RESUMO
The cancer patient's journey not only includes a threat to one's life, but the need to face many medical and emotional challenges. The free Cancer Supportive Care Program (CSCP) within the Center for Integrative Medicine Clinic at Stanford University Hospital and Clinics has been identified as a successful model for helping patients to deal with these challenges. Its programs include informational lectures, support groups, chair massages, exercise, alternative modality classes, a Life Tapes Project, an informational website, and a bimonthly newsletter available free to anybody touched by cancer. Now in its third year, this program benefits from a blending of leadership resources, availability of space, institutional agreement on patient need and funds from private and corporate donations. By presenting the basic premises of the Cancer Supportive Care program and outlining specifics about the program, institutions in various national and international demographic regions may implement similar programs according to their resources and the needs of patients. It is our hope that the CSCP can become a model for the development of similar programs in various parts of the United States and abroad.
Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Neoplasias , Serviço Hospitalar de Oncologia/organização & administração , Cuidados Paliativos/organização & administração , Adulto , Idoso , California , Prestação Integrada de Cuidados de Saúde/normas , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Neoplasias/psicologia , Neoplasias/reabilitação , Neoplasias/terapia , Avaliação de Programas e Projetos de Saúde , São FranciscoRESUMO
Women following the stress resulting from the diagnosis and treatment for breast cancer draw resources from their network of friends and relatives. These resources include both emotional support and instrumental resources such as getting a ride to a medical appointment. Emotional support buffers the effects of the stresses they face and improves their mental well-being while the existence, rather than the use, of instrumental supports is positively related to physical well-being. These hypotheses are tested on a population-based cohort of 336 women in the United States, diagnosed and treated for breast cancer when aged 50 or less. Most are married (65%), work (75%), have dependent children (63%), are white (70%), and had a mastectomy (51%). Results of the multi-variate analyses indicate that consistent with predictions, controlling for socio-demographic and treatment-related variables, the size of the social network was related to greater emotional and instrumental support, and greater emotional support was related to better mental well-being. Contrary to predictions, greater use of instrumental resources was related to poorer physical well-being. The results indicate the importance of social resources on well-being following life-threatening illness.
Assuntos
Neoplasias da Mama/psicologia , Apoio Social , Estresse Psicológico/prevenção & controle , Adaptação Psicológica , Adulto , Feminino , Humanos , Análise dos Mínimos Quadrados , Pessoa de Meia-Idade , Análise MultivariadaRESUMO
BACKGROUND: Metastatic breast cancer carries with it considerable psychosocial morbidity. Studies have shown that some patients with metastatic breast cancer experience clinically significant anxiety and depression and traumatic stress symptoms. Supportive-expressive group psychotherapy was developed to help patients with cancer face and adjust to their existential concerns, express and manage disease-related emotions, increase social support, enhance relationships with family and physicians, and improve symptom control. METHODS: Of 125 women with metastatic breast cancer recruited into the study, 64 were randomized to the intervention and 61 to the control condition. Intervention women were offered 1 year of weekly supportive-expressive group therapy and educational materials. Control women received educational materials only. Participants were assessed at baseline and every 4 months during the first year. Data at baseline and from at least 1 assessment were collected from 102 participants during this 12-month period, and these participants compose the study population. RESULTS: Primary analyses based on all available data indicated that participants in the treatment condition showed a significantly greater decline in traumatic stress symptoms on the Impact of Event Scale (effect size, 0.25) compared with the control condition, but there was no difference in Profile of Mood States total mood disturbance. However, when the final assessment occurring within a year of death was removed, a secondary analysis showed a significantly greater decline in total mood disturbance (effect size, 0.25) and traumatic stress symptoms (effect size, 0.33) for the treatment condition compared with the control condition. CONCLUSION: Supportive-expressive therapy, with its emphasis on providing support and helping patients face and deal with their disease-related stress, can help reduce distress in patients with metastatic breast cancer.
Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Transtornos do Humor/terapia , Psicoterapia de Grupo/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Adaptação Psicológica , Adulto , Idoso , Neoplasias da Mama/psicologia , Comorbidade , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Metástase Neoplásica , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Apoio Social , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Resultado do TratamentoRESUMO
In a study comparing lesbian and heterosexual women's response to newly diagnosed breast cancer, we compared data from 29 lesbians with 246 heterosexual women with breast cancer. Our hypotheses were that lesbian breast cancer patients would report higher scores of mood disturbance; suffer fewer problems with body image and sexual activity; show more expressiveness and cohesiveness and less conflict with their partners; would find social support from their partners and friends; and would have a poorer perception of the medical care system than heterosexual women. Our predictions regarding sexual orientation differences were supported for results regarding body image, social support, and medical care. There were no differences in mood, sexual activity or relational issues. Not predicted were differences in coping, indicating areas of emotional strength and vulnerability among the lesbian sample.
Assuntos
Adaptação Psicológica , Neoplasias da Mama/psicologia , Homossexualidade Feminina/psicologia , Estresse Psicológico/etiologia , Mulheres/psicologia , Doença Aguda , Adulto , Atitude Frente a Saúde , Feminino , Heterossexualidade/psicologia , Humanos , Modelos Psicológicos , São FranciscoRESUMO
PURPOSE: The psychosocial outcomes of testicular cancer and Hodgkin's disease were compared to test our hypotheses that more specific dysfunction and less hiding of symptoms would be found in the former group, as cancer visibly affects a sexual organ. Since those with Hodgkin's disease could more easily deny the disease, poorer psychosocial adjustment was predicted. PATIENTS AND METHODS: The sample consists of 85 men with Hodgkin's disease and 88 men with testicular cancer (seminomatous, n = 39; or nonseminomatous, n = 49). They were interviewed once, at least 1 year following the end of treatment. Measures of sociodemographic characteristics, physical functioning, psychologic distress, and social outcomes were collected. Treatment data were collected from medical records. RESULTS: Men with testicular cancer report more focused symptoms: less sexual enjoyment and poor health habits. Men with Hodgkin's disease report more generalized symptoms: fatigue, energy loss, and work impairment. Multivariate analysis indicates that most of these differences are site-related; independent effects of treatment on outcomes were found for more generalized symptoms. Contrary to expectations, both groups reported similar levels of infertility and erectile dysfunction. CONCLUSION: The response to testicular cancer is site-specific, while the response to Hodgkin's disease is related to both site and treatment (stage-related).
Assuntos
Disgerminoma/psicologia , Doença de Hodgkin/psicologia , Qualidade de Vida , Neoplasias Testiculares/psicologia , Atividades Cotidianas , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Disgerminoma/tratamento farmacológico , Feminino , Doença de Hodgkin/tratamento farmacológico , Humanos , Masculino , Sensibilidade e Especificidade , Fatores Socioeconômicos , Neoplasias Testiculares/tratamento farmacológico , Resultado do TratamentoRESUMO
To test a method of assessing quality of life, 200 primary brain tumor patients in an outpatient clinic answered a 20-minute questionnaire covering ten aspects of quality of life. These results were compared with Karnofsky performance scale (KPS) scores, taking age into account. Among patients with KPS 90-100 (two-thirds of the patients), the KPS alone was difficult to interpret. The questionnaire, with its specific questions related to the key dimension of well-being, provided a more definitive assessment of status. The central importance of well-being was supported by its strong statistical relationships with other dimensions. Particularly, well-being was related to freedom from depression (p < 0.0001), active social life (p < 0.0001), energy (p < 0.01), and fewer symptoms (p < 0.05). The KPS was more useful in differentiating the other one-third of the patients (KPS 50-80) but was highly sensitive to age. KPS scores, therefore, may have been unreliable. Depression, reported by half of the patients, was not predicted by the KPS when age was excluded from the regression analysis but was related to the scores in well-being and socializing. Neither depression, well-being, nor socializing was influenced by age. Thus, the questionnaire directly assessed these central, emotionally based variables, particularly among patients with satisfactory KPS. Such an assessment is especially crucial as a supplement to the KPS in evaluating brain tumor survivors, whose emotional well-being is often severely challenged by treatment after surgical excision.
Assuntos
Neoplasias Encefálicas/fisiopatologia , Qualidade de Vida , Autoavaliação (Psicologia) , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/psicologia , Criança , Depressão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Análise de Regressão , Inquéritos e QuestionáriosRESUMO
The psychosocial problems that develop in long-term survivors of Hodgkin's disease were examined in a cross-sectional survey of 403 patients. The average age at treatment was 27 years and at interview was 36 years. The median time since treatment was 9 years. Sixty percent of the patients were treated for stage I or II disease and 40% for stage III or IV. Eighty-two percent of the patients had never relapsed, and 98% were free of disease at the time of interview. The study investigated the type and frequency of problems by means of a self-administered questionnaire using standard survey items to assess disruption in three areas of life: sense of well-being, family relationships, and employment. Results indicate that energy had not returned to patients' satisfaction in 37% of the cases. This was influenced by age, time since therapy, stage of disease, and type of treatment. Patients with self-reported energy loss were more likely to be depressed. Moderately high divorce rates (32%), problems with infertility (18%), and less interest in sexual activity (20%) were reported. Employment patterns favored men returning to work, and number of hours worked was highly correlated with less depression, younger age, and return of energy. Difficulties at work were reported by 42% of the cases. The interaction of treatment, biologic, psychosocial, and functional variables is described.