Page 1648 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 90 Psychosocial Aspects of Hematologic Disorders 1469

NCCN Guidelines Index
Distress Management TOC
Discussion
SCREENING TOOLS FOR MEASURING DISTRESS Second, please indicate if any of the following has been a
problem for you in the past week including today. Be sure to
check YES or NO for each.
YES NO Practical Problems YES NO Physical Problems
Instructions: First please circle the number (0-10) that best Child care Appearance
describes how much distress you have been experiencing in Housing Bathing/dressing
Insurance/financial Breathing
Transportation Changes in urination
Work/school Constipation
Treatment decisions Diarrhea
10
Extreme distress 10 Eating
9 Family Problems Fatigue
9
Dealing with children Feeling Swollen
8 8 Dealing with partner Fevers
7 7 Ability to have children Getting around
Family health issues Indigestion
6 6 Memory/concentration
Emotional Problems
5 5 Depression Mouth sores
Nausea
4 4 Fears Nose dry/congested
Nervousness
3 3 Sadness Pain
Sexual
2 2 Worry Skin dry/itchy
Loss of interest in
1 1 usual activities Sleep
Tingling in hands/feet
No distress 0 0
Spiritual/religious
concerns
Other Problems: _________________________________________
________________________________________________________

®
Version 2.2012, 03/12/12 © National Comprehensive Cancer Network, Inc. 2012, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN®. DIS-A
Fig. 90.2 NATIONAL COMPREHENSIVE CANCER NETWORK (NCCN) DISTRESS MANAGE-
MENT GUIDELINE DIS-A-DISTRESS THERMOMETER. (From National Comprehensive Cancer Network:
The National Comprehensive Cancer Network 1.2005 Distress Management, the complete library of NCCN clinical
practice guidelines in oncology (CD-ROM), Jenkintown, Pennsylvania, 2005, National Comprehensive Cancer Network.)

multidisciplinary approach that includes regular avenues and options are ruled out, an anxiolytic agent is the treatment of choice, except
for communication about patient management and status updates is for patients who present with panic episodes, in whom selective
imperative. Numerous studies have documented the efficacy of a serotonin reuptake inhibitors are most efficacious. Medications are
variety of modalities in managing psychosocial problems for such most effective when used at adequate dosages and as standing orders.
patients. Psychologic distress that can be managed effectively include Use of these medications may assist the patient with participating in
anxiety and depression; sexual dysfunction; body image disturbances; psychotherapy, which can provide more lasting control over psycho-
noncompliance, pain, and neurologic complications such as delirium logic symptoms. All pharmacologic treatments must be monitored
and dementia induced by brain metastasis or treatment; anticipatory for effectiveness and side effects.
and posttreatment nausea and vomiting; anorexia and feeding prob- Patients commonly demonstrate transient depressive symptoms
lems; and marital and family difficulties. at various points in the disease trajectory. In patients who exhibit
prolonged or severe depressive symptoms, a major depressive illness
must be considered. Depression can be related to a recurrence of a
Pharmacologic Interventions past depressive disorder or the stress associated with treatment, or
it can be a result of the illness process or treatment agents. Anti-
Pharmacotherapy, as an adjunct to one or more of the psychothera- depressant medications are easily administered and are an effective
pies, can be an important aid in bringing psychologic symptoms treatment strategy. Disadvantages include the need for repeated
under control. For patients with severe anxiety, factors other than a visits to health care clinicians to monitor patient response and
psychologic state must first be evaluated. Metabolic abnormalities, adjust the dosage, possible adverse side effects and medical reactions,
pain, hypoxia, and drug withdrawal states all can present as anxiety. potential use in suicide attempts, and the need for strict adher-
Many common medications are associated with anxiety and depres- ence to the medication schedule. Patients should be informed that
sion. Medications such as steroids and antipsychotics, often used to most antidepressant medications must be taken for 4 to 6 weeks
control nausea, can cause anxiety characterized by agitation and before a significant response is achieved. The clinician must be
motor restlessness. After medical or drug-induced causes for anxiety aware that patients at risk for suicide become more energized with