Supportive Treatments: Hold the Mind Strong During Cancer
Demet Sag, PhD
Cancer is described under a general terminology of uncontrolled cell proliferation and changes that results in out of control development. Thus, correcting the cell division and immune control are the two focus areas. Yet, on the other side of the coin like any given terminal diseases there is another big factor that needs to be resolved that is mental health. This is usually not well discussed among many. After all fighting with a disease is a game of strength. I think that is one of the reason we say congrats to many cancer survivors since they won not only with their treatment but also with their psychological strength. However, it is like a balloon after the disease the battle is still on.
Here are the few articles discussing mainly advanced cancer patient’s psychiatric conditions, their clinical treatments, and training of the healthcare givers including oncologists, nurses, social workers, and other ancillary staff.
Last fifty years there is an improvement to cure mental illnesses yet there are many unresolved issues like passing blood brain barrier or specificity etc. Many of these drugs also used for the adjuvant treatment of cancer-related symptoms. Some of these are pain, hot flashes, pruritus, nausea and vomiting, fatigue, and cognitive impairment. However, the condition of cancer patient requires making psychopharmacology to improve quality life of cancer patients.
There new drugs with less side-effects and safer pharmacological profiles, has been a major advance in clinical psycho-oncology.
Since at least 25-30% of patients with cancer and an even higher percentage of patients in an advanced phase of illness meet the criteria for a psychiatric diagnosis, including depression, anxiety, stress-related syndromes, adjustment disorders, sleep disorders and delirium.
About 50% of patients with advanced cancer meet criteria for a psychiatric disorder, the most common being adjustment disorders (11%-35%) and major depression (5%-26%).
At least 30-40% of patients with cancer and even a higher percentage of patients in an advanced phase of illness.
In addition, age is a big issue since the outcomes and treatments changes based on expectations and challenges in their life. It is now possible to diagnose early and treat more means tolerance level to aggressive treatments also increases. In older patients aging and cancer and in younger patient’s career and relationships broken. This is not just a longevity but improving the quality of life of a patient after cancer’s transition from likely death to survival. Therefore, it is equally important to give their life back fully so there is an increased awareness on psychosocial issues and quality of life.
For example, there is a Psycho-oncology group in National Cancer Center. They are now conducting several clinical studies such as biological studies (neuro-imaging studies), studies to establish novel treatment strategy (n-3 poly unsaturated fatty acid), and multi-faceted intervention study (screening and individually tailored psychotherapy and pharmacotherapy). Hope to see more studies combining not only treat the physiological symptoms but psychological factors.
|Table 1. Prevalence of Psychiatric Disorders in Advanced Cancer|
|Advanced disease||Terminal illness||Caregivers|
Grassi L1, Caruso R, Hammelef K, Nanni MG, Riba M. Efficacy and safety of pharmacotherapy in cancer-related psychiatric disorders across the trajectory of cancer care: a review. Int Rev Psychiatry. 2014 Feb;26(1):44-62. doi: 10.3109/09540261.2013.842542.
Curr Psychiatry Rep. 2015 Jan;17(1):529. doi: 10.1007/s11920-014-0529-x.
References for the table treatment:
Holland JC,Morrow GR,Schmale A, et al. A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol. 1991; 9: 1004–1011.
Razavi D,Kormoss N,Collard A,Farvacques C,Delvaux N. Comparative study of the efficacy and safety of trazodone versus clorazepate in the treatment of adjustment disorders in cancer patients: a pilot study. J Int Med Research. 1999; 27: 264–272.
Pugliese P,Perrone M,Nisi E, et al. An integrated psychological strategy for advanced colorectal cancer patients. Health Qual Life Outcomes. 2006; 4: 9.
Kornblith AB,Dowell JM,Herndon JE2nd, et al. Telephone monitoring of distress in patients aged 65 years or older with advanced stage cancer: a cancer and leukemia group B study. Cancer. 2006; 107: 2706–2714.
Goodwin PJ,Leszcz M,Ennis M, et al. The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med. 2001; 345: 1719–1726. Web of Science® Times Cited: 249
Classen C,Butler LD,Koopman C, et al. Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial. Arch Gen Psychiatry. 2001; 58: 494–501. Web of Science® Times Cited: 156
Pirl WF,Siegel GI,Goode MJ,Smith MR. Depression in men receiving androgen deprivation therapy for prostate cancer: a pilot study. Psychooncology. 2002; 11: 518–523. Web of Science® Times Cited: 43
CA Cancer J Clin. 2015 Jul-Aug;65(4):300-14. doi: 10.3322/caac.21285. Epub 2015 May 26.
Hanna A,Sledge G,Mayer ML, et al. A phase II study of methylphenidate for the treatment of fatigue. Support Care Cancer. 2006;14: 210–215. Web of Science® Times Cited: 18
Pitman RK,Lanes DM,Williston SK, et al. Psychophysiologic assessment of posttraumatic stress disorder in breast cancer patients.Psychosomatics. 2001; 42: 133–140. Web of Science® Times Cited: 21
Derogatis LR,Morrow GR,Fetting J, et al. The prevalence of psychiatric disorders among cancer patients. JAMA. 1983; 249:751–757.PubMed, Web of Science® Times Cited: 837
Travado L,Grassi L,Gil F,Ventura C,Martins C;Southern European Psycho-Oncology Study Group. Physician-patient communication among Southern European cancer physicians: the influence of psychosocial orientation and burnout.Psychooncology. 2005; 14: 661–670. Web of Science® Times Cited: 16
“CREATE Trial Providing Valuable Information on Epoetin Treatment for Anemia.” Hematology Week August 25, 2003: 10.
“Doubts Over Epoetin in Cancer.” SCRIP World Pharmaceutical News October 24, 2003: 24.
“Researcher Working on Medical Patch to Deliver Marijuanalike Drug.” Cancer Weekly September 9, 2003: 126.