Reactions to cancer diagnosis: Despite significant advances in treatment and steadily increasing rates of survival, cancer is perceived by most to be a frightening and painful disease. Receiving the diagnosis of cancer evokes the possibilities of disabling illness, suffering, changes in appearance and physical abilities, altered social and professional goals, loss of personal control and independence, and even death. Shock, emotional “numbing,” and denial are common responses to the diagnosis. Treatment of the disease may be associated with unpleasant and often severe side effects such as pain, disfigurement, fatigue, and nausea. Not surprisingly, cancer diagnosis typically engenders distress, and patients commonly experience at least periodic feelings of hopelessness, fear, and dysphoria during the course of their illness. Although a minority of cancer patients develop psychiatric illnesses, many experience unpleasant psychological or social problems that hinder coping skills and quality of life. The manner in which patients adapt to cancer is determined by individual and family characteristics, illness-related factors, and cultural and societal influences.
Individual and family characteristics: The developmental stage of the patient at the time that cancer is diagnosed and treated influences how the illness is perceived and which developmental tasks may be disrupted. For example, cancer treatment in childhood or adolescence involving changes in appearance, pain, or weakness can hinder self-confidence and make social development more difficult. In early adulthood, illness-related disruptions can affect job performance and modify career goals and perceptions of self-worth. In later adulthood, cancer can markedly alter financial status and long-awaited expectations for retirement years.
Other factors influencing the extent that cancer affects psychosocial functioning include personality, emotional maturity, coping style, and prior experience with illness. General coping tasks of all cancer patients involve regulating stress and anxiety caused by the diagnosis and treatment requirements; adapting to changes in social, familial, and occupational roles; coping with new role demands associated with being a patient, including participating in treatment efforts, maintaining a sense of self-worth, continuing relations with family and friends (such as spouses and employers); and developing acceptance and satisfaction with post-illness circumstances. Personality variables such as optimism, flexibility and openness to change, emotional expressiveness, and acceptance of emotional support appear to help with coping. For some, prior exposure to a serious illness whether their own illness or that of someone close to them makes adaptation to cancer more difficult. A history of psychiatric illness before cancer diagnosis also appears to be a risk factor for poor coping. Some cancer patients, including those without prior psychiatric histories, develop psychiatric illness in response to stressors associated with cancer. The most common of these are depression and anxiety. Left untreated, these conditions can markedly reduce patients’ quality of life, adherence to treatment regimens, and overall adaptation to cancer. Fortunately, effective medicines and psychological therapies exist to treat psychiatric illness in cancer patients.
In most cases, cancer affects all members of a patient’s family, and the response of the family in turn affects the patient’s adaptation to the illness. Family members’ reactions to a diagnosis of cancer can be extreme and sometimes mirror the struggles and adaptive demands experienced by the patient. Parents of children with cancer are faced with unusually difficult challenges; however, most are able to effectively deal with the worry, family disruption, and myriad behavioral and emotional demands that accompany the diagnosis. A family’s makeup, relationships, cohesiveness, communication patterns, and especially level of support have been identified as factors contributing to cancer patients’ psychosocial response to their illness. The impact of serious illness frequently alters family members’ roles and responsibilities, necessitating adaptation to these changes.
Families are the primary providers of support to most patients, and a family environment characterized by high levels of communication and emotional expressiveness, along with low levels of conflict, predicts better adjustment in cancer patients. Having a family that is critical, emotionally distant, or unresponsive to patient distress appears related to poorer patient adaptation to the challenges of cancer. Patients who lack support from family or friends may benefit from participating in support groups in terms of improved mood, coping skills, pain tolerance, and general mental health.
Illness-related factors: Disease-related factors contributing to psychosocial adaptation to cancer include the type, stage, and location of the disease; its symptoms; treatment demands and side effects; and the prognosis for rehabilitation, cure, or survival.
Certain types of cancer appear to be particularly potent in producing emotional distress in patients. For example, the diagnosis of breast cancer and awareness of associated treatments and potential side effects (such as surgical intervention and disfigurement, chemotherapy and hair loss, radiation and infertility) can be profoundly disturbing to many women, especially those of childbearing age. Other types of cancer associated with behavioral or lifestyle factors (such as smoking and lung cancer) may produce debilitating guilt and self-reproach in the patient. For most, initial emotional turmoil gives way to a return to more normal coping strategies and gradual adaptation to the demands of their health status.
Pain, diminished strength and physical abilities, and attendant loss of independence are some of the symptoms associated with cancer that require psychosocial adaptation in patients. For those patients who have a realistic hope of cure, unpleasant or painful treatment side effects, such as nausea, weakness, vomiting, or hair loss, are endured with the hope of long-term benefits. Counseling, meditation, support groups, and medication may be employed to assist the patient in controlling psychological symptoms stemming from treatment. Because patients are increasingly surviving cancer, there is greater awareness of how individuals adapt to life after their illness. Many survivors find positive aspects to their experience with illness, including examining life goals and searching for more meaningful pursuits and spiritual growth. Many survivors struggle with anxiety associated with fears of recurrence of the disease or how they will cope as they resume roles and activities disrupted by their illness. Although successful coping is seen in most individuals, some experience esteem issues, grief, difficulties with intimacy, and a heightened sense of vulnerability even after several years of survival.
In terminal cases, the transition from active treatment to palliative or comfort care, and the attendant confrontation with the inevitability of death, can be very difficult for patients and their friends and family. Reactions to this change often involve shock and denial of physical realities. Similar to what is seen at initial diagnosis, after a period of distress, most patients draw on their usual means of coping and adapt to new therapeutic goals such as pain control, comfort care, and maximizing quality of life. Increasingly, terminal care is provided at the homes of patients, with benefits to the patient and family resulting from greater comfort and closeness during the patient’s final days. Progress in the control of symptoms of advanced illness (such as pain) has significantly improved the quality of life for many patients and thereby facilitated psychosocial adjustment to end-of-life issues.
Cultural and societal influences: Cultural and societal factors that influence adaptation to cancer change as knowledge, perceptions, and beliefs about the illness evolve. Historically, when effective treatment options were limited and a culture of paternalism held sway in medicine, the diagnosis of cancer was kept from individuals, because the disease typically led to death and patient awareness was viewed as merely adding to the suffering. Treatment advances, coinciding with overall efforts in medicine to increase patient participation in medical care, have curtailed this practice. Improved patient-physician communication and a greater sense of autonomy and control in the patient are some of the benefits of this change. Increased public access to medical information (such as via the Internet) has led to heightened awareness of cancer and has reduced the prevalence of some associated myths (for example, that cancer is a contagion), which previously contributed to stigmatizing those with the disease. Greater exposure to accurate information regarding treatment alternatives for many forms of cancer has led to a generally less grim view of the disease by the general public. Consequently, reflexive catastrophic emotional responses to the diagnosis may be reduced. However, overall increases in optimism regarding cancer may be tempered in some cases by access to starkly realistic prognostic and treatment information associated with the more virulent types of the disease. Also, access to inaccurate sources of information, such as those erroneously attributing the cause of cancer to inadequate personality traits or “toxic” relationships, may unnecessarily add to the psychological burden of the patient. Greater awareness and cultural acceptance of mental health problems and the availability of effective treatment has increased the likelihood of cancer patients receiving care for depression and anxiety. Treatment of these conditions has been found to improve the quality of life of cancer patients.
Carr, Brian I., and Jennifer Steel, eds. Psychological Aspects of Cancer: A Guide to Emotion and Psychological Consequences of Cancer, Their Causes and Their Management. New York: Springer, 2013. Print.
Christ, Grace, Carolyn Messner, and Lynn Behar, eds. Handbook of Oncology Social Work: Psychosocial Care for People with Cancer. New York: Oxford UP, 2015. Print.
Gatchel, Robert, and Mark Ooordt. Clinical Health Psychology and Primary Care: Practical Advice and Clinical Guidance for Successful Collaboration. Washington, DC: Amer. Psychological Assn., 2003. Print.
Goldman, Larry S., Thomas N. Wise, and David S. Brody. Psychiatry for Primary Care Physicians. 2nd ed. Chicago: Amer. Medical Assn., 2004. Print.
Hong, Waun Ki., et al., eds. Holland-Frei Cancer Medicine. 8th ed. Shelton: People's Medical, 2010. Print.
Paludi, Michele A., ed. The Praeger Handbook on Women's Cancers: Personal and Psychosocial Insights. Santa Barbara: Praeger, 2014. Print.
No comments:
Post a Comment