distress in gynae-oncology patients. relevance common 1 easier to intervene early simple...
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Distress in gynae-oncology patients
Relevance Common1
Easier to intervene early Simple interventions can be very
effective2
Communication skills core2
May impact on treatment and complications (and on outcome in terms of QoL, not survival)3
The five d’s of cancer Death Disability Disfigurement Decline Dysfunction What everyone thinks of when they
hear the word cancer
Gynaecological cancers Fertility issues Sexuality effected directly and
indirectly Diagnosis often delayed Treatment invasive Stigma1
Gynaecological cancers Ovarian Late diagnosis
common Vague symptoms1
Family risk2
Chronic3
Cervical Multiple adversity4
Young women Impact on sexual
function5
stigma
Phases of the journey Initial diagnosis/awaiting results Awaiting treatment Treatment Post treatment/survivorship Recurrence Advanced disease Palliative care/dying
Initial diagnosis/awaiting results Breaking bad news (staging)1
Uncertainty/dread/anticipation of grim process and outcome (cancer = slow death)
On-going symptoms (pain) Shock/disbelief 2
What to disclose to others (children)3
Medical juggernaut4
Financial and other practical concerns5
Awaiting treatment ‘Busy’ activity –
displacement/denial/effort to establish sense of control1
Decision making – information2
Nobody is ‘doing anything’3
Disclosing to others – dealing with comments4
Adapting to diagnosis of cancer when not ‘that ill’
Treatment General1
Anxiety Trust Information Choices Access/cost2
Impact on role3
Impact on others3
The patient role4
Surgery Pain Disfigurement Impact on sexual
function Stoma Ward vs. home3
Treatment Chemotherapy Nausea Hair loss1
Fatigue2
Complications3
Time demands Travel demands5
Radiotherapy Invasive Embarrassing Fatigue2
Bowel problems Skin problems4
Time demands Travel demands5
Post treatment: 1 Residual symptoms1
Residual side effects (fatigue) Body image2
Sexuality changes2
Meaning of physical experience changes1
Menopause Expectations of ‘recovery’ (including the
expectations of others)3
Post treatment: 21
Existential issues – self/future altered – life plans “stolen”
Impact of loss of fertility/other functional losses Grief at multiple losses Anxiety around reviews/scans/tumor marker
levels2
Concerns about family risk (esp. daughters)3
How is information about risk/recurrence presented/understood4
Recurrence “Bad news” consultation More treatment vs. no treatment1
Dealing with others2
Implications3
Symptom management Existential issues (“why me”)4
Advanced disease Hope of cure1
Ongoing burden of care2
Uncertainty – living from test to test ‘tied’ to the health care system3
Alternative/complementary therapies1
New treatments (chemo) but not offer of cure1
Legal/financial issues4
Palliative care/dying Deteriorating function – multiple
losses one after another Loss of role (effort of refashioning)1
Dependence on others (burden)2
Family/carer stress and ways of coping3
Legal/financial issues4
Management issues Sleep Nausea Pain Body image Sexuality Menopause Anxiety incl. specific phobias (needle) Depression
Useful skills Eliciting concerns Eliciting symptoms (mood) Problem solving Relaxation Sleep management “support” Prescribing
Adjustment (Disorder) Patterns of coping usually life-long They are a reflection of ‘personality’ Main differential diagnosis – mood
disorders (depression/anxiety disorders)
Grief/loss are often themes
Coping – ways of doing it Helpful Humour Family/friend networks Focus on specific
problem(s) & solution(s) Exercise Distraction (pleasurable
activity) Spiritual practices Goal setting (realistic)
Unhelpful Alcohol/drugs Avoidance Blame (self/others) Focus on emotions Too much/too little
dependence Global definitions of
problems Inflexibility Struggle for control
Mood symptoms Anxiety Agitation Return to same
issues/questions Seek reassurance Seek control Initial insomnia
(worry) Focus on negative Poor retention of new
information
Depression Loss of pleasure Waking in the early
hours of the morning Loss of motivation Preoccupation with
death Feeling a burden on
others Non-compliance/
futility
Help! Referring on
Local/generic Website1
NSW Cancer Council Support groups Local D&A and mental
health services Community health (social
workers) Relationship counselling Pastoral care
Specialist services Sexual health clinics Menopause clinics Women’s health
centers/clinics Social work services
through hospital gynae-onc centers
Sex therapy Clinical psychology Psychiatry
REMEMBER! All of this has an impact on the staff
providing care This means you
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