Psycho-Oncology (2)

This book actually probably didn’t really merit two posts, but given that I wrote a part one earlier on I felt I had to write a part two as well now that I’ve finished it. I’ve also recently read Josephine Tey’s The Daughter of Time and Agatha Christie’s Cards on the Table, but as mentioned earlier I’ve been thinking about getting rid of the fiction coverage here and so I won’t cover those here in any detail – all I’ll say is that Cards on the Table was awesome (5 stars on goodreads), and Tey was an enjoyable read (4 stars … do recall if you read it that it’s a work of fiction).

Goerling’s book is a neat little book – I liked it. It’s not super comprehensive, but it’s the kind of book that can be read without problems by both patients and their caregivers as well as doctors and other health care professionals. Many people will/would probably benefit from reading this book. Occasional talk about stuff like ‘Mindfulness-Based Stress Reduction’ and similar stuff subtracted a star or two along the way, but most of the stuff is actually quite interesting. I’ve added a few observations from the second half of the book below:

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“With the favorable trend regarding survival of cancer in the Western world, there is an increasing focus among patients, clinicians, researchers, and politicians regarding cancer survivors’ health and well-being. Their number is rapidly growing and more than 3 % of the adult populations in Western countries have survived cancer for 5 years or more. Cancer survivors are at increased risk for a variety of late effects after treatment, some life-threatening such as secondary cancer and cardiac diseases, others might negatively impact on their daily functioning and quality of life. The latter might include fatigue, anxiety disorders and difficulties returning to work while depression does not seem to be more common among survivors than in the general population. […] Today, the relative 5-year survival is 60–65 % for patients diagnosed with cancer (American Cancer Society 2012, Verdecchia et al. 2007). In Norway, cancer survivors alive ≥5 years from diagnosis represent 3.3 % of the total population (The Cancer Registry of Norway 2010). For some cancer types such as testicular cancer, breast cancer, and Hodgkin’s lymphoma, the 5-year relative survival exceeds 90 %. According to cancer types the most common survivor groups are survivors of female breast, prostate, colorectal, and gynecologic cancer (American Cancer Society 2012).”

“Treatment-related solid second cancers are usually diagnosed at a latency of 10–30 years after radiotherapy, and their development is related to the radiation dose within the target field, but also to scattered irradiation beyond the field borders. […] During the last two decades increasing documentation has emerged that cytotoxic drugs in a dose-dependent manner are carcinogenic leading to an increased risk of leukemia […], but also of solid tumors […] Dependent of their previous treatment long-term cancer survivors may develop asymptomatic or symptomatic left ventricle dysfunction, heart failure, premature coronary atherosclerosis, arrhythmia, or sudden cardiac death, most often due to myocardial infarction (Lenihan et al. 2013). Mediastinal radiotherapy and treatment with certain cytotoxic drugs (antracyclines, trastuzumab) represent well-known cardiotoxic risk factors, with clear dose–effect associations to cardiac dysfunction.” [treatment for cancer can be really bad for you, but often the alternative isn’t great either…]

“For the cancer survivor to be able to make the optimal decisions regarding own present and future health, they need information regarding the long-term health risks they face and how to best handle them. The literature indicates that today’s cancer survivors are not aware of their risks for later adverse health events […] These findings might not only relate to lacking information per se. We must also assume that the survivors have an ambivalent wish for information about future health risks.”

“CBT strives to be evidence based and much effort has been put in scientific research, including large randomized controlled studies. In patients suffering from cancer, CBT has been demonstrated to improve anxiety and depressive symptoms, self-esteem, immune functions, quality of life, optimism, self-efficacy, compliance, coping effectiveness and satisfaction, and to decrease cancer-related fatigue, cortisol levels, pain, and distress (Andersen et al. 2007; Daniels and Kissane 2008; Greer et al. 1992; Hopko et al. 2005; Lee et al. 2006; Manne et al. 2007; Mefford et al. 2007; Moorey et al. 1998; Osborn et al. 2006; Penedo et al. 2007; Tatrow 2006; Witek-Janusek et al. 2008; Wojtyna et al. 2007).”

“psycho-oncological interventions seem to influence treatment adherence, but its relevance for survival is controversial (Chow et al. 2004; Smedslund and Ringdal 2004; Spiegel et al. 1989). A systematic Cochrane review examining the effectiveness of psychosocial interventions in breast cancer patients on survival outcome showed insufficient evidence for such an effect (Edwards et al. 2008).”

“In a very impressive paper Laurie Lyckholm (2001) reports on handling stress, burnout, and grief in the practice of oncology. Causes of stress are seen in insufficient personal or vacation time, a sense of failure, unrealistic expectations, anger, frustration, as well as feelings of inadequacy or self preservations, reimbursement, and other issues related to managed care and third party payers, and last but not least grieving. Burnout can manifest itself in substance abuse, marital conflict, overeating and substantial weight gain, higher frequency of mistakes in clinical care, inappropriate emotional outbursts, interaction problems, depression and anxiety disorders, and even suicide. Lack of or inadequate training of communication and management skills are also considered causes of burnout (Ramirez et al. 1996). In a survey of 7,288 physicians in the United States, 45.8 % reported at least one of the following symptoms of burnout: loss of enthusiasm for work, feelings of cynicism (depersonalisation), and low sense of personal accomplishment (Shanafelt et al. 2012).”