Psychiatric management of patients with head and neck cancers

Dr. Arun Kumar Pandey

MBBS, MD[Psychiatry] DAFE,PGDGC. MBA[Hospital Mgt.]

2.15 PM ---- 25/03/2012

Cancer
Diseases in which abnormal cells divide without control and are able to invade other tissues, spreads through the blood and lymph systems.

One of the most feared of diseases ; 100+ Cancer types ;

Understood as unpleasant and slow way to die Distress in patients, family , caregivers, professionals Psychological and Social problems more common
Pain Finances Childcare Nausea Employment Family Fatigue Housing Spiritual doubts

Patient may develop psychiatric illness

Can be minimised by well-planned care.

Biopsychosocial model of Illness

Hazard Illness (well-being)

Psychosocial Factors Attitudes Behaviour Quality of Life

Challenges to cancer patients

Keep active

Keep independence

Accept cancer ; Seek / understanding medical info and support

Coping with Illness and treatment related issues.

Regulate emotions and Manage stress ; Maintain positive outlook

Psychological Consequences
Elizabeth Kubler Ross In Late 60s gave 5 stages in coping with loss.

Shock & a period of denial ---- anger--- bargaining--- despair ---acceptance.

Distress

Delay seeking help

Fear

Increased somatic complaints

Pain Fatigue Breathlessness

Adjustment Disorder commonest ; Depressed / Anxious;

Neuropsychiatric complications / Increased risk of suicide in early (other) stages / Reduced QoL

Distress
An unpleasant emotional experience of a psychological, social, or spiritual nature.

May interfere with a patient's ability to cope with cancer and its treatment.

May be related to
-Fear of cancer -Fear of treatment and outcome

-Fear of treatment disfigurement

-Practical problems/ Family/ Emotional / Spiritual Vulnerable Sadness Fear Depression Anxiety Panic Isolation Crisis

Risk Factors for Psychiatric Disorder

Patient sources View about Illness Coping style Available & perceived support History of psychiatric disorder View about Treatment & medical care Cancer sources

Limitation of activity Disfigurement Poor prognosis Treatment sources Isolation Disfigurement Side effects and cost

Akechi T et al. Psychiatric disorders in Cancer Patients : Descriptive analysis of 1721 psychiatric referrals at two Japanese cancer centre Hospitals. J JC O. 2001;31(5):188-194.

Care for Cancer Patients

Issues : 1. Patients can be distressed due to non-cancer related issues.
2. Psychological care overlooked by medical focus on treatment. 3. Psych. care can be delivered even in Primary Care; Staff need skills

Good case managers needed

Active screening esp. for Depression and Anxiety

Improve survival (time) Benefits QoL

Psychological Care for Cancer Patients

PRIMARY CARE Multidisciplinary skills

Individually agreed collaborative care

Regular liaison with units / agencies Local training SPECIALIST UNITS Sensitisation Training in psychological aspects for the primary treating staff. Regular review of treatment plans Understand at risk stages Specialist nurses, psychiatrists and psychologists Self-help methods and specialist agencies

Specialist Treatment
Problem solving discussions ; Joint / Group / Family Therapy.

Persistent / severe distress -- Refer to Psychiatry / Psychology Deptt.

Cognitive Behavioural Therapy (CBT) of psych. Complications / to cope with Illness/ treatment related issue

Antidepressant Drugs & supportive treatment

Others

Success Rates for the Treatment of Common Medical Disorders

Disorder
Mental Health Panic Bipolar Major depression Schizophrenia OCD Cardiovascular Arthrectomy Angioplasty 52 41 80 80 65-80 60 60

Treatment Success Rate (%)

THANK YOU