PSYCHOLOGY Incidence Psychological aspects of CANCER

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PSYCHOLOGY Incidence Psychological aspects of CANCER

Dakota State University, US has reference to this Academic Journal, Psychological aspects of CANCER Professor Lorraine Sherr Incidence 1 in 3 will develop cancer Quarter of a million cancer diagnosis per annum in the UK Breast cancer – 25,000 new cases per annum Breast cancer – 15,000 die per annum Yet 46% of women in addition to 35% of men alongside cancer will be alive 5 years after diagnosis PSYCHOLOGY Mental health Emotions Behaviour

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4 Areas will be discussed BEHAVIOURAL ISSUES LEADING TO PREVENTING OR DETECTING CANCER, PSYCHOLOGICAL ASPECTS OF DIAGNOSIS PSYCHOLOGICAL ASPECTS OF TREATMENT PSYCHOLOGICAL ASPECTS OF ILLNESS Behavioural issues Smoking Diet Sexual behaviour Sun exposure Chemical exposure (Chernobyl, pill) Breast self examination Screening attendance Genetic screening/counselling Theories so that explain smoking Theory of Reasoned action (Fishbein Ajzen) Importance of intentions, social norms in addition to attitudes not only knowledge Stages of change (DiClemente) Precontemplation Contemplation Decision Change Sustain Revert

CANCER OR CANCERS Brief overview of different forms of cancer in addition to the relevant psychological factors Lung Cancer Behavioural factors: Smoking Bartecchi et al (1994) assert that cigarette smoking related so that 85% of lung cancers Smoking cessation improves prognosis Gas in addition to environmental smoke exposure (Ennever 1990) Psychological distress high (Sarna 1993) Emotional support mitigates in addition to may prolong survival (Ell et al 1988, 1992) Skin Cancers Melanomas in addition to non melanomas Incidence increasing Reduce exposure so that UV Hill et al (1992) provides community in addition to gender behaviour on avoidance in addition to screen use Community awareness leads so that behaviour change in addition to early detection

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Bowel Cancer Diagnosis in addition to investigative procedures are difficult Patients report discomfort, fear, embarrassment in addition to pain Screening is possible in consideration of early detection, but not widely implemented yet After-effects of surgery affect psychological adaptation (psychosexual problems, depression in addition to isolation). Gynaecological Cancers Ovarian, endometrial, cervical, vulval, vaginal, uterine, breast Role of screening (Pap smears) or mammography Delay in detection Screening attendance High psychological burden of positive smear results. Psychological preparation Individual differences Coping styles Psychological aspects of Diagnosis Challenging generates ?existential plight? on diagnosis but even on early medical screening or just contemplating possibility. Withholding diagnosis is seen as problematic Interventions so that enhance adjustment in addition to coping reactions are shown so that be effective Challenging treatment/ process in addition to side effects Decision making in addition to treatment choice

Array of problems associated alongside Cancer diagnosis Knowledge of Disease life threatening inadequate information prognosis uncertainty guilt about causality stigma fears of pain fears of undignified death Coping alongside treatment Mutilating surgery Loss of body image Loss of self esteem Rejection by partner Radiotherapy (depression, nausea, lethargy, skin irradiation) Chemotherapy (Nausea in addition to vomiting, alopecia, mouth ulcers, leucopenia, cardio toxicity, hirsutism, hot flushes) Stages of psychological focus Diagnosis Treatment Outcome Evaluation Quality of life Doctor patient communication Bereavement, facing death, grief in addition to loss Survival Diagnosis Screening Breaking bad news Timing in addition to waiting in consideration of results Seeking out help Social support Coping Decision making around treatment Diagnosis of subsequent recurrence and/or metastatic disease

The Patient A. Universal Patient Fears (in newly diagnosed patients); ?6 D?s? 1. death 2. dependency (on family/spouse) 3. disfigurement 4. disability 5. disruption (e.g. relationships) 6. discomfort (pain) B. Variable Course of Illness & Uncertainty 1. cure, death, or remission (with or without relapse) 2. uncertainty ==> stress! C. Cancer & Psychiatric Disorders 1. most patients cope well alongside chronic stress & uncertainty alongside disease 2. 1st relapse = most psychologically stressful (vs. initial diagnosis or end stages of life) D. Life alongside Cancer 1. most difficult symptoms: nausea & fatigue 2. pain = most feared symptom 3. desire in consideration of patient support group a) survivor guilt ? in consideration of patients in remission

Psychological factors Recall Information processing under stress Associations in addition to meanings of Cancer Fear – Stevens et al 1987 Anxiety Baum et al 1994 Anxiety in addition to threat related so that delayed treatment seeking (Gutteling et al 1987) Coping Adjustment so that diagnosis Coping style in addition to strategies Health beliefs Pre-diagnosis psychological well being Importance of social support (Levy 1992) Anxiety about future (self-examination) Fallowfield & Clark 1990 Recurrence associated alongside high psychological morbidity (Hall Fallowfield et al 1995) Fear of dying, pain, > fear of death (Holland 1990) Problems experienced cancer patients Knowledge of the diagnosis Inadequacy of information Uncertainty about prognosis guilt about causality stigma of cancer fear of a painful in addition to undignified death worries about reaction of family in addition to friends surgery often mutilating in addition to can cause body image problems in addition to loss of physical/sexual function Chemotherapy/ radiotherapy

Treatment Hospital admission Fear of treatments Surgery – see surgery decision making Therapy effects Focus on negative psychological reactions – need so that measure adaptation, resilience in addition to coping THERAPY AND DECISION MAKING Systemic therapy (chemotherapy in addition to endocrine therapy) Decrease sexual desire (Silerfarab et al 1980) Affect body image (Falllowfield & Clark 1990) Ovarian ablation induces early menopause (see young women) Endocrine therapies induce menopausal symptoms Radiotherapy Fear of radiation Effects on partners (Schover in addition to Jenson) Cycle of treatments, anticipation in addition to side effects Depression in addition to anxiety makes it worse

Overall problems Diagnosis related Treatment related Quality of life Why doctors do not measure Quality of Life (Fallowfield) They feel that clinical judgement is sufficient Do not know which tests so that use Feel it takes too much time Think that the patient will get upset Do not know how so that analyse tests Do not know how so that interpret data Charing Cross Hospital Study – only 1.6 consultants behaved above chance level of being able so that assess if patient was depressed) Quality of life assessment can:- Provide data so that assist patent in addition to doctor alongside decision making about treatments Help evaluate outcome of different treatments in outcome trials Identify patients who might benefit from supportive interventions At any given time 1:4/1:3 cancer patients experience clinical anxiety To be used so that inform policy in addition to resource allocation Reveal benefits so that patients despite objective toxicity be of prognostic value in determining which patient is most likely so that benefit from treatment

Prietman in addition to Baum (1978) Quality of life is the best predictor of prognosis in many cases, as opposed so that tumour size, reductions etc. Studies are numerous on this point Use of Q O L Indicator of psychological distress Aide referral Prognostic value – predictive of treatment outcomes Decision making tool Quality of Life Core Domains Psychological Social Occupational Physical Typical items Depression/Anxiety/ Adjustment so that illness Personal relationships, sexual interest, social & leisure activities Employment, cope household Pain/mobility/sleep/ sexual functioning Note order of domains; doctors tend so that emphasize physical

Terminal illness Communication of prognosis Adjustment in addition to coping Palliative care in addition to coping Bereavement Familial diagnoses in addition to their implications

Wheeler, Tom Meteorologist

Wheeler, Tom is from United States and they belong to Meteorologist and work for Tucson Today – KVOA-TV in the AZ state United States got related to this Particular Article.

Journal Ratings by Dakota State University

This Particular Journal got reviewed and rated by Overall problems Diagnosis related Treatment related Quality of life Why doctors do not measure Quality of Life (Fallowfield) They feel that clinical judgement is sufficient Do not know which tests so that use Feel it takes too much time Think that the patient will get upset Do not know how so that analyse tests Do not know how so that interpret data Charing Cross Hospital Study – only 1.6 consultants behaved above chance level of being able so that assess if patient was depressed) Quality of life assessment can:- Provide data so that assist patent in addition to doctor alongside decision making about treatments Help evaluate outcome of different treatments in outcome trials Identify patients who might benefit from supportive interventions At any given time 1:4/1:3 cancer patients experience clinical anxiety To be used so that inform policy in addition to resource allocation Reveal benefits so that patients despite objective toxicity be of prognostic value in determining which patient is most likely so that benefit from treatment and short form of this particular Institution is US and gave this Journal an Excellent Rating.