Psychosocial problems tokyo final

Pat Fobair, LCSW, MPH Supportive Care Program Cancer Center, Stanford University Hospital  1) Describe key psychosocial problems  found among cancer survivors in multiple settings during the past 25 years: distress, depression, fatigue, cognitive changes, body image, sexual dysfunction 2) Discuss four effective interventions for improving mood and returning survivors to a sense of inner control: physical exercise, group support, journal writing, yoga, meditation, and imagery  Literature search of English language abstracts and databases, 1980-2006  International studies, using standardized measures, re: psychosocial problems that trouble cancer survivors following diagnosis and treatment  Intervention research re: physical exercise, group supports and journal writing     Distress (25-62%) Depression (1638%) Energy loss/fatigue (30-76%) Cognitive changes (20- 45%)    Body image (2570%) Sexual satisfaction (36-67%) Sexual problems (45-88%)      20% (77) Faller et al 2003 Psychother Psychosom Med Psychol (Brca) Germany 25% (46) Flatten et al 2003 Psychother Psychosom Med Psychol (Surgical tumors) Germany  37% (303)  38% (2776)  40% 29% (246) Kissane et al 2004 Aust NZ J Psychiatry (Brca) Carlson et al 2004 Br J Cancer (All ca) Canada t1(127) Mehnert & Koch 2006, 33% at t2, Psycho- Bodurka et al 2000 Gynecol Oncol.(Ovarian)USA  47% (135) 2001 Psychooncology,(All ca)USA  62% (136) 35% (4496) Zabora et al 36% (367) Lam et al 2005 Cancer (Brca) China oncology (Brca) Germany Cliff & MacDonagh BJU Int 2000 (Prostate) Britain Tagay et al 2006 Qual Life Res May;15(4) 695(Thyroid) Germany  In, Spiegel, D and J Giese-Davis (2003) "Depression and cancer: mechanisms and disease progression." Biol Psychiatry 54(3): 269-282,  Spiegel and Giese-Davis estimate depression rates among cancer populations to be between a fourth (25%) and a third (33%) of each group     16% (127) Mehnert & Koch 2006 Psychooncology Jul 19; epub, (Brca,)Germany 18% (403) Fobair et al 1986 J Clin Oncol May 4(5): (HD) USA + 18% Tagay 2006 21% (246) Bodurka-Bevars et al 2000 Gynecol Oncol USA 22% (156) Zhou et al 2005 World J Gastroenterol China  25% (1,011) Sawhney et al 2006 ASCO (All ca) USA  27% (299) Korfage et al 2006 BrJCancer(Prostate)Netherlands  33% (147)  35% (217) Sarna et a; 2005 Tercyak et al 2006 Psychooncology (Brca) USA Oncol Nurs Forum Lung USA  37% (303) Kissane et al 2004 Aust NZJ Psychiatry (Brca)  38% (60) Pelletier et al 2002 J Neurooncol.(Brain) Canada  In study w/5,736 Lymphoma and leukemia pts vs 2565 sibling controls found that survivors were signif more likely than controls to report symptoms of depression and somatic distress Zebrack et al 2002, Pediatrics USA  In study w/1,101 adult survivors of childhood brain cancer and 2,817 controls found that survivors reported signifi higher global distress and depression scores than siblings Zebrack et al 2004, JCO USA  154 Brca pts assessed for emotion regulation and adjustment over pts time 12 week Interv 54 group, 56 decliners, 44 control At mo’s Interv.pts.+ better emotional well-being & at 12 mo’s + decrease in emotional suppression = showing delayed impact Cameron et al 2006, Psychooncology, New Zealand  151 Brca pts, week interv.,46 completed study Group had fewer problems with mood and +higher scores vigor vs controls Fukui et al 2000, Cancer Japan  151 Brca pts, week interv 46 participants, Interv group = lower scores for loneliness, and higher scores number of confidants vs controls Fukui et al 2003, Oncol Nurs Forum, Japan  134 Ca pts offered 10 weekly hour groups in 10 cities in Switzerland QL assessed x QL improved in anxiety (p=0.0005), depression (p[...]... 104 Brca pts compared with 102 control over two years found cognitive dysfunction improved in most patients over time Fan et al 2005 JCO Canada    25% of 187 Brca pts treated for benign tumors felt problems w/body image Bukovic et al 2004 Coll Antropol.Croatia 45% of 98 Brca pts felt differences in body image, 1-5yrs after breast conservation surgery Bukovic et al 2005, Onkologie Croatia 46 % of...  50% of 98 Brca w/br conserv surgery = dissatisfied w/sex life after treatment vs 27% before Bukovic et al 2005, Onkologie Croatia  52% of 360 Brca pts, all stages, 0-7 months post diagnosis, w/sex problems Fobair et al 2006, Psychooncology USA  56% of 139 Brca pts 5 years post treatment w/ lack of sexual desire Bloom et al 2004, Psychooncology USA  56% of 108 Brca pts w/mastectomy & adjuv treatment... w/ED  Potosky et al 2000, JNCI USA 85% of 1236 men w/prostate ca 4+ years & w/ rad’s or surgery w/ED (36% before) Schover et al 2002, Cancer USA  88% of 127 men w/prostate ca & prostatectomy reported problems w/ ED at 4+yrs (31% before) Korfage et al 2005, Int J Cancer The Netherlands    Physical exercise improved mortality risk, physical energy, mood, vigor, and sexual functioning Group Support,... well-being & at 12 mo’s + decrease in emotional suppression = showing delayed impact Cameron et al 2006, Psychooncology, New Zealand  151 Brca pts, 6 week interv.,46 completed study Group had fewer problems with mood and +higher scores vigor vs controls Fukui et al 2000, Cancer Japan  151 Brca pts, 6 week interv 46 participants, Interv group = lower scores for loneliness, and higher scores number