Evaluation of the effects of cancer and its treatments on quality of life of cancer patients
cancer patient assessment must be multidimensional (psychological, social, functional and symptomatic), and vary depending on the areas and objectives to be discussed.
understand Quality of life the perception that the patient is on the effects of the disease, its biophysical therapies (chemo, radio, surgery). Cella and Tulsky For the assessment by the patient makes on its current operating level compared with its ideal model. The assessment of quality of life serves to identify those patients requiring psychological intervention, specific rehabilitation needs, and the effects on the patient have medical therapies (not just its survival).
The evaluation has to be different depending on the type of patient, the time when medical intervention is (suspected, diagnosis, awaiting surgery, after surgery, chemotherapy or terminal) must also be multidimensional, using interviews, records, self-reports, objective measures and questionnaires (general and specific to these patients).
Psychological intervention in cancer patients
psychological intervention, integrated inter-and multidisciplinary way, aims to improve the quality of life and adaptation of patients and people in your family. The level of adaptation or adjustment to illness will depend on the clinical severity of the process, the effects of medical treatment, the level of information received, social support and environmental resources, and their ability to cope with stress.
psychological intervention address:
- Counselling. The acquisition and maintenance of healthy behaviors and the elimination of risk habits. For preventive health programs are effective, it requires a proper implementation of early detection behaviors, which is achieved with accurate information on the need for revisions in the absence of symptoms and their benefits (if any disease, early detection, and if not as a means to reduce anxiety and uncertainty). The information has to be aimed at increasing concern but with a moderate level of anxiety, not fear inducing cancer, and that fear is not flattering, but interferes with the adoption of appropriate behavior.
- adequate information to the patient. Is to identify those aspects, content, type, style, way, time and appropriate sequences.
- Preparation for hospitalization and treatment. Control emotional reactions and coping repertoires.
- Treatment to prevent maladaptive emotional responses and psychopathology.
- treatments associated with neoplastic disease. Control conditioned reactions (anxiety, vomiting conditioned to chemotherapy, fatigue, changes in physical appearance, alopecia, burns and discomfort on the radio). Coping with aggressive techniques (punctures, bone transplantation, recurrent infections). Facing the pain caused by the same techniques themselves of cancer and other non-neoplastic. Anorexia, often associated with the treatment, and self-neoplastic cachexia. Treating sexual problems or tumor site itself. Adjustment amputations, ostomies and other surgical effects.
- Intervention in the terminal phase. Maintaining quality of life, ensure a dignified death and prevention of maladaptive responses by the family in mourning.
- Selection and training of volunteer staff
- patient support in coping with stress training health personnel. Prevention of burnout.
Until the early 60's, the trend was not reporting, or do very little about diagnosis and prognosis, the trend in recent years has been reversed. The basic rules of information have to consider the content, who, whom, when and how.
- It should include: diagnosis and clinical characteristics, diagnostic procedures, therapeutic, the reason for use and benefits, side effects of treatments, types, incidence, and how to avoid its negative effects. This information must be truthful and realistic, and managed in accordance with the patient's ability, according to their state and condition, to process and accept it.
- The reporter has to be the expert. Aspects related to the disease by the oncologist (a doctor who ride), and psychosocial psychologist. The information provided by each of them has to be consistent.
- have to be informed the patient, her partner and immediate family. It is desirable that the information is combined (all together) and preferably admission in the center, to establish a clear channel of communication, give a sense of team (which is included in the family) and prevent the patient from feeling passive victim.
- be informed when necessary, depending on when care will be made sequentially, giving accurate and specific information for each situation.
- must be like to adjust the patient's coping style (avoidant to the fair and non-repetitive, to all requesting browsers.)
- In general, it has to be empathetic, to assess their ability to assimilate information, active listening, facilitating both the patient and their families express doubts and emotions, correct mistakes and set the negative information that you provide.
Preparation for surgery
is a major stressor for patients and their families for fear of death, disfigurement, pain, loss of control, etc. According Contrada, Leventhal and Anderson, there are four areas in which, concerns: the danger of the surgery itself, anesthesia and amputation postoperative effects such as pain or reduced physical capacity, inability to take desired social roles, effects and consequences medium and long-term chemotherapy, etc. The intervention has been concentrated on:
- Information surgical procedure Information
- subjective impressions and feelings. Somatic sensations of the operation, its distinction from those specific to the tumor, possible emotional reactions, etc. (which the patient does not interpret them as warning signs)
- specific coping strategies. Problem-oriented strategies such as deep relaxation, physical exercises for the physical, coping strategies and emotion-focused cognitive distraction, visualization, attention focused on positive aspects autoinstruccional control, etc.
This disease and its consequences are a very stressful life event, providing risk situations that negative emotional reactions and psychopathology. Epidemiological studies show that in this disease suffer Like any other of a serious nature (which is no more), appearing depressed mood in 68%, major depression in 13% and 8% with organic mental disorders. When cancer is advanced, depressive disorders appear between 25% and 77%, organic mental disorders between 25% and 40%, but up to 85% when the patient enters the terminal phase. Must be taken into account when making a diagnosis that many of the symptoms are caused by cancer itself or its function are a reaction, so that the DSM-IV criteria are not valid (especially in advanced stages of disease .)
Brief interventions, applied after diagnosis are very effective in improving adaptation and prevent mental health problems. These treatments involve reducing anxiety, depression and other maladaptive emotions, facilitate adaptation by inducing a positive coping style, promoting a sense of control over their lives and active participation in treatment, development of coping strategies problems and difficulties related to cancer patients to facilitate communication with family and improve their social relationships. The procedures are primarily cognitive-behavioral programs, being the most used APT Adjuvant Psychological Therapy (Beck's specifically tailored for Moorey Greer).
APT Adjuvant Psychological Therapy is a structured therapy, non-directional, short (6 to 12 sessions) problem-focused, educational, collaborative, with homework using behavioral techniques, cognitive and work with a partner. Research has demonstrated clearly beneficial effects both short and long term, allowing higher quality of life, an adequate management and reducing anxiety and depression problems. Its phase are: initial phase
(2 to 4 sessions)
- Relief of symptoms by coping techniques for immediate problems such as problem solving, distraction, relaxation, graded assignments.
- live an ordinary life, maximize quality of life, foster a sense of control, increase their motivation, planning and enjoying free time
- Teaching the cognitive model, the link between automatic thoughts, mood and behavior ( you can start recording automatic thoughts)
- stimulate the expression of feelings, negative as anger, despair, etc. identification to hear cases and then deal with them
- Teaching
- challenge automatic thoughts, and to test reality
- Continue technical problem solving, focusing on stress reduction to less urgent issues, but no less important ( partner communication, social isolation, etc), taking an active partner in solving the problems associated with the disease
- Continue to improve the quality of life, using both cognitive behavioral techniques as
- Relapse Prevention, training in strategies to use if you become emotional problems
- Planning for the future. The couple is encouraged to set realistic target ahead of 3, 6 or 12 months
- identify underlying assumptions, beliefs and internal rules
, 65 % of patients are sensitized to chemotherapy, presenting side effects, the most common are nausea, vomiting and anxiety. Of these, 65% showing reactions of anticipatory anxiety (one of the main areas of intervention of psycho-oncology), responses learned through classical conditioning. These effects are so well known that many patients begin therapy and apprehensions. The ability of a stimulus to become proactive, depends on the degree of relationship to chemotherapy, at first the smell of alcohol is strongly associated, then another take on this role, as the personal tone of voice, background music or other visual stimuli . Anticipatory effects correlate with the severity and persistence nausea and vomiting experienced in the first session of chemotherapy, also, any increase in the quantity or toxicity of the mixtures increase the likelihood of increased non-drug side effects. Cognitive aspects also influence its emergence and establishment (those who expected nausea is more likely to suffer) similarly correlated with the level of patient anxiety. The most common techniques for this procedure are:
- Hypnosis, suggestions of deep relaxation and visualization of pleasant scenes that are applied during the course of chemotherapy and has been practicing before. Can cut half the frequency of vomiting and nausea.
- progressive muscle relaxation imagination of relaxing scenes before and during infusion. Applied by the therapist in the first four sessions and the patient in successive. Efficiency of 50% reduction in nausea and vomiting. Biofeedback-EMG
- imaginatively during the infusion. In multiple anatomical locations, the patient is trained in relaxation, when you get a reduction of physiological activity, induced distracting images. Systematic desensitization
- stimuli related to chemotherapy. Very effective, even if not administered simultaneously with chemotherapy.
- attentional control techniques. Distraction by external stimuli, to prevent classical conditioning. Using television, games, video games, etc.
The pain is linked to somatic, but heavily influenced by cognitive and affective aspects, requires pharmacological and psychological intervention. Acute pain can be caused by diagnostic and therapeutic techniques, the tumor process itself or chronic non-malignant.
be assessed through behavioral dimensions (activity or habits interrupted or affected), sensory and physiological dimensions (intensity and characteristic of pain), cognitive dimensions (thoughts and attentional processes) and impact on physical functioning and social interaction.
frequently used relaxation techniques, biofeedback and operant conditioning (behavior useful to reduce complaints and increase motor activity and cooperative health personnel). Recent times have seen great development cognitive-behavioral programs, especially stress inoculation, which consists of the elements:
- education and information aspects of sensory, motor, affective and cognitive associated with pain. Acquisition
- coping skills as relaxation, breathing, attention control, distraction, imagination or reinterpretation of sensations, graduation assignments, social skills, thought stopping, troubleshooting and control of internal dialogue.
- Testing and application of trained skills. Training
- generalization and maintenance.
Intervention in the terminal phase
The terminal phase is characterized by the latter stages of the disease, incurable and rapid progression, no reasonable response to specific treatments, with a prognosis of less than six months, and an intense emotional impact on patients, families and therapists.
intervention aims to maintain a high quality of life for patients and their families. Palliative care is directed first to the physical symptoms eliminating or mitigating the negative and enhancing the resources you have the patient (to increase their autonomy and perceived control) and also psychopathology (using pharmacological and psychological), increasing the degree of satisfaction, positive states, social relations and self-esteem.
With respect to the family, will be emotional support, informational support on coping resources and assistance that can be used during the match to reduce the negative impact.
are also subject to intervention, medical personnel, to assist in managing their own emotions and prevent burnout, and training in the detection of the real needs of terminal patients.
To achieve these objectives, the psychologist can use cognitive behavioral techniques (APT, stress inoculation), relaxation, hypnosis (to reduce anxiety levels) and operant techniques to encourage appropriate behaviors
An evaluation program and intervention in cancer patients
is a program applied to patients with breast cancer. The aim is to increase the quality of life and adaptation of these people. In the preoperative phase, the goal is to provide strategies Control of anxiety about upcoming surgery and hospitalization, in the postoperative phase, the objective is to minimize the stressful impact of diagnosis and mastectomy, chemotherapy phase, the goal is to prevent nausea and vomiting conditioned.
preoperative period
Since contact with the hospital until the end of surgery.
is essential that the medical information supplied. You will be informed diagnosis (or suspected), prognosis and treatment. Diagnostic tests that have been made, and the need final confirmation by intraoperative biopsy and that just by being in the operating room and anesthesia on the final decision will rest with the surgeon mastectomy. You must also answer and clarify all doubts arising (patient and family), if these questions will be formulated to another person, it should tell you who should provide this information and encourage them to request.
psychosocial evaluation be conducted prior to identify which patients require intervention to control anxiety, to cope with the diagnosis, etc. First, personal data are collected and what you know about your diagnosis and treatment, if you come alone or accompanied, and from whom. Then, a semistructured interview to assess fears, reports of the illness, social support, activity level, self-esteem, body image and expectations regarding the placement and surgery. The next day, through questionnaires, measured some predictors of adjustment, state and trait anxiety (STAI), depression (Beck). We also evaluate stressful life events that occurred during the past year.
Behavioral treatment is applied in groups of 2 to 6 patients, in three sessions of 45 minutes. In the first session explains that he will train in skills that can then be put into practice (to facilitate cooperation and adherence to treatment), we explain the transactional nature of stress, reinterpreting the surgical situation (stress did not produce the events, but the interpretation we make of them, our ability to cope and how we perceive it) . This is followed by training in anxiety control (breath explaining their reasons) to achieve self-control training in the conduct and obtaining adaptive interpretations. End of session scheduling tasks and self-reports are delivered sheets which indicate tension before and after exercise.
The second session will entrench learned exercises, lists self-reports, clarifying doubts, it takes a further test of the breathing technique and delivered new self-registration sheets
In the third and final preoperative session, lists and reinforce self-reports and will be followed initiates a process of prolonged exposure in imagination, accompanied by relaxation through breath control, presents the situations and stimuli that are experienced during the intervention, exposure to neutral stimuli and other stimuli prolonged exposure to the surgical situation, which continue to achieve significant reductions anxiety. It ends with another neutral stimulus exposure and training to recognize signs of anxiety ded to quickly start coping. Preoperative phase ends with a re-evaluation of anxiety and depression.
postoperative period
intervention components are:
- Information and education on rehabilitation exercises and precautions. A major impact of mastectomy is the body schema disturbance, feelings of asymmetry, difficulties with clothing and decreased physical attractiveness and femininity (she reports on prosthetics, special clothing, etc.).. Exhibition
- graduated to amputation, to eliminate anxiety about the changes occurring.
- Cognitive restructuring. Please be advised of the importance of cognition in emotion is induced to self-observation, identification and verification of their effects, reality testing and the benefits of substitute more adaptive. It will seek to adopt an active attitude, not a passive fatalistic resignation.
- Troubleshooting. The way to communicate to other aspects of their illness, possible reactions. Also sexual problems and couples that may arise
An evaluation to determine predictive variables (nausea, vomiting, anxiety) and evolution of anticipatory reactions. First with an interview assessing sociodemographic semiestrucutada, history of nausea and vomiting (in cars, etc..) Expectations about drug treatment, alcohol intake, levels of anxiety, depression and quality of life. Subsequently further assess anxiety (STAI), depression (BDI) and quality of life (QLQ-C30).
self-registration sheets are given to indicate anxiety intensity, frequency and duration of vomiting before and after the chemo session.
continues assessment of anxiety and vomiting in each cycle, and the third adds a new assessment of the quality of life.
Psychological treatment is carried out with the drug in each of the six sessions of chemo. In the first session explains the process of acquisition of anticipatory nausea and vomiting, a progressive relaxation training by stress-relaxation, once complemented with the breathing exercises of the previous (delivered a recording session relaxation). In the second session are collected self-reports and positive self-instruction training (in the chemo often appear negative verbalizations "I can not with this "...); concludes with a new practice of relaxation. In the third session, and the information provided by self-reports, is planning control strategies of anxiety associated with chemotherapy, the session ends with an exhibition in imagination to the situation and asked to use the techniques of control learned (test for use in real situations). The fourth and final section is devoted to the revision and consolidation strategies.
After completion of chemotherapy, follow-up will be scheduled.
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