Psycho-Oncology (1)

I finished Lloyd et. al, but I’ll cover that one later – I’m a bit behind on the book blogging as there are a few books I haven’t covered, but I don’t really give a crap about that right now. I might get to those books or I might not. On a related note I’ve been thinking about dropping the fiction book blogging altogether and just limit coverage of those books to whatever I can be arsed to write on goodreads.

I usually don’t find it hard to justify spending time reading a specific book – I don’t have many non-inferior ways to spend my time – but in the grand scheme of things this one was/is particularly easy to justify reading. I consider it not particularly likely that I’ll get cancer (other causes of death are statistically much more likely, and many of them can be expected to kill me before, say, those prostate basal cells start acting up enough for me to get a cancer diagnosis), but assuming I’m still alive in a decade or so there’s a high likelihood someone in my family and/or social circle will have gotten cancer in the meantime. When that happens, it’s probably a good idea to have read a book like this. At least it can’t hurt. I should note that although I did not know this when I started out, some of the observations in the book are quite relevant to areas outside the cancer setting. For instance I behaved like a jerk towards a good friend last week, and I’d have at least to some extent decreased the likelihood of behaving in such a manner if I’d read and taken to heart the remarks on how to optimize communication strategies included in chapter 3 of this book before that specific social exchange took place.

On a related note, “Those who suffer from depression tend to withdraw from friendships and relationships, causing loneliness and isolation. Maintaining networks of family and friends may prevent this from happening.” This quote is actually from Lloyd et al. but I figured I should include it here; as that book also makes clear, the mental health profile of people with chronic diseases like DM is somewhat complicated and I’m not sure how to categorize my current state of mind, but there are some depressive thoughts there and I’m really trying to remind myself of stuff like this these days. Yesterday I went to the chess club despite having absolutely no desire to go at all, and today I went to a Mensa meeting for the first time in a few months – not because I wanted to, but because my social interaction patterns over the last few weeks in particular have been deeply problematic (i.e., I have had pretty much no social interaction).

Anyway, enough blather – below some observations from the first half of the book:

…

“Several meta-analyses and large multi-centre studies have shown that, during the time of cancer diagnosis, about 30 % of the patients suffer from a mental health condition (Mitchell et al. 2011; Singer et al. 2010, 2013a; Vehling et al. 2012). Less is known however about the course of those conditions during the cancer trajectory. Available evidence suggests that their frequency does not decrease considerably over time (Bringmann et al. 2008).
Known risk factors for mental disorders in cancer patients are pain, high symptom burden, fatigue, mental health problems in the past and disability […] There are no consistent correlates of depression in cancer patients (Mitchell et al. 2011).”

“Vocational rehabilitation of cancer patients differs remarkably between countries. For example, while in Scandinavia about 63 % of all patients returned to work after a total laryngectomy (Natvig 1983) and 50 % did so in France (Schraub et al. 1995) only 11 % could return in Spain (Herranz et al. 1999). Predictors of successful return to work are flexible working arrangements, counseling, training and rehabilitation services, younger age, educational attainment, male gender, less physical symptoms and continuity of care (Mehnert 2011).”

“Although the data reviewing sex and/or gender as a primary variable in cancer is quite limited there is a body of literature that is highly informative and is worth a brief review. As it relates to psychological distress, women report more psychological distress overall than do men. This information has been confirmed by many international studies using a wide variety of screening instruments and in diverse cancer populations […] In terms of willingness to report vulnerabilities based on gender, women do report more requests for help (Merckaert et al. 2010) and accept more help (Curry et al. 2002)”

“Pistrang and Barker found that male partner support (high empathy and low withdrawal) plays a pivotal role in the woman’s adaptation and psychological well-being (Pistrang and Barker 1995). […] in a large study of caregivers, Kim et al. (2006) reported that female cancer patients felt that their male partners were very supportive when it came to practical tasks but that they did not provide the emotional support that was so important to them. In essence, men were much more comfortable with demanding and ongoing practical and physical tasks than with the emotional components of the experience. This misalignment has significant implications not only for couples but whenever men and women try to support and connect with each other during times of stress or crisis. […]

“One of the well-documented gender differences found in the literature is the stress response. When under stress, women have been shown to reach out to others and to ‘‘tend and befriend,’’ (Taylor et al. 2000) as an initial response to control their sense of danger and fear. Women feel secure in reaching out to others when trying to manage the stress associated to their vulnerability and do not experience any diminution of self-esteem by asking for help. […] Unlike women, men may experience a sense of diminished self-esteem by sharing their vulnerabilities with others. Although women are adept at prospectively sharing their emotional concerns to reduce their immediate sense of threat, it is only in retrospect that men are generally comfortable sharing their fears and concerns with others, once the sense of threat is reduced to manageable levels. The ways in which many women and men manage their vulnerabilities (women seeking emotional connection and men seeking space and time to think) have significant implications within the context of caregiving. […] when people are under stress they are more likely to revert into their habitual behavioral patterns. In essence, they become more like caricatures of themselves. There are some common behaviors that men and women produce in different frequencies that are generalizations (to be at least considered but never assumed) in the clinical setting.”

“although women are still the primary caregivers for seriously ill family members, men are increasingly taking on the role as primary caregiving role from 25 % in 1987 to 39 % in 2004, (Kim et al. 2006, 2007).”

“There is growing evidence that early integration of palliative care—several months prior to death—not only reduces distress and improves quality of life, but also decreases health care utilization and lastly costs (Temel et al. 2010, 2011; Zhang et al. 2009). Evidence seems to be sufficient for the American Society for Clinical Oncology (ASCO) to recommend early palliative care as best practice in some cancer diagnoses (Smith et al. 2012).”

“Anxiety […] plays an important if not dominant role in symptom perception and expression especially in pain. It is well known from multiple studies in neuropsychology and -physiology that uncertainty and pain are directly linked (Brown et al. 2008; Yoshida et al. 2013).”

“The lack of a common metric makes it difficult to precisely assess the extent of psychological impairment among cancer family caregivers, and the subgroup of caregivers who are at greatest risk; however, it is noteworthy that, across almost all metrics, caregivers consistently have anxiety, depression, and psychological distress rates two or more times that of the general population (Kurtz et al. 2004; Grov et al. 2005; Grunfeld et al. 2004; Northouse et al. 2001; Williams et al. 2013). The lack of precision in the research literature around caregiver psychological impairment in no way obscures what is undoubtedly a major burden for cancer family caregivers. Several studies which concurrently measured psychological impairment in patients and family caregivers, found the family caregivers had higher rates of impairment than the patients with cancer (Braun et al. 2007; Kim et al. 2005; Matthews 2003; Mellon et al. 2006).”