Psycho-oncology

Psycho-oncology - Cancer's Mind Games

• Interface of oncology & psychiatry; addresses psychological, social, behavioral aspects of cancer.
• Focus: Patient & family well-being from diagnosis through survivorship or end-of-life.
• Common psychological responses:
  • Distress (often called the "6th Vital Sign").
  • Anxiety, depression, adjustment disorders.
  • Existential concerns, fear of recurrence.
• Key interventions:
  • Screening for distress & psychiatric disorders.
  • Pharmacotherapy & psychotherapy.
  • Supportive care, communication strategies.

⭐ Prevalence of Major Depressive Disorder (MDD) in cancer patients can be up to 25%, significantly impacting quality of life and treatment adherence.

Psycho-oncology - Mood & Muddle

• Mood Disorders in Cancer:
  • Depression: Affects up to 25%. Key: anhedonia, hopelessness. Screen: PHQ-9. Rx: SSRIs (e.g., sertraline), mirtazapine; psychotherapy.
  • Anxiety: Common. Screen: GAD-7. Rx: SSRIs, short-term benzodiazepines; psychotherapy.
• Muddle: Delirium in Cancer:
  • Acute, fluctuating confusion, inattention. Common in advanced stages.
  • Causes (📌 DELIRIUMS): Drugs (opioids, steroids), Electrolytes, Lack of drugs (withdrawal), Infection, Reduced sensory input, Intracranial, Urinary/fecal retention, Myocardial/pulmonary.
  • Management:

> ⭐ Delirium is often under-recognized but reversible in >**50%** of cancer cases if the cause is treated.

Psycho-oncology - Healing The Psyche

• Psychotherapeutic Interventions:
  • Supportive Psychotherapy: Core for coping, emotional expression.
  • CBT: For maladaptive thoughts, insomnia, pain catastrophizing.
  • Meaning-Centered Psychotherapy: Addresses demoralization, enhances spiritual well-being.
  • MBSR: Reduces anxiety, improves QoL.
  • Group therapy: Shared experiences, mutual support.
• Pharmacological Management:
  • Antidepressants: SSRIs (escitalopram, sertraline) for depression/anxiety. Mirtazapine for insomnia/appetite.
  • Anxiolytics: Lorazepam (short-term for acute anxiety/procedural distress). Buspirone for GAD.
  • Psychostimulants: Methylphenidate/modafinil for cancer-related fatigue, apathy.
• Communication (SPIKES):
  • Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary for breaking bad news.

  ⭐ Depression in cancer patients (up to 25% major depression) is an independent mortality risk factor.

Psycho-oncology - Beyond The Battle

• Survivorship: Addresses long-term psychological sequelae post-cancer treatment (e.g., anxiety, depression, PTSD, fear of recurrence, body image issues, cognitive changes - "chemo brain"). Focus on quality of life (QoL) & rehabilitation.
• Palliative Care Psychiatry: Manages psychiatric symptoms in advanced cancer (delirium, pain, anxiety, existential distress). Goal: improve QoL for patients & families. Integrates with end-of-life care & bereavement support.
• Caregiver Burden: Recognizes & addresses psychological distress in caregivers (anxiety, depression, burnout). Interventions include psychoeducation, support groups, respite care.
• Communication Skills: Crucial for discussing prognosis, treatment goals, and end-of-life issues (e.g., SPIKES protocol).

⭐ Fear of recurrence is one of the most common and distressing psychological concerns among cancer survivors, affecting up to 70%.

• Grief & Bereavement: Support for families after patient death; complicated grief requires specialized intervention.
• Meaning-Centered Psychotherapy: Helps patients find meaning & purpose despite illness, particularly in advanced stages.

High‑Yield Points - ⚡ Biggest Takeaways

• Depression and anxiety disorders (especially adjustment disorder) are highly prevalent in cancer patients.
• The Distress Thermometer (DT) is a rapid screening tool for psychosocial distress.
• Meaning-Centered Psychotherapy (MCP) and CALM therapy are key psychotherapeutic interventions.
• Effective pain management is crucial; untreated pain significantly worsens psychiatric morbidity.
• Early integration of palliative care improves quality of life and mood outcomes.
• Delirium is common, especially in advanced stages; identify and manage underlying causes.
• Be vigilant for drug interactions between psychotropics and anti-cancer agents (e.g., chemotherapy, immunotherapy).