Psychotherapy for cancer patients: What you need to know

This is an automatically translated article.

The article was professionally consulted by MSc Nguyen Trong Hien - Psychological consultant, Psychological Clinic, Vinmec Times City International General Hospital.

When it comes to cancer treatment, most people think of chemotherapy and radiation without knowing that psychotherapy also plays a very important role but is being overlooked. In fact, up to 82% of patients need clinical counseling to relieve anxiety and depression. This shows the importance of psychotherapy for cancer patients.

1. Psychological stages of cancer patients

1.1. Period of medical examination Many patients only think about cancer, they panic, lose sleep, lose sleep. But there are also many people who are subjective, when they go to the doctor, it is too late. In such circumstances, it is necessary to comfort the patient with confidence in the profession and profession: There are accurate tests to detect cancer, and there are specific treatment measures.
When the patient has inappropriate attitudes such as: Taking matters seriously, worrying too much, denying the truth, it is necessary to encourage them, and assure them that they will get the best medical care, diagnosis and treatment. accurate and fast, treatment has a good prognosis.
1.2. Diagnosis stage When the disease is discovered, the patient often has reactions such as:
Shock, distrust: this reaction is sometimes so severe that it is impossible to say anything more about the treatment plan. The doctor must be supportive at this point and another appointment is needed.
Denial of the truth : This is also a normal reaction that does not require further identification.
Anger: At this time, the patient needs to be encouraged to avoid hostile attitudes towards the doctor, family, friends, religion. The doctor must never express anger as a personal provocation.
Anxiety : Emotional support, assurances of care will alleviate, create understanding anxiety.
Disappointment : A disappointment, grief can occur, if the heavy pessimism needs intervention.
Overly denying the truth: This affects the treatment of the patient, it is necessary to discuss with the patient, if it is not okay to have a psychiatric examination.
Frustration and boredom : Frustration can appear at any time after being diagnosed with cancer. Autonomic symptoms such as anorexia, shortness of breath, insomnia, and psychotic symptoms such as frustration, loss of concentration, and delusions of guilt indicate deep disappointment. In addition, the patient may refuse treatment if death is inevitable. In this case, early psychiatric consultation is necessary.
Seeking self-replacement: The use of potentially ineffective but painless treatments in combination with standard treatment should not be objectionable. However, when the patient desires to recover quickly, away from the right treatment, strays into the methods of quack, needs a psychiatric examination for psychological correction..

1.3. The initial stage of treatment Each form of cancer treatment presents its own psychological challenges.
Surgery Most cancer patients believe that surgery is the best cure. However, due to its intrusive nature, surgery makes the patient feel fear or anxiety, tormenting reactions due to the change in body shape, at this time it is necessary to encourage the patient to avoid this feeling by explaining and consolation, or practical solutions after devastating surgery such as reconstruction, prosthetics... need to be discussed.
When the patient has reactions such as avoidance, creating all kinds of excuses for delay, refusing surgery because of fear, this time requires the intervention of a psychologist.
In patients with inadequate explanation, there is an overwhelming concern to seek alternative surgical treatments. Surgeons and oncology teams need to warn against this attitude, as it can be easy to reduce excessive anxiety and make surgical care more favorable.
Situations of disappointment after surgery are very common, or long and severe tormenting reactions, especially when surgery does not bring specific results. If this situation manifests itself excessively, the intervention of a psychologist is required.
Radiotherapy The objectives of radiation therapy should be fully explained to the patient such as: radical, temporary, or local control of the tumor...
Reactions such as fear of machines and their effects side effects, then explanations of the basic principles of radiation therapy will help correct that misconception along with a detailed discussion of the side effects and their treatment. frighten the patient.
Patients fear that the family doctor or facility will neglect all responsibilities or be abandoned between treatment stages, so regular contact with the family doctor is necessary.
When the patient has hallucinations or delusions, refuses treatment, needs to send psychological treatment.
Chemotherapy Today, the fear of chemotherapy, along with its side effects, outweighs the fear of cancer.
Anxiety before treatment: The side effects of chemotherapy can cause anxiety and frustration in patients, while relaxation techniques including hypnosis, bioinhibition, and muscle relaxation all increase participation. patient involvement in the treatment process. For example, taking 0.5 mg of Iorazepam 3 times a day reduces anxiety levels and forgetfulness of unpleasant events. Change the image of the body. Although hair loss is a major concern, a preparation that includes wearing a wig, makeup, and skin care has significantly reduced the impact of hair loss. Voluntary donation of organs such as spinal cord should be encouraged and endorsed because it fosters good feelings that some benefit may arise from a difficult situation.
Certain chemical drugs or combination drugs cause disorientation, hallucinations, or delusions in the patient. Physician-induced encephalopathy may present in other settings such as infection or fever. Supportive measures (such as comforting and fully explaining to the patient what to expect) dose reduction, antagonism, and psychotropic medications may be used only depending on severity of symptoms.
Psychological disorders due to isolation many neutropenic patients must be in isolation environments. The absence of physical contact can lead to feelings of loneliness, depression, and even mental confusion. The emotional support needs of the cancer patient in this setting should be considered to be satisfied, if necessary, in consultation with psychologists.

1.4. Stage of relapse The psychological impact of disease recurrence is similar to that at initial diagnosis, but the situation is more complicated by the higher risk of failure. Therefore, it is important to discuss treatment goals and be able to maintain realistic hope. Doctors need to know that with each stage of treatment, patients react differently and it can be more and more difficult. Patients can endure the first, second, and third times, but it is always unexpected and requires professional support.
1.5. End stage Most patients are aware of the force majeure course of the terminal illness, whether explained or not. Certain fears and special concerns may require referral to a psychiatric examination and supportive psychiatric treatment, and antipsychotic medications need to be prescribed at the right time.
Often patients are worried about cancer in the late stages they will not receive special attention from the medical staff. Therefore, it is important to make sure to show the patient that the doctor and medical team are continuing to provide care. When a patient is near death, the doctor's positive and supportive attitude can alleviate grief for the patient and family.
In the final stage, the patient may feel anxiety about body deformation and loss of dignity, fear of pain, fear of leaving unfinished work. Then make sure that the patient is not left out and that the best medical care, including cancer pain relief, is provided.

2. Screening for cancer-related depression

The American Society of Clinical Oncology (ASCO) recommends screening for depression in patients with cancer. Screening should be done as soon as the patient receives the diagnosis and it should also be done periodically during and after treatment.
Treatment requirements will depend on how many depressive symptoms the patient has and how often it occurs.
Although it may be difficult for you to explain, try talking about your experience to the health care team of the following:
How do you feel Specific causes/sources of your concerns are what? Symptoms in your body. Effects on your daily life. This will help the care team understand your problem and plan treatment.

3. Treatment of depression in cancer patients

Patients with depression need to be treated according to psychology - mental health specialties. For patients with moderate or severe depression, a combination of psychotherapy and medication is often the most effective approach. For some patients with mild depression, talking to a mental health professional may be enough to alleviate symptoms.
Psychotherapy: Mental health professionals include counselors, psychologists, and psychiatrists. They help patients access methods to improve coping skills, develop a support system, and reframe negative thoughts. Options include individual therapy, couple therapy or family therapy, and group therapy. In addition, psychiatrists are the ones who can prescribe medication and evaluate other causes of depression.
Medications: There are many different types of antidepressants available today. The doctor will choose the most appropriate antidepressant based on the following factors:
Patient's history Patient's needs The possibility of side effects Interactions with medications being taken. Tell your doctor about all cancer drugs and related drugs or supplements you are taking. Some medications can interact with antidepressants.
Some patients will see improvement 2 weeks after taking the medicine. However, it usually takes up to 6-8 weeks for the medication to take full effect.
Although the psychology of cancer patients has many negative stages, it is important to have a professional and appropriate psychological intervention team. Besides, the application of the right therapy is also one of the important factors to help cancer patients overcome their fears, depression, and feelings of torment.

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