Transcript Health Psychology - University of Toronto Mississauga

Cancer
• Cancer is a disease of cells where cell
reproduction is uncontrolled
– Caused by a change in cell DNA
• Uncontrolled cell reproduction leads to the
development of a tumor or neoplasm
– Immature cells so don’t perform normal function
Tumor Types
Malignant Tumor
– Cells more immature, dysfunctional
– More likely to spread to other areas of the body (metastasis)
•
Metastasis
– Spread of cancer cells through blood/lymphatic system and abdominal
cavity
(ie primary site to secondary sites)
Non-Malignant Tumor
– Benign cancer
– less likely to spread to other areas of the body
4 Broad Categories of Cancers
1. Carcinomas
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Occur in tissue lining internal/external surfaces of
organs (including the skin)
Account for 85-90% of cancers
2. Lymphomas
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Occur in lymphatic system
(e.g., lymph nodes, lymph vessels, spleen)
4 Broad Categories of Cancers
3. Sarcomas
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Arise in connective tissue
(e.g., muscle, bone, fat)
4. Leukaemias
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Present in blood-forming tissues (e.g., bone marrow)
Essentially involve the production of large numbers of
immature white blood cells (leucocytes) of one form or
another
Most common sites for women
Incidence
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Breasts, colon/rectum, lung, uterus, ovary,
lymphomas
Death
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Lung, breast, colon/rectum, pancreas, ovary,
uterus
Most common sites for men
Incidence
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Prostate, lung, colon/rectum, bladder,
lymphomas, oral
Death
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Lung, prostate, colon/rectum, pancreas,
lymphomas, leukaemias
5 year survival percentages for men and
women with cancers
Immune Surveillance Theory and Cofactors in Cancer
Causes of Cancer
It has been suggested that 75 to 80% of
cancers are caused by modifiable lifestyle
factors!
Causes: random mutations and environmental
agents
Risk Factors
Genetics
– Some breast cancers are very strongly
influenced by genes
Viruses
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Human Papilloma Virus (disease which leads
to suppression of immune function)
Radiation
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UV light (sun), X-rays, nuclear
Lifestyle Risk Factors
Tar in cigarettes
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Accounts for 70-80% of lung cancers and 30% of all cancer deaths
Diet
–
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Fat
Carcinogens (natural or additives)
Methods of food preparation (charring, smoking)
Alcohol (heavy drinkers 2x risk)
Sexual behavior
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Kaposi’s sarcoma, non-Hodgkin’s lymphoma
Psychological Risk Factors
Stress
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Data not consistent
Stress may impact on the progression of cancer
(impaired immune function)
Suppression of Emotion
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Denial, anger
Greer & Morris (1978)
Psychological Risk Factors
Personality
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Eysenck & Grossarth-Maticek
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Type I: Cancer-prone personality
Type II: CHD-prone personality
Type III: Mixed-type (with psychopathic tendencies)
Type IV: Healthy autonomous type
Psychological Risk Factors
Cancer-Prone Personality
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Emotionally non-autonomous (ie dependent on
someone else)
Represses emotions
Does not express anger or anxiety
Unable to cope with stress
(helplessness, hopelessness, depression)
Passive and inhibited
Cancer-Prone Personality
(emotionally non-autonomous)
Withdrawal of/separation from love object
Stress
Increased cortisol production
Impaired immune functioning
CARCINOGENIC CELLS ARE NOT
DETECTED AND DESTROYED
Psychological Risk Factors
Cancer-Prone Personality
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Numerous articles from 3 longitudinal studies
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Type I individuals have a particularly high risk of
dying of cancer relative to the other 3 types
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This effect of personality is considerable larger
than the effect of smoking
Psychological Reactions to Cancer
Psychopathology?
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Reaction depends on a number of factors
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Overall, a maximum of 20-49% will qualify for a
formal diagnosis of a psychological disorder
(depression, anxiety, PTSD)
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Adjustment disorder = the development of
emotional and behavioral symptoms following a
major life stressor
Psychological Reactions to Cancer
The most common responses are:
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Anxiety (symptoms, treatment, prognosis)
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Depressive symptoms
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Sadness, crying, guilt, hopelessness/helplessness, etc
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Most people experience these at some time
Feelings of loss of control
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Positive outcomes are not dependent on individual’s
behavior
Psychological Reactions to Cancer
The most common responses are:
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Cognitive (poor concentration, memory and judgment)
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Sexual dysfunction
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Affects 90% of individuals with cancer
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Caused by distress, symptoms, pain, body image,
preoccupation with cancer
Denial
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useful initial reaction, potentially injurious later
Predictors of Depression/Distress
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Pain (the major predictor of depression/distress)
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Lancee et al. (1994)
Social support and quality of life
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Godding et al. (1995)
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Quality of life the stronger predictor
Personal control
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Hofwartner et al. (1992)
More optimistic, lifestyle changes, seek social support
Positive Psychology
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Search for Meaning
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Taylor (1983)
Psychosocial transition
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Cordeeva et al (2001)
“Research that has focused solely on detection of distress
and its correlate may paint an incomplete and potentially
misleading picture of adjustment to cancer”
Treatment for Cancer
– Physical/medical interventions
• Surgery - remove cancer
• Radiotherapy / Chemotherapy - shrink, slow
cancer, prolong life
• Electricity - sarcostic cancers
Treatment for Cancer
– The role of psychology
• Prevention
• Adjunct to medical treatment
• Recovery/Relapse
The potential role of psychology in cancer
Prevention of Cancer
Psychological interventions
– To modify risk behaviors (eg smoking)
– To improve general functioning and
minimize adverse psychological reactions
– To promote preventative methods
Prevention of Cancer
Primary Prevention
– Control environmental carcinogens
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•
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Remove asbestos from schools
Move all Australian children to Canada … or just
introduce hat-wearing policy in schools, Slip Slop
Slap!?!
Ban on workplace smoking (bars and cafes)
Anti-pollution laws
Treatment for Cancer
Secondary Prevention
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Early detection (reduce spread)
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Reliable, acceptable, accessible screening
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Education (self screening)
Early warning signs of cancer?
1. A change in bowel or bladder habits
2. A sore that does not heal
3. Unusual discharge or bleeding from genital, urinary,
or digestive tract.
4. A thickening or lump is breast or elsewhere.
5. Indigestion or difficulty swallowing
6. An obvious change in wart or mole
7. A persistent cough or hoarseness.
American Cancer Society
Treatment for Cancer
– Psychological interventions
• Aim to improve general functioning and
minimize adverse psychological reactions
Treatment for Cancer
– Psychological interventions
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For adverse reactions
– Support, counseling, and support groups
– Stress management and coping strategies
– Cognitive restructuring (promote hopefulness)
For noxious procedures
– (procedural/sensory information, relaxation,
imagery, systematic desensitization, distraction,
modeling, cognitive restructuring)
Pain management
– (CBT, hypnosis)
Term Paper #2 - Practice Exercise
Decisions in the management of pain and anxiety in hospitals
• Imagine you are a Health Psychologist working at a large hospital. The
CEO of the hospital asks you if you can reduce patients’ level of pain
and anxiety during their hospital stay.
• There are a number of different approaches that might be taken to
treatment and different goals that might be adopted. Briefly, as the
psychologist, what goals and methods would you consider. What goal
might you ultimately recommend to the CEO and why?
Term Paper #2
Decisions in the treatment of a mildly overweight client.
• Imagine you are a Health Psychologist who is consulted by a 35 yearold client who is mildly overweight. She is 5’6” (167.6cms) tall and
weighs 11 stone 6 lbs (74 kgs)…BMI = 26.34. Since adolescence she
has had an extensive history of repeated, unsuccessful dieting, and has
sought assistance from you to lose weight. She is embarrassed about
her weight and her husband says she is fat, and makes her run up and
down the stairs in their house for 10 minutes each day. She believes
losing weight will improve the quality of her relationship with her
husband and make her happier. She tells you her weight goal is 60 kgs
(132 lbs).
• There are a number of different approaches that might be taken to
treatment and different goals that might be adopted. Briefly, as the
psychologist, what goals and methods would you consider. What goal
might you ultimately recommend to the client and why?
Term Paper #2
Decisions in the treatment of a mildly overweight client.
• Maximum Length:
1000 words
• Due Date:
Monday, November 15
• References:
– Sarafino, E. P. (2003). Health psychology: Biopsychosocial interactions.
(Chapter 8, pp. 236-265). Wiley: New York.
– Rosen, J. C., Orason, P., & Reiter, J. (1995). Cognitive behavior therapy
for negative body image in women. Behavior Therapy, 26, 25-42.