Psychosocial Oncology

At the Pancreas Center, we work to meet all the needs of our patients, including the treatment of any psychological, social or emotional conditions. A diagnosis of pancreatic cancer can be difficult for both the patient and their family members. Our psychiatrist has a specialty in psychosocial oncology and is available to consult with Pancreas Center patients as needs arise. Psychosocial Oncology has two main emphases, the first is the study of cancer patients' psychological reactions to their illness at all stages of its course; the second is the analysis of the emotional, social, and behavioral factors that influence the risk of developing cancer and long-term survival following treatment.

Depression

  • Depression is classified in the DSM-IV as persistent depressed mood most of the time for a period of two weeks, appetite and sleep disturbances, and decreased energy and attention.
  • In one large clinical study only 17% of patients, who had an average of approximately 28 days of life left, had clinical depression (Breitbart & Heller, 2003).
  • Observations have been made that the prevalence of psychiatric symptoms appears high in the pancreatic cancer patient population. The review by Green and Austin (1993) suggests that the psycho-pathology of pancreatic tumors may also be linked to tumor induced changes in neuroendocrine or acid base systems, although confirmatory data are lacking (Fitzsimmons et al, 1999).

The Internet as a Resource for Patients

  • The Internet has become an increasingly important health information source. Cancer-related online mailing lists appear to be an important resource, especially for information-seeking, but also for support of cancer survivors.
  • Cancer-related online mailing-list subscribers joined to obtain information on how to deal with cancer, and to get or give support (help others).
  • In addition, some sources estimate that as many as 90 million Americans have participated in online support groups (Rimer, et al 2005).
  • Some studies have shown that electronic support groups have decreased pain, anxiety, and depression, and have increased quality of life (Rimer et al, 2005).

Online Support Groups

  • Cancercare.org provides free support for patients with cancer, including online support groups.
  • Imermanangels.org pairs someone suffering with a certain type of cancer with someone who has successfully beaten it.
  • PanCAN.org offers a multitude of patient services for people with pancreatic cancer and their caregivers.
  • Gildasclubnyc.org provides emotional and social support for people living with cancer and their families.
  • Lustgarten.org offers a number of resources for patients and their families

Quality of Life

  • Fitzsimmons et al (1999) also discovered that patients' perception of quality of life was mediated by the process of coping.
  • Telch and Telch (1986) reported that people in a control group that did not include coping skills training did not adjust as well to their illness as people in a support group that included coping skills training.
  • Groups that are more than just supportive-expressive, and facilitate participants learning experiences through connectedness to a profound emotional experience, help patients learn more effectively (Breitbart and Heller, 2003).
  • Interventions aimed at increasing a person's spiritual well-being and developing a sense of meaning and peace within oneself may have substantial benefits for improving mental health at the end of life. More importantly, by being separate from religion and religious beliefs, these interventions can have a broader appeal for patients who do not hold strong traditional religious beliefs and can be delivered by a wide range of clinicians (McClain-Jacobson et al, 2004).
  • Another study discovered that patients with strong spiritual beliefs have higher overall health-related quality of life (HRQL) irrespective of their religious affiliation (Wan et al, 1999).
  • Prior studies have reported that health-related quality of life (HRQL) in cancer patients tends to be higher among: those with higher socio-economic status, those of male gender, older adults, those who live with others, and those with stronger spiritual beliefs. Individuals with normal functioning levels and favorable relationships with their physicians also report a better quality of life (Wan et al, 1999).
  • Overall, patients who have a more realistic estimate of cure have a better quality of life (Tchen et al, 2003). This speaks to the awareness of mortality.

Novel Approaches & Recent Research

  • Dignity Therapy: Harvey Max Chochinov's novel psychotherapeutic approach, in which patients receiving home-based palliative services were tape recorded while discussing issues that mattered most or subjects they would want remembered.
  • Meaning-Centered Care: End-of-life care based on Viktor Frankl's philosophy that man's search for meaning is our primary motivation in life. Researched by William Breitbart, MD, group psychotherapy that focuses on finding meaning is used to combat hopelessness in terminal patients at the end of life.

References

  • Breitbart W, Heller K. Reframing Hope: Meaning-centered care for patients near the end of life. Journal of Palliative Medicine.2003;6:979-988.
  • Chochinov, H., Hack, T., Hassard, T, Kristjanson, L., McClement, S., Harlos, M. Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology. 2005;23:5520-5525.
  • Fitzsimmons D, George S, Payne S, Johnson CD. Differences in perception of quality of life issues between health professionals and patients with pancreatic cancer. Psycho-Oncology. 1999;8:135-143
  • Green A, Austin C. Psychopathology of pancreatic cancer: a psychobiologic probe. Psychosomatics. 1993;34:208-221.
  • McClain-Jacobson C, Rosenfeld B, Kosinski A, Pessin H, Cimino J, Breitbart W. Belief in an afterlife, spiritual well-being and end-of-life despair in patients with advanced cancer. General Hospital Psychiatry. 2004;26:484-486.
  • Rimer B, Lyons E, Ribisi K, Bowling M, Golin C, Forienza M, Meier A. How new subscribers use cancer-related online mailing lists. Journal of Medical Internet Research, 2005;7(3):32-47.
  • Tchen N, Bedard P, Yi Q, Klein M, Cella D, Eremenco S, Tannock I. Quality of life and understanding of disease status among cancer patients of different ethnic origins. British Journal of Cancer. 2003;89:641-647.
  • Telch C, Telch M. Group coping skills and supportive group therapy for cancer patients: A comparison of strategies. Journal of Consulting and Clinical Psychology. 1986;54:802-808.
  • Wan G, Counte M, Cella D, Hernandez L, Deasy S, Shiomoto G. An analysis of the impact of demographic, clinical, and social factors on health-related quality of life. Value in Health. 1999;2:308-318.