Psychosocial aspect of Cancer

Question 1

What are the different aspects of a disease that psychosocial factors can contribute to?

Answer 1

Onset
Progression
Recovery
Including compliance and adherence to treatment

Question 2

What different aspects of cancer can psychsocial factors affect?

Answer 2

Cancer risk, detection and survival
Interact with internal (genetics, hormones) and external factors (viruses, toxins)

Question 3

What demographic features that affect cancer progression/risk?

Answer 3

Ethnicity
Country of residence
Socioeconomic status

Question 4

Give some examples of the influence of demographics on cancer rates?

Answer 4

White - malignant melanoma more common
Japanese - stomach cancer

Question 5

Explain how demographic factors affect cancer stats

Answer 5

Low SES - higher cancer risk
Exception - myelonoma in high income more common - sun exposure in holidays.
Differences in ethnicities, SES and residence - tends to relate to lifestyle variances aka dietary preferences

Question 6

What behavioural risks are highly associated with cancer?

Answer 6

Smoking - lung, oral and oesophageal
Diet
Sexual behaviour
Alcohol use - oral, pharynx, larynx and oesophagus.

Associated with increased incidence and progression (aka mortality rates).

Question 7

How does diet relate to cancer risk?

Answer 7

Diet related in 1/3 cancer risk
Diet includes poor nutrition, limited physical activity and obesity.
Assoaciated with bowel, breast, womb and oesophagus cancer.

Question 7

What are the different delay behaviours related to cancer progression?

Answer 7

Delay in seeking diagnosis or assistance when experience cancer symptoms
Delay in attending screening programmes.

Question 8

What are the four different aspects of patient delay when help seeking?

Answer 8

Appraisal delay - deciding if symptom serious or shows illness
Illness delay - decide is illness require doctor
Behavioural delay - making the appointment
Schedule delay - time between booking and attending appointment (Caner referall pathway trys to reduce this)

Question 9

What are some psychosocial reasons why patient may show different delay behaviour?

Answer 9

Culture - attitude towards illness, resilience and medical attention
Cultural capita - worthwhile attending doctor, what power to influence own life, access healthcare services that are good quality.
Age - normalisation of illness and symptoms
Personality - attitude towards health and help seeking,

Question 10

What are the key psychological risk facotrs for cancer incidence and progression?

Answer 10

Stressful life events
Locus of control (belief of self responsibility for health) and personality factors
Coping and adjustment to illness
Psychiatric diagnosis
Repression of negative emotions.

Question 11

How does stress influence cancer initiation and maintenance?

Answer 11

Some adverse childhood experiences such as parent death - chronic stress - inc risk of developing cancer.
Affect progression through modification of the immune system - reduce NK cell and cytotoxic cell function - less destruction of cancer cells.
Stress induced Th1 to Th2 shift - allows more viral replication - increase tumour promotion.
May extrapolate backwards to maladaptive coping mechanisms such as smoking - behavioural cause.
Inc incidence and progression in animals such as mice, in human only secure link is progression.

Question 12

What is the relationship between attitude to cancer and cancer outcomes?

Answer 12

Positive attitude - not effect on recurrence and survival rates.
Improves coping and wellbeing - better QoL.
Patients often believe positive attitude achieved remission and stress brought reoccurrence on (although no evidence that stress causes development).

Question 13

What is the relationship between personality and the initiation of cancer?

Answer 13

Certain personalities may be considered cancer prone - cooperative, unassertive, patient and accepting external authority - succumb to diagnosis and mortality
Type C - stoic, perfectionism, over agreeable risk for initiation and progression of cancer - inc delay behaviour and inc chronic stress.
All are associations not causative.

Question 14

What is the link between personality and cancer progression?

Answer 14

Personality does affect cancer progression.
Overly polite, passive - faster progression of cancer - underplay symptoms, slower treatment.
Anger about diagnosis associated with better prognosis - more engaging in treatment, in locus of control
Fighters and deniers have better outcomes that accepters and helpless.

Question 15

What are some common psychological responses to cancer diagnosis/treament?

Answer 15

Anxiety, depression or PTSD
Likelihood of disorder influcned by medical factors - type and severity of cancer
Also individual factors - age, support, psychological history
The risk of a patient developing psychosis is explained in the vulnerability-stress model - all have pre-existing vulnerability (a size bucket), exposed to stress - more vulnerable (smaller bucker) with less adaptive coping (no pump out of bucket) more likely to have psychosis(water overflow from bucket).

Question 16

What are the different stages in the experience of cancer?

Answer 16

1. The recognition/exploratory stage - recongise symptoms and diagnosis
2. The climax stage - anxiety, depression, changing relationship - the emotional, cognitive and behavioural upheaval
3. Adapatation/maldapatation stage - after initiation of treatment
4. Resolution/disorgansiation stage - long term sequelae

Question 17

What is the relationship between cancer and depression?

Answer 17

Depression associated but no causative link with cancer incidence and mortality
Reciprocal link to progression and severity.
Prospective study shows depression history can inc risk of certain cancers
Depression is sig in cancer progression, higher morality in patients with mood disorders developed post diagnosis

Question 18

How does depression and anxiety influence patient compliance with medication?

Answer 18

Depression - non compliance
Anxiety - less studied, may improve compliance
Optimism - improves adherence (converse to anxiety)

Question 19

How does depression impact cancer survival?

Answer 19

Not a significant influence on disease progression.
Mortality higher in depression groups.
Shorter survival times, most prevalent in older age groups.

Question 20

What is the bi-directional relatinoship between depression and cancer?

Answer 20

Links to physiological and behavioural mechanisms
Depression - neuroendocrine and immune changes, lifestyle factors - contribute to cancer progression
Cancer - worsen or contribute to depressed mood - increased vulnerability.

Question 21

What is the diagnostic issue with depression and cancer?

Answer 21

Cancer and its treatment side effects can mimic depression - fatigue, insomnia, reduced appetite, cognitive impairment.
Suicidal thoughts in depression and states of demoralisation (as seen in cancer diagnosis)
Cancer related depression is distinguishable from priarmy depression as tends not to have core depressive thoughts such as guilt and self-dislike.

Question 22

What factors pre-dispose someone to maladaptive coping?

Answer 22

Medical and demographic facotrs - age, gender, diagnosis, treatment
Influences……
1.Disease related factors - pain, proximity to death, stage of disease
2. Psychosocial factors - support, attachment security, self esteem, spirituality and religion
1+2 influcne each other
All influcnes continuum of depression - from nonpathological sadness to adjustment disorder to subthreshold and major depressive episodes.

Question 23

What factors make a cancer patient more likely to commit suicide?

Answer 23

Male gender
Age >65yrs
Specific cancer - prostate, lung, pancreatic, head and neck
Specific period - 1yr after cancer diagnosis

Question 24

How does depression/suicide idealisation present throughout a cancer patients journey?

Answer 24

All stages - suicide thoughts give sense of control over illness, may have method in mind
Remission with good prognosis - serious suicide thoughts indicates serious psychosis, irrational and should receive aggressive treatment often hospitalised
Poor prognosis and poor symptom control - thoughts appear rational, request physician assisted sicide, require evaluation for treatable depression, investigate QoL and comfrott, usually diminish with increase symptom control
Terminal stage - often poor QoL, hopeless, depressed, often request euthanasia.

Question 25

How does patient cognition around caner impact their coping strategies?

Answer 25

Influenced by appraisal of cancer, how stressful we find it.
Percieved as threat or challenge - problem focused coping - seek support, info and accept responsibility for health
Percived as harm or loss - maladaptive or avoidant - denial, wishful thinking, substance use.
Out appraisal is influenced by external and internal factors.

Question 26

How is coping style a risk factor for cancer maintenance and initiation?

Answer 26

Expression/less suppression of emotions, fighting spirit or denial around diagnosis - tend to have longer survival
Hopelessmess or stoic acceptance tend to have shorter survival.
Toxic positivity - ‘fighting cancer’ - not related to cancer progression.

Question 27

What is important about the way medical fields communicate with patients about cancer?

Answer 27

Avoid clinical and social taboo - ‘growth or the big C’
Euphemisims cause concern in patient - doctors concealing diagnosis, scared for me, lack of understanding
Negative attitudes towards cancer from all stakeholders mean communication is emotionally complex
Doctors often perceive cancer patient QoL as lower than the patient.
Patients often have a desired for more information about a terminal illness than doctors anticipate.

Question 28

Should psychological interventions be available for cancer patients?

Answer 28

Yes
Reducing chronis stress and depression - improve immune system ability to cope with cancer - decrease progression
Enhance adaptation - improve QoL and secondary disease outcomes, but not affect survival
Provides psychosocial care
Recommend counselling, mindfulness and support groups.

Question 29

How does psychotherapy help people with cancer?

Answer 29

Decreased depression
Decreased pain
Improved family function
Improved ability to function in early-stage cancer.
Increase QoL - in adherence hence survival

Question 30

How does psychotherapy reduce side effects from cancer treatments?

Answer 30

Overrides classical conditioning - particularly anticipatory nausea and vomiting associated with chemo drugs
Where health care facilities or staff become the conditioned stimulus

Question 31

Why is social support important in cancer patients journey?

Answer 31

Enable health protective behaviours
Less avoidance/delay behaviour
Promote positive outlook on progression - reduce psychiatric illness.
Healthier lifestyles and healthcare utilisation.
Influcnes onset and progression - lower mortality,

Question 32

What are some barriers to cancer screening?

Answer 32

Invasive screening - embarrassed or uncomfrotable
Misconceptions around asymptomatic and purpsoe of test
Lower socioeconomic group, trans, ethnic minority - structural barriers to attendance.

Question 33

What are the main psychosocial factors affecting aspects of cancer care/progression?

Answer 33

Demographics
Personaility
Coping stratergy
Psychosis - depression and anxiety
Social support
Behavioural risk
Stress
Delay behaviour