Page 1650 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 90 Psychosocial Aspects of Hematologic Disorders 1471

TABLE Therapeutic Modalities Useful for Patients and Family Members
90.3
Modality Selected Indications Goals and Advantages Comments
Individual psychotherapy Prolonged adverse reactions to Supports patients and enhances ability to cope with Pharmacology and family
diagnosis, treatment, and other distressing feelings involvement are useful
aspects of chronic illness (e.g., Short-term therapy; focused and goal directed adjuncts in some cases
anxiety, depression)
Support groups Patients desire contact with Supports patient and enhances coping ability Expands social network of
others who are experiencing Patients benefit by observing coping strategies of others patients with limited
chronic illness Usually does not involve a fee support systems
Family and marital therapy Relationship problems secondary Assists couples with clarifying problems and facilitates Problems, issues, and
to illness (e.g., family tension, solving them together concerns about
role changes, conflict, sexual Addresses role changes in the family system relationships including
problems) children can be
addressed
Mind-body therapies, Patients desire assistance with Increases sense of control and participation in treatment Realistic goals should be
including progressive control of pain, anxiety, Individualized to meet patient’s preferences and stated explicitly (Some
muscle relaxation, yoga, anticipatory and posttreatment circumstances patients may view
guided imagery, Reiki, nausea and vomiting, fears Time limited and goal directed these therapies as a
meditation, hypnosis, associated with medical Evaluated in terms of observable changes in symptoms cancer cure)
and biofeedback procedures and self-efficacy

Most patients undergoing cancer treatment, as well as their fami- Edwards B, Clarke V: The psychological impact of a cancer diagnosis on fami-
lies, experience expected periods of psychologic turmoil that occur at lies: the influence of family functioning and patients’ illness characteristics
transition points along the clinical course of cancer. In a small propor- on depression and anxiety. Psychooncology 13:562, 2004.
tion of patients, more severe psychiatric complications may occur, Evan EE, Zeltzer LK: Psychosocial dimensions of cancer in adolescents and
warranting referral to a psychiatric specialist, including psychiatrists, young adults. Cancer 107:1663, 2006.
social workers, psychologists, and psychiatric nurses. Screening for Fleishman S, Greenberg D: Pharmacological interventions. In Holland J,
ongoing psychiatric problems must become standard care. A variety Greenberg D, Hughes M, editors: Quick reference for oncology clinicians:
of psychotherapeutic modalities are useful for helping patients work the psychiatric and psychological dimensions of cancer symptom management,
through the expected psychologic responses to cancer as well as more Charlottesville, Va, 2006, IPOS Press, p 26.
15
severe responses. Supportive psychotherapeutic measures should be Fritzsche K, Struss Y, Stein B, et al: Psychosomatic liaison service in hema-
used routinely because they minimize distress and enhance feelings tological oncology: need for psychotherapeutic interventions and their
of control and mastery over self and environment. For these reasons realization. Hematol Oncol 21:83, 2003.
alone, their value in the care of patients with cancer is paramount. Haylock PJ: The shifting paradigm of cancer care: The many needs of
Throughout the clinical course of cancer, the patient’s relationship cancer survivors are starting to attract attention. Am J Nurs 106:16,
with health care providers and the presence of a supportive social 2006.
network are important factors that can ensure successful management Hewitt M, Sheldon G, Stovall E: From cancer patient to cancer survivor: lost in
of the many physical and psychosocial demands imposed by a cancer transition, Washington, DC, 2006, National Academy Press.
diagnosis and treatment. As scientific inquiry continues to produce Institute of Medicine (US) Committee on Psychosocial Services to Cancer
vast but sometimes conflicting information regarding etiology and Patients/Families in a Community Setting, Adler NE, Page AEK, editors:
treatment of cancers, concurrent research regarding the psychosocial Cancer care for the whole patient: meeting psychosocial health needs, Wash-
aspects of hematologic malignancies is crucial. This line of inquiry ington DC, 2008, National Academies Press.
will, at the very least, assist in promoting psychosocial well-being in Jacobsen PB, Donovan KA, Trask PC, et al: Screening for psychologic distress
patients and family members faced with an extreme and unexpected in ambulatory cancer patients. Cancer 103:1494, 2005.
life crisis. At best, expanding the knowledge base relative to the Jacobsen PB, Sadler IJ, Booth-Jones M, et al: Predictors of posttraumatic
psychosocial aspects of cancer may provide some “missing links” stress disorder symptomatology following bone marrow transplantation
regarding psychosocial adaptation and quality of life and the impact for cancer. J Consult Clin Psychol 70:235, 2002.
of cancer on patients’ survival. The Institute of Medicine report that Jenks Kettmann JD, Altmaier EM: Social support and depression among
recommends that all cancer care should ensure the provision of bone marrow transplant patients. J Health Psychol 13:39, 2008.
appropriate psychosocial health services, states that at a minimum, Khan A, Irfan M, Shamsi T, et al: Psychiatric disorders in bone marrow
patients must be screened for emotional distress and evaluated for transplant patients. J Coll Physicians Surg Pak 17:98, 2007.
additional services. Kishi Y, Meller WH, Swigart SE, et al: Are the patients with post-transplant
psychiatric consultation different from other medical–surgical consulta-
tion inpatients? Psychiatry Clin Neurosci 59:19, 2005.
SUGGESTED READINGS Lim JW, Zebrack B: Social networks and quality of life for long-term survivors
of leukemia and lymphoma. Support Care Cancer 14:185, 2006.
Baker F, Denniston M, Smith T, et al: Adult cancer survivors: how are they Lorenz KA, Lynn J, Dy SM, et al: Evidence for improving palliative
faring? Cancer 104:2565, 2005. care at the end of life: a systematic review. Ann Intern Med 148:147,
Cooke L, Gemmill R, Kravits K, et al: Psychological issues of stem cell 2008.
transplant. Semin Oncol Nurs 25:139, 2009. Manitta VJ, Philip JAM, Cole-Sinclair MF: Palliative care and the hemato-
Cooke L, Grant M, Eldredge D: Hematopoietic cell transplantation: the oncological patient: can we live together? A review of the literature.
trajectory of quality of life. In Ezzone S, Schmit-Pokorny K, editors: Blood J Palliat Med 13:1021, 2010.
and marrow stem cell transplantation, ed 3, Sudbury, Mass, 2007, Jones & McGrath P: End-of-life care for hematological malignancies: the ‘technologi-
Bartlett Publishers, p 391. cal imperative’ and palliative care. J Palliat Care 18:39, 2002.