Anxiety and Depression After Breast Cancerand...The Influence of Uncertainty in Illness, Stress...
Transcript of Anxiety and Depression After Breast Cancerand...The Influence of Uncertainty in Illness, Stress...
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Anxiety and Depression After
Breast Cancer
Ruth H. Steinman, MDClinical Assistant Professor
Department of Psychiatry
Perelman School of Medicine
University of Pennsylvania
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Anxiety and Depression After Breast
Cancer…
Is Common!
Peaks at times which can be confusing
to you and those around you
Lessens over time but sudden
re-experience is common with trigger
Is characterized by multiple, often
conflicting emotions
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Survivors of Breast Cancer Live
With Uncertainty
The psychological and spiritual effects of
pre-existing disease and its treatment
The worry about long term effects
The possibility of cancer recurrence
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Emotional Responses to Uncertainty
Obsessive Worry
and Fear
Anger/Disgust
Apprehension
Hurt
Demeaned
Guilty/Ashamed
Hopeless/helpless
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Triggers of Emotional Distress
Tests/scans
Waiting for results
Appointments with oncology team
Birthdays
Anniversaries
Holidays
Hearing of other’s recurrence or death
Feeling pain or fatigue/developing cough
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What are we afraid of?
Pain, fatigue, nausea, vomiting, hair loss and
long term effects of resuming treatment
Physical deterioration/body image
Inability to care for family
Family’s responses
Being a burden/dependent on others
Helplessness
Threat to financial stability
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What is Obsessive Worry?
“This is unbearable…I feel
damaged/inadequate…Why do I have to feel
this way…This is unfair…I can’t cope with this”
Negative spiral in which the longer you are in
it, the deeper it gets and the more energy it
carries
Can feel like a trance
It can feel compelling, like the path of least
resistance and takes a deliberate effort to shift
gears and get out of this spiral
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Who is at risk for a psychiatric
disorder?
Those with history of mood or anxiety
disorder
Those who have experienced recurrence
Those with a disease free interval of less
than 24 months
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What is an Anxiety Disorder?
Generalized Anxiety Disorder
Adjustment Disorder with Anxiety
Post Traumatic Stress Disorder
Panic Disorder
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What is a Depressive Disorder?
Dysthymic Disorder
Major Depression
Adjustment Disorder with Depressed
Mood
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How many people experience this?
Prevalence psychiatric disorders
following diagnosis is 14-38%
Approximately 25% develop psychiatric
disorder throughout course of illness
Clinically significant psychological
distress at recurrence is > 40%
Prevalence of breast cancer is 2 ½
million
(NCI SEER Cancer Statistical Review of data from 2006 released 4/09)
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“Under Toad Days”…
Elizabeth McKinley, MD
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What type of “coper” are you?
Confrontative Coping
Distancing
Self-Control
Seeking Social
Support
Accepting
Responsibility
Escape-Avoidance
Planful Problem
Solving
Positive Re-
appraisal
(Folkman and Lazarus)
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Strategies for managing uncertainty
Education
Find safe place to share fears and distress
Pace life to avoid being overwhelmed
Treat pain and other persistent treatment
related side effects to avoid demoralization
Set short term goals
Work on developing non-cancer identity
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Friendship
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Spirituality
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More Strategies…
Reinforce past adaptive strategies for
coping under stress and uncertainty
Support from family, community, health
care providers: other’s optimism can
engender hope
Writing
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Taking care of yourself can enhance
your sense of control
Diet/Nutrition
Exercise
Meditation/Mind-body interventions
Energy Therapies: Qi Gong; Reiki
Relaxation techniques
Breathing
Muscle relaxation
Guided imagery
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What is Hope?
Belief that a positive outcome lies ahead.
We can learn to see that a positive
outcome can exist even if what we
originally hoped for is not likely to
happen.
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Take comfort in knowing…
Others have survived this treatment, this
side effect, this waiting, this uncertainty
about the future…I can too!
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Where Can I Find Professional
Help?
American Psychosocial Oncology
Society (APOS) Helpline:
1-866-APOS-4-HELP
www.apos-society.org/survivors/helpline
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Bibliography
McKinley ED, Under Toad Days: Surviving the Uncertainty of Cancer Recurrence, Annals of Internal Medicine,2000;133(6):479-480.
Folkman S, Lazarus, RS. Coping as a Mediator of Emotion. J of Personality and Social Psych; 1988;
Okamura M, Yamawaki, S, et al. Psychiatric Disorders following First Breast Cancer Recurrence: Prevalence, Associated Factors and Relationship to Quality of Life. Japanese Journal of Clinical Oncology. 2005;35(6):302-309.
DiGianni LM, Garber JE, and Winer EP. Complementary and Alternative Medicine Use Among Women with Breast Cancer. Journal of Clinical Oncology. 2002;20(185)34s-38s.
Wonghongkul T, Moore, SM, et al. The Influence of Uncertainty in Illness, Stress Appraisal, and Hope on Coping in Survivors of Breast Cancer. Cancer Nursing. 2000;23(6):422-429.
Nelson, JP. Struggling to Gain Meaning: Living with the Uncertainty of Breast Cancer. Advances in Nursing Science. 1996;18(3):59-76.
Greenlee RT, Murray T, et al. Cancer Statistics. CA Cancer J Clin. 2000;50:7-33.