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Psychological Concerns among Cancer Survivors

Asfia Mohammed OTR, MOT

Senior Occupational Therapist

MD Anderson Cancer Center

Psychological Concerns

Psychological Concerns

Impact occupational performance and participation in therapy

Normal reaction to life-threatening illness

Distress

Range of distress can vary from mild sadness to severe disability

Distress

Unpleasant emotional experience that can hamper the ability to cope (NCCN; 2017)

Untreated distress can lead to low compliance with treatments and therapy

(Lyons, K, 2020)

Manifests into physical symptoms like high BP and sleep disruptions

Anxiety

Leads to avoidance behaviors that reduce anxiety in the short term

Anxiety

An emotional state that is felt as tension, worry, or irritability... (Kazdin, 2000)

Avoidance leads to severely restricted routines and activity patterns when used long term

(Lyons, K, 2020)

Depression

Presents with persistent anhedonia, sadness, poor sleep or appetite, low energy, or poor concentration (World Health organization, 2012)

Depression

(Lyons, K, 2020)

One of the most disabling conditions, can severely impact all aspects of occupational engagement

Also practice avoidance behaviors

Avoidance ultimately restricts routines and limits the opportunity to experience positive emotions during activities

Video

Occupational Therapy's Role

Role of OT

  • Screen for presence of distress, depression, and anxiety

  • Refer to mental health professionals when appropriate

  • Foster occupation engagement to enhance mental health

Identify avoidance of occupational engagement

  • Not engaging in BADLs
  • Avoiding family and friends
  • Avoiding IADLs
  • No longer participating in leisure activities

Screening for psychological concerns

Screening

Distress Thermometer

Patient Health Questionnaire

Generalized Anxiety Disorder 7 item Screener

  • Used with adults
  • Identifies level of disruption to occupational engagement
  • Score of 4 or higher triggers further screening
  • Cut off of more than 10 has 88% clinical significance for identifying clinical depression
  • Score of 5-9 indicates mild anxiety, 10-14 is moderate anxiety, 15 or higher is severe anxiety
  • Adult screener

(NCCN, 2017)

(Spitzer, 2006)

Presence of Distress, Anxiety or Depression

Avoidance behaviors

Increase psychological burden, decrease social support, physical and psychological well-being

Referral

Psychological Concerns are best treated with an interdisciplinary approach

Impact daily routine and coping

Occupational Engagement

Act of performing a personally selected and meaningful occupation within a specific setting and context (AOTA, 2014)

Occupational Engagement

Combat avoidance related coping strategies by facilitating occupational engagement while incorporating positive coping strategies

Cancer Survivors

Cancer Survivors

  • No longer a terminal illness but a chronic illness
  • Diagnoses elicits a variety of emotions
  • Some experience distress, anxiety and depression
  • Some experience post-traumatic growth

Some Mental Health Triggers

Triggers

  • Body Image
  • Sexuality
  • Survivorship

Resilience

Post-traumatic growth

Personal Strength

Post-traumatic growth

Personal experiences improve adaptation, awareness, and psychological functioning after confronting an upsetting event (Tedeschi et al., 1998).

Spirituality

Recognition of new possibilities for life choices

Appreciation of life and social relationships

Positive Coping Strategies

Goal re-engagement: directing renewed energy toward important and achievable goals

Coping Strategies

Involvement in pleasant activities

Facilitate avoidance of maladaptive coping strategies and foster positive strategies.

Maladaptive strategies:

Positive Re-framing

Coping strategies

Conditional goal setting: happiness depends on achieving a certain goal or condition

Active coping

Avoidant coping: avoid things that trigger negative memories or emotions, report more negative changes since diagnosis

Acceptance

Rumination and catastrophize: focus attention on source of distress opposed to solutions, predict negative outcomes and assume it will be unbearable

Religious Coping

(Lyons, 2020)

Intervention

Facilitate engagement in meaningful activities despite the presence of worrisome or negative affect

Intervention

Remember people struggling with distress, anxiety or depression cope by avoiding situations that provoke uncomfortable emotions

Scheduling daily activities

Create/promote

Incorporate stress management techniques

Create/Promote

Promote healthy habits

Identifying avoidance behaviors

Establish/restore

Establish/restore

  • Incorporate evidence-based treatments
  • CBT, mindful-ness therapy, psychotherapy, hope therapy, medication (may require referral to psychiatric professionals)
  • Social skills training

Modify

Problem solving to promote adaptive coping

  • adaptation to changed environment
  • compensating to impaired client factors

Modify

Prevent

Prevent

  • Group intervention
  • Support groups
  • Spreading awareness
  • Education and training for patients, caregivers, family members and treatment team members

Conclusion

Conclusion

  • Distress, anxiety and depression can be experienced by many clients with or without cancer
  • Focus on identifying avoidance behaviors
  • Facilitate occupational engagement in activities that may be causing uncomfortable emotions
  • Leads to health promotion and positive mental well-being
  • Work as a team with psychiatric professionals to enhance coping and compliance

Questions?

Questions?

Contact me via email

ammohammed@mdanderson.org

References

References

American Occupational Therapy Association. (2014).

Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. https://doi.org/10.5014/ajot.2014.682006

Kazdin, A. E. (Ed.). (2000). Encyclopedia of psychology.

Washington, DC: American Psychological Association.

Lyons, K. (2020). Psychological Issues. In B. Braveman & R.

Newman (Eds.), Cancer and occupational therapy: Enabling performance and participation across the lifespan (pp. 253-264). AOTA Press.

National Comprehensive Cancer Network. (2017). NCCN clinical

practice guidelines in oncology: Distress management. Retrieved from https://www.nccn.org/professionals/physican_gls/pdf/distress.pdf

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lowe, B. (2006).

A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092-1097. https://doi.org/10.1001/archinte.166.10.1092

Tedeschi, R. G., Park, C. L., & Calhoun, L. G. (1998). Postraumatic growth: Conceptual issues, In

R. C. Tedeschi, C. L. Park, & L. C. Calhoun (Eds.), Postraumatic growth: Postive changes in the aftermath of crisis (pp. 1-22). Mahwah, NJ: lawrence Erlbaum Associates. https://doi.org/10.1207/s15327965pli1501_01

World Health Organization. (2012). Depression fact sheet.

Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression

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