Supportive Treatments: Hold the Mind Strong During Cancer
Demet Sag, PhD
Psychiatric treatments
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 | |
Adjustment disorder | 14%–34.7% | 10.6%–16.3% | — |
Anxiety disorders | |||
Generalized anxiety | 3.2%–5.3% | 5.80% | 3.50% |
Panic disorder | 4.20% | 5.50% | 8.00% |
Post-traumatic stress | 2.40% | 0% | 4.00% |
Unspecified | — | 4.70% | — |
Any | 6%–8.2% | 13.90% | — |
References:
Mehta RD1, Roth AJ2. Psychiatric considerations in the oncology setting. CA Cancer J Clin. 2015 Jul-Aug;65(4):300-14. doi: 10.3322/caac.21285. Epub 2015 May 26.
Caruso R1, Grassi L, Nanni MG, Riba M. Psychopharmacology in psycho-oncology. Curr Psychiatry Rep. 2013 Sep;15(9):393. doi: 10.1007/s11920-013-0393-0.
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.
Miovic M1, Block S. Psychiatric disorders in advanced cancer. Cancer. 2007 Oct 15;110(8):1665-76.
Akechi T1, Nakano T, Uchitomi Y. [Scientific background of psycho-oncology]. Seishin Shinkeigaku Zasshi. 2004;106(6):764-71. [Article in Japanese]
Thekdi SM1, Trinidad A, Roth A. Psychopharmacology in cancer.
Curr Psychiatry Rep. 2015 Jan;17(1):529. doi: 10.1007/s11920-014-0529-x.
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