Psychosocial Aspects of Breast and Cervical Cancer Diagnoses Emily Lane, MSW, LCSW SIU School of Medicine A little about me… At the end of this webinar, you should be able to… ◦ Identify possible psychosocial stressors associated with breast and cervical cancer diagnoses. ◦ Recognize symptoms of psychological distress in newly diagnosed patients. ◦ Utilize supportive interventions with the hopes of decreasing the level of acute distress in patients with breast or cervical cancers. ◦ Educate patients on avenues of assistance and coordinate appropriate referrals to alleviate some of the psychosocial distress that they are experiencing. Objectives What are psychosocial stressors? ◦ Social conditions that can affect our mental health. ◦ Example: financial concerns can lead to feelings of inadequacy or depression OR major depression could lead to missed days of work and subsequent financial concerns Common psychosocial stressors for persons with cancer Financial Physical Interpersonal Psychological Distress Financial ◦ Unable to work due to appointments or treatment ◦ Uninsured/underinsured ◦ Out-of-pocket costs for medications Physical ◦ Side-effects from chemotherapy, surgery, radiation and/or hormone treatments ◦ Difficulty with activities of daily living ◦ Transportation ◦ Navigation of the healthcare system Interpersonal ◦ Difficulty communicating with loved ones because of high levels of distress ◦ Little support from family and friends ◦ Too many people counting on the person with cancer ◦ Changes in libido and sexuality can lead to difficulties in marriage Significant pain from internal radiation which can lead to difficulty having sex afterward. This can lead to marital strain. Guilt/Shame of HPV infection or stigma Fertility concerns – early menopause Cervical cancer is 10x more prevalent in women who are victims of domestic violence than in general population Cervical Cancer Specific Body image issues may result from physical changes to the breast from surgery, radiation Femininity/Sexuality issues can lead to marital strain Lymphedema – can be a financial burden due to the supplies needed to manage the condition Breast Cancer Specific ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Depression Anxiety Anger Guilt Difficulty sleeping Existential questions Difficulty concentrating Distress over treatment choices The emotional toll of these stressors What is psychological distress? The National Cancer Institute defines psychological distress as “an unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with the ability to cope with cancer treatment. It extends along a continuum, from common normal feelings of vulnerability, sadness, and fears, to problems that are disabling, such as true depression, anxiety, panic, and feeling isolated or in a spiritual crisis” Use of a distress screener can help you find out what your patients are dealing with both physically and emotionally. http://www.nccn.org/patients/resources/life_with_cancer/pdf/nccn_distress_thermometer.pdf We know the problem How do we help? Validation and Communication Empathic Statements ◦ Reflection ◦ Statements of understanding ◦ Ask patients how they feel Mirroring Active Listening Being able to just sit with a patient and their emotions Normalizing emotions Validation Building block of rapport ◦ Adds to patient’s subjective experience of a safe place to express him or herself Facilitates hope Improves patient compliance and satisfaction Why is empathy important? Provide education as to what the next step is regarding treatment and/or follow-up. Ask patients if it would help them if you made the follow-up appointments for them. Ask them if they have any immediate concerns, such as support at home, transportation, insurance coverage and/or other financial issues. Provide information regarding resources in the community. Communication A word about survivorship… Illinois Breast and Cervical Cancer Program American Cancer Society ◦ Patient navigators to assist with financial concerns and other needs ◦ Wig Salon ◦ Look Good, Feel Better ◦ Road to Recovery ◦ Co-Pay Assistance Community Action Agencies ◦ Sangamon County Resource Center Local Support Groups Resources www.needymeds.com www.getcoveredillinois.gov www.cancer.org www.nccn.org/patients/resources/life_with_cancer/ www.livestrong.org www.cancercare.org Helpful websites Final Thoughts Each person is unique, and their response to a cancer diagnosis will be just as unique. 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