Summary of first 9 lecture part 1

SUMMARY PART 1

 

Hi DR Ryan here, medical oncologist , PROFESSOR, RETIRED COLONEL AND CANCER SURVIVOR and this is when tumor is the rumor and cancer is the answer. THIS IS first of two parts of a summary OF OUR FIRST 9 WEEKS TOGETHER SO I WILL TAKE QUESTIONS AS NEEDED and take them as we go along as the division into two parts will give us more time

We first covered the only set of attitudes that work to improve the quality of life and perhaps even survival because of all the spin off benefits of being more engaged in your care. We also embraced the mind body connection that is not to be denied for all of us. Quality of life improves when attitudes and knowledge improves , anxiety diminishes and most likely so does odds of survival. So listen up,

 

 

There is no grand mystery to the ingredients to be happy no matter what the circumstances but when we have a cancer or a loved one does we tend to panic and forget them when we need them most

 

But if there was ever a time to do so- get real friends close , it is when you are in the worst times , your quality of life largely depends on you and who you surround yourself with.

Equally true is that the mindset, the lifestyle with which you embrace the disease has immense impact. Repeatedly, I have seen families and patients have meaningful improvement in handling the gamut of emotions that occur from rumor of tumor to cancer as the answer when they affect a simple yet profound attitude.

There is good news. Being with those you love

.. Doing so pays for itself. It is its own reward and doing so with those you love is one of the greatest rewards of all

The more you can nourish and sustain yourself in the company and care of those who love you and whom you love, the better

 

. Again the suffering is not to be alone and rarely are you.

SO       GET INFORMED

 

We are hard wired with a blueprint to happiness, a map to finding peace and serenity and we lose our way most when we are most afraid but I assure you the hardwiring and map are there

Beware pretenders and offenders to common sense when it comes to treatments just as you would beware magical promises of cancer cures.. Beware internet promises, rumors, well meaning totally uniformed family or friends, anecdotes, Dr. Google without discernment , unproven therapy, things that seem to be too good to be true and promises of magical cures. Demand high caliber proof  and multisite corroboration with strong statistically valid controls over any new claims of Uncles Joes Kickapoo Joy Juice

. Look to the experts first and foremost,, those who have dealt with folks in your situation hundreds of time and draw on knowledge of folks like you thousands of times and who have been studied in controlled scientifically proven manners. Although you are in charge, do not ignore the VALUE OF THE ultimate truism that you are co captain of your ship

.

. .. Have a purpose in your life when things are dark, a laser focus to get knowledge to kill anxiety born of ignorance. Have a direction

Add productivity...  Don’t just sit there. Be engaged and active in your team. Do not let things happen to you. Be involved.  Be productive in your therapy and in your life- never never ever underestimate the profundity of this

. God made you as the only being truly capable of creativity. It keeps the flame alive. It matters not what it is but make something else other than your misery. You will be amazed at the power of doing so

Be gentle with yourself , there is no timer on your tempering your emotions so move your mind deliberately in the right direction but move

Remember being productive and creative are best pals, they go together. Remember all these things fit together in a wonderful  way …let them

Next is forgiveness giving it gets more then you give-including to yourself. Unpack those bags of a guilt trip

 

Forgive yourself for whatever you may have done to assist this cancer like smoking, alcohol, obesity no exercise and so on . You will tend to feel guilty about many things sometimes. Drop that in the crapper where it belongs and stop the behavior and move forward and do not surround yourself with those who have bad behaviors . Forgiveness of self is mighty powerful when sometimes, not always , it is needed

Laugh at yourself. Humor is a fantastic treatment especially when we look to it early and always.

 

. Never forget the power of music,

Stay active. Fight the weariness. Exercise because it changes not just attitude but response rates and possibly survival. There is more than observational data on this, there is a scientifically explained basis similar to the runners high and the heightened immune system of someone in shape versus a slug. Exercise helps

. Do simple sweet things that bring back fond reminiscences

Remember,. Life is not pain free, especially emotionally and psychologically, pain will happen. Embrace it but do not dwell on it . You will get burned, roll with it and remember the fear of pain can be many times more disabling than the pain itself.

Remember a lot of the non physical pain is a choice, a hard one to be sure, but a choice and choosing mindfulness and positive attitudes towards real body pain due to the cancer or how the therapy can make a difference as well.

Things ranging from hypnosis, to acupuncture, meditation, yoga acupressure massage, and in some cases even pot,( but there is a lot to say about that and it is no panacea at all) all can  assist and even lower needed pain medications and can work

 

Remember you are not in this alone . Others have gone through similar experiences, talk with them in the chemo suites, the waiting rooms, with the nurses, the support groups you should be in/ family friends in most cases but especially those who have travelled the road before you, or are on it now.

 

There is immense power in the connection  that we in cancer medicine, with powerful friendships can form.

If you are open, you probably have a boatload of those capable of rowing a similar boat to the one you are in . You are not alone. Attitude  can bring a better aptitude of how all this treatment goes and as I have said many times…the data  show it in quality of life and remission duration and even survival.

Common sense and life all show that you are not alone . So…. Despite all the weightiness, the sorrow, the guilt , the fear of loss on control and dignity, set the table of your heart and mind with help from others in a beautiful way and bon appétit

 

Now that we have reviewed attitude let’s talk about autonomy

 

You are the center of all your care and you are the co captain of your ship. Remember, your doctors degree, MD, does not mean magnificent demagogue.

I am sure you are familiar with our opening song   from chariots  of fire. A man has a plan and in a day it is crushed…… so it is when you have been told you have cancer ,thoughts of loss of control, soul sucking anxiety, what about your family and the list goes on as it hits  you like a ton of bricks.

In the film he rose above it  …he took control… and so you too will be a hero ………I have seen no exception… no matter how afraid you are, and control is what we are going to talk about today … your AUTONOMY when first diagnosed and through your course of therapy.. What works?

The supreme court said so a long time ago and more than once

 

You need this next topic, autonomy, as part of your repertoire of thinking when suspected of cancer all the way to whatever end.

 

 

 

 Autonomy may come naturally to some but usually not

 

How to achieve being the co captain of the ship as much as possible when diagnosed…. Yes , that seems impossible when everything turns to crap and you are most scared

 

What works?

Trust me you need this…

 

Autonomy.

It is something you must do, something you must demand, ……autonomy.

 

Your quality of life and those that love you will increase dramatically, so will your response to therapy because you are more in tune with your disease, your therapy and your options and……. Your physician is on notice as is the whole team that it is a team effort , you are co captain of your ship;;;

 

Autonomy….so what does it mean especially in oncology

 

This is the single most important word and concept the reader of my book or listener to this show must grasp. Philosophically, it refers to the fundamental principle that all humans are independent moral agents with the personal capacity to make moral decisions and act on them.

In modern days, autonomy most often equates with the phrase, self-determination. Individuals are autonomous when their actions are truly their own without coercion or inappropriate influence.

The final decision of the competent adult is theirs.

Thus, patient autonomy refers to the capability and right of patients to control the course of their own medical treatment and participate in the treatment decision-making process.

Physicians and their teams must fully inform their patients to the best of their ability and the best of the patients’ ability to understand. Health care providers lead the patient to intelligence. However, it is the patient’s job, once lead, to think..

God gave you the gift of choice and the greater gift of sufficient intelligence to make those choices if you are sufficiently informed. That is exactly what I am and the show and the book are attempting to do; inform. That is why this section appeared early on.

 

So empowered , you will be able to transform the pain of anxiety, which is fear of the unknown , into the hero producing powers behind fear which are a god given hard wired set of emotional, physical and intellectual responses that can and do lead us to wise, autonomous personal decisions

It is improving with the advent of integrative medicine and the advent of patient centered care  See comment in PubMed Commons below

The medical practice of patient autonomy and cancer treatment refusals: a patients’ and physicians’ perspective.

The idea that patients should take up an autonomous position in the decision-making process is generally appreciated.

However, what does patient autonomy mean in the case of patients who refuse a recommended oncologic treatment.

In contrast to what is generally believed, decisions of patients to refuse an oncologic treatment do not so much rely on the medical information about disease and treatment options, but are rather inspired by patients’ own experiences or those of close others…or Dr Google. You would be amazed  .

In certain unique circumstances government may have the right to temporarily override the right to bodily integrity and autonomy in order to preserve the life and well-being of the person.

 

Such action can be described using the principle of “supported autonomy”,[13] a concept that was developed to describe unique situations in mental health (examples include the forced feeding of a person dying from the eating disorder anorexia nervosa, or the temporary treatment of a person living with a psychotic disorder with antipsychotic medication).

While controversial, the principle of supported autonomy aligns with the role of government to protect the life and liberty of its citizens. But even then there is some debate…. I fall on the side of government

How about when the disease approaches a terminal phase Perhaps autonomy should have been the guiding principle long before this transpired in case it came to pass and thus avoid ethical quagmires, distressed next of kin and playing god

Medical and social attitudes toward cancer have evolved rapidly during the last 20 years, particularly in north america.1,2 most physicians, most of the time, in most hospitals, accept the ethical proposition that patients are entitled to know their diagnosis.

However, there remains in my experience a significant minority of cases in which patients are never informed that although informed of the diagnosis, are not informed when disease progresses toward a terminal phase..

There are cultural and family differences..

Korean-American and mexican-american subjects are more likely to hold a family-centered model of medical decision making rather than the patient autonomy model favored by most of the african-american and european-american subjects. This finding suggests that physicians should ask their patients if they wish to receive information and make decisions or if they prefer that their families handle such matters.

Nonetheless, You, the patient, are the co captain of the ship. You have a responsibility to know the sails, the keel, the rudder the rigging, the set of the sails, the heading the clinical trials you have been taught about and demanded to know about or learnt how to responsibly find out about trials, You are a co expert on you

It is your body

No your are not an MD but you are a MD on your person in a large sense with your own personal doctorate, not just another case or person with a disease

Think of it.

You make autonomous decisions everyday, where and how you live, what you buy, a new car a mortgage, planning for you or your children’s future,

We are wired with free will and its exercise is manifested in autonomy, not arrogance and  not idiocy ,,,autonomy.

Just like in school,,, the more you know the smarter you get and you progress and the less the anxiety…and it is infectious to those around you

Believe it or not most physicians in oncology love the appropriately autonomous patient , they are partners with you when there are no right decisions as well as when there is . They can unburden themselves and you from the sense of playing god and being the only one in the know which will happen naturally because of their superior training often enough

But rarely are patients so intellectually challenged that they cannot grasp major decisions and make them together with their doctor ,,,

Caretakers are consultants but are not the patient

They are invaluable but are not the patient

They are loving but are not the patient

This is your life and you are dying to live not living to die….

Act like it

You will be more in touch with your signs and symptoms

You will actually trust yourself more and your doctor,

Your will handle therapy better and not surrender yourself into hands you do not know ,

Dying to live not living to die…..   Autonomy

Anxiety

 

Anxiety and fear

It is anxiety that is the killer, NOT FEAR. We humans suffer most when not knowing all that needs known, especially when there is so much to fear. Anxiety is fear of the unknown

Anxiety is not abnormal and may in fact be an emotion that leads to a positive outcome. Nonetheless, it hurts the cancer patient and family.

. It is knowledge that is the oncologists’ first and most precious gift to the patient. It is knowledge that the patient and family must demand. Knowledge delivered through teaching that must be thorough, comprehensible, and empathetic. Physicians must teach patients how to deal with family, friends, sources on the internet, the staging procedures and their meaning, the treatment and the value of second opinions. Patients must learn well that they will not be alone, that thousands have handled this and that others were no less anxious and no braver.

Physicians must speak to their patients of the odds of cure, remission and durability of remission. They must not shy away from discussing spirituality, life’s goals, and the effects of treatment on normal bodily function. Common anxiety-laden patient questions, as “what functions or abilities will I lose” as well as “what will I keep” are essential front burner issues. Discussions must be frank regarding the specter that pain, nausea and vomiting often represent to patients. Moreover, physicians will find the more empathetic time spent the greater the patient’s trust and quality of life.

Patients need to know if research studies hold out a realistic promise. Oncologists must explain the amazing armamentarium of medications they have, the psychological assistance patients will be given and potentially, the beautiful role which hospice may play.

Remember it’s ok to tell someone you are not ok

Other issues are what some have called scanziety and also the issue of telephone messages.

Scanxiety refers to the fear and worry associated with imaging, both before and after a test is performed, and lasts until the test results are communicated to the patient. As described by cancer survivor, “scans are like revolving doors, emotional roulette wheels that spin us around for a few days and spit us out the other side. Land on red, we’re in for another trip to cancerland; land on black, we have a few more months of freedom.”  The root of this anxiety is  related to the uncertainty of the test results and the amount of time that elapses between when the test is performed and the results known. Not surprisingly, most patients report an escalation of anxiety that correlates with longer wait times.

In an ideal world, scanxiety could be alleviated by immediate test results. When scans show no evidence of disease, or a blood test is within normal limits, the phone calls are easy to make. It’s a different story when the scans or tests are abnormal or indicate disease progression. In these cases, face-to-face conversations about treatment options are best.

“phone tag” frustration

So, what can healthcare providers do to reduce scanxiety? Some oncology practices schedule patients for a clinic visit on the same day a scan or test is performed or results known

Every oncology facility should have procedures that reduce the likelihood that patients will “fall through the cracks” and not be followed up.

An option is the doximity dialer, an app that allows healthcare providers to call patients without revealing their personal cell phone numbers. Patients see an office or clinic number instead. The app allows healthcare providers to call patients at any US number, choose the caller id that appears, and send return calls to an office or clinic.

The app can be downloaded for iphones at the app store and for android devices at Google play.

 

The bottom line is that there are a number of strategies to help patients reduce scanxiety and cope with its effects . Being diagnosed with cancer is hard enough; we need to do all we can do to make the journey less stressful. –

The physical changes regarding patient’s anxiety are measurable assessments after chemotherapy included distress, fatigue, and mindfulness.

Researchers have put yoga and mindfulness to the scientific test for years, and the results so far have been impressive. The practice has been shown to lower anxiety.

But it can also help those who are already ill feel better. A new study suggests that doing yoga twice a week may improve quality of life for men being treated for prostate cancer and may help reduce the side effects of radiation, which include fatigue, sexual dysfunction and urinary incontinence.

So again if you have any of these tell your doctor, there is help

  • Difficulty concentrating and making decisions
  • Heart palpitations, sweating, shaking
  • Shortness of breath, feeling faint
  • Numbness or tingling in the hands or feet
  • Heightened sense of alertness
  • Anticipating feeling anxious or a persistent worry
  • Feelings of guilt, worthlessness, and/or helplessness
  • Feeling of unreality or detachment from oneself
  • Fear of dying or losing control
  • Irritability, restlessness
  • Dry mouth
  • Muscle tension
  • Nausea
  • Sleep difficulties
  • Cold or sweaty hands
  • Loss of interest in activities or hobbies once pleasurable
  • Withdrawal from normal activities and friends (avoidance)
  • Appetite change or weight change (usually loss)
  • Persistent aches or pains, headaches, cramps, or digestive problems
  • Lets also give a non scholarly but becoming so, nod to smoked cannabis, the psychoactive form in alleviating anxiety- there are some early trials in the 80’s mostly about control of nauseas and vomiting where it was no better than what was then the standard and inferior to what we have now with exceptions existing on a case by case basis. It being a class 1 drug highly controlled by the FDA has made scholarly work hard but there is a growing body of evidence that supports a possible role in alleviating anxiety, besides improving mood , appetite and pain as well as anticipatory nauseas Mostly we are left with it being no better than standard of care but there are some powerful small studies and of course individual anecdotes. Remember ,anecdote does not equal antidote

 

None of the above is true for any other herbal substance despite what you think or may have heard

Remember anecdote does not equal antidote

 

Family-centered care is crucial to the care of children with cancer,

Challenges associated with a cancer diagnosis, treatment, and adaptation impact the entire family. Recent research has demonstrated that families experience altered family function and may face an accumulation of risk for mental health and severe emotional problems including anxiety over the course of illness,

Other research reports that the experience of cancer increases family cohesion and family resilience. So it can bond as well as break- it is a case by case , family member by family member SITUATION even within the same family .

The nurse’s role

. Oncology nurses directly impact families through communication and can model open, compassionate, developmentally appropriate communication with families. Moreover, coaching and teaching are inherent to nursing care of families. Thus, oncology nurses role can be 2-fold: communicating with families across settings to increase their comfort or to provide education and

 

Coaching in discussing sensitive, emotional topics related to the illness. .

 

Typical anxious fears are

fear of getting recurrence of cancer

Anxiety about having cancer

Constant fear of getting cancer

Fear of cancer diagnosis

Fear of cancer

Cancer and anxiety attacks

Cancer anxiety symptoms

Anxiety after cancer

So, anxiety is soul sucking, it has many forms and presentations, it is harmful and it is treatable in cancer patients and families by MANY approaches

DEPRESSION

The topic, as it is so often, is the “hidden” curse and THE NEVER AND forever lie= it will never change and will forever be this way .

Depression incidence in cancer patients is twice that of the general population, under diagnosed and has twice the suicide rate.

OVERVIEW

Over 15.5 million cancer survivors are alive today in the US, which is similar to the populations of New York City, Los Angeles, and Chicago combined.

The number of survivors continues to grow, not just because of earlier detection and treatment AND AGING OF THE POPULATION , but because of revolutionary new therapies that have been emerging over the past decade.

Now, patients with poor-prognosis metastatic cancers such as lung cancer and melanoma can live many years with good quality of life while on active treatment. For many individuals, this changes the landscape from a terminal illness to more of a chronic illness.

Concurrent with advances in cancer treatment, the importance of psychosocial care of individuals with cancer is being increasingly recognized. There is documented under-detection and failure to optimally manage psychiatric disorders and psychosocial needs in patients with cancer and their families.

 

Unmet needs can have negative consequences for quality of life, treatment adherence, and survival..

 

GUIDELINES ARE NOT ALWAYS FOLLOWED NOR IS  SCREENING ALWAYS DONE

 

SORRY BUT THAT IS REALITY AND RESEARCH SUPPORTS THAT

 

 

Although most cancer centers provide some psychosocial services AND IT IS IMPROVING , increased attention to the psychosocial needs of patients with cancer may result in increased referrals to mental health professionals . Some basic knowledge about a patient’s cancer and treatment are essential for psychiatric management.

 

Studies have documented that a cancer diagnosis results in high levels of emotional distress. Patients go through an adjustment period for about 4 to 6 weeks after diagnosis. SOME LONGER AND EXPECT THAT.

 

Cancer for many patients is synonymous with death and debilitating treatments, with images of a prolonged painful dying process. Patients often say they feel overwhelmed trying to assimilate medical information and make treatment decisions—all while continuing to manage family, work, and other responsibilities.

 

However, for the majority of patients, once they receive a plan of action and begin treatment, their emotions tend to level out.

 

Yet, cancer IS a series of crises that may occur at any time in the disease trajectory from diagnosis, treatment, cycles of recurrences and remissions, post-treatment, and sometimes palliative care.

 

Assessment and treatment

SIGNIFICANCE FOR THE PRACTICING PSYCHIATRIST

 

Coordinating with the oncology team. With the patient’s permission, consulting and informing the oncology team of your involvement is critical. As mentioned earlier, psychiatrists need to understand the patient’s cancer diagnosis, staging, treatments, adverse effects of treatment, and prognosis to appreciate the challenges the patient is coping with throughout treatment as well as survivorship or end-of-life. Medical concerns can cause or MAKE WORSE, BOTH depression and anxiety.

 

Knowing that survival with metastatic breast cancer can be years is critical in providing psychiatric care for the patient.. Psychiatrists contribute to oncology care by providing information to the oncology team regarding the patient’s emotional status and potential barriers to care and treatment adherence.

 

 

Pharmacotherapy. The most prescribed antide­pressants in cancer patients are WHAT YOU HAVE HEARD CALLED ssris OF WHICH THERE ARE MANY, At times the choice of an antidepressant is made based on the antidepressant adverse-effect profile.

 

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Some psychiatric medications may adversely affect the efficacy, THAT IS , THEY MAY INTERFERE WITH of commonly used systemic cancer therapies.

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Be aware that some systemic cancer treatments are associated with psychiatric adverse effects. DRUGS TO TREAT leukemia and some lymphomas, may cause depression. Interferon at high doses can cause depression and even suicidal THOUGHTS. SOME CAN CAUSE can cause lethargy, depression, mania, confusion, and hallucinations. THEY can potentiate the effects of alcohol, opiod, and tricyclic antidepressants.

 

Glucocorticosteroids such as prednisone and dexamethasone are widely used in cancer care. They can cause a range of psychiatric symptoms, from emotional lability, depression, anxiety, restlessness, irritability, and insomnia to paranoia, delusions, and hallucinations..

 

Pain management. Suffering from uncontrollable pain is one of the most common fears of cancer patients. Unfortunately, pain is under-recognized and undertreated in patients with cancer. Explaining to the patient that at times she may need to use opiods under the care of her oncologist without fearing addiction can prevent the patient from suffering unnecessarily. Poorly managed pain can lead to depression and anxiety. Once pain is appropriately managed, depressive and anxiety symptoms often diminish or resolve. ONCE THE PAIN MEDS ARE RESPNOSIBLY GIVEN THERE IS OFTEN GREAT RELIEF

 

HOWEVER     While some psychiatrists and oncologists have expertise in pain management, others may not and are reluctant to prescribe the necessary medications at the appropriate doses. AND SOME OVERPRESCRIBE

 

Speaking with the oncology team and helping to get appropriate referral to a cancer pain specialist or palliative care team is crucial to the quality of life of cancer patients, especially those with advanced disease.

 

Before the patient’s visit with the pain specialist, it is helpful for the psychiatrist to provide education and correct some common misconceptions. The following 3 key issues should be considered regarding referral for pain management:

  1. A majority of cancer patients do not have a history of addiction and actually fear becoming addicted to pain medications
  2. Patients view the taking of pain medications as associated with death and dying: “Only a patient who is dying takes morphine”    3)Patients may need education on the difference between addiction and tolerance, in order to comply with prescribed pain medications Psychiatry appointmentsPatients often include their family in oncology visits,. Family members may need support in coping with their own concerns and often need educationThe American Psychosocial Oncology Society (www.apos-society.org) has published quick reference handbooks on psychosocial care for adults, children, and elderly adults with cancer and produces webinars on particular topics, such as sexual health and cancer.
  3.  
  4. The traditional paradigm for psychiatric treatment may require a more flexible approach to scheduling to adjust to the reality of the patient’s needs during treatment. . FLEXIBILITY IS CRUCIAL. SUFFERRING HAS NO TIMECLOCK
  5.  
  6.  

7 Physical Clues You Could Have Depression

 

Many people who suffer from chronic illnesses also suffer from depression. Depression isn’t something that should be overlooked; it should be brought to your doctor’s attention so that it can be treated. But how do you spot depression?  With help from prevention.com, we’ve put together a list of some of the most common physical signs that someone is suffering from depression.

 

Aches and Pains

Although many chronic illnesses have their share of aches and pains, depression can also make muscles and joints feel sore or exacerbate the problem. People who are happy or content generally feel pain less than those who have depression.

Difficulty Sleeping or Waking Through the Night

Not being able to relax enough to fall asleep or frequently waking up during the night and finding it difficult to go back to sleep could both be signs of depression. Lack of sleep or disturbed sleep can have a profound effect on mood and the ability to concentrate.

Changes in Weight

Loss of appetite or comfort eating are both associated with depression, but you may not realize you have either until you step on the scale and notice a difference. In addition, if you’re not sleeping well because you’re anxious or depressed, this can also mess with your appetite leading to weight loss or gain.

Skin Complaints

Because depression affects hormones, this often becomes apparent in our skin. Depression can lead to skin complaints like acne, psoriasis, and eczema and treating the depression can help with the skin complaint.

Stomach Problems

Mood definitely affects the gut, and people with depression may suffer from symptoms like nausea, constipation, diarrhea, heartburn and indigestion.

Headaches and Migraines People with depression are more likely to experience frequent headaches or migraines. Although this could also be a side effect of medication or treatments you take for your chronic illness.

Oral Problems

People with depression are more likely to need dental work such as tooth extractions and cavities than those who don’t. The thought behind this is that if you’re depressed, you’re less likely to be as diligent about oral health.

Suicide is twice the rate as least in cancer patients and in depressed ones some studies say it is 4 times higher

Once again REMEMBER Suicide IN DEPRESSED CANCER PATIENTS WHO HAVE TWICE THE RATE OF DEPRESSION IS ALSO TWICE THE RATE OF NON CANCER PATIENTS

AND STUDIES SUGGEST  THAT FEWER THAN 30% OF ONCOLOGISTS FORMALLY SCREEN FOR IT AND THE PATIENT OR CLOSEST CAREGIVER MORE COMMONLY SILENTLY SUFFERS THAN SPEAK UP

Elderly patients with cancer and depression

Are far less likely to be diagnosed with depression than patients in any other age group for two primary reasons: There is an overlap between cancer symptoms,/treatment side effects and the diagnostic criteria for depression, …….and older adults are more likely to present with anhedonic “depression without sadness,”

“This represents a significant public health concern that will grow in importance as the U.S. population continues to age.”AND THAT IS KEY AS THE BOOMERS ARE HOME TO ROOST

Diagnosing Depression IN THE ELDERLY

Common symptoms of depression—fatigue, diminished concentration, thoughts of death/suicide, weight loss/gain—are confounded with side effects from cancer treatments or, potentially, the cancer itself.

Depressed mood and loss of interest—anhedonia depressed mood without sadness , reduction in social relationships/loneliness, loss of meaning and purpose, and lack of usefulness and sense of being a burden are all common.

Four minor themes also emerge: attitude toward treatment, mood, regret and guilt, as well as physical symptoms and limitations.

. “THIS IS CRITICAL AND PATIENTS GO BACK TO IT (WHAT THEY DID IN THE PAST) OVER AND OVER AGAIN. They perseverate. “The depressed patients seemed to ruminate on their regrets, ,”

Cancer survivors show patients how to overcome the ordeal WITH so called head foods….this is MEDICINE FOR WHICH THERE IS SCANT TO NO PROOF OF POSITIVELY HELPING THE DEPRESSED PATIENT…. REMEMBER ANECDOTE DOES NOT MEAN ANTIDOTE LETS SAY IT AGAIN ANECDOTE DOES EQUAL ANITIDOTE AND NO HEAD FOOD EXISTS

But

New SUGGESTED clinical guidelines on integrative, mind-body therapies for patients with breast cancer finds IMPROVED RATES OF AND TREATMENT OF DEPRESSION AS PART OF INTEGRATIVE MEDICINE WITH :

    • Use of music therapy, meditation, stress management, and yoga for anxiety and stress reduction;
    • Use of meditation, relaxation, yoga, massage, and music therapy for depression and mood disorders;
    • Use of meditation and yoga to improve quality of life;
    • Use of acupressure and acupuncture for reducing chemotherapy-induced nausea and vomiting;
  • NOTE THIS LAST POINT WELL… THIS IS NOT JUST ME TALKING. THERE IS A lack of evidence supporting the use of ingested dietary supplements OR OTHERWISE MANIPULATING THE DIET or botanical natural products as part of supportive care and/or to manage breast cancer treatment-related side effects.

 

Yet Studies show that up to 80 percent of people with a history of cancer use one or more complementary and integrative therapies,

ALSO Patients NEED TO fully understand the potential risks of not using a conventional therapy that may effectively treat cancer or manage side effects associated with cancer treatment, DO NOT GO RUNNING HELTER SKELTER WITH DR GOOGLE OR UNPROVEN THERAPIES WHICH MAY NOT ONLY NOT WORK BUT CAUSE HARM.

 

Patients are using many forms of integrative therapies with little or no supporting evidence and that remain understudied,

Then in the last of part of one of our summary we looked at some of the nuts and bolts of oncology

Overview of Specialty

Let us first look at what is required to become a medical oncologist.

Training requirements:

University (BS or BA)        4 years

Medical school (MD)       4 years*

Internship                          1 year

Internal medicine residency    2 years

Oncology fellowship             or  2 years

Hematology fellowship   or     2 years

Hematology/Oncology            3 years (combined)                                          *Osteopathy degree is also acceptable in place of MD

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My advice is never be treated by a non-board certified (in medical oncology or only hematology) physicians with few exceptions.( leukemia and lymphoma are often treated expertly by both. The board pass rate is 58-65% with board certification only good for 10 years, as you must re-pass a new exam. As mentioned, many do not sit for the hematology board and remain “board eligible

Specific and related fields

 

Medical oncology involves the management of most cancers in adults and is one of the younger Internal Medicine sub-specialties. The need for a “cancer specialist” did not arise until early 1970’s with the advent of sophisticated chemotherapy regimens. A “quarterback” for cancer care was needed. Patients are usually referred to us after the diagnosis.. Our role has largely evolved to being deeply involved behind the scenes when the diagnosis is suspected but not made.

Pediatric oncology.

Gynecologic oncology

Urology involves the primary surgical approach, but not the chemotherapy, if any, of bladder, kidney, and prostate cancer..

Otolaryngology, also known as (ENT) involves primarily surgery only on cancers of the head and neck and may parent with radiation and chemotherapy.

Surgical oncology largely concentrates on breast, colon, melanoma, and other solid tumors: some have training sufficient to credential them to give chemotherapy.

Neurosurgeons deal largely with the removal and or biopsy of tumors of the brain or spinal cord tumors.

Thoracic surgery concentrates on early stage lung cancers and occasional open biopsies of the lining of the heart or other chest structures.

Orthopedic surgery deals with the primary surgery of bone cancers or metastases, surgical removal and stabilization of bones (rods/ pins) weakened by cancers.

Radiation Oncology they give radiation to different types of cancer as primary treatment such as brain tumors, lung cancers, some lymphomas (cancer of lymphocytes) or treatment after surgery (breast after removal of breast cancer) or treatment along with chemotherapy (synergism)-head and neck, rectal, anal, and lung, or treatment of local painful boney areas of tumor spread.

The Scope Of The Problem

Age is the greatest single factor worldwide for developing malignancy.

Globally, over 13 million people are diagnosed with some form of cancer yearly with 8 million deaths. This represents a global cancer burden doubling in the last 30 years of the 20th century, with doubling again between 2000 and 2020 and nearly tripling by 2030. By 2030, over 25 million people a year may be diagnosed with cancer, with two thirds dying from it..

The most recent figures show that for the first time since records have been kept, less than 20 percent of adults were smokers in 2007. However, cigarette companies are finding new customers in developing countries. About 40 percent of the world’s smokers live in just two nations — China and India.

Cancer treatment facilities are out of reach for many and life-saving treatments are less available. .

Cancer is uncommon in adolescents and children (with only about 150 cases per million in the U.S.), with leukemia the most common. If we put all ages and both sexes together the odds of getting cancer are about 460 per 100,000. This is not rare

Cancer in the first year of life has an incidence of about 230 per million in the U.S. with the most common cancer being nueroblastoma.

In the U.K., cancer is in the lead over cardiovascular disease yet it appears much lower in third world countries most likely owing to much higher deaths from infectious diseases such as malaria and TB and accidents. Nonetheless, cancer remains a major public health problem worldwide with skin, lung, prostate, and breast, lung, colorectal and urinary bladder representing the majority of types