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WA Psycho-Oncology Service Susan Thorman Specialist Clinical Psychologist Team Leader Ph: 9382-7480 Fax: 9382-7479 WA Cancer & Palliative Care Network Some psychological impacts of brain tumour in adults 24 May 2017 Slide 2 WA Psycho-Oncolgy Service • WA Psycho-Oncology Service established 2007 • Primary purpose to offer specialist psychological care to adult cancer patients and family (Not Breast Cancer) • Free, state-wide, private and public, all adult cancers • Located Shenton Park + In-reach SCGH, RPH, FH • 3.8 FTE Clinical Psychology + 1 FTE Admin Assist • Psycho-oncology vs Clinical Psychology 24 May 2017 Slide 3 Cancer and mental health • Psychological distress after cancer dx/tx is common • Clinically significant distress found in (NHMRC) 20-30% new diagnosis 50% recurrence • Few studies specific to Brain Cancers support similar levels of distress 24 May 2017 Slide 4 Brain Cancer and Mental Health • Lack of studies = new area + small case numbers • Brain Cancers 1.5 % of all cases (144 cases, 2007 WA Ca Reg) • ‘Big 5’: high volume cancers Breast+Prostate 30% (2900 cases) Colorectal 12% (1189 cases) Skin 10% Lung 9% 24 May 2017 Slide 5 Future Research: % Cases Dx Breast/Prostate 30 high volume vs high distress? % WAPOS Cases (2007-2009) 11 Colorectal 12 9 Skin 10 8 Lung 9 12 Haematological 7 12 Brain Cancers 1.5% 14 Head & Neck, 11 Upper GI, Gynaecological 24 May 2017 Slide 6 7 Brain Cancer and Mental Health • Wellisch et al 2002 89 adult brain cancer patients given clinical interview 28% MDD (DSM-IV) • Mainio et al 2006 101 adults high/ low grade gliomas Depression associated with lower survival time low grade 24 May 2017 Slide 7 Brain Cancer and Mental Health • Janda et al (2007) Queensland study 75 patients and 70 carers HADS Anxious mood: 30% patient 40% carers Depressed mood: 17% patient 10% carers • Significant psychological impact on the patient and the whole family system 24 May 2017 Slide 8 The Whole Family is Affected 24 May 2017 Slide 9 Effects of Brain Tumour • Neurologic Symptoms Headaches, dizziness, impaired speech or movement • Cognitive Deficits Memory problems Behavioural Changes • Due to the tumour, surgery, medication and treatments 24 May 2017 Slide 10 Common Cognitive Deficits •Anger/labile affect •Inappropriate behaviour •Attention and concentration •Emotional changes •Communication •Apathy •Confusion and disorientation •Personal care •Self-focus •Memory •Problems solving •Repetition •Fatigue •Impulsive behaviour 24 May 2017 Slide 11 Depression Anxiety and Brain Tumour • Difficulty with identifying depression • Seek medical advice • Normal shock and adjustment 24 May 2017 Slide 12 Depression Symptoms • more tearful than usual • miserable most of the time • withdrawing from peoples • guilty at being a burden • loss of enjoyment in things •bad person, worthless • unable to concentrate/ watch TV •hopeless thoughts “no point” • increased alcohol or other drugs •sleep disturbance •friends, or feeling like a bad person • appetite disturbance • frustrated irritable • weight loss or gain. • tired fatigued 24 May 2017 Slide 13 Anxiety Disorders • constant uncontrollable worry • restless, on edge, tight muscles (e.g. sore jaw or back) • Butterfies, churning stomach, sweaty, breathless • easily tired, irritable, easily startled • difficulty concentrating, racing thoughts, busy mind • difficulty falling or staying asleep or restless sleep • Recurrence of traumatic memories, dreams, flashbacks 24 May 2017 Slide 14 Treatments • Psychological : CBT, Mindfulness and Relaxation skills • Combination of psychological and drug treatments • Support groups 24 May 2017 Slide 15 Cancer Physical Sx Med Sideeffects Unfamiliar Situation Daily Stressors Myths Spiritual & Existential Concerns Don’t Understand Procedure Effects of Tumor Uncertainty of Future Self-esteem Conditioned Response to Setting DrugSeeking (sedatives) Existing Past Mental Trauma Health & Loss Disorder Personality Temperament 24 May 2017 Slide 16 Cognitive Difficulties Psychological distress has complex underpinnings. It affects our behaviour our emotions and our capacity to think and communicate. WA Psycho-Oncology Service Tel: 9382-7480 Fax: 9382-7479 Email: [email protected] Postal Address: Thorburn House Lv 3 East Wing RPH: Shenton Park Campus Selby St Shenton Park WA 6008 24 May 2017 Slide 17