in cancer patients. Bonanno (2004) proposed a widely used model of trajectories of response to trauma. Deshields et al. (2006) examined Bonanno’s trajectories as applied to depression in a sample of breast-cancer patients finishing cancer treatment and found that the “resilience” trajectory was most common (61% of participants). More recently, in a study of 125 cancer survivors, Bonanno’s model was applied to newly diagnosed patients (Lotfi-Jam et al., 2019). Again, most survivors (80%) exhibited the “resilient” response, generally coping well over time, while 9% exhibited a “chronic” pattern of persistent distress over time. A “recovered” trajectory characterized 6% of the sample, with high initial distress that abated over time. Patients characterized by the remaining trajectory – “delayed,” representing 5% of the survivors – coped well initially but struggled after completion of treatment. The good news about this study, and others like it, is that it shows us that most cancer survivors tolerate the course of cancer diagnosis and treatment without developing significant psychological difficulties. In individuals with cancer, resilience has been positively correlated with QoL and negatively correlated with depression (Maatouk et al., 2018; Popa-Velea et al., 2017).Nevertheless, a noteworthy minority of patients struggle after diagnosis, and for those individuals, psychological support can be helpful.

1.4.3 Posttraumatic Growth

A concept related to resilience is posttraumatic growth (PTG), which was first defined by Tedeschi and Calhoun in 2004. PTG refers to growth after experiencing a traumatic event, which makes it different from resilience by suggesting that the individual improves as a result of their cancer experience (the “trauma” in this context), versus recovering baseline levels of functioning. While prevalence rates vary by type of cancer, in a sample of patients with different types of cancer, PTG was moderate to high in 20.5% (Liu et al., 2021). A recent systematic review found that most studies demonstrate a significant positive association between QoL and PTG in cancer survivors (Liu et al., 2020).

|6|1.4.4 Survivorship

As cancer survival rates increase (CDC, 2021), the length of cancer survivorship is also extended. Survivorship refers to an extended time that individuals diagnosed with cancer live with the physical and emotional sequelae of the disease and its treatment. There is a growing recognition of the persistent effects of cancer treatment as well as the late effects of cancer treatment. Examples of persistent effects include lymphedema, hormonal or fertility issues, fear of recurrence, fatigue, neuropathy, and cognitive difficulties (“chemobrain”) (Cancer.Net, 2019