Chapter 12 Flashcards
(104 cards)
1
Q
Is cancer a single disease? If no, what term does it refer to? Are the underlying processes of different forms of cancer the same?
A
> Cancer is not a single disease, but rather a term to refer to a group of more than 100 illnesses
> the basic process underlying dif-ferent types of cancer, however, is the same
2
Q
What are the underlying processes of cancer?
A
> Cell proliferation normally is stringently regulated so that new cells are created to replace damaged or dying cells.
> Mechanisms are in place during cell division to repair damaged deoxyribonucleic acid or to activate programmed cell death if the DNA damage is too extensive to repair.
> DNA damage can occur due to genetic processes or damage from carcinogens or viruses.
3
Q
What is cancer a result of?
A
> Importantly, cancer is typically a result of multiple gene mutations, and these mutations are usually acquired during the lifespan.
> When genes that regulate cell division have mutations the result is a breakdown in the regulation of cell division, leading to uncon-trolled cell proliferation
> The new tissue that develops from unregulated cell growth is called a tumour or neoplasm.
4
Q
What kind of tumors are harmful? What do they do and what systems do they go through to achieve this?
A
> Malignant tumours are cancerous.
> Cells in malignant tumours can invade surrounding tissue and spread to a distant site in the body through the blood or lymph systems in a process called metastasis.
5
Q
What kind of tumors are not harmful? Can they be removed? What do they not do?
A
> Benign tumours are not cancerous and typically are not life-threatening.
> Often, they can be removed and do not invade nearby tissue or metastasize
6
Q
The main categories of cancer are broadly classified according to what?
A
> according to the tissue in which the cancer originates.
7
Q
What is Carcinoma? Are most cancer carcinomas?
A
> Carcinoma: Malignant neoplasms (i.e., new, abnormal tissue growth) that develop in the cells of the skin or tis-sues that line or cover organs (e.g., res-piratory tract, reproductive tract). Most human cancers are carcinomas.
8
Q
What is Sarcoma?
A
> Malignant neoplasms that develop in connective tissue, muscle, or bone.
9
Q
What is Leukemia? (where does it form)?
A
> Cancer that develops in blood-forming tissue (e.g., bone marrow), causing a rapid proliferation of white blood cells.
10
Q
What is Lymphoma?
Cancer of what system?
A
> Cancers of the lymphatic system.
11
Q
Central nervous system cancer is cancer that develops in what two areas?
A
> Cancers that develop in brain tissue or the spinal cord.
12
Q
Cancer type is typically named after what?
A
> the organ or type of cell in which the cancer initially develops (e.g., breast cancer for cancer that begins in breast tissue)
13
Q
Cancer is a leading cause of death worldwide-
1. How many deaths are there?
2. What percentage of all deaths are cancer related?
A
> approximately 8.2 million (13 per cent) of all
deaths are cancer related
14
Q
In Canada, what is the leading cause of death? What percentage does this account for?
A
> In Canada, cancer is the leading cause of death, accounting for 30 per cent of all deaths each year
15
Q
Over the past 30 years the number of new cases diagnosed and cancer-related deaths have increased, mainly due to what? Are incidence rates stable? Are mortality rates decreasing? Are survival rates changing?
A
> due to the growth of the aging population (CCS, 2016).
> However, incidence rates are becoming stable or increasing only modestly, and mortality rates are decreasing, suggesting that survival rates are improving for some cancers
16
Q
What are the three most common cancers in North America?
LPB
A
> lung, prostate, and breast
17
Q
What is the most common cancer world wide? What is the most common cause of cancer death in the world?
A
> Lung cancer is the most common cancer worldwide, accounting for 13 per cent of all cancer cases
> lung cancer is the most common cause of cancer death in the world
18
Q
- When did incidence & mortality rates decrease for men and women?
- What have been the trends for incidence and mortality rates for lung cancer in men and women?
- Was there a lag in the rates? If so- what caused it?
- Which gender has higher rates?
A
- began to decrease in the mid-1980s for men but did not do so until the mid-2000s for women
- This lag is attributed to gender dif-ferences in smoking behaviour. *Decreased smoking for men in the 1960s’ but not for women until the 1980s.
- however, that men still have higher incidence and mortality rates of lung cancer than women*
19
Q
What is the most commonly diagnosed cancer among North American men?
A
> prostate cancer is the most commonly diagnosed cancer among North American men
20
Q
Is prostate Cancer a leading cause of death in NA?
(In Canada and the US)?
A
> In Canada, prostate cancer is the third leading cause of cancer death
in the United States it is the second leading cause
21
Q
What is the survival rate for lung cancer when it is localized? What percentages of diagnoses are made at this stage (localized)?
A
> the survival rate is 55 per cent when the cancer is localized, but unfortunately only 16 per cent of lung cancer diagnoses are made at this early stage
22
Q
- What is the five-year survival rate for prostate cancer in the US and Canada for all type combined?
- Does the rate every reach 100% (if so what causes it)?
- What percentage of this type of cancer is spotted in the local or regional stages?
A
- the five-year survival rate for all stages of prostate cancer combined is between 95 per cent in Canada and 99 per cent in the United States
- This rate becomes 100 per cent when the cancer is localized
- 92 per cent of prostate cancers are discovered in the local or regional stages.
23
Q
What are the incidence rates for prostate cancer (have they increased/fluctuated/decreased? Since what year if they have?
What are the mortality rates for prostate cancer? What year did the rates change?
A
> Incidence rates have fluctuated due to increased rates of cancer screening but have generally decreased since the early 2000s in both Canada and the United States.
> Mortality rates have also decreased since the mid-1990s because of the improved effectiveness of treatment.
24
Q
What is the most common diagnosed cancer among women and north american women specifically? How many cases were reported in 2012?
A
> Around the world, breast cancer is the most diagnosed cancer among women, with an estimated 1.67 million cases diagnosed in 2012
> Breast cancer is also the most commonly diagnosed cancer among North American women
25
What percentage of cancer diagnoses does breast cancer account for? Is it a common cause of cancer death for North american women?
> Breast cancer accounts for approximately 26 to 29 per cent of all cancer diagnoses
> it is the second-most common cause of cancer death among women in North America
26
1. What is the survival rate of breast cancer across all stages of the disease for five years after diagnosis in Canada and the US?
2. What is the rate for localized cancer?
3. What is the rate for cancer that has spread?
4. What percentage of breast cancer is localized?
1. 87 per cent of Canadian women and 89 per cent of American women survive at least five years after diagnosis
2. this rate is as high as 99 per cent when the cancer is localized
3. is 85 per cent when the cancer has spread to surrounding regions
4. 61% of breast cancer is localized.
27
1. Have the incidence rates for breast cancer remained stable? Since what year (if they have)?
2. When has mortality from breast cancer decreased and why has it decreased?
> Incidence rates have generally remained stable since the early 2000s
> mortality from breast cancer has generally decreased since the mid-1980s thanks to early detection and more effective adjuvant therapy after surgery.
28
Treatment for cancer involves procedures that address cancerous cells locally, such as:
> surgery and radiation, and treatments, such as chemotherapy, that eradicate cancerous cells that may have metastasized to other areas of the body where they may develop into secondary tumours.
29
What is the purpose of surgery in cancer treatment? *Why do they extract tumors?
> Sur-gical removal of tumours allows them to be examined further by a pathologist to determine how aggressive they may be and whether they are likely to respond to particular types of adjuvant treatment.
30
How many types of Cancer drugs are there?
> over 250.
31
What is chemo used for and how can it be used when it is not the main intervention?
> Chemotherapy may be given as intravenous infusions or taken orally as pills.
> Some-times chemotherapy is administered to shrink a tumour before surgery, or even pal-liatively, to alleviate symptoms associated with a tumour’s growth.
32
What makes the determination of the cause of cancer a challenge?
> the long delay between exposure to risk fac-ors, such and the onset of cancer
33
Does cancer share clinical characteristics? (Do they vary?)
> Although different can-cers share similar clinical characteristics, the causes and risk factors associated with cancers at different sites varies.
34
cancer is often the result of the interaction of various risk factors, which can include what factors/agents?
> genetic factors,
> environmental factors,
> infectious agents,
> behavioural factors, and
> sociodemographic factors.
35
1. Genetically, which people are at a heightened risk for developing cancer?
2. What type of mutations cause cancer?
3. What aspect of family history causes cancer?
1. People who carry cancer gene mutations are at a heightened risk of developing cancer.
2. can be because of inherited genetic mutations, although most cancers are due to sporadic mutations acquired during the lifespan.
> In addition, a family history of cancer, specific-ally in first-degree relatives, can confer increased risk; (they share genetics + lifestyle factors).
36
Exposure to certain environmental factors that are carcinogens can increases the risk of cancer development? What 4 types cause an increrased risk?
> asbestos, radon, and formaldehyde, can increase the risk of some can-cers
> Exposure to ionizing radiation, such as ultraviolet radiation (the principal cause of skin cancer), can increase cancer risk through damaging DNA.
37
Approximately 9.2 per cent of cancers in developed countries are attributable to infectious agents, including:
| Related to sexual diseases-
> Helicobacter pylori, human papillomavirus (HPV), and hepatitis B (Plummer et al., 2016).
38
What percentage of cancer deaths are related to lifestyle choices?
> 35%
39
What are the main lifestyle choices that increase the risk of Cancers?
> tobacco use
> smoking
> high alcohol consumption, a diet low in fruits and vegetables, lack of exercise, and obesity
40
How does age affect the risk of developing Cancer? Why does incidence change?
> the incidence of cancer generally increases with age
> the increased risk with age may be due to a combination of risk factors, including an accumu-lation of genetic mutations, a weaker immune system, and more carcinogen exposure
41
When age is controlled for, do men have higher rates of incidence for cancer than women?
> When age is taken into account, men generally have higher cancer incidence and mortality rates than women
42
Low SES is associated with increased risk of developing cancer, including which two types?
| Think of what they do (lifestyle factors...)
> lung and gastrointestinal cancers
43
What is Low SES associated with in respect to cancer?
> low SES is a risk factor for cancer mortality in general
44
What may account for the development of cancer in those with low SES?
> they have a later stage of diagnosis
> a more aggressive biology of cancer
> lower quality of care,
> differences in behavioural risk factors (higher rates of smoking/obesity for example).
45
Differences in cancer incidence and mortality have also been observed based on geography and ethnic ancestry - what cancer is common in certain geographical locations?
> breast cancer - western nations
> Asian-American women born in the United States have been found to have a breast cancer risk 60 per cent higher than Asian-American women who were born in the East
> those who had lived in the US longer had an increased risk of breast cancer, with incidence rates closer to those of White women than rates of women in their home country.
46
Geographic differ-ences in cancer incidence and mortality are believed to be due to what two differences? what biological difference may also contribute?
> due to environmental and behavioural differences, though genetic dif-ferences may also contribute
47
There are also race and ethnic diferences in the incidence and mortality of various cancers.
> For example, non-Hispanic White women in the United States are more likely to develop breast cancer than any other race/ethnicity group, but African-American women are more likely to die from the disease
48
The most consistent evidence has linked cancer incidence with what three psychological factors?
1. severe life events (e.g., bereavement),
2. extreme distress
3. chronic depression
49
Lillberg and colleagues (2003) examined whether major life events were related to increased cancer incidence in a prospective study with approximately 11,000 Finnish women- what was found about these women who experience major life events? As a result, what disorder has been linked to developing cancer?
> Women who had experienced a major life event (death/seperation) were at an elevated risk for breast cancer.
> Depression has also been linked to an increased risk of developing cancer
50
In general, the evidence linking psychosocial factors to cancer progression and mortality has been stronger than the evidence for what cancer process? Specifically, what causes rapid progression and poorer survival?
> cancer onset
> Depression, stressful life events, and social isolation have been associated
51
Cancer progression and mortality are associated with what two psychological factors?
| (socially)
> social isolation and a lack of social support
52
However, a decrease in cancer mortality is associated with what three psychological factors?
| They are postiive and social related
1. high levels of perceived social support
2. a larger network size
3. being married
53
Among those not currently married, cancer mortality appears to be differentially associated with a history of what?
> history of marraiges
> patients who were separated from their spouse at the time of their diagnosis had the lowest five-and ten-year survival rates, followed by those patients who were widowed, divorced, and never married
54
Inwhat two ways can psychosocial factors influence the initiation and progression of cancer? (What does behavioural change affect in the cancer process and what does pyschosocial factors influence in the cancer process?
> Both indirect behavioural and direct physiological pathways have been proposed.
1) First, behavioural changes (accompany psychosocial factors) = play a role in cancer onset and development
2) Psychosocial factors = influence cancer initiation and pro-gression through physiological pathways.
55
In what bodily system are stress and the immune system linked?
> Stress and the immune system are linked through the sympathetic nervous system (SNS)
56
How does the development of cancer relate to the immune system and stress? What type of surveilence does this system do?
> Chronic stressors = impair immune function
> When healthy, the immune system detects transformed cells, it attempts to destroy these cancerous cells, a process referred to as immunosurveillance
> If the immune system is inhibited and all tumour cells are not destroyed, the tumour will grow, leading to cancer.
57
How do stress hormones and immunosuppression influence cancer?
> Stress hormones can cause DNA damage, impair mechanisms for DNA repair, and inhibit programmed cell death (promotes onset and progression)
58
How does a lack of social support affect cancer progeression? (What is a specific example of specific cancer) Plus is this a physiological pathway?
> High levels of social support have been associated with lower levels of these growth factors in women with ovarian cancer,
= physiological pathway through which a lack of social support influences cancer progression
59
Cortisol, which is a significant steroid hor-mone (a glucocorticoid, produced by the adrenal cortex), has also been shown to do what to cancer cells?
> has also been shown to stimulate growth and proliferation of cancer cells
60
Negative psychosocial states, through their effects on stress hormones, have been associated with the inhibition of what bodily response?
> inhibition of the cellular immune response, thus decreasing immunosurveillance
61
Behavioural changes can be made to help to reduce what risk?
> Behavioural changes can be made to help reduce one’s risk of developing cancer.
62
What is the secondary prevention measure for Cancer? Describe what it is and how it works:
> Cancer screening is a secondary prevention measure.
> Allows us to detect it earlier, reduces morbidity/mortality as it is easier to treat and is less agressive.
63
Examples of efficacious cancer-screening tests are:
> are mammography for breast cancer, Pap tests for cervical cancer, and fecal occult blood tests and colonoscopy for colorectal cancer.
64
What are the associated harms with cancer screening?
> Can be physically harmful = perforation of the colon from a colonoscopy
> incorrectly detect absent cancer or may miss present cancer.
> False positives cause stress and anxiety.
> unnecessary follow-up diagnostic tests, can be painful and invasive.
> False negatives usually result in a delay in diagnosis and treat-ment.
65
What is ONE actual identified problem with cancer screening? What does this problem lead to?
> The issue of overdiagnosis has also been identified as a problem of cancer screening in that it can lead to unnecessary treatment
66
What screening test has been discouraged in the US and Canada? Why?
> In recent years, the use of the prostate-specific antigen (PSA) test to detect prostate cancer has been discouraged in both Canada and the United States
> due to its high false-positive rate, risk of overdiagnosis, and lack of a reduction in prostate cancer-specific mortality.
67
Mammography screening decreases breast cancer mortality by what percent? How accurate is it?
> 19 to 31 per cent
> mammography correctly identifies those with breast cancer approximately 77 to 95 per cent of the time and those without breast cancer approximately 94 to 97 per cent of the time
68
For instance, the health belief model in predicting the likelihood of getting a mammogram, considers one’s beliefs about:
> barriers to engaging in a behaviour (e.g., mammography is painful) in combination with one’s beliefs about one’s susceptibility to a condition (e.g., breast cancer),
> the severity of the conse-quences of that condition (e.g., surgery, death),
> the perceived benefits of the behaviour (e.g., a clear mammogram would provide peace of mind),
> and one’s perceived sense of self-efficacy in performing the behaviour.
69
What are the reasons for non-adherence in mammograms?
> Reasons for non-adherence include a fear of radiation, fear of pain, anxiety about a positive screening result, and lack of accessibility to a screen-ing centre
70
As treatments have improved and cancer mortality has decreased in some cancer types, cancer is increasingly becoming what?
> a chronic illness
71
A diagnosis of cancer can create a period of crisis. Major concerns for many patients in-clude:
| D,DB, DOO, DF
> death, disability, dependence on others, and disfigurement.
72
Common initial reactions to a cancer diagnosis include:
disbelief and denial of the veracity of the diagnosis
73
What are the stages of a cancer diagnosis?
> (disbelief and denial) This initial phase typically lasts less than a week.
> Patients then move to the dysphoria phase, during which the diagnosis is acknowledged. This dysphoria phase is characterized by negative affect, last two weeks.
> Finally, patients typically adjust to the diagnosis and treatment for cancer and attempt to resume regular routines.
* The quality of this long-term adaptation phase depends on many factors and varies greatly among individuals
74
Psychosocial adaptation to cancer is what kind of process?
> Psychosocial adaptation to cancer is an ongoing process that changes with the disease stage, symptoms, prognosis, and treatment
75
Coping with cancer involves the use of different coping strategies according to the nature of the...? What coping stratefies are used for existential issues and what for physical issues in palliative care?
> the nature of the stressor
> i.e., palliative care = problem-focused coping less frequently for existential issues and emotion-focused coping less frequently for physical stressors
76
Helplessness and hopelessness are associated with what?
> poor adjustment
77
The ap-praisal of cancer-related stressors is also an important factor that determines what?
> determines which coping strategies a patient will use. For example, if cancer is appraised as a threat or a challenge, problem-focused coping is more likely to be used to deal with the stressor
78
Social support is thought to have positive effects on psychological and physical health both directly, by doing what?
> enhancing health behaviours, and indirectly, by acting as a buffer against cancer-related stressors
79
Emo-tional support and, more specifically, emotional expression (i.e., having someone to talk with about cancer-related concerns) may be especially important for what?
> successful adjustment to cancer
> Emotional expression is also associated with better survival
80
Cancer is a strain on interpersonal relationships and is also stressful for the patient’s friends and family
> the patient may have to limit social activities due to treatment schedules and side effects.
> Friends and family may act in unintentionally harmful ways towards the patient, such as avoiding physical contact or open communication about cancer, because they are unsure of how to behave
81
What is cancer a major source of?
> Cancer is a major source of stress, and more severe psychological problems, such as depres-sion, can develop in patients.
82
However, depression can be difficult to diagnose in cancer patients because of what?
> because the symptoms of depression (e.g., weight loss, insomnia, fatigue) may be mistaken for symptoms of the dis-ease
83
Patients who are socially isolated and have greater physical impairment due to cancer are more at risk for what type of adjustment?
> for poor adjustment
84
Treatment for cancer has changed from being focused solely on medically managing the dis-ease to now incorporating what? Why is this now important?
> preserving quality of life + more attention has been paid to the psychological needs of patients
> this has become especially important as medical ad-vances have allowed cancer patients to live long after their treatment is complete
85
Screening is useful in that it may identify patients who do not perceive themselves to be in need of psychosocial services. Specific instruments include what?
> the Distress Thermometer, a single-item scale that de-picts a thermometer and asks respondents to indicate the level of distress that they have ex-perienced over the past week from 0 (no distress) to 10 (extreme distress).
> The Patient Care Monitor 2.0 uses 86 items to identify difficulties commonly encountered by cancer patients, including psychological distress, problems with performing their roles in life, physical prob-lems, and lowered overall quality of life.
86
A predominant belief underpinning the development of psychosocial interventions for cancer patients was that:
> the challenges that cancer presents are so disruptive that most patients could benefit from some type of psychological intervention.
> Recent research, however, has shown that those who are more distressed appear to benefit the most from such interventions
87
Current practice guidelines recommend that psychological assessment be part of an ideal plan to identify cancer patients whose psychosocial needs are likely to affect their health. None theless such screening is not yet considered what?
> is not yet considered routine in cancer care
88
many women with breast cancer will be in the position of deciding between being treated with what?
> mastectomy vs breast-conserving surgery plus radiation.
> Being offered this type of choice is helpful in allowing patients to maximize the aspects of quality of life that are particularly important to them, such as body image concerns vs worry about being exposed to radiation. However, this latitude also brings with it the burden of making a decision during an already stressful time.
89
Patients often vary in the extent to which they do what?
> they desire to share their treatment-related decision making with their physicians
90
Men diagnosed with prostate cancer may be offered a similar type of decision between what? Why do these options exsist for this type of Cancer?
> having their tumour surgically removed or treated with radiation and “active surveillance” or watchful waiting to detect signs that a cancer is aggressive or has started to progress.
> this is because most prostate cancers are not life-threatening and evidence suggests that survival time is similar for men who are treated with either radical prostatectomy or active surveillance
91
What Deciding between treatment or watchful waiting is made more arduous by the fact that the side effects of prostate cancer treatment, including impotence and urinary incontinence, are considered what?
> threatening to quality of life, and some men may consider these quite prob-lematic. However, taking no action against a tumour may also be anxiety-promoting and risky
92
What are dehabilitating side effects of cancer treatments?
> these include loss of function, disfiguration, lymphedema, fatigue, nausea, vomiting, hair loss, skin burns or irritation, mouth sores, neuropathy, and even “chemo brain,” the awareness that one’s thinking is no longer sharp
93
What do the side effects of cancer treatment cause and how long can they last?
> these side effects result in diminished body image and self-esteem; depression and anxiety; disruptions in family, marital, and social relation-ships; and occupational and financial consequences.
> The side effects or ramifications of cancer treatment may last months or even years so that ongoing support is essential.
94
Fortunately, now more than ever, a wealth of psychosocial resources are available for cancer patients through various social service and charitable organizations- They include:
> These resources assist in meeting the informational, emotional, social, and practical needs that arise during the various stages of cancer diagnosis, treatment, and recovery.
> includes: information on cancer-related treatments, peer support, counselling/psychotherapy, pharmacological management of mental symptoms, medical supplies, transportation, family and caregiver support, assistance with activities of daily living, legal services, cognitive and educational services, financial and insurance advice, benefits counselling, and financial assistance
95
Among the types of treatments that have been subjected to empirical evaluation, a major theoretical orientation has been what approach? what does it involve and what is an example?
> cognitive behavioural approach
> which focuses on recognizing and altering problematic thoughts and behaviours and on reducing negative emotions related to cancer. An example of this type of treatment involved developing effective problem-solving skills and identifying and challenging maladaptive thoughts; learning relaxation techniques; and using resources such as family and friends and pleasurable activities to cope
96
Like the CBA, what are two other positive approaches?
1) Supportive-expressive group therapy focuses on expressing emotions, generating social support among group mem-bers, and exploring existential concerns like the fear of dying (Classen et al., 2008).
2) Another type of well-researched treatment is education, which focuses on increasing knowledge and re-ducing uncertainty by providing information on topics such as treatment options, side effects, and psychosocial challenges
97
One popular type of coping assistance is provided in the form of support groups. These may be offered through organizations such as:
> Cancer Care, The Wellness Community, or through the hospitals where medical treatment occurs.
> These may be offered in person or online, and may be led by professionals such as nurses, social workers, or clinical psychol-ogists, or by cancer survivors or “peers.”
> These groups may be comprised of members with various types or stages of cancers, or may be restricted to those with a particular cancer, gender, age, or stage of disease or treatment.
98
What two kind of social comparisions do cancer patients use?
1. use downward social comparison (comparing oneself to those who are doing less well)
2. and upward social comparison (comparing one-self to those who are doing better).
99
Another type of intervention useful for many cancer patients is physical activity, including;
> aerobic exercise and resistance training.
100
In previous years, cancer patients experien-cing fatigue were encouraged to rest, take things easy, and refrain from exerting themselves. However, this strategy is thought to lead to a vicious cycle that promotes:
> deconditioning and further fatigue.
101
Interventions for terminally ill cancer patients aim not only to manage psychological distress, but also to promote coping with what?
> the end of life and fostering a good death by focusing on spiritual well-being and finding meaning in one’s life.
> i.e., the short term life review
102
What is the short term life review?
> this involves bringing to mind and sharing the important events and memories from one’s life during an interview with a therapist.
103
What is meaning centered therapy?
> Meaning-centred psychotherapy (van der Spek et al., 2014) is a new therapy based on psychiatrist Viktor Frankl’s ideas forged from his experience as a concentration camp inmate and outlined in his book, Man’s Search for Meaning.
> Such programs may be particularly valuable for advanced-stage cancer patients, for whom more spiritually ori-ented concerns may be focal, and feelings of hopelessness, despair, and even a desire for hast-ened death can prevail.
104
