Distress in gynae-oncology patients

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Distress in gynae-oncology patients
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Relevance

• Common1
• Easier to intervene early
• Simple interventions can be very effective2
• Communication skills core2
• May impact on treatment and complications (and on
  outcome in terms of QoL, not survival)3

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The five ds of cancer

• Death
• Disability
• Disfigurement
• Decline
• Dysfunction
• What everyone thinks of when they hear the word
  cancer

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Gynaecological cancers

• Fertility issues
• Sexuality effected directly and indirectly
• Diagnosis often delayed
• Treatment invasive
• Stigma1

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Gynaecological cancers

• Ovarian
• Late diagnosis common
• Vague symptoms1
• Family risk2
• Chronic3

• Cervical
• Multiple adversity4
• Young women
• Impact on sexual function5
• stigma

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Phases of the journey

• Initial diagnosis/awaiting results
• Awaiting treatment
• Treatment
• Post treatment/survivorship
• Recurrence
• Advanced disease
• Palliative care/dying

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Initial diagnosis/awaiting results

• Breaking bad news (staging)1
• Uncertainty/dread/anticipation of grim process
  and outcome (cancer slow death)
• On-going symptoms (pain)
• Shock/disbelief 2
• What to disclose to others (children)3
• Medical juggernaut4
• Financial and other practical concerns5

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Awaiting treatment

• Busy activity displacement/denial/effort to
  establish sense of control1
• Decision making information2
• Nobody is doing anything3
• Disclosing to others dealing with comments4
• Adapting to diagnosis of cancer when not that
  ill

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Treatment

• General1
• Anxiety
• Trust
• Information
• Choices
• Access/cost2
• Impact on role3
• Impact on others3
• The patient role4

• Surgery
• Pain
• Disfigurement
• Impact on sexual function
• Stoma
• Ward vs. home3

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Treatment

• Chemotherapy
• Nausea
• Hair loss1
• Fatigue2
• Complications3
• Time demands
• Travel demands5

• Radiotherapy
• Invasive
• Embarrassing
• Fatigue2
• Bowel problems
• Skin problems4
• Time demands
• Travel demands5

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Post treatment 1

• Residual symptoms1
• Residual side effects (fatigue)
• Body image2
• Sexuality changes2
• Meaning of physical experience changes1
• Menopause
• Expectations of recovery (including the
  expectations of others)3

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Post treatment 21

• Existential issues self/future altered life
  plans stolen
• Impact of loss of fertility/other functional
  losses
• Grief at multiple losses
• Anxiety around reviews/scans/tumor marker levels2
• Concerns about family risk (esp. daughters)3
• How is information about risk/recurrence
  presented/understood4

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Recurrence

• Bad news consultation
• More treatment vs. no treatment1
• Dealing with others2
• Implications3
• Symptom management
• Existential issues (why me)4

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Advanced disease

• Hope of cure1
• Ongoing burden of care2
• Uncertainty living from test to test
• tied to the health care system3
• Alternative/complementary therapies1
• New treatments (chemo) but not offer of cure1
• Legal/financial issues4

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Palliative care/dying

• Deteriorating function multiple losses one
  after another
• Loss of role (effort of refashioning)1
• Dependence on others (burden)2
• Family/carer stress and ways of coping3
• Legal/financial issues4

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Management issues

• Sleep
• Nausea
• Pain
• Body image
• Sexuality
• Menopause
• Anxiety incl. specific phobias (needle)
• Depression

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Useful skills

• Eliciting concerns
• Eliciting symptoms (mood)
• Problem solving
• Relaxation
• Sleep management
• support
• Prescribing

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Adjustment (Disorder)

• Patterns of coping usually life-long
• They are a reflection of personality
• Main differential diagnosis mood disorders
  (depression/anxiety disorders)
• Grief/loss are often themes

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Coping ways of doing it

• Helpful
• Humour
• Family/friend networks
• Focus on specific problem(s) solution(s)
• Exercise
• Distraction (pleasurable activity)
• Spiritual practices
• Goal setting (realistic)

• Unhelpful
• Alcohol/drugs
• Avoidance
• Blame (self/others)
• Focus on emotions
• Too much/too little dependence
• Global definitions of problems
• Inflexibility
• Struggle for control

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Mood symptoms

• Anxiety
• Agitation
• Return to same issues/questions
• Seek reassurance
• Seek control
• Initial insomnia (worry)
• Focus on negative
• Poor retention of new information

• Depression
• Loss of pleasure
• Waking in the early hours of the morning
• Loss of motivation
• Preoccupation with death
• Feeling a burden on others
• Non-compliance/futility

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Help! Referring on

• Local/generic
• Website1
• NSW Cancer Council
• Support groups
• Local DA and mental health services
• Community health (social workers)
• Relationship counselling
• Pastoral care

• Specialist services
• Sexual health clinics
• Menopause clinics
• Womens health centers/clinics
• Social work services through hospital gynae-onc
  centers
• Sex therapy
• Clinical psychology
• Psychiatry

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REMEMBER!

• All of this has an impact on the staff providing
  care
• This means you