RESUMO
BACKGROUND: French legislation about sedation in palliative medicine evolved in 2016 with the introduction of a right to deep and continuous sedation, maintained until death. The objective was to describe midazolam sedation at the COL (Centre Oscar Lambret [Oscar Lambret Center], French regional center for cancer control), in order to establish a current overview before the final legislative changes. METHODS: Descriptive, retrospective and single-center study, concerning major patients in palliative care hospitalized from 01/01/2014 to 12/31/2015, who had been sedated by midazolam. The proven sedations (explicitly named) and the probable sedations were distinguished. RESULTS: A total of 54 sedations were identified (48 proven, 6 probable). Refractory symptoms accounted for 48.1% of indications, complications with immediate risk of death 46.3%, existential suffering 5.6%. Titration was performed in 44.4% of cases. Sedation was continuous until death for 98.1% of the cases. Probable sedation had a higher failure rate than proven sedation. Significant differences existed for the palliative care unit compared to other units regarding information to the patient, their consent, anticipation, mention by correspondence and carrying out titrations. When patients had already been treated with midazolam, the induction doses, initial maintenance doses, and doses at the time of death were significantly higher. For those receiving opioids, the maintenance dose at the time of death was higher. No comparison found a difference in overall survival. CONCLUSIONS: After a sufficient follow-up has enabled teams to familiarize with this new legislation, reflection on sedation should be conducted to adapt to final recommendations.
Assuntos
Midazolam/farmacologia , Neoplasias/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , França , Humanos , Hipnóticos e Sedativos/farmacologia , Hipnóticos e Sedativos/uso terapêutico , Masculino , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Estudos RetrospectivosRESUMO
OBJECTIVE: Since February 2016, French Claeys-Leonetti law has recognized patients' right to confront incurable diseases with short-term prognosis and refractory physical or psychological or existential symptoms by requesting continuous deep sedation until death (CDSUD). Determining when psychological or existential distress is refractory and unbearable remains complex and controversial.This review provides a comprehensive thought on CDSUD for advanced incurable patients with refractory psychological and/or existential distress in palliative care settings. It offers guidance on psychiatric or psychological diagnosis for explaining patients' requests for CDSUD. METHOD: A narrative literature review (2000-2019) was conducted on the MedLine search about the use of palliative sedation in cases of refractory psychological and/or existential distress. RESULTS: (1) Definitions of "refractory symptom," "refractory psychological distress," and "refractory existential distress" are inconsistent; (2) alternative diagnoses might obscure or be obscured by psycho-existential distress; and (3) criteria on meanings, reasons for requests, decision-making processes, and functions are evolving in practice. SIGNIFICANCE OF RESULTS: Before implementing CDSUD, palliative healthcare professionals should seek input from psycho-oncologists in palliative care. Mental health professionals should analyze and assess the reasons for psychological and/or existential distress, consider the intentionality processes of requests, and explore alternative diagnoses, such as depressive or adjustment disorders, demoralization syndrome, desire to hasten death, and desire for euthanasia. Therapeutic responses (e.g., pharmacological and psychotherapeutic) should be implemented before deciding that psycho-existential distress is refractory.
Assuntos
Sedação Profunda/métodos , Cuidados Paliativos/métodos , Angústia Psicológica , Sedação Profunda/psicologia , Sedação Profunda/normas , Eutanásia/psicologia , Eutanásia/estatística & dados numéricos , Existencialismo/psicologia , França , Humanos , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Estresse Psicológico/etiologia , Estresse Psicológico/psicologiaRESUMO
OBJECTIVE: Cancer patients can present with impossible behavior, which can jeopardize their treatment and challenge healthcare professionals' teamwork. METHOD: Report of two unusual psychiatric cases, including Munchausen and Peter Pan syndromes, which occurred in a comprehensive cancer center.ResultGuidelines in medical and surgical wards are suggested to address such situations regarding oncologic compliance.Significance of resultsMultidisciplinary collaboration between medical and surgical teams and the psycho-oncologic department is highly recommended.
Assuntos
Oncologia/métodos , Síndrome de Munchausen/complicações , Neoplasias/psicologia , Idoso , Feminino , Comportamento de Busca de Ajuda , Humanos , Masculino , Oncologia/tendências , Pessoa de Meia-Idade , Síndrome de Munchausen/psicologia , Neoplasias/complicaçõesRESUMO
OBJECTIVE: Leptomeningeal metastasis (LM) is a neurooncological complication of advanced cancer that has a poor prognosis. The incidence of LM is increasing due to advances in neuroimaging. At the same time, the development of new systemic treatments with poor central nervous system penetration has improved outcomes and survival. However, diagnosis of LM remains quite difficult due to clinical polymorphism, inconsistent imaging abnormalities, and the inconsistent presence of neoplastic cells in cerebrospinal fluid. Psychiatric manifestations can blur the neurological frame and confound management of this complication. METHOD: To illustrate these difficulties, we report the case of a patient with no past psychiatric history who presented with a manic episode that was attributed to a recurrence of leptomeningeal metastasis. RESULTS: With this case report, we highlight the importance of referring the patient to a psychiatrist or a member of the psychooncology unit when new behavioral disorders present. SIGNIFICANCE OF RESULTS: Leptomeningeal metastases can elicit psychiatric consequences. A hypothesis of this diagnosis should be considered for cancer patients who present with sudden or recent profound mental changes during the course of their disease. Oncologists and neurooncologists should be aware of this possibility. Collaboration with a psychooncologist is recommended to better manage this neuropsychiatric pathology.
Assuntos
Transtorno Bipolar/diagnóstico , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Neoplasias da Mama/complicações , Neoplasias da Mama/psicologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Neoplasias Meníngeas/fisiopatologia , Pessoa de Meia-Idade , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Recidiva , Punção Espinal/métodosRESUMO
OBJECTIVE: Brain tumors are classically associated with neurological and/or psychiatric symptomatology. Behavioral or cognitive disorders can underlie delirium, personality changes, psychotic reactions, and mood disorders. METHOD: To illustrate this, we report the case of a 60-year-old male patient confronted with an inoperable glioblastoma multiforme on the splenium of the corpus callosum, of poor prognosis, treated by concomitant radiochemotherapy with temozolomide, who developed psychotic depression with Cotard's syndrome. Clinical manifestations of this syndrome with untoward consequences in terms of prognosis are classically characterized by intense moral suffering, indignity and pessimistic fixations, suicidal ideations, and a nihilistic delusion relating to one's own body. RESULTS: Nevertheless, this association between Cotard's syndrome and glioblastoma has been seldom described. To our knowledge, this is the first time that this has been described as a complication of this particular tumor location. Some neuropsychopathological hypotheses are proposed, which involve medical, iatrogenic, and psychogenesis issues. SIGNIFICANCE OF RESULTS: This case report points to the necessary collaboration between psychiatrists, neuro-oncologists and radiation oncologists in improving the patient's management and quality of life.
Assuntos
Neoplasias Encefálicas/complicações , Quimiorradioterapia/efeitos adversos , Delusões/etiologia , Transtorno Depressivo Maior/etiologia , Glioblastoma/complicações , Transtornos Psicóticos/etiologia , Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/psicologia , Neoplasias Encefálicas/terapia , Terapia Combinada , Corpo Caloso/patologia , Dacarbazina/análogos & derivados , Dacarbazina/uso terapêutico , Glioblastoma/psicologia , Glioblastoma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Tentativa de Suicídio , Síndrome , TemozolomidaRESUMO
OBJECTIVE: Intensive Care Unit (ICU) delirium is a common complication after major surgery and related among other potential medical precipitants to either pre-existing cognitive impairment or the intensity and length of anesthesiology or the type of surgery. Nevertheless, in some rare situations, an organic etiology is not always found, which can be frustrating for the medical team. Some clinicians working in an intensive care unit have a reluctance to seek another hypothesis in the psychological field. METHOD: To illustrate this, we report the case of a 59-year-old woman who developed a massive delirium during her intensive care unit stay after being operated on for a left retroperitoneal sarcoma. Interestingly, she had had no previous cognitive disorders and a somatic explanation for her psychiatric disorder could not been found. Just before the surgery, she was grieving the recent loss of a colleague of the same age, and also a close friend, and therefore had a death anxiety. RESULTS: With this case report, we would like to point out the importance of psychological factors that might precipitate delirium in a predominately somatic environment such as an intensive care unit. SIGNIFICANCE OF RESULTS: ICU delirium can sometimes be considered as a "psychosomatic" problem with either a stress response syndrome after surgery or a defense mechanism against death anxiety. Clinicians should be aware of the possibility of such psychological factors even if they always must first rule out potential somatic causes for delirium and encourage thorough investigation and treatment of these medical causes. A collaboration with the psycho-oncologist is recommended to better manage this "psychosomatic" problem.
Assuntos
Cuidados Críticos/psicologia , Delírio/psicologia , Complicações Pós-Operatórias/psicologia , Transtornos Psicofisiológicos/psicologia , Ansiedade/etiologia , Ansiedade/psicologia , Atitude Frente a Morte , Delírio/diagnóstico , Delírio/etiologia , Delírio/terapia , Medo , Feminino , Pesar , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Fatores Desencadeantes , Transtornos Psicofisiológicos/diagnóstico , Transtornos Psicofisiológicos/etiologia , Transtornos Psicofisiológicos/terapia , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgiaRESUMO
OBJECTIVE: The belief that cancer inevitably leads to a dreadful and painful death is widespread. This may contribute to society's cancerophobia and denial with subsequent frequent delays in seeking medical attention and treatment for suspected cancer. Cancerophobia is an active behavior of fear of cancer that can lead to repeated medical examination without giving full reassurance to the patient. Denial is a mechanism of defense that usually helps the patient to cope with painful, threatening, overwhelming, or awkward thoughts. When it turns out to be ineffective and pathological, it can cause either delay or avoidance in seeking treatment for symptoms relevant for a true malignancy and will lead inexorably to death if not cured. METHOD: To illustrate this, we report the case of a 62-year-old woman who died of massive concealed ovarian cancer, straightaway at a palliative stage, who always had a persistent denial of her medical condition and a past history of cancerophobia. RESULTS: With this case report, we would like to point out that supportive or palliative care staff should pay attention to this lethal behavior. SIGNIFICANCE OF RESULTS: Some brief recommendations to deal with this specific problematic are outlined.
Assuntos
Negação em Psicologia , Neoplasias Ovarianas/psicologia , Transtornos Fóbicos , Relações Médico-Paciente , Adaptação Psicológica , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
PURPOSE OF REVIEW: Clinical guidelines for depression screening, assessment and management in the oncologic field and palliative care are becoming paramount in routine cancer care. This psychiatric comorbidity has several impacts on quality of life, anticancer treatment compliance, hospital stay duration, health-care costs, morbidity and possibly mortality even if discordant reports exist. RECENT FINDINGS: Recent development of brain imaging techniques (MRI, positron emission tomography), neurobiological and genetic tools allow new understanding of the pathophysiology process of depressive disorders in cancer populations besides the usual endocrinologic and psychoneuroimmunologic hypothesis. Broader indications besides depressive or anxiety disorders appear or must be investigated for the new generation of antidepressants (selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, noradrenergic specific serotonergic antidepressants) in oncology, such as hot flashes, neuropathic pain, fatigue, anorexia/cachexia. Psychosocial interventions seem to have a slight impact on well-being, quality of life and depressive symptomatology but not on survival. SUMMARY: The present article reviews recent literature on depression and cancer and highlights practical assessment and detection of depression, biological and physiopathological correlates and its pharmacologic and psychosocial treatment. Implementation of these several techniques must be supported by ongoing research about the complex relation between depressive disorders and generally mental health and oncology.
Assuntos
Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/terapia , Neoplasias/fisiopatologia , Transtorno Depressivo/diagnóstico , HumanosAssuntos
Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Qualidade de Vida , Inquéritos e Questionários , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias da Mama/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sexualidade , TrastuzumabRESUMO
Bipolar disorders belong to the spectrum of mood disorders and represent a serious psychiatric comorbidity. Behaviors adopted by bipolar patients can foster cancer occurrence but also impact its management, especially during acute depressive or manic episode. Oncologists must adapt their protocols in order to obtain the best compliance for treatment and avoid any possible mood destabilization, with the inherent risk of suicidal attempt. Potential interactions between mood-stabilizing agents (lithium, divalproate, atypical antipsychotics, and anticonvulsivants) and oncologic treatment (chemotherapy, targeted therapy, immunotherapy, corticotherapy) will be particularly watched. To do so, a closely collaboration with the oncopsychiatrist but also with the referent or liaison psychiatry team is necessary during the patient's oncologic care. Some clinical vignettes will illustrate the modalities of care of bipolar disorders in oncology.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Neoplasias/psicologia , Neoplasias/terapia , Corticosteroides/uso terapêutico , Antineoplásicos/uso terapêutico , Antipsicóticos/uso terapêutico , Humanos , Imunoterapia , Terapia de Alvo Molecular , Equipe de Assistência ao Paciente , Cooperação do Paciente , Radioterapia , Suicídio/psicologiaRESUMO
Patients confronted to advanced organic diseases at a palliative stage can present psychological distress that might announce the occurrence of genuine psychiatric disorders. Some frequent and comprehensible symptoms such as sadness, mild agitation, anxiety or more disturbing such as hallucinations, delusions or suicidal ideations must alert the clinician who should not minimize them by attributing them in a reactive way to the consequences of the evolution of physical disease or treatment's side effects. Literature data regarding psychiatric disorders (mainly anxiety disorders, delirium and depressive disorders) in palliative care are emerging and can guide clinicians in their role to detect them and providing early and efficient management. Occurrence of warning symptoms of psychiatric disorders can impaired quality of life and impact the prognosis of patients already weakened by the context of an advanced physical disease. The clinician will have to be careful to any psychiatric prodromic symptom and not hesitate to treat and to refer if necessary to a heath mental professional.
Assuntos
Transtornos Mentais/terapia , Cuidados Paliativos , Assistência Terminal , Ansiedade/diagnóstico , Ansiedade/terapia , Confusão/diagnóstico , Confusão/terapia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Humanos , Transtornos Mentais/diagnósticoRESUMO
Factitious diseases and pathomimias and particularly Munchausen's syndrome, due to their rarity, are poorly diagnosed by medical teams working in oncology. Consequences can be serious and result in unadapted surgery or non justified implementation of chemotherapy and radiotherapy regimens. These patients simulate diseases in order to attract medical attention. They might become belligerent and are likely to promptly discharge themselves from hospital if they do not get the desired attention or are unmasked. With two following case reports and literature review, we would like to alert clinicians about difficulties encountered in diagnosis and management of factitious disorders. When faced with this diagnosis, the patient will tend to deny reality and break contact with the medical team who exposed him. Medical peregrinating behavior surrounded by conflicts with medical team, past psychiatric illness, history of working in the medical and paramedical field and social isolation can guide the diagnosis. Somaticians and especially surgeons working in the oncologic field must remain vigilant about this diagnosis and collaborate with either the psycho-oncologic team or the consultation-liaison psychiatric team. Some recommendations for medical professionals how to cope with these patients will be suggested.
Assuntos
Transtornos Autoinduzidos/diagnóstico , Oncologia , Neoplasias da Mama/psicologia , Transtorno Conversivo/psicologia , Diagnóstico Diferencial , Transtornos Autoinduzidos/epidemiologia , Transtornos Autoinduzidos/psicologia , Feminino , História do Século XVIII , História do Século XX , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Munchausen/diagnóstico , Síndrome de Munchausen/história , Síndrome de Munchausen/psicologia , Prevalência , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/psicologia , Neoplasias Testiculares/psicologiaRESUMO
AIM: Physical or psychological well-being is an essential component of quality care assessment in palliative unit. This assessment is mainly based on self-assessment (questionnaires or interviews). The aim of this study is to compare the clinical characteristics of patients able to fulfill a questionnaire and those not able to do that. METHODS: The clinical characteristics of 166 cancer patients admitted in palliative care unit from December 2006 to February 2008 have been collected. Characteristics of patients able to fulfill a questionnaire (80, 48.2%) have been compared to other patients (86, 51.8%). Moreover, functional independence measure (FIM) had been evaluated by nurses. RESULTS: Median age (60 versus 62) and sex ratio (40/40 versus 42/44) are similar in both groups. Lung primaries are significantly less frequent in patients able to fulfill the questionnaire (4% versus 17%, P=0.005). Patients able to fulfill the questionnaire had had better performance status (Karnofsky Index≤30%: 54% versus 21%, P<0.0001). The total score of FIM (56.0 versus 91.5, P<0.00001) and the median overall survivals (2.3 weeks versus 6.6 weeks, P=0.0001) were significantly lower in the group of patients non able to fulfill the questionnaire. CONCLUSIONS: Patients able to fulfill a questionnaire represent only 48.2% of all consecutive admitted patients. These patients are not representative of all patients since they had better performance status, they are less dependent and they display significant better survival. We have to think about new methods to avoid the biases generated by the use of patient-reported outcomes.
Assuntos
Nível de Saúde , Avaliação de Estado de Karnofsky/estatística & dados numéricos , Neoplasias/psicologia , Cuidados Paliativos , Doente Terminal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/psicologia , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Estudos Prospectivos , Autocuidado , Inquéritos e QuestionáriosRESUMO
Sleep disorders and more particularly insomnias are very frequently found in cancer patients. We notice a growing interest for this subject in the current literature. However, they still remain under diagnosed and thus mostly not taken into account. Nevertheless, these insomnias represent a real discomfort for these patients, with not insignificant repercussions on their quality of life. It is important to be able to screen these disorders with a detailed and precised interview allowing a global patient care including pharmacologic and non-pharmacologic treatment.
Assuntos
Neoplasias/complicações , Distúrbios do Início e da Manutenção do Sono/etiologia , Antipsicóticos/uso terapêutico , Terapia Cognitivo-Comportamental , Gerenciamento Clínico , Humanos , Hipnóticos e Sedativos/uso terapêutico , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/psicologia , Distúrbios do Início e da Manutenção do Sono/terapiaRESUMO
Confronted with a patient with a personality disorder, the oncologist must recognize it and adapt his treatment accordingly. Some pathological character types require interpersonal adjustments to ensure a good understanding of the cancer disease and also to obtain the best compliance with supportive care. Given the fact that specific pharmacological treatment does not exist, collaboration between oncologists and the psycho-oncology team is paramount. The interaction between the somatic disease and the psychiatric disorder demand collaboration among caregivers sharing explanations and recommendations. Clinical examples will illustrate each personality disorder and will focus on the several problems raised by the psychiatric disorder. Treatment principles will be addressed in a second section.
Assuntos
Neoplasias/psicologia , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/terapia , Adulto , Feminino , Humanos , Transtornos da Personalidade/classificação , Psicoterapia/métodosRESUMO
The present study assessed how preventive medical information about hereditary breast and ovarian cancer is spread within the family before actual genetic test results. Forty-two women (19 had a breast or ovarian tumor and 23 did not) were asked to fill out a questionnaire about: (1) the spread within the family of the medical information received during the consultation; and (2) the reasons for sharing this information. Results indicate that all of the women socially shared medical information with an immediate family member for preventive purposes, and generally not for seeking emotional or informative social support.
Assuntos
Neoplasias da Mama/genética , Relações Familiares , Predisposição Genética para Doença , Neoplasias Ovarianas/genética , Revelação da Verdade , Adulto , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/prevenção & controle , Medicina Preventiva , Inquéritos e QuestionáriosRESUMO
The first aim of this study was to build a French validated tool (ICEC-R) assessing the objective comprehension of the modalities and purposes of participating to a randomised clinical trial (phase II or III). The second goal of the study was to compare the scores different groups of participants got at the ICEC-R in accordance with their level of expertness in this domain (physicians vs patients included in a randomised CT vs patients with standard treatment vs uninformed) and to assess whether these scores of objective comprehension were, or not, impacted by the patients' anxiety state or their satisfaction about the care they receive. The sample was composed of 474 participants, namely 73 "target patients" suffering from cancer and participating to a randomised clinical trial, 97 "standard patients" suffering from cancer but who were not included in a clinical trial, 25 "physicians" who include patients in clinical trials, 18 "caregivers" who do not include patients in clinical trials, and 261 "uninformed" (psychology students). "Target" or "standard" patients received a questionnaire composed of the randomised clinical trials comprehension inventory (ICEC-R), a trait-state anxiety scale (STAI-Y), and a scale assessing their satisfaction about the care (SAT). In addition to general information, physicians, caregivers and uninformed only completed the ICEC-R. The analyzes led us to keep a one-dimensional comprehension inventory composed of ten items which are sufficiently discriminant among the patients and for which expert physicians gave consensual answers. Finally, the patients' answers to this questionnaire seem not to be influenced by either their anxiety or their satisfaction about the care. Better evaluations of the knowledge of the patients who participate to randomised clinical trials seem to be a distinct asset to improve these patients' global clinical care.
Assuntos
Compreensão , Oncologia , Neoplasias/psicologia , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto/psicologia , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Cuidadores , Ensaios Clínicos Fase II como Assunto/psicologia , Ensaios Clínicos Fase III como Assunto/psicologia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Educação de Pacientes como Assunto , Reprodutibilidade dos Testes , Adulto JovemRESUMO
The announcement of the cancer diagnosis, an important moment in the set up of the doctor/patient relationship, must come together, if possible, with a quality of communication. This announcement is never insignificant, often traumatic both for the one who receives it and sometimes for the person who provides it. It must observe some rules of temporality, in its enunciation and take into account the psychological defences of patient's mechanisms. More accessible, but also more complex medical information is supposed to be more transparent, taking into account the wishes of patients considered as full actors of their health. As such, the announcement of bad news is in a relationship of care, trust represents the start of a full therapeutic act. One of the challenges of the diagnosis announcement remains the education of patients and physicians to encourage better adaptation to the disease and its treatments. This education can only take place in a pluridisciplinarity in order to optimize care. The diagnosis announcement must continuously oscillate between fair distance and proximity while respecting the autonomy, dignity and freedom of patient's choice. The respect of ethical principles will prevent incomprehension phenomena and seal the pact of trust between doctors and patients.
Assuntos
Comunicação , Neoplasias/diagnóstico , Neoplasias/psicologia , Relações Médico-Paciente , Revelação da Verdade , Humanos , Acontecimentos que Mudam a Vida , Educação de Pacientes como Assunto , Relações Médico-Paciente/ética , Revelação da Verdade/éticaRESUMO
Five to 10% of breast and ovarian cancer are linked to a BRCA1 or BRCA2 mutation. In our country, the information given to the relatives is inevitably mediated by the persons who have consulted. The report of a gap between the number of presumed persons concerned by the genetic information according to our genealogies and the actual number of consultants brought us to question about the transmission of the information in the family, about the possible motives for the lack of transmission, about the rate of consultation of the concerned relatives and on the presumed motives of non-consultation. This sample includes 31 target consultants (index cases) of mutated families which received the result of the genetic test during the period from January, 2003 till June, 2005. According to the information gathered, most of the relatives (73.1%) are informed about the presence of a deleterious mutation in the family, especially women (80.7%). The motives for non-information are the social and emotional distance, as well as the stressful character of the information. Apparently the information is disclosed through the family by the women who are alive and carry the mutation. On the other hand, a minority of the women (39.7%) who are supposed to be informed and living in the region attended the oncogenetic consultation, which represents 32 % of all concerned women who come of age. The motives for short-term absence of consultation can just be presumed. The characteristics which we studied do not allow us to point out some particularities among women who consulted except the nearness with one mutated relative.
Assuntos
Saúde da Família , Genes BRCA1 , Genes BRCA2 , Disseminação de Informação/métodos , Mutação , Neoplasias Ovarianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Coleta de Dados , Relações Familiares , Feminino , Predisposição Genética para Doença , Testes Genéticos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Fatores Sexuais , Revelação da VerdadeRESUMO
Patients with advanced cancer often experience with physical impairment and loss of autonomy sometimes preceding inexorable death. It is that can emerge Suicidal ideation occasionally associated with suicidal attempt can arise in this particular context but also following the initial diagnostic talk and during all the stages of the disease. The risk is often considered twice higher in this patients'group compared to the general population and increases with advanced stages of the disease. Among patients with cancer, suicidal crisis can be expressed as part of a request for euthanasia, physician-assisted suicide and para suicide behaviors. Clues can help the clinician to identify early these vulnerable patients. Therefore, suicidal situations can emerge in the particular context of physical impairment, poor quality of life and poor control of physical symptoms (such as pain, tumoral localization in particular lung, head and neck, pancreas). The association of hopelessness and helplessness and a loss of control of the situation are strongly correlated with the expression of suicidal ideations. The presence of a confusional or psychomotor disinhibition with hallucinations, irrational thoughts and the absence of a libidinal object of investment have also to be taken into account. This suicidal crisis can be considered as a way for the patient to escape an intolerable situation (uncontrolled pain or other symptoms) and maintain self-control and decisional autonomy. Management of suicidal crisis in patients with cancer includes careful attention and legitimization of the patient's distress without inducing any guilt. Appropriate control of physical symptoms is warranted including screening and treating any mood disorder or any organic mental disorder. Treating associated anxiety and making sure that the patient's safety is under control are essential. Last but not the least, involving the whole treatment team is key in preventing transformation of the suicidal crisis into institutional crisis.