1/12. cognition and the cancer experience. Clinical implications.OBJECTIVES: The authors demonstrate the application of cognitive therapy in oncology care by presenting a brief review of theory and relevant case studies. MATERIALS AND methods: In light of the life and death nature of the fears evoked by cancer, it is important for the oncology clinician to recognize the role that cognition plays in patient responses to the diagnosis and treatment of cancer. After presentation of a theory base that creatively links cognition and the cancer experience, key cognitive concepts are defined and discussed. Case material illustrates the application of these concepts and how oncology clinicians can use select interventions adapted from the brief mental health treatment modality of cognitive therapy to promote adjustment to cancer. RESULTS: Patient and family views about cancer have emotional and behavioral consequences, influence ability to cope with diagnosis and treatment, and serve to focus clinical intervention. Cognitive interventions can help patients and families think about cancer in objective, adaptive ways. Focusing on perceptions and questions of meaning, clinicians can be effective using cognitive lines of questioning that expand patient stories and elicit beliefs about cause, control, and responsibility for their cancer. CONCLUSIONS: Cognitive interventions are brief and solution-focused interventions that acknowledge and build on generalist interviewing skills common to each discipline. As such, they are particularly useful in physical health settings where work is fast paced and clinicians are faced with the challenge of dealing in a collaborative manner with patient and family coping responses as they apply to the medical problem and care plan.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
2/12. Suffering: a relatively unexplored phenomenon among family caregivers of non-institutionalized patients with cancer.Suffering is a phenomenon with physical and emotional components. Although several studies have drawn attention to the needs of, and demands placed on families who provide care for patients with a diagnosis of cancer at home, few have discussed the suffering which many of these caregivers experience. This paper will illustrate the phenomenon of suffering as seen in the responses made by family caregivers of patients with cancer. Eighty-three family caregivers drawn from a probability sample of patients with a diagnosis of cancer were interviewed in their homes to determine needs they encountered in their caregiving roles. The caregivers consisted of 43 males and 40 females, with mean ages of 53 and 54 years respectively. Families not only identified their needs, they also indicated several areas which were for them sources of suffering. The findings revealed that family suffering often stemmed from fear of loneliness; uncertainty about the future (their own and that of the patients); lifestyle disruption; communication breakdown; lack of support; and their sense of helplessness. These findings suggest that health professionals, particularly nurses, who work with families in their homes, must be alert and sensitive to cues and circumstances which could indicate suffering, and in so doing, take the necessary steps to ameliorate their situation.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
3/12. Patient perspectives: Kundalini yoga meditation techniques for psycho-oncology and as potential therapies for cancer.The ancient system of Kundalini yoga (KY) includes a vast array of meditation techniques. Some were discovered to be specific for treating psychiatric disorders and others are supposedly beneficial for treating cancers. To date, 2 clinical trials have been conducted for treating obsessive-compulsive disorder (OCD). The first was an open uncontrolled trial and the second a single-blinded randomized controlled trial (RCT) comparing a KY protocol against the relaxation Response and mindfulness meditation (RRMM) techniques combined. Both trials showed efficacy on all psychological scales using the KY protocol; however, the RCT showed no efficacy on any scale with the RRMM control group. The KY protocol employed an OCD-specific meditation technique combined with other techniques that are individually specific for anxiety, low energy, fear, anger, meeting mental challenges, and turning negative thoughts into positive thoughts. In addition to OCD symptoms, other symptoms, including anxiety and depression, were also significantly reduced. elements of the KY protocol other than the OCD-specific technique also may have applications for psycho-oncology patients and are described here. Two depression-specific KY techniques are described that also help combat mental fatigue and low energy. A 7-part protocol is described that would be used in KY practice to affect the full spectrum of emotions and distress that complicate a cancer diagnosis. In addition, there are KY techniques that practitioners have used in treating cancer. These techniques have not yet been subjected to formal clinical trials but are described here as potential adjunctive therapies. A case history demonstrating rapid onset of acute relief of intense fear in a terminal breast cancer patient using a KY technique specific for fear is presented. A second case history is reported for a surviving male diagnosed in 1988 with terminal prostate cancer who has used KY therapy long term as part of a self-directed integrative care approach.- - - - - - - - - - ranking = 3keywords = fear (Clic here for more details about this article) |
4/12. Misperceptions and inadequate pain management in cancer patients.This article examines misperceptions and barriers to adequate pain relief in cancer patients. Healthcare professionals have gaps in their knowledge of opioid drugs as well as misconceptions concerning tolerance, physical dependence, and addiction that often lead to the underprescribing of these agents. The pervasiveness of the "say no to drugs" message in our society and the fear of addiction on the part of patients and their families creates yet another barrier to the legitimate use of opioids to treat cancer pain. Legal and regulatory documents filled with arbitrary and ill-defined labels meant to promote the legitimate use of these drugs and curtail their misuse may instead intimidate healthcare professionals and negatively influence prescribing habits. Increased educational efforts for pharmacists and other healthcare professionals as well as the development of clinical role models and state cancer pain initiatives are cited as means to break down these barriers in order to achieve adequate pain relief for all cancer patients.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
5/12. Cardiac transplantation in patients with preexisting malignancies.A history of preexisting malignancy has been considered a contraindication to cardiac transplantation. The reasons for this prejudice include concerns about potentially deficient intrinsic immunomodulation and fear of cancer recurrence (or development of second cancers) because of therapeutic immunosuppression. In the past four years at the Northern indiana heart Institute seven patients with preexisting malignancies underwent cardiac transplantation. Their two-year survival rate was 100%, which is comparable to a rate of 81% in non-malignancy patients. After an average 31 months of follow-up (range = 6-56 months), only one patient has had a recurrent tumor (basal cell carcinoma). Statistical comparison of immunosuppression dosages, incidences of rejection, and incidences of infections between patients with preexisting malignancy and those without preexisting malignancy was performed. We found that the only significant difference was an increased number of infections in preexisting malignancy patients. Additionally, we found no difference in the incidence of posttransplant coronary artery disease in the preexisting malignancy group when compared with those patients without preexisting malignancies. This study demonstrates that patients who have been successfully treated for malignancies have no greater incidence of rejection than those patients without preexisting malignancy. Furthermore, preexisting malignancy patients require no significant modulation of immunosuppression. Although preexisting malignancy patients have a higher incidence of infections than patients without preexisting malignancy, their two-year survival is not worse than the patients without preexisting malignancy.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
6/12. Control of pain in cancer patients.Almost three quarters of patients with cancer have severe pain, from invasion of the cancer itself, from effects of therapy, or from causes unrelated to the cancer (but often exacerbated by it). With the proper pain-management strategy, however, pain can be controlled in most patients. The analgesic ladder for pain control, promoted by the world health organization, begins with a nonnarcotic agent, progresses to a weak narcotic plus a nonnarcotic, and finally reaches a strong narcotic. Adjuvant agents, which increase the analgesic potency of the drug being used, may be added at any level. The most common reasons for inadequate pain control in cancer patients are incorrect narcotic dosing and incorrect switching from one narcotic to another and from one route of administration to another. Factors that influence pain management (eg, fear, anxiety, sleep disturbance) should be treated as well with appropriate medications, behavioral therapy, counseling, hypnosis, and other supportive techniques. These points are illustrated in the case report (see box, page 328).- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
7/12. pain management in a drug-oriented society.A drug-oriented society promotes drug treatment of illness but responds with restrictive legislation and mores when faced with serious drug abuse by the populace. narcotics are currently controlled because of their history of abuse and associated crime, and when their use, for whatever purpose, is suspected of abuse. Inadequate treatment of cancer pain with narcotics may stem, in part, from these events. Its major causes are confusion of legitimate and illegitimate narcotics use by society in general and health care providers in particular, combined with undefined terms (e.g., addicts, habitual users) primarily in state statutes, which should be revised and standardized. These factors intimidate physicians from prescribing rationally. For example, a prescription for an extremely large dose, and ordering an adequate quantity of a drug to have at home for a reasonable period of time, as is often required for the control of severe pain, may be perceived as an invitation for investigation of the physician's legitimacy. The real or imagined fear of an investigation encourages him or her to write prescriptions for multiple narcotics, each at the "acceptable" dosage, rather than for single narcotics in larger doses, which is simpler for the patient and preferable from a medical standpoint. Drug abuse is not generally a problem among cancer patients with pain. physicians should strive to change social attitudes toward pain control with narcotics by enlisting the support of colleagues and, if necessary, by political activism.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
8/12. Silicone plesiotherapy molds.Plesiotherapy, the treatment of superficial lesions by radioactive molds has largely been replaced by teletherapy techniques involving high energy photon and electron beams. There are, however, situations for which a short distance type treatment, in one form or another, is superior to any other presently available. Traditionally, molds have taken the form of rigid devices incorporating clamps to attach them to the patient. This ensures a reproducible geometry about a localized region since the molds are applied on a daily basis. To make such devices requires considerable skill and patience. This article describes an alternative method that eliminates the use of cumbersome devices in many situations. Silicone molds made from a plaster cast model have been found suitable for the treatment of surface lesions and especially for lesions in the oral and nasal cavities. With the use of radioactive gold seeds the molds may be left in place for a few days without fear of them moving.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
9/12. Manifestations of death consciousness and the fear of death in children suffering from malignant disease.The consciousness of death and the fear of death are analysed, and their symptoms, especially as they manifest themselves in children with chronic lethal disease, mostly tumours and leukaemia, are described. fear of death is not often expressed by direct verbal communication; sometimes it is manifest in illusions, jokes, plays, dreams, etc. Basically, it is a fear of separation. One should struggle against it until the last moment with occupational therapy, regular teaching, free visiting time, frequent permissions to go home, activity, affection and love.- - - - - - - - - - ranking = 6keywords = fear (Clic here for more details about this article) |
10/12. Cancer: denial or suppression?Medical personnel often reach erroneous judgments on the reaction of cancer patients to death and dying. patients with terminal cancer sometimes will say little or nothing to hospital staff members or other professionals about their fears or expectations. This silence is generally construed as indicative of the primitive defense mechanism of denial. Usually, however, such patients are not truly "denying" cancer and its consequences, but have merely decided, more or less voluntarily, to "suppress" these thoughts as a method of coping with their illness. The medical staff, through careful observation of cancer patients, and through discussions with patients' families, should be able to distinguish between denial and suppression. This distinction can be significant because it enables the staff to understand the patient's feelings correctly, and thereby to provide more effective care. The staff, and the patients themselves, are thus in a better position to orchestrate the patients' various physical, emotional and interpersonal needs and resources optimally.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
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